| To be a catholic doctor represents many tasks and obligations. They are, no doubt about, very often difficult, but many times joyful. A catholic doctor has, of course, also a great advantage: realisation to be helped, backed up, supported and assisted by our Lord. WHAT ARE THE TASKS OF A CATHOLIC DOCTOR?
1) To be a specialist of the highest qualities.
Everybody is invited by our Lord to work in the perfection of our world. A doctor is invited to work on the perfection of the health of his patients. To love God by all force, heart and also by all intelligence is the highest commandment. Because our Lord wishes us to care of our neighbours, we must simply cultivate our intelligence and to take all force to help our patients. It may be often very time consuming and take all the time. Many doctors have a trouble how to divide the time between growing number of their patients who ask their help and the time they should give to the permanent and long-life education and study to keep at least some pace with an enormous increase of the scientific knowledge in biomedical sciences. Moreover, there are other tasks a doctor should fulfil (vide infra) and of course most of them should fulfil their tasks in the family and society.
Many of such doctors may be called "workaholics" in the people round him. Psychologists speak about the role of "compulsive dominance of the professionality" and about the "necessity to be resistant against the pressure of conventions, especially those which dictate the perception of prestige and reputation". It may be right in some cases but surely too simplificative in many others. The amount of work is not always constructed by the doctor himself but dictated by the needs of others. Moreover, it is not only the question of quantity but even of quality of the work. A catholic doctor should do his work with uppermost care, perfection, integrity, honesty, fairness, faithfulness, reliability and others. In this variance and antagonism between the amount of work and the capability to manage it, it is a permanent contact with the Lord which can help to resolve the problem.
Of course, in some doctors it may be a need to be a successful businessman with all the necessary competition which dictates his enormous performance. In such case the consequence may be deleterious: loss of spirituality, private contacts, solidarity and ability to testify the human suffering. Again, the religious belief may be a suitable antidote. 2) To be a strong and morally integrated personality
It is a very difficult and uneasy tasks. Of course, he must follow the commandments as others of his faith. Moreover, he must resist the pressure of conventions which are common in his milieu: to be successful at each price, to grow into a rich businessman, to be a man working mainly for his standing, for his fame, for his family. In many cases it means to sacrifice his carrier. In this respect and in the milieu of the commercialisation of medicine he must be a non-conformist, he must be a dissident. And he may be even restrained in his activities. In many states it is not possible for a Catholic doctor to become a gynaecologist &endash; simply because during his postgraduate study he must prove to make an abortion.
The Catholic doctor must hate totalitarian systems and all sorts of dictatorships. He must fight against all sorts of the injustice. But his fight is not that of arms and bombs. Very often he must be very patient but persistent, relentless and enduring.
The Catholic doctor must defend the life. He must defend the life from the very beginning up to the very end. Moreover, he must defend even the respect to dead bodies and we know that they are somewhere the good article of business.
In my country sometimes the Catholics are accused that they are interested only in the conception and euthanasia. This is of course completely false. The Catholic doctor fights for the preference of upbringing of children in families instead of social institutes. The Catholic doctor fights for the rights of children. He tries to solve the problem of drogues and try to help the addicts. In some countries the pester can be a great problem among children and teenagers. He works against social injustice, unemployment, frustration in the occupations. He fights against the famine and is a pioneer of a rational help to the third world. He cares of all frail groups and societies in the nation. They may be political immigrants, national minorities but also old people and disabled persons. Old people deserve a special care and in many states they are always neglected. They deserve a special care even in medicine and in many parts of the world this is not yet realised. On the contrary: physicians are instructed that there is no worth spending money for old people. The rights of disabled people remain a burning problem, too. Physicians are taught, that disabled people have not right to existence because they drain limited economic resources. Catholic physicians should strongly oppose such tendencies (1).
The catholic doctor should be what one friend of mine (quoting a sociologist of the past generation David Riesman) called "in-directed person". Spiritually directed person. Person directed by his experience with God. 3) To understand a patient's spiritual foundation and guide appropriate care
With escalating demands on the physician's skill and energy and economic pressure to limit the amount of time spent talking with patients, busy physicians would focus on scientific and technical concerns. Some of them see religious belief as fundamentally opposed to science, while others argue that because religious beliefs are deeply private, physicians should avoid these matters in the discussion with patients. Moreover because of variety of religions and belief systems in our multicultural society, physicians may find it safest not to open a dialogue around religious and spiritual issues.
Also in these respects, there is a great regional and cultural difference. Recently, a vast discussion on this topic emerged in United States, inclusively medical journals such as American Journal of Medicine (2), Journal of American Medical Association (3,4), Archives of Internal Medicine (5,6), Annals of Internal Medicine (7,8), Postgraduate Medicine (9), American Family Physician (10,11), Pediatrics (12) or Medical Clinics of North America (13) to quote at least some of them. Of course, first of all it is important to realise, what the word "spirituality" means in these articles. In a vocabulary of a catholic doctor, "spirituality" will probably mean a relationship with the God. However, some of the authors define the spirituality like "the way one find meaning, hope, comfort and inner peace in his life &endash; sometimes through religion, sometimes through music, art or a connection with nature" (14). Anyhow, most of Americans use spirituality and religion interchangeably (4). American studies (9) suggest that 91% - 98% of Americans belief in God or a higher power and only 2-6% belief in atheism or agnosticism. The belief in God or a higher power may certainly be only very vague, because according another exploration only 54% of Americans see God as a personal entity (9). Anyhow, even such a belief may be a good start for a dialogue between the physician and his patient.
In this connection many questions emerge. Will such a dialogue be welcome by a patient? What sense has such a dialogue? Should not be such a dialogue reserved for a religious professional?
Again, the American experience is interesting (9). 63% of American adults stated that it is good for doctor to talk with patients about spirituality. In addition, about 77% of outpatients surveyed in the south-eastern United States stated that physicians should address the patient's spiritual needs as part of routine medical care. And a study from the University of Pennsylvania showed that about 94% of outpatients who acknowledged religious or spiritual beliefs stated that physicians should inquire about their beliefs if they become gravely ill. Although many people approve of having physicians address spirituality in medical care, only about 10% of patients reported that a physician had done so. It may be because of lack of time, it may be because lack of training but it may be also due to a perceived lack of value by the physician. Unfortunately, I have no data at hand from other countries of the world. However, the experience from my country which was very heavily hit by 40 year anti-religious and anti-spiritual propaganda of the communistic regime, shows that many people when heavily ill are at disposal and sometimes eager for a dialogue of religious and spiritual matters. A spiritual dialogue is not possible and even not appropriate for every patient, although for those with illness that threatens life or way of life, it probably is.
What such a dialogue on spiritual and religious matters by a physician is good for? First, it is evident, that a patient want to bee seen and treated as whole person and not as a disease. The pure science make the human being depersonalised. The experience of many patients is that scientific medicine seems to have left the human person out of the picture, turning the subject of medicine, the human person, into an object.
Many seriously ill patients use religious beliefs to cope with their illnesses. It was demonstrated, that people adapt more successfully to stress of the disease if they are religious (3). The positive effects of the religious belief, spirituality and prayer on the course of the diseases is widely acknowledged (2&endash;13). Already in 1910 the famous Sir William Osler wrote about the faith that heals: "Nothing in life is more wonderful than faith … the one great moving force which we can neither weigh in the balance nor test in the crucible &endash; mysterious, indefinable, known only by its effects, faith pours out an unfailing stream of energy while abating neither jot nor tittle of its potence" (quot. according 10).
Of course, physicians should not "prescribe" religious beliefs or activities only for health reasons. A physician should not be only an expert but certain guide in diseases of his patients. Moreover, Christians know, that an illness may be an indicator on the crossroad of their lives. It may have a supernatural meaning and it may be composed into a plan of his salvation.
Should not we prefer the trained clergy to make a dialogue on religious and spiritual matters? Certainly, in-depth religious counselling to patients is best done by well trained priests. For the first contact with a diseased man it is however a physician who is often indispensable. He must recognise, when it is necessary to call a trained professional or a priest. In religious patients the physicians should always consider supporting the patient's religious beliefs that aid in coping with the disease. Religious patients, whose beliefs often form core of their system of existence, almost always appreciate the physician's sensitivity to these issues. No doubt about, the best experience we have with physicians with clinical pastoral education. Not every physicians, not even catholic physician, will have such an education. But certain levels of skills, knowledge and practice he should gain during his training. Such training may be given at medical schools. But what about theological faculties? Should not they arrange some special courses for physicians and medical students? 4) To realise he lives in a pluralistic world and so to be a man of a dialogue
Every doctor lives in certain community. In the present world this community is scarcely unicultural and a doctor cannot be hidden in a close community of Catholics. He, as well, is responsible for the new evangelisation. As a doctor he is usually in certain centre of close attention of his patients, his colleagues and his surroundings. He meets opinions of others and he must be able not to ignore them, to deny them or turn them to ridicule. He must be able to logically explain his attitudes. It is not always easy. It desires a certain cultural level and the deep spirituality of the doctor. He should not be ridiculous. He should be enthusiastic but not a fanatic. He must be rational. He cannot be unfriendly. Dialogue is a certain art but wants much of skills, practice and knowledge. Who else can be a master of a dialogue than a doctor?
A physician lives in a permanent dialogue. First, it is a dialogue with his patients. Then it is a dialogue with the relatives of his patients. Very often a dialogue among his colleagues to find out the right and proper diagnosis and way of treatment. He must have a dialogue with his friends. The way of the new evangelisation is the way of dialogue. The Gospels demonstrate many dialogues our Lord had with not only his disciples but common people. But a doctor must have even a dialogue in a community and in a society he lives in. He must be a political man. To make politics, it means to be interested and to take part in the formation and rule of the society. Every doctor, and especially a Catholic one, should have a special interest to be involved and engaged in politics. The politics means to form and create social attitudes, to answer the challenges with a Christian morality and ethics, to have some sort of good influence on the community. Even the health-care system we must work in, we exploit all his advantages and scold all his disadvantages, is the fruit of existing political system. Of course, he will not persuade everybody to become a Christian, to become a Catholic. But every good thing, everything what was done for a good sake, praises our Lord.
It is certainly not simple to bee a good doctor. To be a good Catholic doctor seems to be still more difficult. But a Catholic doctor is not deprived of much help &endash; much help from the side of our Lord, of the Church and from his friends. Associations of Catholic Physicians may form such an institution of mutual help. So apparently impossible things may happen to come into a reality. |
| Quoted literature 1) Munzarova M.: Towards the abolition of man: the voice of disabled persons cannot be ignored. Bull. Med. Ethh. 1,2002, 13-21.
1) Astrow A.B. et al.: Religion, spirituality, and health care: Social, ethical, and practical considerations. Am. J. Med. 110, 2001, 283-287.
2) Koenig H.G.: Religion, spirituality, and medicine: Application to clinical practice. J. Amer. Med. Ass. 284, 2000, 1708.
3) Lo B. et al.: Discussing religious and spiritual issues at the end of life. J. Amer. Med. Ass. 287, 2002, 749-754.
4) Rosner F.: Religion and medicine. Arch. intern. med. 161,2001, 1811-1812.
5) Chibnall J.T. et al.: Experiments on distatnt intercessory prayer. God, science and the lesson of Massah. Arch. intern. med. 161, 2001, 2529-2536.
6) Post S.G. et al.: Physicians and patient spirituality: professional boundaries, competency and ethics.
7) DeMarco D.G.: Medicine and Spirituality. Ann. intern. Med. 133,2000, 920-921.
8) Plotnikoff G.A.: Should medicine reach out to the spirit? Postgraduate Med. 108,2000, 19-25.
9) Larimore W.L.: Providing basic spiritual care for patients: Should it be the exclusive domain of pastoral professionals? Amer. Family Physic. 63:2001, 36-40.
10) Anandarajah G., Hight E.: Spirituality and medical practice. Amer. Family Physic. 63:2001, 81-88
11) Barnes L.L. et al.: Spirituality, religion, and pediatrics: Intersecting worlds of healing. Pediatrics 104,2000, 899 &endash; 908.
12) O'Hara D.P.: Is there a role for prayer and spirituality in health care? Med. Clin. N.Amer. 86, 2002, 33-46.
13) American Academy of Family Physicians. Spirituality and Health. Information from your family doctor. Amer. Family Physic. 63, 2001, 89. |
