Chaplains, the hidden assets.

As we embark on our exploration of the Spirituality/Medicine Interface Project, I would like to emphasize that it is not our intention to advocate that clinicians attend to the spiritual needs of patients under their care. The overarching goal of this series is to highlight the impact the patients' spirituality may have on the prognosis of their illness and how, in at least some instances, the patients' spirituality may be harnessed to improve the ultimate prognosis.

The mere body of knowledge needed for present-day clinicians to perform their duties and meet their responsibilities precludes them from delving into the spiritual needs of their patients. They have not been trained to do as such, and it would be unrealistic, I dare say irresponsible, to expect them to do so. Indeed, no one would advocate that an internist repair an inguinal hernia or that a surgeon treat a patient's hypertension. The expectation is that the internist will refer the patient with an inguinal hernia to the surgeon for repair and the surgeon will refer the patient with hypertension to the internist or cardiologist. Why then should we expect clinicians to meet the spiritual needs of patients under their care?

Medicine has evolved to such a degree that specialization is inevitable and there is no way one could be familiar with recent advances in all areas of medicine. So to provide the best possible care, specialists tend to focus on increasingly narrowed areas. As the various specialties have evolved, they have established their own domains and certification mechanisms. Clinicians refer their patients to other specialists, reassured that these specialists are allowed to practice only after having fulfilled various educational requirements, training experience and met parameters of competency as established by national boards. This process is greatly facilitated by the various regulatory authorities.

When it comes to chaplains, however, clinicians often are not familiar with the educational background, training, experience and requirements they must meet before becoming involved in health care. Chaplains are often regarded as shadowy marginal figures, and their roles are not fully understood. This is regrettable because unless clinicians are comfortable with the expertise of chaplains, they will not freely refer patients to them. They also will not be able to fully appreciate the potential that chaplains have to help patients. We therefore feel it is important for clinicians to understand the educational background and experience needed for chaplains to practice in health care settings. This is the main emphasis of this section of the Spirituality/Medicine Interface Project issue.

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In addition to standards from the USA, we have included input from various other countries, not only because the readership of the SMJ now spans the six continents, but especially because we feel it may foster a meaningful interaction between interested parties.

Attending to the patient's spiritual needs is an integral part of the management of the patient's illness. The patient's spirituality cannot be ignored just because most clinicians have neither the knowledge, nor the expertise, nor the time to get involved in these issues. Chaplains are readily available in most health care teams to meet the spiritual needs of patients and are very willing to get involved in patient care. Clinicians should take advantage of the knowledge, expertise and availability of chaplains to enhance the prognosis of some spiritual patients or those struggling with their spirituality.

Obviously not all patients should be referred to chaplains, no more than all patients should be referred to, for instance, physical therapists. Many patients, either because of the nature of their illness, or their spiritual background, have no spiritual needs. Referring these patients to a chaplain would not only be a waste of time and resources, but also could be counterproductive for the patient, chaplain and treatment team.

Chaplains should be considered an integral part of the treatment team and a symbiotic relationship should be established with other health care professionals to enhance effectiveness and efficiency in patient care.

I hope that after reading this issue of the Journal, clinicians will better appreciate the potential role of chaplains, will consider them as partners, and will feel more comfortable referring patients to them. It is also my ambition that as a result of this series, a mature dialogue will evolve between clinicians and chaplains.

Ronald C. Hamdy, MD, FRCP, FACP 

Editor-in-Chief