Medicine should be for mind, body and spirit
Experience is teaching us that the COVID-19 pandemic has been an assault not only on our health but also on our spirit.
I recall sleeping at my grandparents’ house as a young child of six or seven. Their house was always bright and crisp. Everything in its place, yet welcoming and exciting. We sat down for dinner, and due to a “grasp malfunction,” I spilled an entire pitcher of borscht, a purple, Eastern European drink derived from beets, on their clean white tablecloth.
Did I mention that the tablecloth was alabaster white?
Within seconds, the purple liquid penetrated the tablecloth like a gaping wound. Time stopped, as did my breathing. My body was frozen, and my mind and consciousness anxious and confused. I had no idea what would happen next.
To my surprise, my grandfather paused, looked at me, smiled and said, “I always thought that tablecloth needed a little more color.” With that, all my tension tense melted away and my spirit soared.
Since then, I have come to understand that the elation I felt was not merely from being spared punishment. Rather, it was what I would later come to know as a tangible connection with the very spirit, force or essence of life. Painters, writers, artists and sculptors have all attempted to capture the human spirit in their creations.
The fount of meaningfulness
The spirit is not just an imaginary construct, nor is it consigned only to the world of religion. It is a very real, ever-fluid and arguably palpable aspect of being human that reflects how we interface with the experiences of life. The human spirit is inextricably linked with emotion — dampened by fear, pain and suffering and liberated by understanding and joy. A soaring spirit is often tantamount with a raison d'être for living a full and complete life.
Treating the spirit
Today, some 45 years after my borsht debacle, the human spirit and its effects on disease manifestation and maturation are increasingly becoming a staple of medical treatment in some healthcare arenas.
Attention to the human spirit in the context of medicine has matured over the past two decades. Some have posited that the spirit provides the essential link between a patient’s presenting problem and the patient’s need for effectively treating that problem. The idea is that patient-centered medicine should view the patient’s spiritual needs as an integral component of high-quality care.a
In today’s epoch of COVID-19, the wake of spiritual havoc cannot be overstated. Although many healthcare organizations have post-COVID-19 clinics that tend to the physiologic, organ-centric manifestations of the disease, not all tend to the spiritual crippling that COVID-19 has caused. A patient’s broken spirit can be a result of the amalgam of economic, clinical, psychosocial and/or political ruin exacted by the pandemic.
A broader realm of treatment
How does one deal with this problem? How does one treat the spirit?
It is not always straightforward. Diagnosing and treating spiritual conditions requires a quite different approach from something like diagnosing polymorphic ventricular tachycardia when an EKG demonstrates Torsade de pointes. Treating the spirit requires listening for the silences in between the sentences, demonstrating empathy, appreciating the subtleties of the dialogue and respecting a patient’s cultural uniqueness. Holding the hand of the patient and even crying with them can affect the spirit in beneficial, nonlinear ways.b Some may consider such behavior inappropriate, but others consider it to be a testament to a healthcare worker’s humanity.
Such behavior does not connote an effort to cultivate patient friendship, which some believe detracts from healthcare professionalism. Rather, it acknowledges a reality that nurturing a patient’s spirit can foster empowerment and healing in ways that we are just beginning to appreciate.c
Healthcare financial leaders can advocate for the following three areas of action to promote a focus on treating the spirit in healthcare.
1. Endeavor to understand how patients experience a medical condition and its impact on their lives and spirit. An improved understanding of the patient’s mind-body-spirit connection can foster improved clinical outcomes.d In the very least, patients want to be treated with compassion and empathy, and it should be considered as a core part of an organization’s mission and culture to show respect for patients’ humanity and spirit. Moreover, where possible, demonstrating these values should incorporate high-profile support and commitment of the organizations’ leaders.
2. Interface, where applicable, with community advocacy groups to better understand patients’ cultural, religious and economic issues. This effort can help identify common elements that can streamline crucial resources toward benefiting a majority of patients from such sectors.
3. Pursue healthcare-focused forums with select constituencies, including clergy, disease-specific associations and foundations and other non-allopathic entities, relevant to the hospital’s focus. The objective of these activities should be to introduce healthcare practitioners and students to different modalities of thought on the human spirit and its effect on medicine to broaden and inform their awareness of this issue and its full diversity.
The only path forward
COVID-19 has been the bearer of unique and ubiquitous concerns that affect us all and that are causing many of us to face unprecedented difficulties. Yet amid this crisis, we should remember it is the spirit of our humanity that enables us to prevail and soar toward greatness, and this spirit is timeless. My grandfather provided me with an early glimpse of the power of the spirit, and that reality has constantly informed my own practice to this day.
a Yawar, A., “Spirituality in medicine: what is to be done?” Journal of the Royal Society of Medicine, October 2001; Karff, S.E., “Recognizing the mind/body/spirit connection in medical care,” AMA Journal of Ethics, October 2009.
b Shepard, K., “Why it’s okay to cry with patients and their families,” TravelNursing.com, Accessed Dec. 30, 2020: Gulland, A., “Is it okay to cry in front of patients?” The BMJ Opinion, Dec. 15, 2014.
c Puchalski, C.M., “The role of spirituality in health care,” Baylor University Medical Center Proceedings, October 2001.
d Taylor, E.J., Spiritual care: Nursing theory, research and practice. Upper Saddle River, NJ: Prentice Hall, 2002.