There's a change coming to the sick room

There is increasing acceptance, both in the community and in the medical fraternity that we benefit from a holistic approach to healthcare. From a patient perspective, being consulted about their spirituality is important to Australians, and there's a general belief that spirituality helps recovery.

These assertions formed the opening part of Associate Professor Kellie Bennett's presentation at the recent Compassion, Spirituality and Health Conference held earlier this month in Adelaide.

She's the recipient of a Templeton Foundation research grant awarded to her to assess spirituality content in medical education in Australian universities nationally, as she also gauges the attitudes of Deans, teachers, students, and practitioners to the use of spirituality in patient care.

Dr Bennett works in the School of Psychiatry and Clinical Neurosciences at the University of Western Australia. When she first looked at the curriculum on joining staff there, she was "surprised to see that there was nothing about spirituality in the curriculum", although she later discovered it was part of a 'hidden curriculum' that was often rather random.

UWA has made some progress, offering elective units like Spirituality, Suffering and Healing. But Dr Bennett is looking towards an integrated model where spirituality would be embedded into the curriculum.

We sat down and talked one day between sessions at the conference. She said that there are some good things going on in Australian hospitals, including the work of chaplains, counsellors and nurses, but doctors are seeking guidance and clarification from the whole community as to their role in the use of spirituality in medicine, bearing in mind that what doctors don't need is yet another job to add to a very long list.

With the Association of American Colleges,  Joint Commission on Accreditation of Health Organisations and the World Health Organisation all on board as to the importance of the recognition of spirituality in healthcare, and the majority of US and UK medical schools already providing it in the curriculum, the Australian medical scene is poised to start considering the complexities of how, what , who, how much, when: that is, how to move to a biopsychosocial-spiritual model of treatment.

Bennett's aim is to have some sort of national standards and a national framework written up that includes student competencies that every medical student could possess. Doctors need to be able to communicate; to at least open up the dialogue about spirituality with the patient, she says. And it's not just the patients who benefit. She feels that there's a serious gap in student and practitioner self-care.

Coming from a genetics background, Dr Bennett now does some research in mindfulness-based cognitive therapy and is dedicated to evidence-based medicine. She spoke of "incredible research coming out" where you can see actual neurological changes from the practice of meditation.

She feels that the fact that meditation is found to be beneficial, has very low harm associated with it, and that there's a significant body of corroborating literature, needs to be communicated to people.

Everyone from Hugh Jackman to some prisoners to my real estate agent is doing it. "Nothing has opened my eyes like transcendental meditation has. It makes me calm and happy…", Jackman explains. And considering the literature Dr Bennett refers to, it also makes him healthier.

As she takes on board how the US, UK Brazil and Canada have introduced spirituality to their medical curricula, we discussed how complementary and alternative medicine is a step ahead. "They've always been patient-driven".

There's progress towards integration though. Charles Gairdner Hospital in Perth already have a complementary centre for oncology that sits inside the cancer word, where massage, Reiki, reflexology are practiced.

Dr Bennett was as ready to talk about the benefits of prayer as she was meditation. She'd done some work with it through the Cancer Council.

Research focusing on the power of prayer in healing nearly doubled in the 1990s and continues today. Herbert Benson, MD has conducted his own studies on prayer, mainly focussing on the healing effects of meditation. He has documented on MRI brain scans the physical changes that take place in the body when someone meditates.

"Distant prayer" is prayer geared toward doing something – interrupting a heart attack or accomplishing healing", said Dr Mitchell Krucoff, associate professor of medicine in cardiology at Duke University Medical Centre, in an interview for WebMD a few years ago.

In the pilot study, the patients were assigned to a control group or to touch therapy, stress relaxation, imagery, or distant prayer. A therapist came to the bedsides of patients in the touch, stress-relaxation and imagery groups, but not the bedsides in the control or distant-prayer groups. People in those two groups didn't know whether prayers were being sent their way or not.

Those early results "were very suggestive that there may be a benefit to these [prayer] therapies", Krucoff explained as he launched into the trial's second phase with 1,500 patients undergoing angioplasty. "We're not looking at prayer as an alternative to angioplasty," he adds. "We're very high-tech people here. We're looking at whether in all of the energy and interest we have put into systematic investigation of high-tech medicine, if we have actually missed the boat. Have we ignored the rest of the human being – the need for something more – that could make all the high-tech stuff work better?"

Dr Bennett would concur. However, she did emphasise that unlike her genetics research, bringing spirituality into the medical curriculum will be more difficult … "will need more evidence almost than perhaps other areas that just don't need much justification. You'll need to understand the mechanism and everything that goes with it, whereas we don't understand the mechanisms for a lot of our drug therapies."

The mechanism, or biochemical interaction, in regard to meditation is now being studied and recorded. Helpful as that will be to the inclusion of spirituality into the curricula of medical schools throughout Australia, the benefits will be seen more in the associated advantages for both patients and staff.

We're beginning to look beyond what is visible to find not just a psychological cause for sickness, but also identifying and fulfilling a spiritual need. When speaking of the affect of contemplative and affirmative prayer, an early mind-body researcher and thought leader explained, "Its pharmacy is moral, and its medicine is intellectual and spiritual, though used for physical healing."

Spirituality, emphasising the healing of the whole person not just the disease, promotes trust in a higher power and often results in a more buoyant disposition, self-forgiveness, self-forgetfulness, a sense of peace and certainty, hope, optimism, increased kindness and compassion, along with a decrease in pain and depression. With other complementary therapies, it is often practiced in an environment free from harmful side-effects

By all accounts, we could be seeing a transformation in how we do medicine in the next 10 or 20 years. There's a change coming to the sick room.