Physician and philosopher Daniel Sulmasy, who completed his residency training and postdoctoral fellowship at Johns Hopkins, lived for nearly 27 years as a Franciscan friar. Over the course of his impactful career, Sulmasy has devoted much of his energy to writing about problems in medical ethics, specifically exploring the connections between spirituality and medicine.
Last spring, he authored a perspectives essay that appeared in The New England Journal of Medicine that resonated with many at CIM — particularly cardiologist Roy Ziegelstein, who coined the term “personomics” in a widely cited editorial in the Journal of the American Medical Association a decade ago. The premise of personomics: In the rush to embrace the high-tech advances of precision medicine, too many doctors can lose sight of the individual patient’s unique life experiences.
“Dr. Sulmasy has written a masterful article about a very important aspect of personomics, describing how a patient’s spiritual and religious beliefs, practices and community are critical elements of the ‘personome’ that health care providers must understand and appreciate to take optimal care of the patient,” says Ziegelstein, vice dean for education and the Sarah Miller Coulson and Frank L. Coulson, Jr. Professor of Medicine.
“As originally described, personomics includes the psychological, social, cultural, behavioral and economic factors that influence health and disease,” continues Ziegelstein. “With respect to spirituality, I might have previously said, ‘It’s in there!’ as in the Prego spaghetti sauce commercial from 40 years ago. However, this article brilliantly highlights why spirituality should be considered a distinct domain of uniqueness — as stated in the article — ‘for people of all religions and of no religion.’”
Sulmasy is currently the inaugural André Hellegers Professor of Biomedical Ethics and director of the Kennedy Institute of Ethics at Georgetown University, with co-appointments in the Departments of Philosophy and Medicine. In December, he expanded upon insights from his article for a rapt group of attendees of a Johns Hopkins CIM Seminar. Among his central points:
Physicians play a key role in spiritual care. By inquiring about patients’ spiritual needs, they demonstrate respect for them as whole persons and strengthen the patient–physician relationship.
Doctors may be the only team members who uncover spiritual struggles or negative forms of coping that can interfere with a patient’s well-being, notes Sulmasy. He suggests following a “FICA” framework. This involves inquiring about the patient’s faith and spiritual beliefs; the importance of religion and spirituality in their lives; whether they belong to a spiritual community that could serve as a resource for them; and how patients would like to see spirituality addressed in relation to their medical care.
“It’s useful to make such assessments part of the routine social history, so that this knowledge can later be applied in patient care,” he writes.
Inquiry and engagement with the patient should be tailored to the specifics of the case: the seriousness of the medical condition, the setting, the patient’s level of distress, and their openness to spiritual conversation.
For patients with serious illness, physicians can start by asking about spiritual or religious beliefs and then broaden with more spiritual questions: “What are your deepest hopes? What sense, if any, can you make of this?” Following the patient’s lead, the questions can become more specific: “Are you at peace? Do you realize you are still valued and cherished, no matter how sick you are?” If the conversation becomes too complex, Sulmasy counsels doctors to step back and ask if a chaplain could stop by to continue the conversation.
Physicians may believe that if they don’t share the patient’s faith, they shouldn’t ask about spirituality or religion lest they make a mistake, offend the patient or seem disingenuous. But the deepest spiritual questions are applicable not only across all faiths but also to people who practice no religion.
“Buddhists and Christians, for instance, respond differently to human suffering,” he writes, “but the suffering that accompanies illness or injury is a universal aspect of the human predicament.”
