It’s been 10 years in the making … and it’s now available … so, if you’ve not seen or signed up for my daily devotional, “Morning Glory, Evening Grace,” I hope you’ll take up a look at it. Continue reading
As we approach the Christmas holiday, Christians will often be challenged by those who note the “pagan” origin of Christmas. As a result, some Christians believe we should not celebrate the holiday at all, given the origin of its elements. Here are some thoughts on this topic from the wonderful folks at PleaseConviceMe.com: Continue reading
NEWS: I’m launching a new twice-a-day devotional on December 19. I hope you’ll sign up for it. Continue reading
The Bible teaches, “‘In your anger do not sin': Do not let the sun go down while you are still angry …” (Ephesians 4:26). In other words, let go of your anger, regrets, bitterness, sorrow, etc. Why? Wallowing in these emotions is always harmful to our physical, emotional, relational, and spiritual health. Continue reading
It’s been proclaimed from pulpits and blogs for years — Christians divorce as much as everyone else in America. But some scholars and family activists are questioning the oft-cited statistics, saying Christians who attend church regularly are more likely to remain wed. What’s the truth? The answer may surprise you. Continue reading
Here’s an interview with me, from HCJB Global, about my teaching time at a large international medical conference in Quito, Ecuador, last month. Continue reading
Regular churchgoers may lead more satisfying lives than stay-at-home folks because they create a network of close friends who provide important support, a new study suggests. Conducted at the University of Wisconsin, the researchers found that 28 percent of people who attend church weekly say they are “extremely satisfied” with life as opposed to only 20 percent who never attend services. But the satisfaction comes from more from participating in a religious congregation along with close friends, rather than a spiritual experience, the study found.
Here are the details from HealthDay News: Regular churchgoers who have no close friends in their congregations are no more likely to be very satisfied with their lives than those who never attend church, according to the research.
Study co-author Chaeyoon Lim said it’s long been recognized that churchgoers report more satisfaction with their lives. But, “scholars have been debating the reason,” he said.
“Do happier people go to church? Or does going to church make people happier?” asked Lim, an assistant professor of sociology at the University of Wisconsin, Madison.
This study, published in American Sociological Review, appears to show that going to church makes people more satisfied with life because of the close friendships established there.
Feeling close to God, prayer, reading scripture and other religious rituals were not associated with a prediction of greater satisfaction with life. Instead, in combination with a strong religious identity, the more friends at church that participants reported, the greater the likelihood they felt strong satisfaction with life.
The study is based on a phone survey of more than 3,000 Americans in 2006, and a follow-up survey with 1,915 respondents in 2007. Most of those surveyed were mainline Protestants, Catholics and Evangelicals, but a small number of Jews, Muslims and other non-traditional Christian churches was also included.
“Even in that short time, we observed that people who were not going to church but then started to go more often reported an improvement in how they felt about life satisfaction,” said Lim.
He said that people have a deep need for belonging to something “greater than themselves.” The experience of sharing rituals and activities with close friends in a congregation makes this “become real, as opposed to something more abstract and remote,” he added.
In addition to church attendance, respondents were asked how many close friends they had in and outside of their congregations, and questions about their health, education, income, work and whether their religious identity was very important to their “sense of self.”
Respondents who said they experienced “God’s presence” were no more likely to report feeling greater satisfaction with their lives than those who did not. Only the number of close friends in their congregations and having a strong religious identity predicted feeling extremely satisfied with life.
One reason may be that “friends who attend religious services together give religious identity a sense of reality,” the authors said.
The study drew a skeptical response from one expert.
“Some of their conclusions are a little shaky,” said Dr. Harold G. Koenig, director of the Center for Spirituality, Theology and Health at Duke University Medical Center in Durham, N.C.
The study showed that religious identity is just as important as how many friends a person has in their congregation, said Koenig, also a professor of psychiatry and behavioral sciences at the university.
The way the data was analyzed ensured that the spiritual factors (prayer, feeling God’s love, etc.) would not be significant because people with a strong religious identity were controlled for, or not included in the analysis, according to Koenig.
“Religious identity is what is driving all these other factors,” said Koenig. Social involvement is important, “but so is faith.”
Lim said the data show that only the number of close friends at church correlates with higher satisfaction with life. The study acknowledged the importance of religious identity, as well as number of friends, suggesting that the two factors reinforce each other.
“Social networks forged in congregations and strong religious identities are the key variables that mediate the positive connection between religion and life satisfaction,” the study concluded.
Lim said he wanted to examine whether social networks in organizations such as Rotary Clubs, the Masons or other civic volunteer groups could have a similar impact, but it might be difficult.
“It’s hard to imagine any other organization that engages as many people as religion, and that has similar shared identity and social activities,” said Lim. “It’s not easy to think of anything that’s equivalent to that.”
Here’s the sixth of an eight-part devotional for men based upon my chapter on health in Coach Joe Gibbs best-selling book, Gameplan for Life. The devotional was featured by the Men of Integrity ministry of Christianity Today. I hope you enjoy the series. Here’s Part 6 of 8
THE SERIES’ THEME: Healthy Through and Through. What does it mean to be a truly healthy man of God?
THE SPIRITUAL WHEEL
What does it mean to be in a state of maximum well-being as we relate to our Creator? Obviously, for us to be spiritually healthy, any break in our relationship with God must be prevented or treated.
Your spiritual wheel must be seen as the most crucial one, because good physical, emotional, and relational health alone will not make you a highly healthy person. Spiritual well-being has to be a consistent priority.
In the New Testament, the apostle Paul instructs his young disciple Timothy about this very thing: “‘Physical training [the physical health wheel] is good, but training for godliness [the spiritual health wheel] is much better, promising benefits in this life and in the life to come.’ This is a trustworthy saying, and everyone should accept it” (1 Tim. 4:8-9).
Can you see the value of learning to view your physical, emotional, and relational health as secondary to your spiritual health?
Though we’re not promised a perfectly healthy physical life, the Bible does promise abundant life to those who have a vital relationship with God. An abundant life is one that will be full and meaningful—infused with purpose, contentment, and joy.
My Response: What changes might I need to make in order to be more spiritually healthy?
THOUGHT TO APPLY: A bodily disease which we look upon as whole and entire within itself, may, after all, be but a symptom of some ailment in the spiritual part.—Nathaniel Hawthorne(writer)
You can learn more about this principle in my book, 10 Essentials of Happy, Healthy People: Becoming and staying highly healthy. Autographed copies are available here.
Here’s the entire series:
- Part 1 – Introduction
- Part 2 – The Four Wheels of Health
- Part 3 – The Physical Wheel of Health
- Part 4 – The Emotional Wheel of Health
- Part 5 – The Relational Wheel of Health
Adapted from Game Plan for Life (Tyndale, 2009) by permission. All rights reserved by the copyright holder and/or the publisher. May not be reproduced.
The Chicago Tribune reports, “The relationship between prayer and physical healing has long been the subject of conflicting studies. Some indicate prayer can help, but at least one study concluded that in some cases it can be harmful.”
Researchers “found that coronary bypass patients who were told strangers were praying for them did worse than those who got no prayers.” But, “increasingly … prayers are being offered by chaplains, doctors, nurses, and social workers. They are recited in hospitals before and after surgery, during treatments, upon admission and discharge, and on the anniversary of a diagnosis.”
Despite this one negative study, there are not “some” studies showing prayer can help, but hundreds of studies showing a positive association between a wide variety of spiritual interventions (spiritual assessment, prayer, spiritual counseling, etc.) and physical and emotional health outcomes.
You can read more on this topic in my book, Alternative Medicine: The Christian Handbook. You can order a signed copy here. You can also read some of my blogs on Faith-Based Health and Healing:
- Part 1 – What does the Bible say about health?
- Part 2 – What Value Should We Place on Our Health?
- Part 3 – Devout Faith Helps but Does Not Guarantee Good Health
- Part 4 – Can Faith be Unhealthy?
- Part 5 – What Causes Sickness?
- Part 6 – Why God’s Response Isn’t Always to Heal
- Part 7 – Not All Healing is From God
- Part 8 – Illegitimate Spiritual Practices
- Part 9 – Life Energy and Medical Magic
- Part 10 – Medical Characters Condemned for Pursuing Certain Forms of Healing
- Part 11 – Look to the Bible, Not Inner Voices, for Guidance
- Part 12 – Biblical Principles on Which to Base Medical Decisions and The Power of Faith
This post is excerpted from my book, 10 Essentials of Happy, Healthy People: Becoming and staying highly healthy:
Finding a doctor and other health care team members who share your spiritual foundation and practices may be crucial for you—and thankfully it’s fairly simple. You can use a spiritual inventory.
Doctors are increasingly using spiritual inventories in their care of patients. In fact, when I make presentations at medical centers, medical schools, and professional meetings, the question I most often hear is, “How can doctors take useful spiritual inventories of their patients?”
In the same way a doctor can inquire about a patient’s spiritual beliefs, a patient should feel free to ask about how a doctor’s spiritual beliefs and practices relate to his or her medical care.
A winning health care provider should be perfectly willing to let you know where he or she stands on these issues.
Furthermore, when it comes to alternative or complementary care providers, these questions can be critical, because some have been known to use their therapy to actively recruit unsuspecting patients into spiritual belief systems I think are highly unhealthy. (You can read more about this in my best-selling book: Alternative Medicine: The Christian Handbook).
Here are a few questions you could ask at your interview of the prospective health care provider—or during your first official appointment. I’m sure you could come up with some of your own to add.
I’m aware that most people probably won’t follow my suggestion to ask a provider all the following questions—especially at a first meeting. However, if your spirituality is very important to you, and if you want a provider who shares your beliefs, then each question might by useful for you to discuss with your physician at some point.
- Are you willing to consider my spiritual preferences as you care for me?
- Are you open to discussion of the religious or spiritual implications of my health care?
- Are you willing to work with my spiritual mentors (pastor, priest, rabbi, elder) and other members of my health care team (family, friends, mentor, support group) in providing me with the best possible health care?
- Are you willing to pray with me—or for me—if I feel the need for prayer?
For those who are working to inflate and balance their spiritual wheel, asking questions 1, 2, 3, and 4 is perfectly reasonable—and, I would expect, acceptable to most physicians and providers. Some might consider the following questions to be too personal and intimate to ask of a total stranger. So if you’re not there—no problem.
- What does spirituality mean to you? How much is religion (and God) a source of strength and comfort for you?
- Have you ever had an experience that convinced you that God or a higher power exists?
- How strongly religious or spiritually oriented do you consider yourself to be?
- Do you pray? If so, how frequently?
- Do you attend religious worship times? If so, how often do you generally attend?
Even if you decide that asking these questions in an interview style is not comfortable, you may want to look for opportunities to talk informally during a visit. But at least consider asking the first four questions.
Frankly discussing this can strengthen all four of your health wheels, as well as your trust relationship with your health care provider.
A number of Christian scriptures recommend meditation as a spiritual discipline:
- Psalm 77:12: I will meditate on all your works and consider all your mighty deeds.
- Psalm 119:15: meditate on your precepts and consider your ways.
- Psalm 119:27: Let me understand the teaching of your precepts; then I will meditate on your wonders.
- Psalm 19:14: May the words of my mouth and the meditation of my heart be pleasing in your sight, O LORD, my Rock and my Redeemer.
- Psalm 104:34: May my meditation be pleasing to him, as I rejoice in the LORD.
Now, comes a study showing that positive brain changes take hold after just 11 hours of practicing a form of meditation. Here are the details in a report from HealthDay News:
The study included 45 University of Oregon students who were randomly selected to be in either a study group that did integrative body-mind training (IBMT) or a control group that did relaxation training.
IBMT was adapted from traditional Chinese medicine in the 1990s.
A comparison of scans taken of the students’ brains before and after the training showed that those in the IBMT group had increased brain connectivity. The changes were strongest in connections involving the anterior cingulate, an area that plays a role in the regulation of emotions and behavior, Yi-Yuan Tang of Dalian University of Technology in China, University of Oregon psychologist Michael I. Posner, and colleagues found.
The boost in brain connectivity began after six hours of IBMT and became more apparent after 11 hours of practice, according to the report published in the Proceedings of the National Academy of Sciences.
The meditation-induced changes may be due to a reorganization of white-matter tracts or due to an increase of myelin that surrounds the brain connections, the study authors suggested.
“The importance of our finding relates to the ability to make structural changes in a brain network related to self-regulation. The pathway that has the largest change due to IBMT is one that previously was shown to relate to individual differences in the person’s ability to regulate conflict,” Posner said in a university news release.
In my book, Alternative Medicine: The Christian Handbook, I write this about meditation:
What it is:
Meditation is a word that has been so broadly applied to an array of both healthy and harmful activities that it is difficult to get consistent agreement about its impact on health.
For example, one person’s idea of meditating may be to sit quietly while encouraging his body to relax. He will inhale deeply, exhale slowly, and create a moment of restful quiet in the midst of an otherwise hectic day.
Another person’s idea is to tune out everything while daydreaming or concentrating on something that is not the primary concern of the moment.
When discussing meditation, it is crucial to make sure that everyone knows what everyone means by the term.
In general, it refers to a whole range of practices generally designed to take our minds off everyday business and stressful activities, helping us become more relaxed and reflective. Some use it to reduce or eliminate rational thoughts.
The type of meditation recommended as an alternative therapy sometimes has its origin in Eastern religions and mysticism.
Transcendental Meditation (TM) is a recent adaptation of these older concepts.
In general, the meditator wants to relax in a peaceful environment. Most sit comfortably, focusing their thoughts on something that minimizes troubling or distracting thoughts.
Some focus on their own breathing, concentrating on the movement of air in and out of their lungs. Others repeat a mantra — a sacred word or formula given by a spiritual master — or just an ordinary phrase. With practice, people can consciously relax their muscles and learn to control other bodily functions not usually under their control.
What the research shows:
Clinical studies have confirmed that meditation can provide short-term benefits in reducing stress, relieving chronic pain, and reducing blood pressure.
Studies also have shown that meditation can give some people a better sense of happiness and control of their bodies.
However, what has not been shown is whether these changes have long-term health benefits.
For example, a 2001 review found twenty-seven studies examining the impact of patients’ anxiety levels before surgery on their recovery after surgery. These studies didn’t examine the impact of any relaxation techniques, just whether anxiety was related to recovery.
Clear connections were shown between pre-surgery anxiety and post-surgery mood and pain. However, no clear associations were found between anxiety and more objective measures of recovery such as length of stay in hospital or rate of wound healing.
The field of research examining the impact of anxiety and relaxation on physical recovery and healing is relatively new, with evidence not yet available for many interesting issues.
Meditation has been documented to cause problems.
Transcendental Meditation, initially promoted by Maharishi Mahesh Yogi, was very popular in the 1960s and did much to familiarize Americans with meditation and Hinduism. But studies have found that its results are not always positive.
Almost half of those active as TM trainers reported episodes of anxiety, depression, confusion, frustration, mental and physical tension, and inexplicable outbursts of antisocial behavior.
Other studies have documented adverse effects as serious as psychiatric hospitalization and attempted suicide.
Problems can arise when meditation is viewed as a simple exercise, when in fact it has considerable power to deeply impact a person psychologically and spiritually.
The spiritual enlightenment some maintain occurs in meditation can involve contact with spirit guides.
The desire to rely more on one’s own intuition contrasts with the biblical declaration that our intuition can lead to falsehood and deception.
In many ways, humanity’s problems stem from our reliance on ourselves to know what is best. God told Moses to have the Israelites sew tassels onto the corners of their garments to remind them of this important teaching. “You will have these tassels to look at and so you will remember all the commands of the LORD, that you may obey them and not prostitute yourselves by going after the lusts of your own hearts and eyes” (Numbers 15:39; see also Deuteronomy 12:8; Judges 17:6).
Insight received during meditation is especially problematic.
Divination and visions are altered states of consciousness used to gain spiritual insight. Yet unless this insight comes from God, it only reveals the futility and deception of people’s own minds.
“Then the LORD said to me, ‘The prophets are prophesying lies in my name. I have not sent them or appointed them or spoken to them. They are prophesying to you false visions, divinations, idolatries and the delusions of their own minds’.” (Jeremiah 14:14; see also 23:16 – 17, 25 – 32).
God spoke through the prophet Ezekiel to warn the Israelites about “those who prophesy out of their own imagination” (Ezekiel 13:2).
What is learned during meditation must be evaluated, both medically and biblically.
Christians should relax and reduce unnecessary stress in their lives. “Be still, and know that I am God; I will be exalted among the nations, I will be exalted in the earth” (Psalm 46:10).
The Bible tells us to meditate: “Do not let this Book of the Law depart from your mouth; meditate on it day and night, so that you may be careful to do everything written in it. Then you will be prosperous and successful” (Joshua 1:8; see also Psalms 1:2–3; 19:14; 49:3; 104:34; 119:97, 99).
But Christian meditation is not emptying one’s mind or focusing on one’s inner self.
Rather, it is filling one’s mind with biblical truth while focusing on the Creator God of the universe.
We will gain insight when we meditate on biblical truth. But this insight is based on the revealed Word of God and should lead to a life more in conformity with his ways.
Christians should make every effort to retain control over their thought life. “We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ” (2 Corinthians 10:5).
Altered states of consciousness can open people to spiritual suggestion, making them vulnerable to demonic or other unwholesome influences. Meditation should therefore be seen as a method of promoting reasoned reflection on God and his Word.
For my book, Alternative Medicine: The Christian Handbook:
- You can order an signed copy here.
- You can see the Table of Contents here.
- You can read the First Chapter here.
I wanted you to read an excerpted from, “Belief in God Relieves Depression,” an interesting article in the The Washington Times by Jennifer Harper:
The “Big Man Upstairs” is getting accolades from mental health specialists who say they are finding that a belief in God plays a positive role in the treatment of anxiety and depression. University of Toronto psychologists reported last year that “believing in God can help block anxiety and minimize stress,” their research showcasing “distinct brain differences” between believers and nonbelievers.
In patients diagnosed with clinical depression, “belief in a concerned God can improve response to medical treatment,” said the new research, which has been published in the Journal of Clinical Psychology. The operative term here is “caring,” the researchers said.
“The study found that those with strong beliefs in a personal and concerned God were more likely to experience an improvement.”
“In our study, the positive response to medication had little to do with the feeling of hope that typically accompanies spiritual belief,” said study director Patricia Murphy, a chaplain at Rush and an assistant professor of religion, health and human values. “It was tied specifically to the belief that a Supreme Being cared,” she said.
“We found that religious people or even people who simply believe in the existence of God show significantly less brain activity in relation to their own errors,” said Michael Inzlicht, assistant psychology professor at the University of Toronto, who led the research. “They’re much less anxious and feel less stressed when they have made an error,” he said.
A fellow member of the Christian Medical and Dental Associations with me, lawyer and psychiatrist Robert Rogan, DO, JD, wrote this in response:
Faith is “the substance of things hoped for.”
Many of us can still recall what living without Christ was like – everything was up to us. Striving and uncertainty were the norm for many of us. A serious disease was terrible and overwhelming with seemingly no chance of hope.
Realizing there is Someone infinitely greater who really cares about us, even loves us, brings great assurance and relief.
Today, unfortunately, we’re taught to be an “army of one.”
As per the article the belief that a Supreme being cared for the patient made the difference in healing and recovery. We can even believe that our mistakes and failures are for a good (perhaps divine) purpose.
Have we not as physicians noticed the trend that patients with faith recover sooner and may even have ‘thinner’ charts?
Of course the researchers did not cover the actual experience of salvation through Christ and the freedom associated therewith. Also the article did not specify the actual brain responses revealed in the study.
Nevertheless, for us as Christian physicians we need to stay alert to the patient’s faith and work with that faith to develop the best treatment plan for them.
Our faith is in that same Supreme being (in most cases). But, our current politically correct environment makes our work more challenging and that is where our faith comes into play.
Let us not forget that God designed our brain’s neurochemistry too.
All I can say, is, “Amen.”
My dear friend, Al Weir, MD, is an oncologist in Memphis, TN. He has served in Africa as a missionary and served with the Christian Medical Association. He’s just written a wonderful devotional called, “Bedside Economics” It is based upon Psalm 106:3, “Blessed are they who maintain justice, who constantly do what is right.” Al’s writings alway provoke me to deep contemplation. None moreso than this one:
He was an oncologist transplanted from the Caribbean to Canada where he worked in a small British Columbia city. We sat beside each other at a medical meeting and began to discuss the economics of healthcare in both his country and mine.
In discussing a given treatment regimen, both effective and approved for use, he made the statement, “Those drugs are too expensive for the 5% of people whom thy actually save, so I don’t use them.”
In the midst of our national healthcare reform discussion we are all aware of the cost of healthcare. Healthcare costs too much for many of our patients and for our country’s economic health. Sometimes in our discussions, and even in our practice decision making, we may confuse the macro economics of patient care with the economics of caring for the individual patient who is sitting in front of us.
The cost of care in each is extremely important, but the doctor’s considerations in each are quite different. As doctors, we do have a special level of understanding of the healthcare arena and thus have a responsibility to inform the national debate regarding the expenditure of healthcare dollars. We should enter this debate publically without the bias of personal gain and seek to maximize both good for patients in general and for our nation as a whole.
However, when we face our individual patients with diagnostic and therapeutic decision making, our concerns are modified.
We, as Christian doctors, understand that we have a covenant relationship with our patients in which they offer their trust and compliance, while we offer our full dedication to their benefit, unaffected by our desire for personal gain. Actually, we have a three way covenant relationship since our Lord is partnering with us in their care, increasing our concern for the good of the patient and adding the commitment that our care should point towards Him.
This covenant relationship should lead to at least three defining questions each time we present our patients with diagnostic or therapeutic options:
- Which approach provides the greatest benefit for this patient, both toward his/her stated goals and toward my understanding of their best good?
- Which approach harms my patient least economically?
- Am I certain that my recommendations are not distorted by personal gain?
I have discovered in my own practice that when I fail to ask these questions, I will drift toward my natural desire for personal fulfillment, which may not be the best way to show God’s love for my patient.
Dr. Weir then offers this prayer, one that I prayed today:
Dear God, please let me always put the good of my patients first so that Your reflection from my life may not be distorted by the economics of their care. Amen.
This headline is likely not news to most of the readers of this blog — or likely to most people. We all seem to know intuitively that terminal diagnoses cause people to begin to think about spiritaul and eternal issues. HealthDay reports, “Addressing the spiritual needs of someone with advanced cancer could be just as important as taking care of their medical needs.” This is based upon a study appearing in the Journal of Clinical Oncology.
The study of 670 patients showed that 60 percent “said that their spiritual needs either hadn’t been met or were minimally supported,” even though patients ranked “pain control and being at peace with God” as the two most important factors “at the end of their lives.”
Patients who received “greater spiritual support from their medical team” said they had “a higher quality of life as they neared death.” Addressing the spiritual needs of someone with advanced cancer could be just as important as taking care of their medical needs, a new study suggests.
The take home for us healthcare professionals is that we all need to do a better job of taking a spiritual history on our cancer patients. In fact, the Joint Commission requires a spiritual history or assessment for all patients admitted to long-term care, home care, behavioral care, and hospital admission.
What should the assessment include? The Joint Commission says that it “should, at a minimum, determine the patient’s denomination, beliefs, and what spiritual practices are important to them.”
Why? They say, “This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed.”
The take home for the rest of us is to be sure that our family and friends who receive the diagnosis of cancer have the spiritual support upon which their health and well-being may depend.
The famous Johns Hopkins medical professor, Sir William Osler, writing in an editorial, titled “The Faith that Heals,” printed in the first edition of the British Medical Journal (BMJ 1910;1:470-2), wrote, “Nothing in life is more wonderful than faith … the one great moving force which we can neither weigh in the balance nor test in the crucible …” He wrote that faith is”… mysterious, indefinable, known only by its effects, faith pours out an unfailing stream of energy while abating neither jot nor tittle of its potence …”
Psychotherapist Arthur Kornhaber said, in a 1992 interview published in Newsweek magazine, “To exclude God from a medical consultation is a form of malpractice … spirituality is wonder, joy and shouldn’t be left in the clinical closet.”
I was the chief author of a systematic review (Annals of Behavioral Medicine 2002;24(1):69-73) that concluded, “The current evidence would encourage physicians, health-care providers and systems to learn to assess their patients’ spiritual health and to provide indicated and desired spiritual intervention. Clinicians should not, without compelling data to the contrary, deprive their patients of the spiritual support and comfort upon which their hope, health, and well being may hinge.”
Here’s the HealthDay report:
When asked what was important to them at the end of their lives, people dying of cancer ranked two factors highest: pain control and being at peace with God, the study found.
“Medicine tends to focus on the more scientific aspects of the person, and we’ve made wonderful strides in improving patient care, but there’s another important component of patient health: spirituality,” explained Dr. Tracy Anne Balboni, a radiation oncologist at the Dana-Farber Cancer Institute in Boston and the study’s lead author. “This is clearly an area where some important advancements can be made.”
The researchers discovered that people with advanced cancer were far more likely to choose hospice care when their spiritual needs had been addressed. And among those who were very religious, meeting spiritual needs increased the odds that a terminal patient would choose to forgo aggressive, yet often unsuccessful, medical treatments, the study found.
However, at least six of 10 people with advanced cancer reported that their spiritual needs were only minimally or not at all supported.
The new study involved 670 people with advanced cancer from seven treatment centers in the Northeast and Texas. The final analysis included information from 343 people who later died and whose caregivers completed a post-death interview. The average time between the start of the study and the person’s death was 116 days.
For purposes of the study, spiritual care was defined as patient-perceived support of their spiritual needs by their medical team and the receipt of pastoral care services.
Most people (60 percent) said that their spiritual needs either hadn’t been met or were minimally supported at the start of the study, and 54 percent had not received pastoral care visits. In the final week of life, 73 percent of the participants received hospice care, and 17 percent received aggressive care.
Those who had greater spiritual support from their medical team, including doctors, nurses, chaplains and more, reported a higher quality of life as they neared death than did those who felt unsupported spiritually.
People who felt they were getting better spiritual support were 3½ times more likely to receive hospice care. And among highly religious people, those whose spiritual needs were supported were five times more likely to receive hospice care and five times less likely to receive aggressive medical care, the study reported.
“We found that patients whose spiritual needs were well-supported seemed to transition to hospice more frequently and had a marked reduction in the use of aggressive care,” Balboni said.
Yet despite the findings, said Dr. Harold G. Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center, “few people are getting their spiritual needs met by the medical system.”
“Many doctors are uncomfortable discussing spirituality and haven’t been trained to do so,” he said. “And churches have a role, too. Although it’s not a popular topic, churches need to talk about the end of life in the pulpit. People don’t know theologically what they’re supposed to do.”
Religious people, Koenig said, are often left to think they should always have hope and should always “give God a chance to provide a miracle.” Hospice care, though, can often provide spiritual guidance and help people prepare for death, he said.
Doctors don’t need to actually provide spiritual care, Koenig said, but it’s important for physicians to acknowledge their patients’ spiritual needs and make sure they’re addressed by pastoral care or hospice. “The doctor does have to be the one to orchestrate this,” he said.
But if someone’s spiritual needs are not being met, Koenig and Balboni agreed that the person — or a friend or family member — needs to speak up. And if the patient’s doctor doesn’t feel qualified to discuss end-of-life spiritual issues, the doctor should be able to refer you to someone who can.
Back in 2004, while serving as Vice President of Medical Outreach at Focus on the Family, I was asked to testify before the Subcommittee on Criminal Justice, Drug Policy and Human Resources on the topic of “Faith-based Perspectives on the Provision of Community Services.” Recently someone asked me to post my comments, so here they are. You can also read them in the Congressional Record here.
Mr. Chairman, I am Walter L. Larimore. Prior to joining Focus on the Family in Colorado Springs, Colorado in February 2001 to become Vice-President of Medical Outreach, I practiced family medicine for over 20 years in small rural towns in North Carolina and Florida. In both practices, I was actively involved in teaching medical students and residents. I was also involved in medical research and writing and four adjunct clinical academic appointments at the medical schools of the University of Colorado, Duke University, the University of South Florida and the University of Florida.
In addition to my practice and research, I have been a medical journalist since 1995. Since January 2002, I have been hosting the nationally syndicated Focus on Your Family’s Health news features on radio and TV stations across the U.S.
My testimony today, as a physician, researcher, lay and professional educator, medical journalist, and author, is on the impact that positive spirituality can have on individuals and a society.
Positive spirituality, as I and my research colleagues have defined it in the medical literature, is distinctive from faith, morality, or religion in that it involves an ever-evolving, authentic, and personal relationship with God that is not bound by race, ethnicity, economics, or class. This relationship promotes the wellness and welfare of others and of self. It includes the beliefs and values by which an individual lives and results in the visible spiritual “fruit” of love, joy, peace, patience, kindness, goodness, gentleness, and self-control, referred to by the apostle Paul in his letter to some of the first Christians. Positive spirituality is positive and internalized – it changes one from the inside out. Positive spirituality is clearly outlined in the Bible and is also called true spirituality by Christian theologians.
Over the last forty years, researchers have increasingly shown that those with positive spirituality (i.e., those who internalize biblical teachings by frequently praying, applying what the Bible says to their lives, believing they have a close and personal relationship with God, and “practicing what they preach” or believe) have high levels of satisfaction in life, a sense of well-being, and overall happiness. Positive spirituality is also more likely to be associated with a wide variety of positive physical and emotional health outcomes.
The Handbook of Religion and Health, published by Oxford Press, examined the religion-health relationship by documenting more than 1,600 research studies and thirty-five medical review articles that have explored the relationship between religious or spiritual activity and emotional, social, and physical health outcomes. The vast majority of these studies demonstrated that a patient’s religious and spiritual beliefs can be clinically beneficial and have an important role in both coping with and recovering from illness.
One systematic review on this topic concluded: “…the published empirical data suggest that religious commitment plays a significantly beneficial role in (1) preventing mental and physical illness, (2) improving how people cope with mental and physical illness, and (3) facilitating recovery from illness.” The social impacts of this evidence are staggering. Just a few of the many, many positive findings include longer life, lower blood pressure, improved surgical outcomes, shorter hospital stays, improved mental health, improved overall well-being and improved coping with illness.
Positive spirituality may also postpone the development of physical disability in later life, and chronically ill people with true spirituality perceive themselves as less disabled than they really are.
Positive spirituality also results in optimism, hope, purpose, and meaning, even in the midst of negative life circumstances. These beliefs and attitudes frame a response to disease and disorder. The trust and confidence in God, with whom those with positive spirituality are in constant communication via prayer and Bible study is likely a crucial mechanism in the results discussed above. Further, for those with a positive spirituality, whether an illness gets better or not, having such a powerful ally and companion as their God, has an enormous impact on relieving loneliness and isolation and, again, assisting them in maintaining or regaining a sense of control. As long as God is with them, leading and directing them, the person with positive spirituality can rest. A person with positive spirituality can experience peace and healing, even when a cure is not forthcoming.
Relationships between mental health and strong faith, devout prayer, and religious socialization may have consequences that are far-reaching and perhaps greatly underestimated. Positive spirituality is associated with improved attendance at scheduled medical appointments, greater cooperativeness with medical treatment plans, better compliance with medical recommendations, and improved medical outcomes.
Faith-based, community-serving organizations rely greatly on volunteers that are drawn largely from churches, synagogues, and other religious institutions. Positive spirituality, as measured by frequency of church attendance and membership in church organizations, correlates strongly with voluntary service. People who attend services once a week or more are approximately twice as likely to volunteer as those who attend rarely if ever. Even one third of persons who volunteer for specifically secular service activities also relate their service ‘to the influence of a relationship based in their religion – or, a positive spirituality.
As George Gallup has observed, “Churches and other religious bodies are the major supporters of voluntary services for neighborhoods and communities. Members of a church or synagogue tend to be much more involved in charitable activity, particularly through organized groups.”
Community-serving faith-based organizations are the “army ants of civil society, daily leveraging ten times their human and financial weight in social good. They are the paramedics of urban civil society, saving lives and restoring health, answering emergencies with miracles.”
Let me close my testimony with a few suggestions for how the facilitation of faith-based organizations in health care may be beneficial to individuals and society. Although many suggestions could be offered, let me offer the subcommittee three practical suggestions for promoting positive spirituality via faith-based organizations:
1) Encourage healthcare organizations and caregivers to incorporate positive spirituality into clinical care
For the past several years, I have attempted to meet this need by teaching a Continuing Medical Education (CME) course to more than 6,000 health care providers (and, another 4000 via a small-group video curriculum). Most of the learners were primary care physicians. The course teaches caregivers how to incorporate positive spirituality into their clinical practices. These learners seem interested in the ethical and practical “how-to’s” of incorporating basic spiritual skills (“How to take a spiritual assessment”; “How and when to provide a spiritual consult or referral”; and “How and when to pray with a patient or family”) into their practices. In post-course surveys, over 97% of attendees reported satisfaction with the training and over 95% predicted that they could use one or more of these spiritual interventions in their practice. When attendees are surveyed 6 or 12 months after the course, over 90% report that they were able to incorporate and have continued to incorporate this training into their practice.
Since 1996, the Joint Commission on the Accreditation of Healthcare Organizations (JACHO) has required a spiritual assessment upon hospital admission. And, increasingly, professional organizations are calling for greater sensitivity and better training of clinicians concerning the management of religious and spiritual issues in the assessment and treatment of patients.
Promotion of such faith-based activity by healthcare givers can only improve doctor-patient relationships and the very powerful faith factor in physical and mental health.
2) Encourage education in the proper implementation of the HIPAA regulations so as to not prevent patients from receiving the positive spiritual care they desire and need
In times of personal crisis, many people want and need spiritual support. And perhaps few crises can shake one’s foundation more deeply than a confrontation with possible death from a serious illness. For as long as there have been hospitals, visiting the sick has been an important part of every pastor’s mission. Hospitals today are even required by uniformly accepted operational standards to provide chaplains. But new regulations may have messed up something that wasn’t broken.
A combination of a new, vaguely written health privacy laws and changes in Medicare rules appear to be making it needlessly more difficult for pastoral professionals to visit patients in hospitals and for hospitals to provide training for in-house chaplains.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes language originally intended to prevent electronic patient information from being sold and used for marketing. But it has tied the health care industry in knots and prompted most prudent providers to err on the side of zero access to patient data.
For many pastoral professionals, it means they can no longer stop by a hospital in search of members of their congregation without having permission or a specific list of names of people to visit. Hospitals generally try to accommodate pastoral professionals by asking patients upon admission if they would like a pastor to visit. The bottom line is that in many areas bureaucracy is getting in the way.
It has been contended that these bureaucratic snafus could be readily fixed by the federal Department of Health and Human Services with a clarification of the privacy rules and the intent of HIPPA.
3) Continue and expand clinical pastoral education (CPE)
One area of savings in the Medicare program would include the rollback or cutback in the training of hospital chaplains. A move in this direction was The Center for Medicare Services (CMS) publication of a revised ruling regarding Medicare funding of CPE centers. Effective October 1, 2003, Medicare reimbursement to hospital CPE programs was significantly altered in that only first year intern or residency CPE programs would qualify for the funding. All other program will be excluded from reimbursement. This exclusion represented a major change of policy.
Yet, we are hearing that this regulation may result in either CPE programs closing or reducing the number of chaplains trained. If this anecdotal feedback is accurate, it could negatively impact patient care. For example, a cross-sectional survey of medical-surgical inpatients and psychiatric inpatients at Rush-Presbyterian-St Luke’s Medical Center in Chicago found that 76% of medical-surgical and 88% of psychiatric inpatients had 3 or more religious needs during hospitalization. The most commonly expressed needs were: (1) A desire to speak with a chaplain or other clergy, (2) An opportunity to attend a hospital worship service, and (3) Spiritual reading materials or someone to pray with.
Let me conclude by quoting one of the most renowned physicians of the last century, William Osler of Johns Hopkins. In 1910, in the first editorial published in the British Medical Journal, Sir William Osler wrote about “the faith that heals” when he said, “Nothing in life is more wonderful than faith…the one great moving force which we can neither weigh in the balance nor test in the crucible, – mysterious, indefinable, known only by its effects, faith pours out an unfailing stream of energy while abating neither jot nor tittle of its potence.”
Positive spirituality is not only a path to wholeness – it is associated with improved physical and mental health outcomes and increased ability to cope with and recover from medical difficulties.
Positive spirituality does not happen overnight. For most of us it is a lifelong pursuit. And, positive spirituality is the foundation to the hope, health, and well being for which we all long. How could we want any less for ourselves, our families, our communities and our country?
The evidence to date tells us that it is clear that clinicians, communities, and Congress should continue to encourage positive spirituality. Health policy makers, healthcare givers, and faith-based organizations should assess the spiritual needs of people and provide indicated and desired spiritual interventions – along with other forms of indicated care and caring.
Our faith-based programs should not, without compelling data to the contrary, deprive people of the spiritual support and comfort upon which their hope, health and well being may hinge.