By: Victor S. Sierpina, MD
Spirituality and religious beliefs may seem like an inappropriate topic to discuss in the health care setting. Perhaps such conversations are best held by a pastoral counselor, clergy, or the hospital chaplain. Patients and their families always have some value system in place, whether based in traditional religious structures, personal spirituality, or some philosophy of life. It is often helpful to elicit these beliefs in order to understand a person’s support system, how and why they make health care choices, and how they might affect palliative care or end-of-life choices.
One model for addressing spiritual belief systems has been developed under the auspices of the John Templeton Foundation and is taught to health professionals through the George Washington Institute of Spirituality in Health. It is called FICA. This is a rather straightforward approach that allows a neutral, non-threatening, and supportive approach to inquiring about the patient’s beliefs. FICA is an acronym for:
Faith and Belief. A question like, “Do you consider yourself spiritual or religious?” can open up rich dialogue on personal values and beliefs.
Importance. A physician or health provider might ask, “What importance do your faith or beliefs have related to your health.”
Community. “Are you part of a spiritual or religious community?” This helps determine the support system.
Address in care. “How would you like me, as your healthcare provider, to address these issues?” They may not want to go any further at this time, but at least we now have permission to enter into this level of conversation.
In my experience, patients are eager and open to discuss spiritual beliefs with their doctor, yet most physicians feel uncomfortable initiating such discussions. By normalizing this kind of conversation and including it in the routine intake history with a patient, it becomes a matter of record and, with practice, easier to discuss. This requires more than dutifully recording the patient’s religious affiliation in the medical record. It also helps to avoid making the patient feel like they are at death’s door, as their doctor is suddenly talking about their belief system or religion.
Of course, healthcare professionals must be cautious not to proselytize their own religious beliefs on patients and to be diligently mindful of any conscious or even unconscious bias about someone of a different faith or spiritual belief than their own. We are there to explore the patient’s support system, to understand how they process the mysteries of life, and how they make decisions. If a patient and provider share the same religious outlook, patients often feel reassured by discussion, prayer in the office, sharing scriptures of relevance, and the like. Be attentive for “faith flags,” like religious symbols, certain verbal expressions, religious jewelry, T-shirt mottos, reading materials, even tattoos, as these might give a clue to a patient’s spiritual orientation and thus occasion a deeper discussion.
In his landmark book, Victor Frankl, a Jewish psychiatrist and death camp survivor, observed that even under the horrific conditions of the concentration camp, those who held onto some kind of personal goal, hope, or meaning for their life frequently survived. Often, those right next to them without such a spiritual construct were the first to die. Without hope, without meaning, without spirit, the body shuts down.
Our goals as health providers are to value our patients as human beings, mind, body, and spirit; to relieve both physical and metaphysical suffering; and to offer love, support, and caring on as many levels as the patient is ready to accept. Spirituality belongs in the clinical setting for these reasons.