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