Vignettes & Dialogue

The program was originally entitled “Spirituality and Disease Management”, but “Bedside Spirituality” describes it better. Participants scrutinize critical physician relationships in the hospital, namely the relationships with patients, patient’s families, other health workers, and other physicians. They explore spiritually depleting physician behaviors, namely proselytizing, addictions, staff abuse, and the use of medically futile treatment. Staff members act out short vignettes. Then questions and dialogue bring out stories that teach the best behaviors. Physicians, like most people, tend to modify their behavior toward the group norm. Since physicians rarely have conversations like this, they are not clear on the group norm or even what one or two other physicians are doing. These conversations accomplish much. A seasoned facilitator is a must.

Spirituality and Disease Management

Several members of our mission team noted that a didactic approach often closes the door to spiritual conversation and limits the development of excellent practices. In response selected members of our hospital staff developed a day-long retreat for nursing teams that included ample time for reflection and storytelling. The architects of the program comprised about 15 people including nurses, chaplains, physicians, managers and human resources specialists. Realizing that physicians will act more readily on truths that they discover themselves and on truths that are endorsed by physician colleagues whom they trust, we deleted much of the didactic material from the nurse program; we shortened the retreat by half to make it accessible for physicians. Attendance was best when we held the program between 4:30 p.m. – 8:45 p.m. and included dinner. A safe environment is needed for the dialogue. While cerebral physicians usually talk at the “head” level, this dialogue effectively encourages physician conversations at the “heart” level. Storytelling nearly always brings best practices to the surface.

Bedside Spirituality

What happens at the patient’s bedside is the focus of hospital medicine. Nurses and physicians dominate those events and come with diverse attitudes about what spiritual expressions are appropriate. Most expressions are well-intended. Some will be incompatible with the institution’s mission or style. In no other area can the challenge of modifying physician behavior be greater. How does one foster best practices?

Orientation Overview

The physician champion does not require detailed knowledge of formative theory, but through it the direction of the orientation may be clearer. It starts in appraisal and moves toward spiritual direction. Another way of thinking about this orientation program is that is promotes a confluence of three spiritualities, the physician’s, the patient’s and the hospital’s, where the hospital’s spirituality is expressed in its mission. It is a reminder of why we are here. It is a reminder we need often.

Formative Analysis

This orientation is spiritually formative. Each segment is designed to provide a formative event. Over the course of the orientation the participants can engage in a number of spiritual practices. Each spiritual practice is only briefly experienced but has a rich tradition to explore. The following chart gives an overview with the formative elements that dominate each segment: Formation/Learning Formative Spiritual Segment Objective Event Practice 1 Gather & Breakfast Field Appraisal Conference 2 Hospital History Information Reflection, Reading 3 Meaning of Spirituality Information Journaling, Conference 4 Examining Purpose Resistance Centering, Appraisal Journaling 5 Spirituality Disposition Listening in Health Care Appraisal 6 Personal Care Spiritualizing Reflection Disposition 7 Opportunities Spiritual Spiritual Direction Direction The formative events refer to descriptions in Van Kaam’s formation theory

Providing Mission Opportunities

A third opportunity to offer new physicians is the Physicians Outreach Network. The network is a large group of physicians who work in charity clinics, provide relief services and travel on mission trips. They meet periodically and provide information about mission opportunities. For more details on Physician Outreach Network visit PhysicianFormation.com New physicians would be able to join one of the projects. Physicians might wonder how to fit that in to their schedules or think that family obligations will prevent participation. The participating physicians have successfully dealt with all of those issues, too.

Coaching Doc 2 Doc

The message I like to give physicians during orientation includes a pitch for coaching: When you are in transition it is valuable to have another physician coach you. We have a group of physicians who have been specially trained to provide this service for you. While coaches can be very expensive, these physicians care so much about their colleagues that they donate their time and expertise. We call this program Doc 2 Doc. It is voluntary. If you are interested we would interview briefly to help find you the right coach. You would meet with your coach for an hour every two weeks for about three months. Many new physicians believe that they must work with someone in their own specialty, but it is better to be paired with someone outside your specialty. Many new physicians believe that their new partners will adequately coach them. However, few physicians are trained to coach new physicians, and although partners can be helpful, new physicians may need help with partner relationships.