By Rev. Ken
Blank and Dr. John Campbell – Oklahoma Health Center Clinical Pastoral
Education Institute, Inc. Ó 2005
When medical students in their second year at Yale
University medical school enter a patient’s room to do a personal history,
including questions about the patient’s spiritual life, they go in prepared.
According to an article entitled Med Students Learn Finesse in Asking About
Faith by Julia C. Keller, published in the January, 2005,
issue of Science and Theology News, their professor, Dr. Auguste
Fortin, has taught them what to do.
Dr. Fortin believes patients ‘want health care
providers to ask about’ [spirituality issues] in their lives – but he also
believes ‘knowing how and what is appropriate to ask is a skill needing to be
taught in the medical school curriculum’.
Dr. Fortin uses an interview method developed by Dr.
Robert Smith, professor of medicine and psychiatry at Michigan State
University: the Integrated Patient-Centered, Doctor-Centered Interview.
In a doctor-centered encounter between doctor and patient, the physician
typically interrupts the patient after only 18 seconds of speaking, not
allowing the patient to complete his first thought. In a patient-centered
encounter between doctor and patient, the patient is allowed to express him or
herself first and actually list the issues they want to discuss with the
physician. There are a number of benefits to the physician from this approach
according to Dr. Smith. Some of these include cutting down on patients’ return
visits, giving patients more satisfaction with the process, increasing patient
compliance with medical advice, diminished instances of “doctor shopping”,
fewer lawsuits against physicians, and better health outcomes. Dr. Smith says ‘get to the reason a person
comes to the hospital’ – including the reasons beyond a particular disease or
body ailment.
The medical students hear more: ask the questions from
a tone of respectful curiosity and allow for the patient to be
willing to “take the question”. Avoid coughing and stammering on
potentially sensitive questions, such as about their sexuality, as it conveys
the impression this is something embarrassing or shameful (on this issue, the
article says 91% of people want the doctor to ask them about this). Enter the
questioning with open-ended questions and don’t feel the need to cover
every question on the history form. But remember that each question is
important and the medical student should consider asking the ones he or she
really dreads to ask. Dr. Fortin encourages the medical student to build
empathy with the patient through echoing a patient’s words, sitting forward
in the chair, and maintaining eye contact. The patient-centered interview is
conducted in an open and non-judgmental way.
Specifically, to begin the spirituality history, Dr.
Fortin advises using a question like “Do you consider yourself to be a
spiritual or religious kind of person at all?”. Responses may range from negative reactions, in which case
the medical student can move on to other questions important to keeping the
patient healthy, or positive reactions, in which the patient asks the
student to pray with them. If the latter case, Dr. Fortin advises to consult
the chaplain for appropriate management, with the student serving as an
important conduit for getting the support a patient needs for his spiritual
health.
To let us know YOUR opinions on this topic: please
send responses to:
Mail: Chaplain
Services, VAMC #125, 921 N.E. 13th Street, Oklahoma City, OK
73104 OR
Scan it and attach it to an email to us at mailto:survey@cpeokc.org.
Visit our website at http://www.cpeokc.org.
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