“Is our society becoming less religious?”
“Is spirituality building as people as people utilize more modalities focused on mindfulness and meditation?”
“Is there an overlap between religion and spirituality?”
”Why do these questions matter in our work as neurosurgeons?”
We asked these questions within minutes of sitting down in the same room: a rabbi working as a chaplain and educator, a neurosurgeon who studied ministry, a yogi neurosurgeon. By and large, neurosurgeons tend to meet most patients and their families in a moment of crisis, after a tragic trauma or when they are told they have brain/spine cancer. Because it is a crisis, we focus on delivering the best surgical care using the most sophisticated technical advances. We want to help our patients and are proud of our technical skills, is this enough?
In a recent survey of the religious landscape of the United States, 70.6% of Americans endorsed themselves as Christians, of whom 46.5% were Protestants, 20.8% were Catholics and 3.3% were other Christians including Mormons, Jehovah’s Witness and Orthodox Christians. An additional 5.9% of the population endorsed non-Christian faiths, including Judaism, Islam, Buddhism, Hinduism and other, whereas 22.8% of the population endorsed themselves as unaffiliated and included atheists, agnostic and none. [1] Thus, 76.5% of Americans consider themselves to belong to a faith tradition of some kind. Of the 22.8% unaffiliated, 18% described themselves as religious; 37% described themselves as spiritual but not religious and the remaining said they were neither. [2] Since spiritual and religious expression can be diverse and idiosyncratic, it is important to differentiate between the two concepts.
For busy neurosurgeons time is limited. How could we possibly “waste time” to sit down and talk to our patient/their family members about their faith, religion, and spirituality while we need to turn our attention toward another surgery? Talking about faith and religion is a difficult conversation; it might make us feel uncomfortable. Yet, patients’ spirituality often influences treatment choices during a course of serious illness. A practical, evidence-based approach to discussing spiritual concerns in a scope suitable to a physician-patient relationship may improve the quality of the clinical encounter [3]. Additionally, it improves patient’s satisfaction. A Press Ganey study of more than 1.7 million patients demonstrates that responses to the question “staff addressed my emotional and spiritual needs” is one of the three main drivers of patient satisfaction with the hospital experience [4]. Other studies showed that those who reported that their spiritual needs were met were more likely to be satisfied with their care [5] and when patients’ spiritual needs are unmet, their rating of both satisfaction with care as well as the quality of their care received are significantly lower [6].
The need for patient access to spiritual care has been highlighted by the American Medical Association (AMA) with encouragement to expand it [7]. In addition to being a need, spirituality can also provide benefits to healing. Whereas ample neurobiological evidence exists showing a link between meditation and healing, data linking a neurobiological connection between religion/spirituality and brain function is more limited. Integrated data from fMRI, EEG, PET suggest differences in the balance between prefrontal and parietal cortex activation with components of spiritual thought or experience including a sense of self (insular regions), emotional modulation (frontal and cingulate regions) and executive planning (prefrontal cortex) [8]. Ongoing research focuses on understanding the link between such activations and healing. The deeper understanding of the importance of spirituality as it pertains to the practice of medicine has prompted some medical schools to integrate spirituality within the medical school curriculum [9]. However, for those physicians who graduated from medical school prior to such integration, this training never occurred.
Unless we pursued ministry studies on our own, we might feel unprepared when it comes time to talk to our patients. In most medical centers, however, there are health care chaplains who offer invaluable resources to us and our patients. Board-certified chaplains are trained to work with patients and their loved ones on understanding their hopes, needs, and resources, all with a focus on wholeness and healing. Chaplains help patients use their own inner wisdom, whether that is a set of values, spiritual beliefs, or religious practices to help make sense of their situation, their illness or crisis, and facilitate rituals. Chaplains focus on witnessing and helping patients tell their stories; this can empower patients and their loved ones to traverse difficult moments in their lives. Chaplains may or may not be ordained, but each has undergone extensive training and education to ensure they are providing whole-person, compassionate, and competent care at the bedside regardless of what a patient’s spiritual or religious background may look like.
For neurosurgeons, even asking a simple question of patients such as, “Are you at peace?” [3] can help the neurosurgeon to recognize when there is existential distress that needs to be addressed. By referring to a chaplain, we can ensure a patient is being treated and cared for physically, emotionally, and also spiritually.
References
1. Pew Research Center. “America’s Changing Religious Landscape”. 2015.
2. Pew Research Center. “Nones” on the Rise: One-in-Five Adults Have No Religious Affiliation. 2012.
3. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/409431
4. Clark PA, Drain M, Malone MP. Addressing patients’ emotional and spiritual needs. Joint Commission journal on quality and safety. 2003;29(12):659-670.
5. Williams JA, Meltzer D, Arora V, Chung G, Curlin FA. Attention to inpatients’ religious and spiritual concerns: predictors and association with patient satisfaction. J Gen Intern Med. 2011;26(11):1265-1271.
6. Astrow AB, Wexler A, Texeira K, He MK, Sulmasy DP. Is Failure to Meet Spiritual Needs Associated With Cancer Patients’ Perceptions of Quality of Care and Their Satisfaction With Care? J Clin Oncol. 2007;25(36):5753-5757.
7. Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001.
8. Barnby JM, Bailey NW, Chambers R, Fitzgerald PB. How similar are the changes in neural activity resulting from mindfulness practice in contrast to spiritual practice? Conscious Cogn. 2015;36:219-232.
9. Puchalski C, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000;3(1):129-137.
