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Personal and Spiritual Assessment
Dan Fountain, MD, MPH
The importance of this In medicine, the physical history and review
of symptoms reveal the pathophysiology The personal history reveals personal
issues in the life of the person We take a Spiritual history to understand
our patient’s spiritual pathophysiology Do they believe their life is “making it?” Can they acknowledge it if they are not? What is their relationship with God?
An essential part of the history
Personal life issues affect health They influence recovery from illness We must find out about them We must ask key questions We must listen to the answers We must process the answers –
verbal and non-verbal – to discern the real problems
A routine part of the social history
Do you smoke, drink? How much? Are you married? How long? Happily? What kind of work do you do? Any church or religious preference? These are non-threatening questions They are often on the computer intake
form Look or listen for clues about problems
General questions How are things going in your life? At Work? At School? At Home? How are you coping with this illness? To whom can you go for help in time of
need? (support systems)
Relationships
Are you having any trouble with your children?
Spouse? Or parents? Co-worker? Or Boss? Friends? Or other persons? With someone of the opposite gender? Are you really angry at someone?
Levels of Stress What is your stress level? Do you feel stressed out? From what? Do you feel anxious about anything? Are you having difficulty concentrating? How are you sleeping? How is your appetite? Any problems with finances or employment?
Recent loss
Have you recently lost a spouse, child, or close friend or relative?
Are you going through a separation of a divorce?
Have you lost your job, or feel you might do so?
Have you just retired? How is that going?
For a young person How are things going in school? Where are you heading in life? What would you like to be? Do you feel like you are not getting
what you desire out of life? Have you thought about who you
really are? If you should die, who would miss
you?
Identify Patient’s Issues LISTEN to what our patients are saying
Fear, anxiety, gloom Anger, resentment, bitterness Guilt, shame, denial, self hatred, lonely Addictive behaviors, sabotaging self Self pity, hopelessness, passivity, loss of
creativity These are important personal issues Helping a person cope with them is part of
spiritual care
When a significant issue arises Perhaps you can handle it quickly
within your time constraints You may want to refer the person to
the spiritual caregiver on the team It may require professional counseling
help Or you may give the person some
“homework” (reflection) to do and then return for another visit
Make a record of findings and care
An abbreviated note about personal problems that will pass inspection but will help you recall the problem(s)
A similar note about your recommendations
On subsequent visits ask, “You mentioned… could you expound on that…?
Objections may arise
“Why are you asking me all these personal questions?”
“Do you think my problem is all in my head?”
A careful explanation of what medical science now knows about the affect and physiology can help
Proverbs 14 : 30 may help
A helpful response
These questions are so that I can understand you better and know how best to guide the treatment.
How we think and feel does affect the functioning of our heart and all of our organs and systems
Taking a spiritual history
First establish a level of trust Proceed gently and go only as far as
the person wishes us to go Faith is of benefit to health and to
recovery from illness But imposition of our beliefs is
unethical and must be avoided Proselytism is not permissible
Opening questions
Tell me about your faith Do you attend church? – temple,
synagogue, etc. Do you find that helpful? Does your faith help you cope with life
and with this illness? Where do you feel God is in this? Has you found help from him?
Church affiliation
Discussion of denominations is to be avoided
Find out if the church, or temple, provides support and help
A personal relationship with Christ
This is of positive benefit to health Sense of meaning, purpose, and destiny Peace of mind Joy in living
It is ethical to ask about this, but not to “push the issue”
Avoid “churchy” terminology
Explaining a personal relationship with Christ
God has created us for a relationship with him
Many of us prefer to “go it alone” We resist knowing God and following
him He came to earth as Jesus, lived
among us so that we could better understand God, and made it possible for us to live with God
Living with God now
We acknowledge our wrong-doing and our need for his help
We invite him to live within our spirit and show us how to live
Daily communication with him Trust in his goodness and power to
help us
Guiding Principles
Proselytism must be avoided If the person is not interested or is
resistant to the Christian Faith, keep an open caring relationship, but do not push Christianity
Interest may develop later The word ‘sin’ may be offensive If so, talk about ‘regrets’
Discussion of Faith should only come after
A relationship of openness and honesty has been established
The sick person has described the illness or problem for which they are there
We have demonstrated an interest in them
If appropriate, share your own spiitual story
Your story is yours. It is not an argument or an effort to persuade
Usually somewhere along the line there is an identification
It makes you more real to the one with whom you are speaking
“Would you like to hear how God has helped me?”
Making A Spiritual Diagnosis From your conversations, certain spiritual
needs emerge What is the sick person’s self image? Does she have joy, peace, and hope? How is he coping with the consequences of the
illness? Where does she find help in time of need? Does he have a relationship with the Lord? Once you identify a spiritual need, confer with
your consultant, the Holy Spirit, and follow His lead
Be Careful…
Do not ask too many questions at once
This is not an inquisition The goal is healing Ask only those questions that move
toward this goal
As Christian Care Givers…
We need to confront their spiritual health as well as their physical health
Explain if asked why we are bringing “that” up, that you care about them, and recognize it impacts their health
Confronting We tell patients truths, because they need to hear them We earn the right to confront when the patient knows
they are loved, accepted, valued and understood As clinicians we have the moral obligation to identify
destructive factors in patient’s lives Are there other things going on in your life that
may be contributing to your problem? I’m really concerned that unless you deal with…
it may impact your overall health These may be physical, emotional, or spiritual issues
Church attendance
Attending a good church is beneficial Encourage regular attendance Learn about the churches in your area Many people do not attend church so
may not be comfortable at first In this case, offer to take them to your
church for the first time to introduce them to “church culture”
The Gospel
The power of God for salvation of all who believe
Salvation (Yeshua) includes health and wholeness
Remember :
Spiritual care has a solid base of evidence
It must be patient directed It can bring new life It can bring healing of heart, soul, and
spirit and, in many cases, of the body