This single important fact has underpinned how we have trained hospital chaplains for many decades now. But, in recent years other professions -- including doctors -- have started to recognize this as well and have started to integrate this fact into their own training curriculums. And, as I learned at the Spirituality in Health Care Education conference last week, even pre-med (or maybe pre-med) undergraduates are getting a taste of this.
Professor Elizabeth R. Mackenzie spoke about a freshman writing tutorial class she teaches on healing narratives and humanistic medicine.
When I was an undergraduate at Grinnell College, I took such a freshman writing tutorial (mine was on Eastern European history) and I remember it as one of the most influential and inspiring classes of my entire college career. Dr. Mackenzie's class also sounds like it has the potential to be that exciting for her undergraduates thinking of entering medicine.
They have some eight essays over the course of the semester. The first two sound very exciting:
- 1) Write a first-person illness narrative that ends with a life lesson that can be applied to others.
- As Mackenzie points out, this can be heady stuff for a 18-year old who may have led a somewhat sheltered life and may never have been seriously ill. But she said, for example, an athlete could write about a time he or she got injured; there's a lot of excellent learning for a young person in thinking about how that experience might reflect something general about the human condition and not just their own individual experience.
- 2) Collect an illness narrative by interviewing a peer using active listening techniques.
- This helps introduce them to the whole idea of qualitative research, she said.
Here are some of the books she uses:
- Two by highly successful physicians who underwent their own struggles with their own illnesses:
- Rachel Naomi Remen's Kitchen Table Wisdom: Stories That Heal
- Mackenzie said if there's one thing she wanted people to get from her presentation, it was to go out and immediately buy Remen's books. She also likes Remen's My Grandfathers Blessings : Stories of Strength, Refuge, and Belonging
- Jody Heymann's Equal Partners: A Physician's Call for a New Spirit of Medicine
- A Life in Medicine: A Literary Anthology
Here are some articles she uses as well:
- Telling Stories: The Health Benefits of Narrative, by James W. Pennebaker in Literature and Medicine - Volume 19, Number 1, Spring 2000, pp. 3-18
- Rita Charon's 2001 article in JAMA on narrative medicine.
- Jerome Groopman's A great case, a doctor's account of dealing with his young son's illness and the insensitivity he experienced from physicians.
- John Pryor, a trauma surgeon from UPenn kept blog entries while he was in Iraq. Some info on that can be found here.
- An article about basketball star Alonzo Mourning's spiritual awakening while recovering from a kidney transplant.
One fascinating question that was only touched on briefly at the conference was the question of whether medical education should be involved in helping the doctor his or herself to be spiritually healthy. As David Hufford pointed out we would not, for example, make going to the gym part of a student's education on cardiology; we leave it up to the individual student to take care of whatever they might need to do to maintain their own physical health, and do not make it part of their formal learning.
I would agree about that example. But I think spiritual health is fundamentally different than physical health -- a physician in bad spiritual health (one who, for example, is so burned out from seeing death and suffering that they can hardly stand to talk to patients anymore) is one who is going to do damage to his or her patients. In short, I don't see how a physician who is not whole (spiritually), can possibly treat the whole patient (that is, treat the patient as a real person and not just a set of symptoms and diagnoses).
I think that's the point of Mackenzie and Charon and Barry Bub's work -- it's not just about benefit to the patient. It's about benefit to the doctor, and the assumption is that that benefit to the doctor ultimately accrues to the patients as well (who get better treatment, as a result). Bub, I think, would even say that the benefit the patient gets is not just spiritual, but is physical as well. That is, the physician who is whole enough to listen better is going to be able to miss less things and ultimately be able to diagnose and treat more effectively.
Hufford, however, seems very concerned that medical school teaching on spirituality not look soft in any way. For it to be taken seriously by students, he says it is essential that it be required, tested and graded. Just as it would be for a class on cardiology, he says the classroom curriculum needs to focus on real cases and needs to include real research based on real statistics. The content needs to have "clinical utility" he says. In that vein, it is important to point out that, no matter what you may think about the place of spiritual concerns in medicine, a very high percentage of patients make their most serious medical decisions based in part on religious/spiritual concerns; this alone makes it important to train physicians to have some sensitivity to spirituality, he says.
Another fascinating thing about Mackenzie's course is that she has had her students create and maintain some entries on Wikipedia. She said her students created the narrative medicine entry there, as well as the one on humanistic medicine.