In my previous blog post, I argued that physicians and other practitioners have an ethical imperative to address patients’ spirituality. This raises the question of how they are to do so. It is to this topic that I will now turn.

An initial question is the nature of the practitioner’s role in addressing patients’ spiritual needs. Dr. Harold Koenig, a leading authority of the subject of spirituality and health care, states the practitioner’s role is to take a spiritual history and orchestrate resources to meet those needs.[1]

In a spiritual history, practitioners ask patients about their spirituality and their spiritual needs. Koenig writes that “taking a brief spiritual history if necessary in order to 1) understand the role that spiritual beliefs play in the patient’s coping with illness, 2) understand how spiritual beliefs may be a source of stress or distress for patients, 3) become familiar with the patient’s religious beliefs as they relate to decisions about medical care, 4) become aware of how much those medical decisions are likely to receive from the patient’s social network (which is often their faith community), and 5) identify spiritual needs that could affect the patient’s health outcomes or use of health services.” He also writes that taking a spiritual history “sends a message that this aspect of the patient’s identity is recognized and respected by the health practitioner and that the patient is valued as a whole person.” [2]

Koenig suggest the best times to take a spiritual history are “1) when taking the medical history during a new patient evaluation, 2) when taking the medical history while admitting a patient to the hospital, nursing home, hospice, or palliative care setting, 3) when doing a health maintenance visit as part of a well-person evaluation, and 4) whenever the medical situation calls for it.”[3]

In clinical situations that are rushed, Koenig suggest the following question: “Do you have any spiritual needs or concerns related to your health?” This acknowledges to the patient that this is an area that the heath practitioner is concerned about and opens the door to future conversations.[4] Christina Puchalski has developed an instrument called FICA to facilitate taking a more in-depth spiritual history.[5] F stand for faith and belief.This includes questions such as, “Do you consider yourself spiritual? What gives your life meaning? Do you have spiritual beliefs that help you cope with stress?” I stands for importance of the person’s spirituality. This can be assessed this by asking questions such as”What importance does your spirituality or your beliefs have in our life? Have your beliefs influenced how you take care of yourself in this illness? C stands for the patient’s community support. To assess this, practitioners can ask: “Are you part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you?” A stands for how practitioners can address the patient’s spirituality.Puchalski recommends a question such as “How would you like me, your healthcare provider, to address these spirituality issues in your healthcare?”

After taking a spiritual history, a clinician’s second role can be to orchestrate spiritual resources for the patient.   This includes, most importantly, referring patients to spiritual care professionals such as chaplains and clergy. In addition, based on the patient’s wishes, practitioners can work with spiritual professionals to provide helpful spiritual support such as inspiring music and reading, meditation, and support groups

When taking a spiritual history, it is important that practitioners know their limits and be clear about certain boundaries. First, they must respect patients’ privacy. If they don’t want to talk about their spirituality, practitioners need to honor that. Secondly, practitioners must be vigilant about not imposing their beliefs on patients since doing so would be abusing their authority in an especially vulnerable time in patients’ lives. Finally, a spiritual history is not the same as an in-depth spiritual assessment. For intensive spiritual counseling and spiritual crisis, practitioners should refer patients to chaplains who have skills and training in this realm.

[1] Koenig, Harold. (2013) Spirituality in Patient Care: Why, How, When, and What. Templeton Press

[2] Koenig, Harold. (2013) Spirituality in Patient Care: Why, How, When, and What. , Templeton Press

[3] Koenig, Harold. (2013) Spirituality in Patient Care: Why, How, When, and What. , Templeton Press

[4] Koenig, Harold. (2013) Spirituality in Patient Care: Why, How, When, and What. , Templeton Press

[5] Puchalski, C. Taking a Spiritual History Allows Clinicians to Understand Patients More Fully. Journal of Palliative Medicine 3 (2000): 129-37