Appropriate Faith Conversations

Vignette #2 explores proselytizing and physician to patient relationships: Actors: Physician and patient Scene: Patient sits in chair with blanket to simulate a patient in bed. The physician is making note in the patient’s chart. Patient: I am so happy that my heart attack was mild, and thank you for doing my open heart surgery so quickly. I feel like I've been given a second chance in life. I'm so grateful. Physician: God has given you that second chance. He has something in mind for you. Do you have a personal relationship with the Lord? Do you have a church home? Patient: Well, I haven’t been much of a church-goer. You know. Sometimes at Easter I’ll take the family. Maybe it would be a good thing. I’m not really not sure. Physician: Our church has a wonderful course called "Getting to know God in the New Millennium". . . I'll leave some literature for you and your family. For now let's go to God on bended knee and with a humble heart for the gratitude which we all feel at this moment. Patient: Doc, you’re gonna have to help me out of bed. I've just had open-heart surgery. The actors freeze momentarily to mark the end of the vignette. Some questions to stimulate small group discussion for the second vignette are: What did you think of this physician’s remarks? What would you do differently? Is it ever appropriate to share your faith with a patient? When is it appropriate to share your faith or beliefs? How do you do it? What are the signs and symptoms of spiritual distress? What are some good openings? Are you aware of publications about this? (Ref Prayer is good medicine by Larry Dossey as a reference.) Some questions to stimulate large group discussion for the second vignette are: What did you talk about most in your groups? What surprised you during your conversations? How will you change your practices? While the participants are fully engaged and before the dialogue is fully completed, move to dinner. The conversations will often continue informally over the meal. Resume the program after the meal. Allow about 45 minutes for dining.

Medical Futility and Relating to Patient Families

Vignette #1 deals with medical futility and the physician’s relationship to the patient’s family: Actors: Nurse, Family Member, Physician Scene: Family Member, Mrs. Crane, is seated. The nurse enters. Mrs. Crane stands, eager for news. Nurse: Mrs. Crane? Mrs. Crane nods: Yes. Nurse: Have a seat. I’ve been going over Frank’s situation with the nurse that took care of him last night. It is clear that he will need dialysis because his kidneys are still not working. Water and toxic substances are beginning to build up in his body. He had a repeat brain wave test, an EEG, late yesterday and still there is little activity. As you know Frank has not regained consciousness since his operation two weeks ago, and there has been no change overnight. The prognosis is not good. Mrs. Crane wipes her eye and tries to keep her composure: We aren’t surprised. We all talked yesterday. You know…about Frank. He really fought the good fight. We all wanted to hear something else…a miracle, I guess, but we all knew that the end was near when Frank came into hospital. Physician enters: Good morning Miss Flynn, Mrs. Crane. Nurse Flynn: Good morning Doctor. I was just updating Mrs. Crane on her husband’s condition, that his kidneys are failing and that his repeat EEG shows minimal activity. Mrs. Crane and the family understand that Frank is at the end of his life. Physician: Oh! Oh! Wait a minute. Let’s not give up just yet. There are still things we can do to try to save him. Admittedly, his life will not be like it was before, but it’s not over. We can start dialysis. We can continue to support his breathing with the respirator. He will need a tracheostomy in the next two or three days. I just wrote orders for total parenteral nutrition so that he doesn’t starve. The situation is not hopeless. Mrs. Crane: My husband didn’t want this. None of the family wants this for him. Can you just keep him comfortable? Physician: I know all of these tubes and treatments are frightening but they help him stay alive. Look, just trust me that more can be done. The actors freeze momentarily to mark the end of the vignette. Some questions to stimulate about 10 minutes of small group discussion for the first vignette are: What are the issues for the family member? What are the issues for the physician? Underlying motivation and belief about each of their decision making processes? What does the family member need? What is behind the difference in approach of the physician compared to the nurse? What did you agree with or disagree with regarding the physician’s response? Some questions to stimulate about 10 minutes of discussion by all participants about the first vignette are: What was the most important theme for your discussion group? What made it so important? Whose opinions should dominate medical decision making? Why? How should care-givers respond when there is a disparity in treatment goals? Best practices will come out of these dialogues. Writing the best practices on a flip chart keeps the ideas in front of the participants.

Have a Good Time

The segment entitled “What is Spirituality?” allows the Physician Champion to reiterate the differences between spirituality and religion. I also introduce the concept of the Spiritual Formation Field as conceived by Van Kaam. This sets the stage for understanding the following clinical vignettes as a part of the formation field. As you prepare the program, a few inquiries will turn up 3 – 4 amateur actors on the staff. The vignettes run no longer than 3 minutes and stop in mid-action with key unresolved issues. The table facilitators begin a dialogue about the issues. Because our program began with cardiovascular physicians, our whimsical acting troupe called themselves The Cabbage Patch Players. It is important to have a good time.