When empathy, devotion, and spirituality combine with medicine
By Rudrani Ghosh
“The walls of hospitals have heard more prayers than the walls of temples, mosques, and church”
In the study and practice of medicine, the bias against the discussion of spirituality and religion is slowly beginning to change as the physicians have started to appreciate the importance of incorporating spiritual discussions into medical care and the well-being of the patient. In this article, Dr. Sunil Chandy, Chief Medical Officer, ITC India, explores how a deep sense of devotion and empathy play an important role in the practice of the medical profession.
Association between Spirituality, devotion, and medicine
In the context of serious illness, evidence shows that there is an indelible correlation between medicine and spirituality (expressed in religious forms). In his experience in the Nazi concentration camp, Victor Frankyl, the psychiatrist, wrote, “Man is not destroyed by suffering; he is destroyed by suffering without meaning. One of the major challenges that the physicians face is to help people find the meaning and acceptance amid suffering and chronic illness.”
In this context, the word “compassion” becomes extremely crucial as compassionate care is nothing but asking the physicians to be partners with their patients amid their pain rather than dictating information and medical jargon to them.
Dr. Chandy believes, “When a person is afflicted with illness, there is an unavoidable element of negativity and dejection that takes over, albeit temporarily. With chronic illness, they tend to persist long enough to fragment the totality of personhood. One’s faith and connection with God surely help patients to navigate the difficult journey of illness and fill in the need gaps that medicines do not. This is the reason why many hospitals have multi-faith chapels and chaplains on its rolls – to listen, counsel, pray and support.”
He further notes, “Historically, western, middle-eastern and Indian systems of medicine have had a foundational link with their respective deities – as seen in the ancient medical literature. This has diminished in contemporary scientific thinking which accommodates only objectivity and evidence-based conclusions. But that is changing,” Dr. Chandy adds, “In the Indian context, where life is so profoundly influenced by conservative socio-spiritual upbringing, there is a need to include a spiritual dimension to patient care, to make the recovery more holistic. The power of prayer-assisted meditation and devotion must become integral to medical education and clinical practice in a non-obtrusive, consented, and gentle way.”
Patient Experience of Critical Illness
Once, a physician working in the critical unit of a hospital, told me about his nervousness when the patient posed him with questions like: “What will happen to me after I die? Will my family survive my loss? Will I be missed? Will I be remembered? Is there a God? If so, will he be there for me?” He further stated, “It is so difficult to know what to say; there are no real answers to these questions.”
However, the answers to these difficult questions are essential when it comes to true healing. Patients long for their doctors and families and friends to sit with them and support them in their healing, which at its very core is deeply spiritual.
Research reveals that people with serious illness reflect on existential life questions and spirituality and devotion are often identified as helping these people to deal with their situation. Even Dr. Chandy points out that there is scientific evidence to suggest that spirituality and meditation is an independent determinants of quality of life and emotional well-being in cancer survivors-—with nearly 70% reporting spirituality helped them through their cancer experience.
Providing care for people with serious illnesses is challenging for healthcare professionals. It is common for caregivers to feel helpless at this time when they are unable to provide the kind of support that the patients and family members need, however, ignoring the concerns is not helpful.
Digital Transformation Vs. Loss of Personal Touch
The pandemic has accelerated the healthcare industry’s slow march towards digitalization and teleconsultation. However, this digital innovation and transformation do leave us with thoughts like - Will healthcare lose empathy if it swings too far into digital transformation? Dr. Chandy believes that although the digital transformation that healthcare is undergoing is expected to make quality time available to the clinician for better patient care, it will not be so in practice.
The doctor states, “The time saved will instinctively be spent in smartphone browsing, personal messaging or clearing back-log of e-mail. Some will accommodate more patients to enlarge the scope of their practice to gainfully use the time saved. The net time for patient interaction may remain the same. The flip-side of digitization is the enlarging disconnect that gadgetry will cause between doctors and patients. The EMR computer screen and electronic charts on rounds have visibly reduced patient-contact in outpatient care and bed-side time in inpatient care, respectively.”
“Compassion and empathy which are off-shoots of physical interaction will certainly not be automatic in the digital transformed healthcare. The less time spent with the patient, the less will the stimulus be to feel empathetic. Patients will increasingly become case-numbers and diagnosis-flagged” he adds.
Re-humanising Medicine when the world is busy making money
One of the biggest challenges the healthcare sector facing today is how the healthcare policies and future strategies are driven by business interests rather than patient interests. Empathy and civility is an attitude which is a part of healthcare’s DNA. India is a country where there exists a dichotomy between how healthcare is delivered from time immemorial.
Dr. Chandy who has always been sensitive about these issues, affirms, “The first step to re-humanize medicine is to accept the fundamental truth that healthcare is essentially a service entity, where patient interests must always have primacy over its business aspects. That non-negotiable principle will then flow into the work-ethic of its stakeholders – medical personnel, hospitals, and the leadership.”
He believes that “it is possible to create such an ecosystem through the adoption of a need-based diagnostic and therapeutic approach, compassionate technology and austere facilities. The leadership circle must drive this culture in their domains. It is also possible to reduce medical expenses by 30% by applying lean management principles in the entire ecosystem.”
Integrating spirituality in the clinical courses
There are certain key beliefs like - Hospitals are primarily institutions of technology and cure rather than organizations aimed toward humanistic care; Physicians conceptualize themselves primarily as scientists, and secondarily as health managers, rather than primarily as healers attentive to the whole person. This separation model in medicine is unquestioned largely throughout the academic medical school and teaching institutes. However, evidence suggests that medicine requires integrating the concept of spirituality and devotion in their courses to help students recognize how it affects their professional practices – to understand how their calling as physicians, as servers because serving others is at the root of the profession as physicians.
Professor Chandy thinks, “With increasing knowledge of the science of medicine and the advent of technology, the art of medicine is taking a back-seat. With more and more curative options available in the physicians’ armamentarium, care has become objective and organic. Medicine is general has become reductionist and organ-specific, with less focus on the whole person perspective.”
“The re-integration of the whole ‘person’ into the ‘patient’ would now necessitate the inclusion of all the components defined in Health – a state of physical, mental, social and emotional well-being, not just the absence of illness. Integration of ethics, humanities, spirituality, and wellness into the medical education and practice is a desirable direction to take in future” he adds.