In the following sections I examine what you can do by and for yourself to grow spiritually and progress on your own spiritual path; what you can do spiritually for the patients in your medical practice; what you can do spiritually with your patients; and what you can help the patient do for himself/herself in the area of spirituality.
For Ourselves
There are many methods to develop and practice a spiritual life. There are some practices that are virtually universal to all major religions such as worship, prayer, meditation, and fasting, although there are obvious cultural differences. I would suggest reading the book Celebration of Discipline: The Path of Spiritual Growth by Foster.4 Foster is a Quaker with profound suggestions for living a spiritual life.
There is a caveat. There is potential for abuse of power. Spirituality should be used for good, but can be used in many ways for evil purposes. Seek the good. We little realize the power we have.
To help others spiritually you must be as integrated and centered as you can be. Of course, perfection is not attainable. It takes time and effort to develop spiritually. The spiritual life is a journey, and that journey is different for each and every individual. Seek your own journey, and be aware of where you think you are on that path. Develop the skills for your spiritual journey through study, prayer, meditation, worship, and community.
Study. Select carefully the materials you choose. There are many to choose from, but they should have proved the test of time. Read the Hebrew Bible, the New Testament, the Koran, the Way of Life of Lao-Tzu, the Talmud, the writings of the desert fathers, and other classics of religion. Nurture the spiritual part of your intellect as much as you would the scientific. But remember that the intellect is not enough.
Prayer. You must develop a prayer life. But what exactly is prayer? There are many forms of prayer, some are appropriate in the medical setting and some are not. I like to think of prayer as a conversation with God. In a conversation you must do your share of listening, and so it is with prayer. Prayer is not just talking. Listen in prayer as much as you talk. Include praise and thanksgiving in prayers before you ask for things. Intercessory prayer is the type of prayer that asks for something—the team to win, the person to be healed, or the car not to break down. Be careful with intercessory prayer to ask for things that are possible. We cannot ask that purple be green, or that triangles have 4 sides.
I like the serenity prayer very much that says,
God, grant me serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference; living one day at a time, enjoying one moment at a time; accepting hardship as a pathway to peace; taking, as Jesus did, this sinful world as it is, not as I would have it; trusting that You will make all things right if I surrender to Your will; so that I may be reasonably happy in this life and supremely happy with You forever in the next. Amen.
I also like the prayer of St Francis:
Lord, make us instruments of your peace.
Where there is hatred, let us sow love;
where there is injury, pardon;
where there is discord, union;
where there is doubt, faith;
where there is despair, hope;
where there is darkness, light;
where there is sadness, joy.
Grant that we may not so much seek
to be consoled as to console;
to be understood as to understand;
to be loved as to love.
For it is in giving that we receive;
it is in pardoning that we are pardoned;
and it is in dying that we are born to eternal life.
Meditation. Meditation means opening our subconscious, our soul, to the influences of higher powers. It is distinct from prayer, but similar, and there are many forms of meditation practice. Herbert Benson,5 MD, has taught the relaxation response for many years. In this simple but effective form of meditation you concentrate solely on breathing and emptying the mind of other distractions. There are many sources of instruction in meditation, including books and seminars.
Worship. True worship involves prayer and meditation, but it also involves participating in spirituality with others, and there is great power in doing this.
Community. You must seek help. Just as you cannot learn medicine from a book you also cannot learn spirituality. This is not easy for physicians, who are constantly looked to and relied on as the authority figures. But all of the previous activities alone will not be sustained and directed without the help and support of a religious community. Now that "community" may be a spiritual advisor, or a pastor, or a rabbi, or it may be a Bible study group or congregation, but our spiritual growth needs to be nurtured by others, or it will be nothing. So seek the help of like-minded people. Seek for them and you will find them.
For the Patient
Admit that we are not omnipotent. The more honestly we admit this the more content we will be. Sincere humility will be appreciated by most patients, and be regarded as a strength rather than a weakness. Hubris, the opposite of humility, is probably the base cause for most lawsuits.
Pray for your patients. The most powerful thing we can do in our medical practice is to pray. Prayer helps us be the vessel and agent for the higher power to bring needed healing, and it helps us to be open to what the specific techniques of healing should be, whether it be prayer, or a healing service, or sweat lodge, or the latest corticosteroid cream, or methotrexate, or psoralen–UV-A. Prayer turns the ultimate responsibility for the patient's welfare over to a higher power, relieving us of the burden of being more than we can be.
I do not believe that it is necessary to ask patients for permission to pray for them. Ask in your prayers for help and guidance so that your medical skills might be best applied to the situation. Ask for what is best for the patient. Usually we think we know but sometimes what we think is best turns out not to be. The "Thy will be done" prayer is as effective as directed prayer.
In the morning as you look at the schedule for the day you might pray for specific people. Pray that they be improved, pray that they lose their anger, and pray that they understand their medical problem. Pray for yourself; that you might be a good listener to your patient's problems, that you apply the correct therapies, and that you be alert to the signs and symptoms of disease.
In the evening when office hours are over take a copy of your schedule and pray for the people you have seen. Pray that they may understand their problems and be motivated to do the right things. Pray for their other needs—the patient whose father is dying or whose wife just had a mastectomy or who is having trouble with his/her parents. Ask for healing of their whole self, not only their specific problems.
With the Patient
Know your patient. One aspect of American society that complicates dealing spiritually with a patient is the plurality of our religious beliefs and practices. Many of our patients have well-developed spiritual lives, but many are antagonistic to spirituality. Many have half-baked poorly organized inconsistent belief systems. Trying to pray with a person who is an avowed militant agnostic is not going to be a beneficial experience for either of you. It takes time and trust to know who you are dealing with. It cannot be done quickly, but it can be done.
One way to know your patients is to notice the jewelry that they are wearing. The cross necklace that a person is wearing may start a conversation about his/her beliefs.
Maugans6 has proposed the mnemonic device "SPIRIT"ual history to help in remembering what to ask. S stands for Spiritual belief system; P, Personal spirituality; I, Integration with a spiritual community; R, Ritualized practices and Restrictions; I, Implications for medical care; and T, Terminal events planning. This spiritual history may take many visits to collect.
Pray. Offer to pray with or for the patient. This must be done with care and tact, but when properly done will be a powerful way to help. When people know that they are prayed for they receive a strength that is not measurable or explainable, but is real. You may tell the patient what you will be praying for, or just simply that you are praying for him/her.
Declare Your Spirituality. I believe it is inappropriate to actively proselytize in the office setting. To try to persuade someone to your personal beliefs is a misuse of the power entrusted to us as physicians. However, I think it is appropriate to indicate in some way our spiritual persuasion, perhaps by wearing a lapel pin cross or by a Star of David on the wall. These stand as silent invitations to discussion that the patient can accept or reject without potential repercussions from you. They give patients permission to bring up their spiritual concerns.
For the Patient to Do
Offer instruction in prayer or meditation. Patients may not know how to pray. With your experience in spiritual discipline you can teach and guide them. Tailor the advice to the spiritual background of the patient. If you force your spirituality on the patient it will not work. He/she will seek another physician. If you offer your spirituality, it can be received with joy.
Let your patients tell you what to do. Listen to their inner voice. Most of the time it will be the correct one.
Give your patient permission to pursue other forms of health care. Many will pursue alternate forms of health care whether you let them or not. Knowing them and what they are doing gives you all the more effectiveness in their care. And granting permission to be open with us also gives us more credibility in the patient's eyes. Now we are caring for them and giving them every chance to get better, not just the chances that our methods might give.
For You to Do Now
Where to start: Seek ye first the kingdom of God. If you do not have a background in spiritual concerns and are not part of a religious community, then begin your spirituality now. Now is the acceptable time. Do not put this off. You can do it. Say a prayer now. Even if it does not help a single patient it will help you. Pray. Meditate. Study. Worship. Seek community.
Seek reconciliation with other forms of alternative health care in your community to learn spirituality from them. If they reject you, it may be because they have been so long and so often rejected by the medical monolithic establishment that they are shy of consorting with it. I have experienced the hostility and rejection of alternative health care workers who have been hurt by rejection from the medical establishment. Give them time and earn their trust. This can only be done through genuine respect. What if you do not have genuine respect? Work on it and find it. Apply the tests of sincerity and effectiveness. Reject the shysters. Be honest and open with those who sincerely believe in what they are doing. Belief is a powerful thing.
CONCLUSIONS
