Tuesday, March 13, 2007

Call for the Chaplain

I do sometimes remember that I am a chaplain.

I can’t watch medical dramas on television. It’s not a matter of how well or how poorly they’re written. “ER” and “House” and others are fine shows; and I can’t watch them.

I can’t watch them for any period of time – more than about ten minutes – without grumbling (or yelling), “It wouldn’t happen that way!” There are lots of details that stimulate that. However, the most important one is when someone – patient, family member, staff member – is wracked with grief and the physician, staff or resident, takes the time to offer grief support. I know from years of experience that that doesn’t happen. I don’t mean to imply that physicians don’t care, or that they wouldn’t stay if they could. However, most physicians in my experience don’t have the training to provide the emotional support they might want to. Indeed, most physicians, and especially resident physicians, don’t have the time to offer support, much as they might like to.

That got triggered again by an article in the February 21 edition of the Journal of the American Medical Association (JAMA). The article, by physicians Paul Maciejewski, Baohui Zhang, Susan Block, and Holly Prigerson, is titled, “An Empirical Examination of the Stage Theory of Grief.” (You can access the article on line here.) To summarize, they found that the stage theory of Elizabeth Kübler-Ross (at least as it has come to be used in much of health care) doesn’t stand up in their study. That is, people don’t progress through grief in clear and distinct stages, and they may come to some measure of “acceptance” much faster than has been commonly assumed.

Now, this principle doesn’t bother me a bit. I’ve been teaching that for years. Indeed, chaplains have been saying form some time that grief doesn’t happen in stages, and doesn’t happen in sequence. There are a number of concerns to raise about Kübler-Ross, and this is only one of them.

What does bother me is that in their literature review there is no reference to the pastoral literature on grief. Indeed, there is no reference to nursing or social work literature, either; but the literature I know best is the pastoral literature.

It’s not that there’s nothing out there. The authors write, “To date, no study has explicitly tested whether the normal course of adjustment to a natural death progresses through stages of disbelief, yearning, anger, depression, and acceptance.” That may well be true. However, there is a great deal of literature on how people grieve, and it includes both empirical quantitative studies and studies of individual cases. For example, in the Journal of Pastoral Care there are five such studies in the past ten years. I haven’t had time to ask my hospital library to do a literature search to include the nursing and social work literature; but my guess is that there is much more out there in those disciplines. After all, we pastoral folks are late (and sometimes lame) in developing our body of research.

I’m not really surprised. One of my chief complaints over the years is that we professionals in health care don’t read each other’s literature. I fear that’s even worse when physicians are the researchers. We comment in health care that you need to get a doctor to talk to a doctor if you want to be heard. These physicians certainly looked at reputable journals and found relevant articles. However, I don’t see any reference to pastoral, nursing, or social work literature; not in their citations, nor even in an offhand reference in the text.

And that’s a shame. When I was primary investigator for a study of nurses’ attitudes about pastoral care (a long time ago now) I discovered there was a wealth of literature from other disciplines – literature that was certainly relevant to my study. I was delighted to discover those resources from colleagues in other disciplines.

So, I’m sorry that these investigators failed to note those resources, even if they didn’t find them useful. I fear they didn’t find them at all, and perhaps because it never occurred to them to look. While doctors do care about grieving families, most of the time they don’t provide the care. The greatest providers of immediate care are nurses and chaplains; and the most common providers of long term aftercare are clergy. It would have made sense, even if professional respect never occurred to them, to at least acknowledge that. And, you know, the professional respect would have been nice, too.

1 comment:

ab said...

The professional respect and courtesy are certainly deserving. Thank you to folks like yourself that not only care, but express it in ways doctors and nurses won't allow themselves. I suppose it's their way of not being overcome, but it's so important to include outward, emotional caring. It's probably my biggest surprise throughout my recent experiences with the healthcare folks. Don't ever forget what eye contact or gripping a hand or even a sincere smile can do for one's well being. :)