Biopsychosocial… spiritual?

Guest blogger Lauren Roddy, one of seven students in this summer’s Community Health Immersion, writes…

Several of my friends and family have been astounded that a place like Siloam exists, where the individuals who need it most not only receive excellent health care, but also are treated as whole people, like the beloved children of God that they are.Whole Person Care

Why is it so hard for us to think of care in these terms? After all, as Christians, we are called to care for and love the poor, plain and simple. This is certainly not to say that those not of a Judeo-Christian faith tradition can’t or don’t have a heart for the poor, but we have specific Biblical instructions and moreover the framework to do so.

“…we are trained…to compartmentalize our lives.”

I don’t think that the problem is necessarily that not enough health care providers are Christians, but rather that we are trained, in America in general but in medicine in particular, to compartmentalize our lives. Our work, family, and church are kept separate, and we are encouraged to leave all personal ideas, passions, and faiths at the door. How can we expect to help prepare individuals for their unique purpose as children of God’s kingdom if we don’t claim our place there as well?

I am grateful and blessed to be a part of the Community Health Immersion Program at Siloam this summer and to have the opportunity to shadow providers that bring their whole selves into a holistic model of healing. Patients not only have access to a Behavioral Health Consultant and to Pastor Doug, who make sure the patient’s social and spiritual needs are met, but they experience God’s love from the front door to the back.

I have witnessed providers over and over again spending a few extra moments to make certain that patients feel heard and that their unique experiences are validated. In return, the patients have a deeper trust in the medical expertise of the providers, and, sometimes, express a deeper hunger to know the Lord.

Roddy, Lauren - next to Compassion sign

Lauren Roddy is a rising senior at in the pre-medical program at Baylor University.

I challenge each of you to interact with others as whole people loving whole people. I pray that I can emulate what I’ve seen and learned so far in my future medical career, and I hope that everyone at Siloam knows that I want to be y’all when I grow up!

Optimized for caring

Feussner, Derek - VUMC PGY-II 9-2013 - with Mark McCaw

Mark McCaw, Associate Director for the Siloam Institute, explains the primary care preceptorship program to Dr. Derek Feussner.

Editor’s note: This blog is written by Vanderbilt internal medicine resident Dr. Derek Feussner who recently completed four weeks of training at Siloam.  He writes about his experience…

So often, in large urban medical centers, patients come and go with little focus given to their spiritual, emotional and cultural well-being. As residents at Vanderbilt, we strive to do a phenomenal job taking care of acute medical problems, diagnosing and treating complicated illnesses and performing research to advance medical knowledge. What we often overlook, however, is a patient’s spiritual health.

During my time at Siloam, I was able to see firsthand the direct relationship between spiritual, mental and physical health as it relates to a patient’s entire care. I remember taking care of one such patient who presented for a routine follow-up visit. Based on my chart review of her chronic medical conditions, her normal recent lab work and the appropriateness of her medication regimen, it figured to be a straightforward patient-physician interaction. However, when I entered the room and began speaking with her via an interpreter, it became clear there was much turmoil in her life. She had recently lost her husband and was attempting to care for her young daughter with limited resources and limited social support. Her entire family still resided in her middle-eastern homeland and her contact with them was limited.  Using the skills I had learned through my daily interaction with Siloam’s wonderful medical team I was able to obtain a social work and pastoral consult in one single visit. She met and prayed with our pastor and was set up with resources to obtain medications and care for her daughter. There was nothing specifically wrong with her body’s physiology, but her health was certainly suffering and she was spiritually ill.

Throughout “generic” medical training, residents are taught about religion and how it relates to medicine; about poverty and how it affects patients access to adequate health care – but what we never learn is how to truly care for someone in their entirety. The majority of patients have strong spiritual belief systems and these intertwine entirely with how they perceive illness, medical intervention and prevention of health problems, but as residents we rarely inquire as to patients spiritual needs. Being able to work in an environment where taking a spiritual history is “normal” has opened my eyes to the need for a more holistic approach to patient care. I look forward to carrying this knowledge into my future practice.

Muslims and Gelatin-based medications

Guest blogger, Elisa Greene, Pharm.D., is an Assistant Professor in the Belmont University College of Pharmacy.  Through a collaborative agreement with Belmont, Dr. Greene dedicates half of her time to caring for patients and precepting pharmacy students at Siloam.

Elisa Greene cropped

Elisa Greene, Pharm.D., counsels a patient on medication.

Anyone who has spent time at Siloam is aware of the variety of cultures, religions and languages represented in our patient population. We all desire to provide the highest quality of care. However, despite our best efforts at cultural competency and effective use of interpreters, we often overlook an important aspect of cross-cultural care: dietary restrictions.

Common dietary considerations include variations in blood sugar during Ramadan and other times of religious fasting, vitamin D deficiencies due to all over body coverings reducing sun exposure, and vitamin B deficiencies in Vegan diets that many refugees follow. An additional, less well known, restriction involves gelatin. Gelatin (stearic acid) is derived from beef or pork products and is an ingredient in almost all medications that are in capsule form. It is sometimes, although less commonly, present in tablet formulations, as well. For our Muslim patients, ingestion of pork is forbidden by their religious convictions. As you can imagine, this often results in a therapeutic challenge for clinicians!

Consider this case encountered by Dr. Kristin Martel (a staff physician at Siloam)…

“I had a Somali patient with severe hypothyroidism who returned for a follow up visit with continued complaints of the same symptoms. She admitted to not taking the thyroid medication I had prescribed. She revealed her fears that there was, in fact, gelatin, in some of the levothyroxine tablets. The patient was relieved when she heard that I could specify gelatin-free formulations of this medication. Since then, she has been more consistent with taking her medicine.”

This case illustrates the importance of considering whether dietary restrictions, and specifically the fear of products containing gelatin, are functioning as a source of non-adherence with medical therapies. Identifying this concern allows for development of alternative treatment plans. Gelatin-free products are often available, but require extra research into the inactive ingredients. In general, choosing tablet forms of medications instead of capsules for Muslim patients, when possible, can minimize gelatin exposures.Capsules

Resources are available to aid in this effort. Here is an excellent website* for identifying inactive ingredients in medications. It can be helpful for those seeking to avoid a substance such as gelatin, lactose, or red dye # 40. Also, a quick Internet search displays many commercially available gelatin-free forms of fish oil, an over the counter medication used to lower cholesterol.

Whole-person health care in general—and care offered by Christian believers in the Incarnation in particular (God among us in the life of Jesus)—should seek to meet the patient where they are.  Whether or not we agree with some of the specific convictions of our patients, we nonetheless need to acknowledge and respect them.  By creating an open, nonjudgmental atmosphere where potential barriers to care can safely emerge, the setting is optimized for healing. Assuming there is no harm to the patient from the proposed alternative, and that it doesn’t cause the clinician to violate her own integrity, we ought to seek to meet and treat patients on their own terms as much as possible.

* www.medicines.org.uk/EMC

Why would a doctor ask about spiritual practices? (Part 5 of 5)

Guest blogger, Laurie A. Tone LMFT, LPC, MHSP, served six years as Siloam Family Health Center’s behavioral health consultant. Today, she continues a five-part series of blogs on the body-mind-spirit connectedness.

Laurie writes…

Welcome back to the series exploring the connection between spirituality and health. We know through research that spiritualityBible - Stethoscope - Siloam Coffee and health share a definitive connection. We can even extrapolate that in Sam’s case (see blog in part 2 of this series) that his guilt, pain, insomnia, and depression are all interconnected. But what does biblical scripture say about this? Are there any references in scripture about the connection between spirituality and health?

While scripture was never intended to be a medical manual, it has some pretty clear references to the connection between spirituality and health. The Creator God has provided through His Word some key principles about His creation and healthful living. While references from scripture should be considered in context, let’s look at the following verses in light of our patient Sam who is suffering from guilt, depression, insomnia and bone pain.

Psalm 32:3 “When I kept silent [about sin] my bones wasted away through my groaning all day long.” Psalm 32:5 continues, “Then I acknowledged my sin to you and did not cover up my iniquity. I said, ‘I will confess my sin to the Lord’ and you forgave me the guilt of my sin.”

Psalm 6:2 “Be merciful to me, Lord, for I am faint; O Lord, heal me, for my bones are in agony.”

Proverbs 17:22 “A cheerful heart is good medicine but a crushed spirit dries up the bones.”

Proverbs 3 also tells us that following the Lord fully will bring health to the body and nourishment to the bones, sweet sleep, prolong life and bring prosperity.

Scripture shares a multitude of references about the connection between spirituality and health and adds to our understanding of the complexity of our integrated beings.

The connection between spirituality and health raises some practical questions regarding patient care. If you were the medical provider for Sam what would you do? Would you prescribe an antidepressant or pain medication? Would you refer him to a religious or mental health provider? Would you even address the underlying guilt as a possible precipitating factor?

While there are no easy answers, patients like Sam make us consider the need for whole-person care.  Healing and wholeness can occur in the various and sundry realms of our being – physically, emotionally, socially and spiritually. In fact, in the New Testament’s list of spiritual gifts, healing is in the plural form -“gifts” of healing (1 Co. 12:4-11).

Although this is the last of this particular series the topic remains on the forefront of the ministry at Siloam Family Health Center and the Institute of Faith, Health and Culture. Patients, like Sam, are a regular occurrence at the clinic and systems are in place through medical providers, pastoral care, social workers and behavioral health consultants to address the myriad of needs patients present.

Please feel free to share your thoughts and stay tuned for future blogs exploring the biopsychosocial-spiritual connection.

All scripture quoted from the NIV.

Why would a doctor ask about spiritual practices? (Part 4 of 5)

Guest blogger, Laurie A. Tone LMFT, LPC, MHSP, served six years as Siloam Family Health Center’s behavioral health consultant. Today, she continues a five-part series of blogs on the body-mind-spirit connectedness.

Laurie writes…

In our last post we covered the first 4 reasons why spirituality and/or religion should be incorporated into health systems (see prior blog – Part 3). Helping Hands too croppedThese reasons are based on the summary of research on the connection between spirituality and health presented by Dr Harold Koenig, Director of the Duke Center for Spirituality, Theology and Health (see Koenig, 2012).

Let’s continue the dialogue with reasons five through eight.

*Fifth, religion and/or spirituality are associated with both mental and physical health and likely affect medical outcomes. Health professionals need to know about these influences, just as they need to know if a person smokes cigarettes or uses alcohol or drugs.

Sixth, the kind of support and care that a patient receives once they return home is influenced by religion and or spirituality. A supportive faith community may ensure that patients receive medical follow up. Support may include providing rides to doctors’ offices or in ensuring compliance with medications. Health care professionals need to know whether patients live alone or have access to social interaction and support, which can influence health care decisions, as well as outcomes.

Seventh, research shows that the failure to address patients’ spiritual needs increases health care costs, especially toward the end of life. During end-of-life care, patients and families may request medical care that is often very expensive and may even be futile. Patients or families may be praying for a miracle. They may view withdrawing life support or agreeing to hospice care as giving up or as a lack of faith and belief in the healing power of God. Taking a full spiritual history can allow for meaningful dialogue on end-of-life care thus avoiding prolonged suffering and unnecessary financial burdens.

Finally, standards set by the Joint Commission for the Accreditation of Hospital Organizations (JCAHO) and by Medicare (in the U.S.) require that providers of health care show respect for patients’ cultural and personal values, beliefs, and preferences, including religious or spiritual beliefs. Being aware of these beliefs allows health care providers to both respect their patient’s perspectives and adjust their care accordingly.

Please stay tuned for the final blog entry in this series addressing the connection between spirituality and health.

Reference:

Koenig, H.G. (2012). Religion, Spirituality, and Health: The Research and Clinical Implications. International Scholarly Research Network (ISRN) Psychiatry. Volume 2012, Article ID 278730, doi:10.5402/2012/278730

(* Please see Koenig, 2012 for secondary sources cited)

Why would a doctor ask about spiritual practices? (Part 3 of 5)

Guest blogger, Laurie A. Tone LMFT, LPC, MHSP, served six years as Siloam Family Health Center’s behavioral health consultant. Today, she continues a five-part series of blogs on the body-mind-spirit connectedness.

Laurie writes…

skeleton walk

Courtesy of: http://www.3ds.com

Do you remember the little song you might have sang as a kid? “The heel bone’s connected to the foot bone. The foot bone’s connected to the leg bone…” and so on. Those connections seem pretty clear but what about Sam’s symptoms (see previous blog – part 2 of 5)? Could they really be connected to his guilt? If such a connection between spirituality and health exists, is there a way to test for it or measure it? Let’s see what the research says:

Dr. Harold Koenig, Director of the Duke Center for Spirituality, Theology and Health, has summarized the research examining the relationship between religion and/or spirituality and mental and physical health (see Koenig, 2012).

In a systematic review, Koenig identified 3,300 quantitative original data-based studies from 1872 to 2010 examining the relationship between religion and /or spirituality and health. Empirical evidence shows a strong connection.

In fact, Koenig reports that the majority of studies report significant relationships between religion and/or spirituality and better health. Such evidence behooves the medical community to do a better job of integrating spirituality and health.

Dr Koenig has identified at least 8 reasons why spirituality and religion should be integrated into medical practice. In this post, I will address the first four reasons.

*First, many patients are religious or spiritual and a vast majority have spiritual needs related to their medical or psychiatric illness. Most of these needs currently go unmet. The unmet spiritual needs, especially if they involve religious or spiritual struggles, can adversely affect patient health and may increase mortality independent of mental, physical, or social health.

Second, religion or spirituality influences the patient’s ability to cope with illness. In some areas of the U.S., 90% of hospitalized patients use religion to enable them to cope with their illnesses and over 40% indicate it is their primary coping behavior. Poor coping has adverse effects on medical outcomes, both in terms of lengthening hospital stays and increasing mortality.

Third, religious or spiritual beliefs affect patients’ medical decisions, such as those with serious medical illnesses and especially those with advanced cancer or HIV/AIDS. Some decisions may conflict with medical treatments and can influence compliance with those treatments.

Fourth, doctors’ own religious or spiritual beliefs often influence their decisions about care provision. Some of these decisions may include the use of pain medications, abortion, vaccinations, and contraception. However, doctors’ views about these matters and how they influence their decisions are usually not discussed with the patient.

Please stay tuned for Part 4 of this series for reasons 5-8 of why, according to Dr. Koenig, religion and /or spirituality should be integrated into medical practice.

Reference:

Koenig, H.G. (2012). Religion, Spirituality, and Health: The Research and Clinical Implications. International Scholarly Research Network (ISRN) Psychiatry. Volume 2012, Article ID 278730, doi:10.5402/2012/278730

(* Please see Koenig, 2012 for secondary sources cited in the first through fourth points)