Puchalski: ‘Healing is not one of only mechanical repair but one of regaining relatedness itself’


Katie McLean | Staff Photographer
Christina Puchalski, founder and director of the George Washington Institute for Spirituality and Health, lectures on the importance of caring for a patient beyond their physical well-being Thursday afternoon in the Hall of Philosophy. Puchalski suggests that doctors should spend just as much time caring for their patients on a mental, social, and spiritual level.

Medical patients have physical needs as well as spiritual ones. And Dr. Christina Puchalski doesn’t believe health care professionals should limit themselves to just the former.

She said that 73 percent of cancer patients said they’ve experienced at least one instance of spiritual need; 40 percent of newly diagnosed cancer patients said they have a significant level of spiritual distress.

“We need to know how to attend to that [distress],” Puchalski said. “We may not be the experts who know exactly what to do, but we should know how to listen for that distress — not just for ‘What’s your pain on a scale of one to 10? Here’s a morphine prescription,’ but ‘What distress are you experiencing? What can I do for you?’ ”

Puchalski spoke at Thursday’s Interfaith Lecture at 2 p.m. in the Hall of Philosophy, focusing on Week Nine’s theme, “Faith, Hope and Healing.” In addition to being an active clinician, she is also the founder and director of the George Washington Institute for Spirituality and Health and a professor at George Washington University. She also co-authored the first textbook on spirituality in health care, Oxford Textbook of Spirituality in Healthcare.

Puchalski’s working definition of “spirituality” is intentionally broad so that it can be applied to a wide range of patients, both the religious and the nonreligious.

“Spirituality,” she said, “is the aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature and to the significant or sacred.”

She said that many years of research have supported the idea that spirituality and religion have an impact on “improved quality of life and a greater will to live.”

After Puchalski asks a patient what their pain level is, on a scale of one to 10, she usually asks how much of it is emotional or spiritual pain. In some cases, she said, severe pain can be caused almost exclusively by spiritual distress.

Puchalski once had a patient who was dying of pancreatic cancer and who was on the maximum doses of his medications. After speaking with him, Puchalski discovered that the patient felt intense guilt about his sexual preference and what that would mean to his Episcopalian community. That guilt was resolved once his pastor visited him and continued to love and care for him. The patient finally died in a much happier state and with very little medication.

“Healing is not … only mechanical repair, but … regaining relatedness itself, to restoration of love and harmony to the heart and mind and family and community,” she said.

The World Health Organization’s definition of “health,” she noted, is “a state of complete physical, mental and social well-being.” In order to deliver this sort of well-being, then, the physician must take into account much more than just the physical state of the patient; the physician must also seek to understand the patient’s story in the context of his or her culture, values and beliefs.

A health care professional’s spirituality is also important, she said, because it affects his or her reasons for working in health care and might even affect the quality of care.

“It’s not a job,” she said. “At some level it is, but it’s a vocation; it’s a call to be present with others who suffer.”

Health care systems can also be transformed into healing environments, Puchalski said. They should provide opportunities to develop and to sustain a sense of connectedness with the communities they serve. Health care professionals should have opportunities to discuss spiritual and ethical conflicts that arise in their care, she said. All health care providers should be trained to be active listeners, to have a broad understanding of spirituality and how to discuss it.

Puchalski said that incorporating spirituality into health care will result in greater patient satisfaction, improved cohesiveness among teams of health care professionals and decreased instances of burnout.

“Decreased error,” she said. “If people are mindful, they’re more attentive. If we’re committed to the relationship with our patients, we’re going to try that much harder.”

Incorporating spirituality will also help in difficult conversations, she said, such as conversations about end-of-life care or choices in treatment.

Puchalski closed by reading from the Fetzer Advisory Council on Health Professions’ call for a reformed health care system: “We are bold enough to say that we want a health care system that is spiritual, even awe-inspiring; a health care system that will transform the hearts of those who give, receive, teach and learn care; a system that will be other-regarding, moving towards justice, by encouraging practitioners to work as a team to deliver service grounded in benevolence and altruism; a system that encourages self-compassion, which says to the practitioner, ‘You don’t have to take this on all yourself.’ ”