Should the Roles of Physician and Chaplain be Fused A Personal Reflection

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Ought to the Roles of Physician and Chaplain be Fused? A Personal Reflection Robert M. Nelson, M.D., Ph.D. Assoc Prof of Anesthesiology, Critical Care and Pediatrics The Children's Hospital of Philadelphia University of Pennsylvania School of Medicine Spirituality, Religion, and Health Interest Group, October 4, 2006

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Fusing the Roles "We concur… that the parts of doctor and peaceful advocate ought to be separate in the early phases of the relationship since patients and their families may not be arranged at first to trust or comprehend the part of such a combined figure . In any case, as the patient-doctor relationship creates, … it might be of esteem to both the patient and the parental figures for the doctor to investigate the patient's existential and otherworldly concerns.… Our involvement in a clinical peaceful instruction program adjusted for clinicians gave us the aptitudes, dialect, and experience… ." Caitlin and Todres JAMA 2002

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Context: The Experience of Illness Religiosity and Spirituality Set of convictions and works on; discovering significance in relationship to extraordinary (other than oneself) Vulnerability - "the body deceives the soul" Depersonalization and innovation Spiritual Crisis of Meaning ("trouble") Ethics: "By what means would it be a good idea for me to react?" (translation) The Goal of Medicine? Specialized Good, Personal Good and Ultimate Good

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Spiritual Care Training Program Modified CPE Program (5 months) Weekly class work, 400 hours of supervision Didactic Sessions (e.g., confidence customs) Professional Training Pastoral call reports ("verbatims") Personal Reflection Weekly process notes, experience of confidence Goals "permit them to go with their patients along these pathways with comparable otherworldly honesty" Incorporate "profound care… into clinical practice" Todres et al CCM 2005

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An Important Distinction Diagnostic Interventions (appraisal) Knowledge of the effect of religion and most profound sense of being on medicinal care Sensitive to otherworldly trouble Therapeutic Interventions Appropriate referral (non-questionable) Able to intercede by and by? Excessively meddlesome? Coercive? Crossing a "scarcely discernible difference"? Manhandle of force?

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Spiritual Assessment: Explore inquiries of significance, esteem and relationship Sulmasy JAMA 2006

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Assessing Spiritual/Religious Needs Sulmasy JAMA 2006

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Whose Job Is It, Anyway? "Doctors ought not disregard the otherworldly needs of their… patients, but rather neither would it be a good idea for them to over-gauge their abilities in tending to these necessities." Physicians "ought to have the capacity to… take a profound history, inspire a patient's profound and religious convictions and concerns, attempt to comprehend them, relate the patient's convictions to choices that should be made with respect to care, attempt to achieve some preparatory decisions about whether the patient's religious adapting is certain or negative, and allude to peaceful care or the patient's own ministry as appears to be suitable." Sulmasy JAMA 2006

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Attending to Spiritual Needs? Dialect: nearness, go with, accomplice Spiritual care is in a general sense social. The Compassionate Clinician How would we be able to support the capacity to "endure with" our patients? Nearness requires being mindful to (aware of) our own otherworldly needs/trouble. Comprehending the torment we witness. Danger of burnout ("jading") and loss of good responsiveness ("standing up to the dim side")

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Some Reflections on Suffering The points of confinement of innovation Technical great neglects to accomplish individual great Technology darkens our vision of the great Common Assumption Technology is "esteem unbiased" (apply/expel) Recapturing vision of "good of the patient" Set aside our "connection" to innovation Confront our own qualities, convictions, which means

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Physician and Chaplain? Specialized Good Does it have any kind of effect whether a doctor who is actually skillful likewise thinks about the patient's otherworldly prosperity? Great of the Patient Can a doctor (or clergyman) who is not mindful of their own inquiries of significance survey a patient's profound or religious needs? Extreme Good Can a "non specific" clinician meet the profound or religious needs of patients from different religious groups?