Personal and Spiritual Assessment

1. Personal and Spiritual Assessment Dan Fountain, MD, MPH

2. The importance of this • In medicine, the physical history and review of symptoms reveal the pathophysiology • The personal history reveals personal issues in the life of the person • We take a Spiritual history to understand our patient’s spiritual pathophysiology • Do they believe their life is “making it?” • Can they acknowledge it if they are not? • What is their relationship with God?

3. An essential part of the history • Personal life issues affect health • They influence recovery from illness • We must find out about them • We must ask key questions • We must listen to the answers • We must process the answers – verbal and non-verbal – to discern the real problems

4. A routine part of the social history • Do you smoke, drink? How much? • Are you married? How long? Happily? • What kind of work do you do? • Any church or religious preference? • These are non-threatening questions • They are often on the computer intake form • Look or listen for clues about problems

5. General questions • How are things going in your life? • At Work? • At School? • At Home? • How are you coping with this illness? • To whom can you go for help in time of need? (support systems)

6. Relationships • Are you having any trouble with your children? • Spouse? Or parents? • Co-worker? Or Boss? • Friends? Or other persons? • With someone of the opposite gender? • Are you really angry at someone?

7. Levels of Stress • What is your stress level? • Do you feel stressed out? • From what? • Do you feel anxious about anything? • Are you having difficulty concentrating? • How are you sleeping? • How is your appetite? • Any problems with finances or employment?

8. Recent loss • Have you recently lost a spouse, child, or close friend or relative? • Are you going through a separation of a divorce? • Have you lost your job, or feel you might do so? • Have you just retired? How is that going?

9. For a young person • How are things going in school? • Where are you heading in life? • What would you like to be? • Do you feel like you are not getting what you desire out of life? • Have you thought about who you really are? • If you should die, who would miss you?

10. Identify Patient’s Issues • LISTEN to what our patients are saying • Fear, anxiety, gloom • Anger, resentment, bitterness • Guilt, shame, denial, self hatred, lonely • Addictive behaviors, sabotaging self • Self pity, hopelessness, passivity, loss of creativity • These are important personal issues • Helping a person cope with them is part of spiritual care

11. When a significant issue arises • Perhaps you can handle it quickly within your time constraints • You may want to refer the person to the spiritual caregiver on the team • It may require professional counseling help • Or you may give the person some “homework” (reflection) to do and then return for another visit

12. Make a record of findings and care • An abbreviated note about personal problems that will pass inspection but will help you recall the problem(s) • A similar note about your recommendations • On subsequent visits ask, “You mentioned… could you expound on that…?

13. Objections may arise • “Why are you asking me all these personal questions?” • “Do you think my problem is all in my head?” • A careful explanation of what medical science now knows about the affect and physiology can help • Proverbs 14 : 30 may help

14. A helpful response • These questions are so that I can understand you better and know how best to guide the treatment. • How we think and feel does affect the functioning of our heart and all of our organs and systems

15. Taking a spiritual history • First establish a level of trust • Proceed gently and go only as far as the person wishes us to go • Faith is of benefit to health and to recovery from illness • But imposition of our beliefs is unethical and must be avoided • Proselytism is not permissible

16. Opening questions • Tell me about your faith • Do you attend church? – temple, synagogue, etc. • Do you find that helpful? • Does your faith help you cope with life and with this illness? • Where do you feel God is in this? • Has you found help from him?

17. Church affiliation • Discussion of denominations is to be avoided • Find out if the church, or temple, provides support and help

18. A personal relationship with Christ • This is of positive benefit to health • Sense of meaning, purpose, and destiny • Peace of mind • Joy in living • It is ethical to ask about this, but not to “push the issue” • Avoid “churchy” terminology

19. Explaining a personal relationship with Christ • God has created us for a relationship with him • Many of us prefer to “go it alone” • We resist knowing God and following him • He came to earth as Jesus, lived among us so that we could better understand God, and made it possible for us to live with God

20. Living with God now • We acknowledge our wrong-doing and our need for his help • We invite him to live within our spirit and show us how to live • Daily communication with him • Trust in his goodness and power to help us

21. Guiding Principles • Proselytism must be avoided • If the person is not interested or is resistant to the Christian Faith, keep an open caring relationship, but do not push Christianity • Interest may develop later • The word ‘sin’ may be offensive • If so, talk about ‘regrets’

22. Discussion of Faith should only come after • A relationship of openness and honesty has been established • The sick person has described the illness or problem for which they are there • We have demonstrated an interest in them

23. If appropriate, share your own spiitual story • Your story is yours. It is not an argument or an effort to persuade • Usually somewhere along the line there is an identification • It makes you more real to the one with whom you are speaking • “Would you like to hear how God has helped me?”

24. Making A Spiritual Diagnosis • From your conversations, certain spiritual needs emerge • What is the sick person’s self image? • Does she have joy, peace, and hope? • How is he coping with the consequences of the illness? • Where does she find help in time of need? • Does he have a relationship with the Lord? • Once you identify a spiritual need, confer with your consultant, the Holy Spirit, and follow His lead

25. Be Careful… • Do not ask too many questions at once • This is not an inquisition • The goal is healing • Ask only those questions that move toward this goal

26. As Christian Care Givers… • We need to confront their spiritual health as well as their physical health • Explain if asked why we are bringing “that” up, that you care about them, and recognize it impacts their health

27. Confronting • We tell patients truths, because they need to hear them • We earn the right to confront when the patient knows they are loved, accepted, valued and understood • As clinicians we have the moral obligation to identify destructive factors in patient’s lives • Are there other things going on in your life that may be contributing to your problem? • I’m really concerned that unless you deal with…it may impact your overall health • These may be physical, emotional, or spiritual issues

28. Church attendance • Attending a good church is beneficial • Encourage regular attendance • Learn about the churches in your area • Many people do not attend church so may not be comfortable at first • In this case, offer to take them to your church for the first time to introduce them to “church culture”

29. The Gospel • The power of God for salvation of all who believe • Salvation (Yeshua) includes health and wholeness

30. Remember : • Spiritual care has a solid base of evidence • It must be patient directed • It can bring new life • It can bring healing of heart, soul, and spirit and, in many cases, of the body