Effective medicine requires developing meaningful relationships with patients. As students, we are taught to start conversations with patients with open-ended questions. Without a simple "yes" or "no" for an answer, the patient shares their story and is able to decide what is important to tell the physician. Clinicians can then ask follow up questions to fill in any gaps in the patient's narrative. Not only is this efficient in terms of diagnosing and treating the patient, but it also facilitates an environment of trust. The patient’s concerns are easily conveyed to the physician and the physician can focus their therapy based on this conversation. Although this is an excellent technique, including spiritual histories could enhance the standard patient interview.
Readily focusing on patient values, spiritual histories allow patients and physicians to connect on a deeper level. They also facilitate planning of advance directives, end of life care, and other spiritually-sensitive medical treatments. By talking about spirituality, patients are able to share, in their own words and in a way that they can understand most, what gives their lives meaning and how this can be applied during difficult times. Physicians have a spiritual role in terms of caring for others and physicians could use this role to their advantage by acknowledging it and using it during patient care.
One method that can be used by residents and physicians to take a spiritual history includes the HOPE acronym:
H: Source of meaning, hope, strength, and connection
O: Organized religion
P: Personal spirituality and practices
E: End of life issues and how spirituality affects medical care
For example, in terms of “H: Source of meaning, hope, strength, and connection”, a physician could ask, “What are the sources of hope in your life?” Alternatively, one could ask, “I understand that religion and spirituality can help people find strength and meaning in their lives; is this true for you?” This step in the spiritual history opens the door to the rest of the questions. If the answer is yes, then the physician could ask about “O: organized religion.” When asking about organized religion, a physician should ask how important the patient’s spirituality is to him or her and what role it has in his or her life.
“P: personal spirituality and practices,” has two sides. One side focuses on the patient’s beliefs independent from an organized religion or the patient’s belief in God and what that relationship looks like. The other, and equally valuable, side looks at the patient’s spiritual practices, such as prayer, meditation, or other practices that helps the patient find motivation and comfort throughout the day. Finally, as it especially pertains to medical practice, a physician should address “E: end of life issues and how spirituality affects medical care.” For example, a physician can ask the patient if there are any spiritual restrictions health care professionals should know about, such as dietary restrictions, that could change the patient’s treatment plan.
So what can physicians do after they have received this information? There are many different options depending on the circumstances and patient’s desires. Firstly, the physician can take no further action with this information if that is what is desired. Even if no further action is taken, the patient will feel a connection with the physician after speaking about his or her spirituality and the physician will gain a better understanding of the patient’s values and what they find meaningful in life. On the other hand, if desired, the physician can incorporate the patient’s spirituality into the patient’s health care. For example, if a patient is dealing with anxiety related to his or her illness, the physician can try to encourage the patient to use spiritual practices such as prayer or meditation to get through difficult times. A physician could also help find resources that the patient could use to find motivation during an illness, such as speaking with a spiritual leader or spirituality-focused support groups.
Incorporating a spiritual history into patient care is important because not only does it open the dialogue, but it also creates a safe space for discussion. This helps to create a meaningful relationship between the physician and the patient that can facilitate trust. In addition, the spiritual history helps the physician to understand where the patient’s desires and values come from. This enables them to be advocates for their patients by making sure that the care that the patient is receiving is in line with his or her values and motivations in life. Considering these advantages, the argument can be made that a spiritual history can be a valuable add-on to a medical history that helps to create a trusting environment between the patient and the physician where open dialogue can be facilitated, patient concerns can be addressed, and care that aligns with the patient’s beliefs can be offered.
This article was written by Michelle Evans, Sidney Kimmel Medical College Class of 2019