Spiritual care doesn’t always go the way you expect it to. I had a middle-aged patient the other day who came in for anxiety.
She was actually my partner’s patient but was unable to see him that day. She received the standard of care. I went through her medications and increased her Zoloft. We talked of the benefits of seeing a counselor. She had good social support.
Finally, I also tried to get into the spiritual aspect. In my patient interactions, I identify those who would be open to spiritual care. Sometimes patients can give you hints. For this patient I noticed that she wore a cross around her neck. I asked if she was a praying person and she nodded her head. I talked about how simple prayers could help with her anxiety. Next I asked if she ever read the Bible and she replied yes. As I began to discuss how Scripture can relieve anxiety, she suddenly blew up, Look I’m not just a stressed mother. I actually have anxiety. Look at this! She pulled up her pant leg to reveal dozens of scabs covering her entire leg. Apparently she had been scratching to bring herself some relief. She continued in her frustration: I just need a doctor to actually listen to me. I’ve been suffering this anxiety. And no one is listening to me.
Her outburst caught me off guard. Suddenly I was unsure of myself. What did I say to offend her? Was I pushing my religion?
In an attempt to diffuse the situation I looked her in the eye and said, I’m sorry to hear about all you’re going through.
I just need a doctor who is going to listen to me, she again reiterated.
I sat there waiting for her to tell me more. She said nothing. I gently prodded her, I’m ready to listen.
She responded, I just need a doctor to listen to me. I need a medication that works.
A moment of silence passed.
I’m sorry, she said.
That’s okay, I said. I see that you’re frustrated and you’re just expressing yourself.
The tension eased a bit.
Here’s what I’ve learned this experience.
The first is that not everyone is ready for spiritual care. They come to the doctor with certain expectations. For many, even if they are Christian as this lady was, they may not be ready to go there. It’s not always easy to tell.
The second lesson is that spiritual care without quality care is a hollow promise. The patient was getting appropriate quality care. Her anxiety was not under control so her depression/anxiety medications were titrated up. But for whatever reason, the perception of this patient was that I was not taking her complaints seriously – at least not initially. Quality of care or in this case the perception of quality of care is a requisite to doing good spiritual care.
Lastly, spiritual care is intensely personal. When we get into the very private areas of a person’s life it can be akin to walking into a minefield. We can inadvertently trigger an emotion that we may not be ready for. And it can get intense.
But it’s still the right thing to do.
If this patient only received medications for her anxiety, she would come up short of the best care possible. She needed other modalities of treatment such as the social support, emotional support and even spiritual support. She needed to personally develop tools that would help her deal with the anxiety. And addressing all these areas isn’t always easy.
How have you dealt with difficult encounters? Leave me a comment.