1. Richard D. Kiovsky, M.D. Professor of Clinical Family Medicine Indiana University School of Medicine

2. 1. My Desire – Your Desire 2. Biblical Call to Integrate Faith into Patient Care 3. Understand the Terms 4. Health Benefits of Faith 5. Professional Standards 6. Patient’s Stories 7. Discussion and Q & A

3. The Genesis Factor: 1. Image of God 2. Loss of Spiritual Connectedness Christ’s Great Commission: Matt. 28:19-20 1. Participate in Evangelism 2. Prepare People for Wholistic Christian Living 3. Equip Believers to Live in a Fallen World Your Work Matters to God (Doug Sherman) 1. To the Praise of His Glory

4. “A religion of some kind is as essential to the mind of man as air is to respiration.” Benjamin Rush (1745 – 1813) “Father of American Psychiatry”

5. Definition: “A pattern of beliefs, values, and practices that an individual has towards God or a higher power according to a set of institutional or congregational codes or traditions”

6. Definition: “A personal search for meaning and purpose that includes ones values, transcendence, connectedness, and practices that give meaning to life. It may or may not be related to religion or a supernatural force.”

7.  Some may consider themselves both spiritual and religious; others may identify themselves as spiritual, but not religious. Still others say they are religious, but not spiritual.  Doing good works, being loving toward others, harmony with nature  Seeing beauty everywhere and in everyone  A relationship with God  Many people have different meanings - explore Fox Chase Cancer Center 2007

8.  86% believe in God (Gallup, 2013) (95% Gallup, 1985)  64% among Health Professionals (Gallup, 1995) ◦ Psychiatrists – 40% ◦ Surgeons – 60% ◦ Primary Care Physicians – 76%  94% of inpatients regard their spiritual health and their physical health as equally as important (King, 2000)  93% of patients with cancer stated that religion helped sustain their hopes (Roberts, 1997)  59% say religions plays a very important role in their lives ◦ 33% Great Britain ◦ 21% Germany ◦ 12% Japan  57% pray at least once a day

9. David Larson’s Findings: 1. 60 – 80% Positive Correlation between better health and spiritual commitment 2. Three-fold Benefit:  Aiding Prevention  Speeding Recovery  Fosters Calmness in the face of ill health 3. Subsequent Studies:  Less Mental Illness  Decreased Cardiovascular Disease

10.  Marital Stability  Happiness in Marriage  Greater Sexual Satisfaction  Vaccination Against Divorce Time Survey, Sex in Marriage, 2003

11.  Death by Cardiovascular Disease was Double  Death by Strokes was Double  Every Type of Terminal Cancer is Increased  Suicide was 4x’s Higher in White Men  10 x’s the Rate of Psychiatric Care  A Costly Legacy for Children and Ex-Spouse

12.  Prospective cohort of 1014 males matriculating between 1948 and 1964 at John Hopkins Medical School  Subjects completed one questionnaire in medical school and another in 1986  13% of cohort met criteria for alcohol abuse  The strongest single predictor during medical school of subsequent alcoholism was a lack of religious affiliation Moore, Am J. Med 1990;88:332-6

13.  Patient’s understanding of their illness  Patient decisions regarding health care  How patients cope with illness  Their adherence to treatment plans  Relationship to their doctors and other members of the health care team All these factors can potentially impact the care patients receive and the outcome of health care interventions. Puchalski 2007

14.  70% US Medical Schools address in curriculum  Joint Commission: Hospitalized patients if request  Quality Palliative Care: spiritual, religious and existential aspects were essential domains (2004)  End of Life Consensus Panel (1999)  Codes of ethics of most health care professions either directly or indirectly address the importance of the spiritual dimension in the care of patients (Puchalski, 2006)

15. Findings concerning the importance of religious beliefs in the clinical process have led researchers to comment that primary care providers: “who would heal cannot choose whether (or not) to confront religious variables in practice; they are operating whether recognized or not” Foglio & Brody, 1988; J. of Fam Pr 27:473

16.  Opens the door for future discussions on matters of spiritual importance  For terminally ill patients, the spiritual history is regarded as a crucial component of palliative medicine  A spiritual history is not necessary for every clinical encounter  Surveys indicate most patients would welcome such spiritual inquires  May determine if a patient is open to faith- based interventions

17. So HCP can:  Understand how beliefs influence how you cope with sickness87%  Understand “what makes you tick”85%  Understand how you make decisions83%  Encourage and provide realistic hope67%  Give advice on taking care of self66%  Can effectively guide/change treatment62%

18.  Critically ill with possibility of dying94%  Suffering from a long-term, ongoing serious illness91%  Just diagnosed with serious illness90%  Loss of loved one87%  Recovering from a serious illness83%  During medical history on initial visit with healthcare professional60%  Office visit for a minor medical problem22% McCord 2004

19. AUTONOMY:  Requires that physicians respect the decisions of competent patients, which are often based on religious and spiritual beliefs  Physicians need not ignore or avoid spiritual issues raised by patients Post, SG. Ann Intern Med. 2000;132:578-583

20. BENEFICENCE:  The physician’s duty is not to judge a patient’s private attitudes and spiritual behaviors, but to understand their clinical importance  Physicians should inquire about and support a patient’s spiritual beliefs and needs, to avoid this may be a form of negligence. Post, SG. Ann Intern Med. 2000;132:578-583

21. NONMALFICENCE (“do no harm”)  Requires that physicians not proselytize  Physicians not prescribe for patients to engage in religious activities  Religious and spiritual practices should not replace effective allopathic treatments Post, SG. Ann Intern Med. 2000;132:578-583

22. “Among all my patients in the second half of my life … there has not been one whose problem in the last resort was not that of finding a religious outlook on life. It is safe to say that every one of them fell ill because he had lost that which the living religions of every age have given their followers and none of them has been really healed who did not regain his religious outlook.” Carl G. Jung, 1932

23.  “Why is my life such a mess? I’m not going to take my insulin!”  “Dr. Kiovsky, I’m not making this decision – you are!”  “Maybe you ought to give God a chance?”  The Power of Prayer – case examples

24.  Don’t be a bystander to the Christian Faith  Pray continually  Take your direction from God’s Word and the quiet leading of the Holy Spirit  Let’s love people into the Kingdom of God DO IT !

25. Richard D. Kiovsky, M.D., FAAFP Professor of Clinical Family Medicine Director, Indiana Area Health Education Centers Director, Medical Student Education (DFM) rkiovsky@iupui.edu 317-278-0310