Richard D. Kiovsky, M.D. Professor of Clinical Family Medicine Indiana University School of...
Transcript of Richard D. Kiovsky, M.D. Professor of Clinical Family Medicine Indiana University School of...
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Faith and Medicine: One Christian
Physician’s Observations
Richard D. Kiovsky, M.D.Professor of Clinical Family Medicine
Indiana University School ofMedicine
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1. My Desire – Your Desire2. Biblical Call to Integrate Faith into Patient
Care3. Understand the Terms4. Health Benefits of Faith5. Professional Standards6. Patient’s Stories7. Discussion and Q & A
Presentation Goals
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The Genesis Factor:1. Image of God2. Loss of Spiritual Connectedness
Christ’s Great Commission: Matt. 28:19-20 3. Participate in Evangelism4. Prepare People for Wholistic Christian Living5. Equip Believers to Live in a Fallen World
Your Work Matters to God (Doug Sherman)6. To the Praise of His Glory
Biblical Call to Integrate Faith
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“A religion of some kind is as essential to the mind of man as air is to respiration.”
Benjamin Rush (1745 – 1813)“Father of American Psychiatry”
Historical Perspective
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Definition: “A pattern of beliefs, values, and practices that an individual has towards God or a higher power according to a set of institutional or congregational codes or traditions”
RELIGION
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Definition: “A personal search for meaning and purpose that includes ones values, transcendence, connectedness, and practices that give meaning to life. It may or may not be related to religion or a supernatural force.”
SPIRITUALITY
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Some may consider themselves both spiritual and religious; others may identify themselves as spiritual, but not religious. Still others say they are religious, but not spiritual.
Doing good works, being loving toward others, harmony with nature
Seeing beauty everywhere and in everyone A relationship with God Many people have different meanings - explore
Interchangeable Terms?
Fox Chase Cancer Center 2007
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86% believe in God (Gallup, 2013) (95% Gallup, 1985)
64% among Health Professionals (Gallup, 1995)◦ Psychiatrists – 40%◦ Surgeons – 60%◦ Primary Care Physicians – 76%
94% of inpatients regard their spiritual health and their physical health as equally as important (King, 2000)
93% of patients with cancer stated that religion helped sustain their hopes (Roberts, 1997)
59% say religions plays a very important role in their lives◦ 33% Great Britain◦ 21% Germany◦ 12% Japan
57% pray at least once a day
Religious Beliefs of Americans
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David Larson’s Findings:1. 60 – 80% Positive Correlation between better
health and spiritual commitment2. Three-fold Benefit:
Aiding Prevention Speeding Recovery Fosters Calmness in the face of ill health
3. Subsequent Studies: Less Mental Illness Decreased Cardiovascular Disease
1200 Studies and 400 ReviewsSystematic Literature Review
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Marital Stability
Happiness in Marriage
Greater Sexual Satisfaction
Vaccination Against Divorce
Religious Commitment:Good For Your Marriage
Time Survey, Sex in Marriage, 2003
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Death by Cardiovascular Disease was Double
Death by Strokes was Double
Every Type of Terminal Cancer is Increased
Suicide was 4x’s Higher in White Men
10 x’s the Rate of Psychiatric Care
A Costly Legacy for Children and Ex-Spouse
FOR DIVORCED MEN
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Prospective cohort of 1014 males matriculating between 1948 and 1964 at John Hopkins Medical School
Subjects completed one questionnaire in medical school and another in 1986
13% of cohort met criteria for alcohol abuse The strongest single predictor during medical
school of subsequent alcoholism was a lack of religious affiliation
Moore, Am J. Med 1990;88:332-6
Professionalism: Precursors of Alcohol Abuse Among Physicians
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Patient’s understanding of their illness Patient decisions regarding health care How patients cope with illness Their adherence to treatment plans Relationship to their doctors and other
members of the health care team
All these factors can potentially impact the care patients receive and the outcome of health care interventions.
Spiritual Factors Have Impact
Puchalski 2007
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70% US Medical Schools address in curriculum Joint Commission: Hospitalized patients if
request Quality Palliative Care: spiritual, religious and
existential aspects were essential domains (2004) End of Life Consensus Panel (1999) Codes of ethics of most health care professions
either directly or indirectly address the importance of the spiritual dimension in the care of patients (Puchalski, 2006)
National Professional Standards
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Findings concerning the importance of religious beliefs in the clinical process have led researchers to comment that primary care providers:
“who would heal cannot choose whether (or not) to confront religious variables in practice; they are operating whether recognized or not”
Foglio & Brody, 1988; J. of Fam Pr 27:473
IMPORTANCE OF RELIGIOUS BELIEFS
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Opens the door for future discussions on matters of spiritual importance
For terminally ill patients, the spiritual history is regarded as a crucial component of palliative medicine
A spiritual history is not necessary for every clinical encounter
Surveys indicate most patients would welcome such spiritual inquires
May determine if a patient is open to faith-based interventions
Spiritual History
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What Patients Want HCP to Do with Spiritual -- Religious Information
So HCP can: Understand how beliefs influence how
you cope with sickness87%
Understand “what makes you tick”85%
Understand how you make decisions 83% Encourage and provide realistic hope 67% Give advice on taking care of self 66% Can effectively guide/change treatment62%
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Situations Critically ill with possibility of dying 94% Suffering from a long-term, ongoing
serious illness91%
Just diagnosed with serious illness 90% Loss of loved one 87% Recovering from a serious illness
83% During medical history on initial visit
with healthcare professional 60% Office visit for a minor medical problem
22%McCord 2004
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AUTONOMY: Requires that physicians respect the
decisions of competent patients, which are often based on religious and spiritual beliefs
Physicians need not ignore or avoid spiritual issues raised by patients
Post, SG. Ann Intern Med. 2000;132:578-583
ETHICAL ISSUES
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BENEFICENCE:
The physician’s duty is not to judge a patient’s private attitudes and spiritual behaviors, but to understand their clinical importance
Physicians should inquire about and support a patient’s spiritual beliefs and needs, to avoid this may be a form of negligence.
Post, SG. Ann Intern Med. 2000;132:578-583
ETHICAL ISSUES
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NONMALFICENCE (“do no harm”)
Requires that physicians not proselytize Physicians not prescribe for patients to
engage in religious activities Religious and spiritual practices should not
replace effective allopathic treatments
Post, SG. Ann Intern Med. 2000;132:578-583
ETHICAL ISSUES
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“Among all my patients in the second half of my life … there has not been one whose problem in the last resort was not that of finding a religious outlook on life. It is safe to say that every one of them fell ill because he had lost that which the living religions of every age have given their followers and none of them has been really healed who did not regain his religious outlook.”
Carl G. Jung, 1932
RECOVERY FROM MENTAL HEALTH PROBLEMS
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“Why is my life such a mess? I’m not going to take my insulin!”
“Dr. Kiovsky, I’m not making this decision – you are!”
“Maybe you ought to give God a chance?”
The Power of Prayer – case examples
Doc’s “Reality” Show
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Don’t be a bystander to the Christian Faith
Pray continually
Take your direction from God’s Word and the quiet leading of the Holy Spirit
Let’s love people into the Kingdom of God
DO IT !
Nike Approach
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Richard D. Kiovsky, M.D., FAAFPProfessor of Clinical Family MedicineDirector, Indiana Area Health Education CentersDirector, Medical Student Education (DFM)[email protected]
Contact Information