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Spirituality and the practice of orthopedic surgery: The links between faith and health
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Introduction
Engaging and connecting with patients requires respect of the whole person – their culture, ethnicity and beliefs. I asked John J McGraw, MD, a thought leader in this realm, to offer his opinions on the importance of embracing patients’ spirituality as a means of being a more complete caregiver and surgeon.
— John D. Kelly IV, MD
Editor, Your Practice/Your Life
The boardroom was packed; not an empty chair. Every partner and member of the senior management/leadership of our large orthopedic group had given up a Saturday to discuss pressing matters of our practice. A highly talented and sought-after medical consultant stepped to the lectern with his PowerPoint presentation in the background.
“For the next several hours, I want you to forget everything except that you are business people,” he said. Something down deep within me bristled: My inner being challenged. Being an orthopedic surgeon/physician is not about being a businessperson. It is a calling and at the very foundation, a sacred relationship between physician and patient.
Suppressing my instincts, I knew that what he was saying was unfortunately necessary. Recent health care legislation is changing the playing field for all us who continue to practice medicine. And although financial/business change is rapid and inevitable in the way we structure and manage our practices, one thing remains constant — nothing should ever overshadow the patient-physician relationship. That bond of trust and advocacy is first and foremost for those who place their confidence not only in our skills and abilities, but also in helping our patients to make the decisions which are in their best interest. The goals of financial solvency, evidence-based medicine, etc. must always have our patients’ best interest as a foundation.
‘Holon’
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In the Western world we tend to follow ancient Greek thought that human beings are separated into three distinct parts: the mind, body and spirit. However, a concept best described by the Greek word “holon” — something that can be both a whole and a part — may be more accurate. People cannot be neatly separated into compartments. As orthopedic surgeons, we would never deny the affect of the mental on the physical. Psychological aspects of musculoskeletal diseases and injuries, as well as various orthopedic procedures, are well documented.
Failure to address spirituality in our practices may be more damaging than we realize. Increasingly, new technologies have caused us to offer them to patients as “ultimate cures.” In some cases, this causes patients to feel alienated from their physicians/surgeons, as noted by Daniel Sulmasy in A Balm for Gilead: Meditations on Spirituality and the Healing Arts. This can lead a patient to feel dehumanized and even depressed.
This singular reliance on technology may even have a harmful effect on orthopedic surgeons. We can become “biomechanical technicians.” Take, for instance, my subspecialty of adult reconstruction. Decreasing revenues for total joint replacement surgery tends to move us more toward surgical assembly lines with much of the patient or family contact accomplished by mid-level providers. No doubt, this phenomenon has given rise to boutique orthopedic clinics which are not only preferred by patients and their families, but also by orthopedic surgeons who enjoy opportunity to become familiar with the patient instead of just another arthritic knee.
Faith and health
In the early days of modern medicine, physicians readily realized that our practice is a sacred one. The giants of modern medicine frequently acknowledged God’s activity in the healing process. The latter half of the 20th century saw a decreased emphasis on the role of the Divine as we went about our vocation. However, in recent years, most specialties of medicine have scientifically established firm links between faith and health. Many medical schools currently offer courses on this topic. Spiritual history of the patient can become an important factor in our ultimate treatment. Orthopedics as a specialty, however, has been slow to explore this connection.
Why is it that we have been reluctant to address the issue of spirituality as a profession? In some cases, could it be that our unwillingness to engage our patients is a symptom of our discomfort with our own faith? After all, achieving the goal of becoming a full-fledged member of our profession leaves little time for other pursuits, especially when it comes to the abstract ideas of spirituality and faith. By our very nature, we chose this specialty and are even more so molded during training, to concentrate on the concrete. We rely on radiological studies which clearly demonstrate pathology, or the lack thereof. We’ve been kidded by our medical colleagues for having the “best toys” as the tools of our trade. The equipment with which we practice our skills is tangible, finely tuned to make our hands perform precisely. Fixing broken or diseased bone and other tissues is what we do best. By our very nature, dealing with things in the abstract like spirituality, are simply outside of our comfort zone.
Finding comfort
Before we can effectively relate to the spirituality of our patients, we must be comfortable with our own faith. Some physicians find that spirituality raises new possibilities in one’s personal life during the course of medical education. Francis Collins, author of The Language of God, found insight from a questioning patient during his junior year of medical school. This encounter was the impetus for his formation of personal faith which has been foundational in his accomplishments as lead researcher of the human genome project and now as director of the National Institute of Health.
Let me interject one caveat. I am, in no way, suggesting that an orthopedic practice should be a platform for evangelism unless stated openly at the outset that it is a missionary effort. Proselytizing one’s own unsolicited personal spiritual views onto our patients is no more appropriate than making sexual advances. However, one need not hide his or her personal beliefs from patients at all costs. The orthopedic surgeon must always be mindful of the sacred patient-physician relationship which must never be abused for personal gain.
Patient disconnect
A recent emphasis by the American Academy of Orthopaedic Surgeons (AAOS) has been placed on helping us to more effectively communicate with our patients. The public has always recognized our surgical skills in regard to the musculoskeletal system, however, there remains a disconnect of sorts with our patients even though there is a trend to improvement in the patient/physician relationship. Surveys of medical practices continue to show that a majority of patients appreciate discussions of faith with their physicians. Not only can understanding our patients’ spirituality help us in areas of communication, but appreciating their religious practices may aid significantly in areas of diagnosis and treatment. As we practice in an ever-expanding multicultural community, various religious practices and spiritual views must be understood and respected as we seek to meet the orthopedic needs of our patients.
The AAOS is an organization that rightfully prides itself in the celebration of diversity. This has been largely along lines of ethnicity, gender and race. However, respect for diversity in faith and spirituality is equally important. Not addressing this aspect of our patients, or maybe our own inward faith, can be as devastating to our practice as ignoring Wolf’s Law in fracture treatment or sterile technique in the operating room. Let’s resolve to explore and utilize the resources available in the area of spirituality of our patients so that our profession can be holon for their good.
References:
- Collins, Francis S. The Language of God. New York: Free Press, 2006.
- Sulmasy, Daniel P. A Balm for Gilead: Meditations on Spirituality and the Healing Arts. Washington, D.C.: Georgetown University Press, 2006.
- John D. Kelly IV, MD, is the editor of Your Practice/Your Life. He can be reached at University of Pennsylvania, Dept. of Sports Medicine, 235 S. 33rd St., Philadelphia, PA 19104-6322; 215-615-4400; e-mail: johndkellyiv@aol.com.
- John J. McGraw, MD, can be reached at The Knoxville Orthopedic Clinic, 120 Hospital Drive, Suite 120, Jefferson City, TN 37760; 865-475-4484; e-mail: jjmcgrawmd@yahoo.com.
