Spirituality and Medicine

By Puchalski, Christina M. | The World and I, June 1998 | Go to article overview

Spirituality and Medicine


Puchalski, Christina M., The World and I


Teaching physicians to use their patient's inner resources in treating serious illness is a key to putting caring into health care.

"Ms. Smith, I'm afraid I have some bad news for you. The biopsy shows you have cancer. We will have to operate."

Sitting in Dr. Harris' office and listening to his cold, clinical statement, Mary Smith is paralyzed by anxiety. As he talks about the options--the different types of surgeries, possible chemotherapy, radiation therapy, and even other newly developed therapies--she can only think fearfully about the worst outcomes: suffering pain, and then death. Mary reacts with profound confusion instead of her usual clarity.

Dr. Harris has seen the reaction many times before. In his experience, within a week or two most patients come to grips with the diagnosis and accept the treatment he recommends. Ms. Smith seems to be a strong woman. She'll probably follow through, like most of his other patients.

Mary's mind is racing. Why now? Her life has been going along well. She is a successful artist. She meditates daily and feels God is with her. But where is God now? What about her two small children, who still need her? It is too early to die. And what will happen if she dies? Her elderly mother will never survive Mary's death.

As Dr. Harris discusses all the technical aspects of Mary's care, he knows that she isn't fully grasping the details. But it needs to be said, and now is the time. She'll probably call back later for clarification, once she settles down.

His words fade into oblivion as the pounding in Mary's heart gets stronger and the reality of uncertainty throbs in her head. All she wants to do is run away and hope this will all disappear. Her impulses to share these feelings with Dr. Harris are immediately squelched by his demeanor and words. It is clear he wants to get through his agenda and set a date for surgery.

Mary leaves the visit feeling hopeless and abandoned.

Dr. Harris is relieved to be finished with this most unpleasant part of his job. He looks forward to helping Mary by excising the cancer, as he has been trained so well to do.

Disease-centered medicine

Medicine has made significant technological advances in the last three decades. Physicians have to acquire an enormous amount of knowledge in medical school. Consequently, much of the medical school curriculum has been "disease-centered": how to diagnose and treat diseased organs in the body. Specialists are trained to excel in a particular area in part because it is too difficult for a generalist, the family doctor, to keep abreast of all the current advances in all the specialty areas. Patients are used to seeing specialists and getting very specific technical information and treatment.

In this era of managed care, time pressure makes it imperative that physicians work efficiently and quickly. In his book The Physician's Covenant: Images of the Healer in Medical Ethics, William May writes that today's physician is viewed as a technician whose relationship with his patient is primarily contractual, with legal and ethical conditions established by a "huge, impersonal, anonymous mass society that delivers health care to strangers and often in the context of total institutions."

For a while, this system worked well. People felt privileged to live in a country that was so advanced scientifically. But gradually they have grown dissatisfied with the system. Something is missing. People watch reruns of Marcus Welby, MD and envy his patients. Marcus Welby really knew his patients: their families, their beliefs, and their fears. He talked with them and really listened. In short, he cared deeply for his patients, and he was in a type of practice where he could show that care and take time with his patients.

Can this only happen on television? The public says no. Since the beginning of this decade, the American people have been turning to alternative medicine with increasing frequency. …

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