By David Holmes, MD
Numerous medical research studies support the idea that health and well-being are affected by four main aspects of a person’s life: physical, psychological, social and spiritual. These aspects also affect recovery from addictions to drugs, alcohol, tobacco, sex, gambling, etc.
This is called the bio-psycho-social-spiritual model of whole-person healthcare. I use this model when taking a patient’s history and recommending a treatment plan. So much of healthcare is focused on the biological or physical aspects of health. We need to learn and strive to provide excellent physical medical care. However, I think all healthcare professionals should also strive to provide excellent psycho-social-spiritual medical care.
When asking psycho-social-spiritual questions, I often ask patients about their biggest stressors and how they cope with them. Probably half of the inpatients I see on a general medical floor in a local hospital are there because of unhealthy ways of coping with stress, anxiety, sadness, boredom or loneliness. These unhealthy coping strategies, such as smoking, overeating, alcohol, inactivity, anger, drugs, isolation, inactivity, etc., can contribute to problems including ulcers, cirrhosis, heart disease, seizures, injuries, anxiety, some types of cancer, etc.
This doesn’t mean these problems are always, or even usually, caused by unhealthy coping strategies, as other factors contribute to these conditions. However, for a number of people, unhealthy coping strategies likely contribute to their health problems.
Once I identify a patient has unhealthy coping strategies, I work with them to identify healthy coping strategies they could use instead. Some of these strategies include exercising, praying, listening to peaceful music, going for a walk, reading Scripture, journaling, doing a hobby they enjoy and talking with someone they trust, like a friend, family member, pastor or counselor.
I also use the bio-psycho-social-spiritual model when I’m working with the patient to formulate a treatment plan. We focus on items they think they can start doing, and then I document the action points in the electronic health record so I can remember to follow up with them at future visits.
A number of years ago, I heard Dr. John Patrick talk about the four levels of happiness on CMDA’s Christian Doctor’s Digest (now called CMDA Matters). Ever since, I’ve included that material in required seminars I teach to medical students about whole-person healthcare. I also use this material in talking with patients who are struggling with addictions.
- Animal Happiness (short-term, self-focused)
You may be unhappy or grumpy because you’re hungry. Then you eat a big meal and you’re happy. A few hours later, you can repeat the whole process again. The same is true if you’re tired and then get some sleep. Other examples of short-term happiness include sex, shelter, health, things, money, pornography, smoking, drugs, alcohol, shopping, etc. Some of these things do bring happiness, but it’s on a short-term basis. Some things can lead to unhappiness. For instance, too much eating can lead to obesity. Smoking and excessive alcohol use can lead to addictions and health problems.
- Accomplishments (self-focused)
Accomplishments provide a deeper sense of happiness and satisfaction. Some examples include doing well on an exam, receiving an award, accomplishing chores at home, getting a good job, reaching a goal, winning a competition, etc. These provide a little deeper sense of happiness and satisfaction in life. However, there are lots of people with great jobs who are still miserable. Therefore, we need more than just our accomplishments to be happy and content.
- Relationships and Service (others-focused)
Unlike the previous two levels, this level focuses on others. Some examples include relationships with your spouse, children, relatives, friends, co-workers, patients and others. It’s also about serving others, such as volunteering and giving of your time, talents and treasure. We all have a need to be needed, so helping others also helps ourselves. However, relationships sometimes don’t work out well. Sometimes, marriages end in divorce. Children grow up and leave the home. Some children rebel. There may be conflicts and tension with friends. Loved ones may die. Then what do we do? We need to rely on our foundation.
- Foundation (God-focused or beliefs-focused)
Examples of a foundation are faith, beliefs, values, culture, identity and integrity. The first three levels of happiness can all be taken away from you. Your foundation is the part of you that can never be taken away. It gives you meaning and purpose in life and can help you through the storms and challenges of life.
The purpose of the foundation of a building is to help it stay standing when storms and bad weather hit. Without a strong foundation, the building may crack and collapse. The same is true with our lives. If we have a weak foundation, then, when the storms and problems hit, we will struggle with those things, because they are difficult. However, if we have a strong foundation, we’ll be able to stay standing and move forward with our lives. If we don’t have a strong foundation, then when the storms arrive, we’re going to collapse.
There will be problem on top of problem, and it will be difficult to dig our way out. When I get to this point with patients, they often relate to having a collapsed life with problems piling on top of one another. At this point, even patients who don’t profess much in terms of spiritual beliefs begin to understand the importance of having a strong foundation. This can open the door to a conversation about how faith can help in building a strong foundation.
If I sense a patient might be interested, I’ll offer them a Life Recovery Bible, which is donated by Embrace Recovery Buffalo. This Bible is filled with explanations about how certain passages in the Bible relate to the 12 steps of Alcoholics Anonymous or Narcotics Anonymous. I suggest they read a few verses each day. Just as having physical food each day helps nourish our bodies, having spiritual and inspirational food each day helps nourish our souls and strengthen our foundation.
Some patients like to journal or are open to doing it. I often offer these patients the Recovery Journal, which is also provided free of charge by Embrace Recovery. Each day has a Scripture verse and brief devotional, followed by space for them to journal a response. If I don’t sense they would be interested in either the Bible or the journal, I offer The Daily Bread devotional booklet, which is available in bulk at no cost from odb.org/getprint. I try to offer it in a non-pushing way, so they don’t feel obligated to take one.
In terms of praying with patients, here are the general guidelines I use:
- I usually only ask patients if they would like prayer if I’m almost certain they will say yes. Taking a spiritual history usually helps me to know if a patient will appreciate prayer or not.
- Some people believe it is best to only pray with a patient if the patient initiates a request for it. That may be the best indication for praying with a patient, but the problem is that it is not common for healthcare professionals to pray with patients. Therefore, most patients wouldn’t even think to ask you to pray for them, especially if they don’t know if you do that with patients. Therefore, it’s up to Christian healthcare professionals to somehow communicate this to their patients. I choose to do that by asking, in a nonjudgmental way, if they would like me to pray for them.
- If the patient says they would like prayer, then I ask them what prayer requests they have. This helps me to know what to focus my prayer on, and it also gives me a glimpse into what’s going on in their heart.
- In general, my prayers are brief and focused on the patient’s prayer requests. I also include gratitude for something positive going on in the patient’s life and/or aspects of God’s character, such as His love and help that He freely gives us. Finally, I often include parts of the treatment plan, such as for God to help them quit smoking.
- I document prayers in the medical record; that way, when I see the patient again, I can be reminded of the fact that we prayed and what we prayed for. If I don’t document this and I don’t remember, then when I see the patient and don’t ask about how things are going with whatever we prayed for, it may appear that I am uncaring about what the patient was struggling with during the previous visit.
I work in a county hospital and clinic, plus I’m on faculty at a state medical school. In 27 years of medical practice and addressing spiritual issues with patients, I’ve had countless positive and meaningful moments with patients, as addressing these issues often strengthens trust and rapport. In that time, I’ve only received a couple complaints from administrators about my faith-based approach to patient care. I simply explain the truth—that I’m practicing evidence-based, patient-centered, whole-person healthcare.
There’s not much they can say in response to that. At the end of my conversation with one of the administrators, she asked if she could have one of the Life Recovery Bibles that I give to patients and if I’d be willing to teach the clinic staff about spirituality in health.
Of course, I said yes to both. It’s amazing how God can use all sorts of things to share the truth of His Word and the valuable role faith plays in our health and well-being, especially when it comes to creating a strong foundation in recovery from addiction.
David Holmes, MD, is a Clinical Associate Professor in the Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, SUNY at Buffalo (UB). He is board certified in family medicine and addiction medicine. He directs the Global Medicine Program and the spirituality in medicine curriculum for the medical school. He’s an Associate Program Director for the family medicine residency program. His research interests focus on global health and the role of faith in addiction recovery. He says that his personal mission statement is “to love and honor God and my family and make a positive and significant difference in the lives of others.”