Monday, October 3, 2022

Does spirituality matter in medicine?

Most Botswana journalists are in agreement that the late darling of the airwaves Thuso Letlhoma went out with a bang. The Radio Botswana news presenter and disc jockey managed a last hurrah that left the nation embroiled in a passionate shouting match.

Weeks before meeting his maker,  Letlhoma found himself bound to a Princess Marina Hospital bed, flirting with death,far from his console at Radio Botswana where he spent a career spanning decades, spinning discs to entertain a legion of secular music enthusiasts.

His illness required that his leg be amputated and thus a blood transfusion be performed. Thuzosky a follower of the Jehovah’s Witness rejected a blood transfusion and stands firmly in his decision.

This Christocentric logic made great sense to Thuzosky, even if it made little sense to his army of fans and colleagues in the media industry. He faced crucifixion  for living out his conscience.

A few weeks before his death the Botswana Media and Allied Workers Union (BOMAWU) organised a demonstration to force Thuzosky to consent to a blood transfusion – a hot-button issue that divided the local media.

Behind the scenes, the medical fraternity is believed to have been caught in the whirlwind. Many years later, there is still that niggling questions that  vexes Botswana like a pebble in the shoe  – Does spirituality matter in medicine?

Clinical psychologist in Gaborone, Dr Sophie Moagi says, “Healthcare providers must remain mindful, respectful and empathetic of a patient’s cultural or spiritual needs. A number of individuals are calmed and comforted when they turn to their faith during major healthcare trials. Due to a vast number of patients turning to their beliefs and faith during hard times, it is vital for healthcare professionals to be empathetic and do what they can to accommodate a patient’s needs to be sure that they receive the best possible care. It is important that providers offer the opportunity for patients to discuss their cultural and religious beliefs, so that treatments can be adjusted if needed. Spirituality or religion can be incorporated into healthcare as long as healthcare providers open the channels of communication with their patients. Listening to their beliefs and views on their faith along with how those beliefs are tied into their health can build trust between physician and patient. Being vigilant regarding spiritual/religious beliefs and practices can lead to earlier patient release dates, fewer medical errors and stronger communication between patient and provider.”

Many patients want their spirituality to be taken into account when they receive medical care. However, many clinicians lack training in spiritual care.

Religion and spirituality are vital factors in many people’s lives, regardless of their individual culture or beliefs. Many identify themselves as religious while others describe themselves as spiritual. Yet, it is found often times within the medical field, that religious beliefs are not always taken into account. A factor behind the medical field seeming to have a disconnect is due to the fact that many healthcare providers have been trained during their education and medical practice to look at things from the mindset of a scientist. Spirituality and medicine have a long, intertwined, history. The very emergence of hospitals arose in part out of the hospitality and care provided by monasteries. Many hospitals have since been founded by religious institutions, and much of medical care throughout the world is still provided by religious hospitals and medical mission efforts. Religious, spiritual life and community provide an important health resource for many people hence why many people’s medical decisions are shaped by their spiritual and religious beliefs. Yet, there has been an increasing division between medicine and spirituality. Certain aspects of medical care have focused more on technology and on disease, than on the person. In many clinical settings, spiritual care is provided very infrequently, even in end-of-life contexts. Physicians now spend more than half their time on tasks that aren’t face-to-face with patients. Even during in-person consultations, a 2020 study said, a large proportion of physician time is devoted to using electronic health records. Religion and spiritual beliefs play an important role for many patients. When illness threatens the health, and possibly the life of an individual, that person is likely to come to the physician with both physical symptoms and spiritual issues in mind. Some physicians find a number of reasons to avoid discussions revolving around the spiritual beliefs, needs and interests of their patients. Reasons for not opening this subject include the scarcity of time in office visits, lack of familiarity with the subject matter of spirituality, or the lack of knowledge and experience with the varieties of religious expressions in our pluralistic culture. Many admit to having had no training in managing such discussions. Others are wary of violating ethical and professional boundaries by appearing to impose their views on patients. Nonreligious physicians have expressed anxiety that a religious patient may ask them to pray. In such instances, one could invite the patient to speak the prayer while the physician joins in reverent silence.

Senior Social Work lecturer at the University of Botswana, Dr Poloko Ntshwarang says, “Religion and spirituality influence people’s understanding of the world, their emotions and psychology, and even how they treat their bodies. Despite this, many medical professionals do not discuss religious beliefs with their patients. Some think religious matters are outside their area of expertise, while others worry about saying the wrong thing or causing a disagreement. But these reasons stem from the same source: Physicians are generally uncomfortable with speaking to patients about religion. “Patient spirituality continues to be an area that clinicians do not discuss as often as they should. Connecting with patients who turn to their religious beliefs during challenging times can help reduce their anxieties about medical care. It can also enable clinicians to recognize the spiritual or religious motivations behind certain behaviors.”

Indeed, in times of illness, questions of life and death may loom all the more strongly in a patient’s consciousness. This is particularly true in obstetrics and gynecology, which deals with bringing people into the world and with terminating pregnancies; in palliative care and intensive care, which are largely concerned with people’s exits from the world; and in psychiatry, which seeks to help people who are no longer relating to the world in a way that is perceived as functional.

In primary care, too, a doctor must be aware of the patient’s spirituality, since the patient’s perceived needs will often be very different from the presenting problem. Indeed, recognizing a patient’s spiritual concerns may be viewed as an essential part of the ‘patient-centered’ medicine increasingly seen as crucial to high-quality patient care. A large issue with the current divide between medicine and religion is that some individuals’ turn to their religious beliefs to assist them in making medical decisions.

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