Faith and Medicine: One Christian

Physician’s Observations

Richard D. Kiovsky, M.D.Professor of Clinical Family Medicine

Indiana University School ofMedicine

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

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

“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

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

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

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

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

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

Marital Stability

Happiness in Marriage

Greater Sexual Satisfaction

Vaccination Against Divorce

Religious Commitment:Good For Your Marriage

Time Survey, Sex in Marriage, 2003

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

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

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

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

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

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

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%

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

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

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

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

“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

“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

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

Richard D. Kiovsky, M.D., FAAFPProfessor of Clinical Family MedicineDirector, Indiana Area Health Education CentersDirector, Medical Student Education (DFM)rkiovsky@iupui.edu317-278-0310

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