Dr. Schweitzer Was Right

By Timothy P. Daaleman, DO, MPH, Department of Family Medicine, University of North Carolina at Chapel Hill

Albert Schweitzer once said that medicine is not only a science but also the art of letting our own individuality interact with the individuality of the patient. I thought of this aphorism after reading the qualitative study by Kuczewski and colleagues and the accompanying commentary on spirituality and health in the January issue of Academic Medicine. Spirituality has lost much of the luster and purchase that it had in health-related circles over a decade ago, and part of this decline is due to the lack of a clear understanding of how spirituality is operationalized in clinical settings among patients and physicians. For example, the wide range of themes identified by medical students in this exploratory study of spiritual care at the end-of-life—communication, patient care, compassionate presence, and personal and professional development—are not unique to spirituality and have been appropriated by other humanistic disciplines in medicine, such as patient-centered care, professionalism, and ethics. This is vexing for other health professions as well, particularly nursing, which struggle with placing spirituality within clinical care, research, and training contexts for similar reasons. The bottom line is that spirituality does not message well in contemporary academic health care centers and other clinical training environments, which are all moving to value-based paradigms. What will be the value proposition for spirituality in future health care systems and for physicians who are formed in these environments and communities?

The good Dr. Schweitzer shows us a way. To begin, my reading of the student narratives interprets a process of self-awareness and interior development that was not separately personal and professional but integrated. Fundamentally, such a process radically challenged and altered the students’ emerging self-identities as persons of care (i.e., their individuality). The texts, to me, also suggested that a profound shift occurred, not by way of coursework or adherence to clinical or educational guidelines, but through authentic relationships with patients who were facing death, encounters that lay bare the individuality of the patient, and probably the student. At the core of these encounters—if my clinical and research experience can be a trusted guide—are the spiritualities, that is, the beliefs, stories, and practices which are being worked out in response to human longing for meaning and purpose.1

This approach to spirituality can claim a unique space and offer a richer and more integrative framework for educational innovations in emerging value-based academic health centers, especially at a time when concerns are being voiced about professionalism in medical students and burnout in physicians. The authors of both the qualitative study and the commentary conclude with future directions that primarily target curricula, protocols, and competencies related to spirituality and health. Although I could not agree more with the overall goal and content within these recommendations, the well-recognized hidden curriculum has washed away many of the best developed and intended educational initiatives, and will do so with any spirituality initiatives that do not take into account the larger context of hospitals, medical homes, and other clinical learning environments. The “art,” which Dr. Schweitzer so rightly speaks, will be how the intersecting spiritualities of patients, doctors, and other care providers can be initiated, developed, and deepened in these clinical settings.2

1.  Shea J. Spirituality and health care, reaching toward a holistic future. Chicago, IL: The Park Ridge Center; 2000.

2. Daaleman TP, Kinghorn WA, Newton WA, Meador KG. Rethinking professionalism in medical education through formation. Family Medicine. 2011;43:325-329.

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One Comment

  1. Kemi Tomobi
    January 12, 2014 at 4:06 AM

    Thanks for this post.  I found this to be one of the most insightful AM posts of 2013, and I am glad that AM is addressing spirituality in medicine.  It is sorely needed in practice, and in medical education. 

    At a health conference last year, one of the attendants mentioned that one of the reasons that American health care falls short in meeting patients’ needs is because in American culture, people are afraid to tell others what to do.  There is this sense that each person should do what he or she wants and can make the choices on his or her own, and it is threatening to order someone to do something.  

    But guess what?   It takes some spiritual maturity to be able to tell someone what to do and provide the appropriate advice to a student or patient.

    The attendee also mentioned that because of this attitude, that it is hard to translate meaningful research into action.  The research provides information, but not enough to provide procedural knowledge on what to do next, so there is very little progress  She gave an example of a quote that gets at the problem, and I agree:

    “You can lead a horse to water, but you can’t make it drink.”

    A problem with this phrase is that one equates the barrier to open human interaction to that of a difficulty in getting a horse to drink.  Instead of building rapport, you build distance.  Horses are not human, and to abide by this quote suggests that one has lost the humanism necessary to understand what the other person’s needs are.  You may struggle to get a horse to drink, but with humans, there is the gift of communication, which is rooted in empathy.  You can teach a human to drink by providing procedural knowledge of necessary steps.  You can tell the human to drink.  You can also demonstrate and show the human how to drink.

    The Bible says, “my people perish, for lack of knowledge (or vision).”  Should the human die from thirst, it would not be because the human did not want to drink water, it would be because the human did not have the information and procedural knowledge necessary to start drinking the water, even if the water is practically at the fingertips.  Communication matters.

    The Bible also teaches us how to be more empathetic, with one of the greatest commands: “Love your neighbor as yourself.”

    This love is not romantic love, but unconditional love.  Does anyone choose to love accept himself or herself conditionally?  Then that person struggles to have empathy, because if you can’t love and accept yourself, you will struggle to love, accept, and understand others unconditionally.  The opposite situation can occur, too, where one considers himself or herself more highly than others; this is a barrier to empathy, too. 

    I hope to convey that even though the field of medicine and medical education may not open up to the discussion of spirituality and its rightful place in healing, that there will be more open discussion and integration into the curriculum, and into practice, to help develop better educators and physicians.  It is a great thing that the January issue of AM addresses spirituality in medicine.

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