Healing: More Than Medicine
MADISON - A deeply spiritual woman who described feeling the presence of God throughout her life, Marilyn was just 35 when she noticed a lump in her breast. When biopsy results proved it was malignant, her doctor said it was though Marilyn had expected the news.
After undergoing a radical mastectomy and radiation therapy, Marilyn struggled for 15 years with recurrences, surgeries, chemotherapy, hair loss, and the knowledge that her children may be left motherless early in life - just as she was when her own mother died of breast cancer.
But throughout her personal struggles, Marilyn wanted to help educate young physicians about the importance of treating patients with compassion and respect. When she addressed Dr. Christina Puchalski's second-year medical school class about the subject, one student asked Marilyn why it was so important to her to have doctors talk with her about her spirituality.
"Because it is who I am at my deepest core. It is what makes me an individual," Marilyn told the class. "When I go to the hospital, my roommate often has the same disease, the same hospital gown, the same chemotherapy, and the same doctor."
"What makes us different is our spirit. It is unique to each of us," Marilyn continued. "And I want my doctor to know who I really am - body, mind and spirit."
While some may say that religion and spirituality are too personal for physicians to address, and that a doctor's domain is to heal the body, Puchalski contends that true healing involves much more than medications, surgeries and the myriad "technical" aspects of treatment.
"People cope with their suffering by finding meaning in their suffering. This is where spirituality plays such a critical role," writes Puchalski, a pioneer in the field of the physician's role in spirituality and health care and founder/director of the George Washington Institute for Spirituality and Health (GWish).
Puchalski's GWish center was developed in 2001 to restore "the heart and humanity of medicine" through research, education and policy work focused on increasing attention to the spiritual needs of patients, families and health care professionals.
Embracing a new philosophy at UW
This philosophy is becoming more mainstream at medical schools across the country, including the University of Wisconsin Department of Family Medicine, which received a three-year, $30,000 grant from GWish in 2006. The award, given to course directors J. Adam Rindfleisch, MD and Luke Fortney, MD, supports the development of spirituality curricula for family practice residents, in order to encourage a more compassionate and humanistic approach to health care.
The Department of Family Medicine used the grant to help residents explore their own spirituality, as well as learn more about others'.
"Basically, what we did was create a playing ground or a field by which they could explore whatever gives them meaning and purpose in a way that resonates with them," Fortney says of the self-exploration element of the program.
For this arm of the curriculum, residents used grant funding to go on a retreat, for example, or to take a course in Mindfulness-Based Stress Reduction, a meditation practice designed to reduce stress and help people develop greater balance, control and participation in their lives.
“One of the main focuses was to protect time for themselves, so they can go and find ways to recover from the fast-paced lane of residency," Fortney explains.
The other facet of the program - learning about others' spirituality - involved opportunities to shadow UW Hospital and Clinics chaplains and develop "spiritual mentor" relationships.
"This program is about self-discovery," Rindfleisch and Fortney say in their curriculum description. "What do we as health care providers believe? Why do we have those beliefs? How do these beliefs influence how we treat our patients?"
"It is about letting residents discover what they believe and how that fits into their professional lives."
By the time Family Medicine residents graduate from the program, they will be able to articulate beliefs on topics such as aging, disease, death and the meaning of suffering, Rindfleisch and Fortney say. Among several other goals of the program, graduates will also enhance their communication skills with patients and be able to explain the central tenets of diverse spiritual paths.
Touching the spirit
For GWish's Puchalski, such skills are critical to developing a compassionate, humanistic approach to health care.
"As a physician, I try to use the best of my scientific abilities to diagnose and treat my patients. With the best technology has to offer, my patients may be cured," Puchalski writes in her paper, "Touching the Spirit: The Essence of Healing."
"But, in the absence of compassion, there will be no healing," Puchalski adds. "This is what a spiritual assessment is about - listening to what is important to a patient."
According to Puchalski, it should be the obligation of all physicians to respond to, as well as attempt to relieve, all suffering, if possible.
"Therefore, physicians should be able to communicate with their patients about their patients' spirituality as integral to the way patients cope with suffering," Puchalski says.
For a patient like Marilyn - Puchalski's breast cancer patient, who ultimately died of her disease - Puchalski tried to help her find peace and cope with deep emotional, physical and spiritual suffering.
"In our conversations together, I did not find answers to her questions, but I listened to her and supported her as Marilyn tried to find peace in the midst of her pain," Puchalski said.
Date Published: 08/26/2008