Discussing spiritual health in primary care

Discussing spiritual health in primary care
Discussing spiritual health in primary care

One basic quality of the field of science is the ability to explain the existence of things. Science seeks to answer the questions, “how?” and “why?” Medicine is undoubtedly an entity of science -- it's basic governing principle is diagnosis.

The typical medical encounter includes a patient presenting with a concern and then relying on a healthcare provider to explain how and why the patient is feeling the way he or she does. The provider seeks to determine the nature and the cause of the patient's ailment and provide an explanation.

But what happens when science is not able to determine why a patient feels a certain way? What if an intervention is not evidence based, or there is no explanation for how a treatment works? 

The holistic approach to providing patient care should not be ignored and often answers the questions that science cannot explain. Holistic medicine includes treatment of the whole person -- body, mind and spirit – according to the American Holistic Medical Association.

We can use science to treat and understand the body, and often the mind as well. However, science cannot explain the human spirit.

Oftentimes, the most frustrating patient encounters are the ones that do not reveal a medical or scientific pathology to an ailment. In these instances, you explain to a patient that his or her vitals signs are normal and screening tests are likewise within normal limits. The patient's weight, height and calculated BMI are better than yours.  And still the patient looks at you and asks, “Then why do I feel so bad?”

In these instances, I respond by explaining that there are two aspects of our health – physical and mental.  Once we have determined physical health is not the cause of  a patient's symptoms, then we must assess mental health.

There is an additional aspect, spiritual health, I often do not address. Not because I do not believe in it, but mostly because I have not mastered how to address this aspect efficiently and effectively.

In general, spiritual health is rarely discussed and poorly received. I often ask myself if I am truly providing holistic healthcare if I do not address a patient's spiritual health as well. Should religion be included in a patient's social history? Should I be able to make a referral for pastoral services?

Spiritual health is often better addressed in the inpatient setting rather than the outpatient setting, as pastoral services are often available in hospitals. Perhaps given the acute nature of illness in the hospital, discussing spiritual health is likely better received in this setting.

Yet as the focus of primary care shifts towards prevention, it would be best if spiritual health were addressed in the primary care office first, as it is an important component of the whole person and a key factor in a person's well being.

If you have any advice for incorporating spiritual health discussions into primary care visits, please share your thoughts. You can send your comments to editor@clinicaladvisor.com.

Leigh Montejo, MSN, FNP-BC, is a National Public Health Service Corp scholar completing her service commitment as a Family Nurse Practitioner at Tampa Family Health Centers Inc. in Florida. Her areas of interest include adolescent health, health promotion and improving access to healthcare in underserved populations.

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