Roshi Joan Halifax, right, with Deborah Marin, MD, Director, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai; and the Reverend David Fleenor, STM, BCC, Director of Education, Center for Spirituality and Health.
Show compassion for patients, for co-workers, and most important, for yourself. That was the central message of the recent Spiritual Health Symposium, sponsored by the Mount Sinai Center for Spirituality and Health and the Department of Nursing. About 125 faculty, staff, and students attended the event in Goldwurm Auditorium, receiving a detailed road map to cultivating compassion in the practice of health care.
A keynote speaker of the event was Roshi Joan Halifax, PhD, founder of the Upaya Institute and Zen Center in Santa Fe, New Mexico. Roshi Halifax— whose title means she is the spiritual leader of a community of Buddhist monks—consults with health systems around the world on compassionate care, but she began her life as a “good Christian girl” in Savannah, Georgia. Her grandmother was a trusted figure in the community who cared for sick neighbors and helped prepare the dead for burial. Roshi Halifax said that listening to her grandmother’s stories taught her three things: that death is normal, that death is a mystery, and that caring for people who are profoundly ill “is sacred work.”
Instructing Medical Students on the Spiritual Side of Patient Care
Many patients would like physicians to ask about their religious and spiritual beliefs, but most physicians do not feel comfortable doing that. To address this gap, the Icahn School of Medicine at Mount Sinai has developed an innovative curriculum described in a recent paper, “Teaching Third-Year Medical Students to Address Patients’ Spiritual Needs in the Surgery/Anesthesiology Clerkship,” in MedEdPortal, The Journal of Teaching and Learning Resources.
“We want physicians, who are the leads of most teams in health care, to pay attention to patients’ religious and spiritual needs in the context of their larger cultural needs,“ says the Reverend David Fleenor, STM, BCC, an author of the paper and Director of Education, Center for Spirituality and Health. Most medical schools provide some spiritual education, but the Icahn School of Medicine is unique in tying it to the clerkship in surgery. Rev. Fleenor teaches the session with a transplant surgeon, Susan Lerner, MD, Associate Professor of Surgery, and Medical Education.
Third-year students participate in a one hour session, learning how to describe the role of a chaplain, how and when to contact one, and how to take a patient’s spiritual history along with the general medical history. Of the 165 students who participated in 2017, 120 provided feedback, which was reported in the study published in December 2018. In short-term responses, 82 percent rated the session above average or excellent, and 72 percent said it was very relevant to patient care. The goal is to prepare physicians to handle spiritual and religious challenges, such as a patient who insists on wearing a special amulet during surgery, or resists a procedure on religious grounds, or is questioning their life’s purpose. “This is the right thing to do,” Rev. Fleenor says, “and it can make things a lot easier in the long run for the hospital and for the patient.”
Compassion is essential in health care, Roshi Halifax said, and instead of leading to “compassion fatigue,” it generally gives providers a sense of well-being and purpose. But still, they are at risk of falling into the “shadow” side of altruism and empathy—neglecting to take care of themselves, or empathizing so strongly that they become distressed and ineffective. To help strike a balance in compassion, Roshi Halifax has developed a process called GRACE to use in challenging situations, or in day-to-day patient care. She explained: The “G” of grace is gathering your attention, pausing for a moment. The “R” is recalling your intention, generally to alleviate suffering. The “A” of grace is attuning to yourself, assessing your physical and emotional state and how it may be affecting your interaction with the patient. The “C” is considering what will serve the patient best, and trying to do it. And the “E” is ending the process, perhaps with a thank you or an expression of appreciation.
The other keynote speaker was Shane Sinclair, PhD, Director of the Compassion Research Lab, University of Calgary in Canada, who is a leader in the study of compassion in health care. “Compassion is like empathy on steroids,” Dr. Sinclair said. “It not only requires action but it extends beyond individuals we can relate to, or we feel are worthy of our care. It targets those we may not easily relate to: the disenfranchised, the homeless, the vulnerable, our enemies, and even to the proverbial ‘difficult patient.’”
Panelists included members of the departments of Nursing, Psychiatry, and Spiritual Care and Education, and leaders of initiatives to improve well-being, such as the Employee Assistance Program, Mount Sinai Fit, and Mount Sinai Calm. “The single most important thing that we can do is listen to the people in our lives and in our work space,” said panelist Jane Maksoud, RN, MPA, Chief Human Resources Officer and Senior Vice President of Human Resources and Labor Relations, Mount Sinai Health System. “If you are ready to listen, without ego, to what the other person has to say, you will make tremendous strides in personal and professional growth and interpersonal connection.”
A panel on well-being initiatives, from left: Dan Hughes, PhD, Director, Employee Assistance Program; Maggie Keough, M.Ed., BCC, Chaplain and Director of Chi Time; Jane Maksoud, RN, MPA, Chief Human Resources Officer and Senior Vice President of Human Resources and Labor Relations; Rajvee Vora, MD, Vice Chair of Psychiatry; Frances Cartwright, PhD, RN-BC, Chief Nursing Officer; Jonathan Ripp, MD, MPH, Senior Associate Dean for Well-Being and Resilience; with a moderator, the Reverend David Fleenor, STM, BCC, Director of Education, Center for Spirituality and Health.
Roshi Joan Halifax, a keynote speaker, is the spiritual leader of the Upaya Institute and Zen Center in Santa Fe, New Mexico.
Panelists on compassion and the patient experience, from left: Lindsay Condrat, RN, MSN, Associate Director of Nursing; Rocky Walker, M.Div, Chaplain, The Mount Sinai Hospital; and MaKaya L. Saulsberry, MPH, Director, Patient Experience, The Mount Sinai Hospital.
Shane Sinclair, PhD, a keynote speaker, is Associate Professor, Faculty of Nursing, and Director, Compassion Research Lab, University of Calgary.