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.