By Marika H. Hull, MDiv, BCC and Sandra Lucas MDiv, BCC
Two physicians who collaborate with chaplains in Fall River, MA, agreed to offer Vision readers their perspectives on the role chaplains play on interdisciplinary teams.
Tenny Thomas, MD, FACEP Dr. Tenny Thomas is attending physician, Emergency Services, at Saint Anne’s Hospital in Fall River and staff physician at the Center for Wound Healing at Saint Anne’s.
Dr. Thomas is a board-certified emergency medicine physician with a special interest in wound treatment and hyperbaric medicine, and has been a member of Saint Anne’s Hospital Emergency Services since 2003. He received his medical degree from Sultan Quaboos University Hospital, Muscat, Oman, and completed his residency at George Washington University Hospital in Washington, D.C.
James Chingos, MD, CPE, FACP Dr. James Chingos, most recently, has served as an oncologist in Medical Oncology and Hematology Services at Saint Anne’s Hospital in Fall River. Dr. Chingos has just assumed new duties as chief medical officer of an innovative program called “House Call Doctors” to bring primary care to patients at home. The program is under the umbrella of Hospice and Palliative Care of Cape Cod, where Dr. Chingos will also serve as medical director. Dr. Chingos will continue to work with interdisciplinary medical teams, which include chaplains. Dr. Chingos received his medical degree from Albany Medical College in New York. He completed his residency in internal medicine at Tufts New England Medical Center in Boston, and a fellowship in Medical Oncology at Memorial Sloan Kettering Cancer Center, New York, and at Tufts-New England Medical Center, in Boston, MA.
Q To what extent does spiritual care participate on the interdisciplinary team in your clinical setting? What role does the chaplain play?
A Dr. Chingos: Over the years and especially at Saint Anne’s, my personal experience has put me in closer contact with the chaplain function. In my work as medical director of hospice, both on the Cape and here (in Fall River) I’ve seen many different kinds of chaplains.
In my experience, even the full-time chaplains I have observed in other hospitals do not interface as much with the staff and patients as they do here.
The chaplain function draws out of people things that I don’t do. The chaplains bring a perspective of understanding of the challenges of life from a spiritual perspective. The chaplain can focus on the mysteries of life, birth and death. Since we started the regular floor rounds the function of the chaplain has assumed equal status to the other members of the team. The rounds keep everyone on the same page.
A Dr. Thomas: Chaplains are part of our team on a daily basis. Chaplains and spiritual care provide a crucial link for patients and their families. Our chaplains provide relief for patients by talking with them and offering prayer.
Q Can you give an example of how a chaplain’s involvement made a critical difference with a patient or family?
A Dr. Chingos: I’ve found the chaplain very useful when it’s time to help patients or families to “let go.”
Chaplains can be particularly helpful, also, when the patient’s code status is being reassessed. When the patient and family hear from a doctor the bad news that no further treatment is warranted, and you start the conversation about resuscitation status, then it’s good to have the chaplain there. The patients and families look to the physician as a bastion of hope. They look to the doctor for miracles. Even when the doctor is clear, patients and families often don’t find it easy to consider being DNR and DNI. That is where the chaplain is helpful because they bring calm into the picture and address the spirituality of the patient.
A Dr. Thomas: Chaplains are present in all our code situations, breaking bad news and supporting the families. Especially when I have to pull away to another patient, the chaplain can remain with the patient or patient’s family and provides a link and continuity.
Q Do you engage patients in conversations about their spirituality or faith? If yes, how do the patients/ families respond?
A Dr. Thomas: Because of the nature of my work in the ED, these discussions don’t have time to occur.
A Dr. Chingos: I don’t ask. I don’t really pursue the religious piece unless there is particular distress. At that point I might ask: “Are you a spiritual person. Do you have a priest or a minister?” This does not come up often. They view the doctor in a “scientific” role.
Q What aspect of caring for patients is the most emotionally/spiritually challenging for you?
A Dr. Thomas: Definitely breaking bad news, a poor prognosis, or death of a patient.
A Dr. Chingos: I would agree that this is a most challenging time. Most doctors, as you know already, are not comfortable with death.
Q How do your physician colleagues look at spiritual care as part of interdisciplinary care? Is there discussion in professional circles about the value of spiritual care in the clinical setting?
A Dr. Chingos: In our unique setting I believe my colleagues are open to the input and guidance offered by our spiritual colleagues, particularly during the patient’s end of life.
A Dr. Thomas: We have overall discussions about patient care, but not too much about spiritual care per se. The value of spiritual care for me is that in spite of the craziness all around us in the Emergency Department we can still give personalized care to the person who needs it, and the chaplain is a significant part of this personalized care.
Marika Hanushevsky Hull is a chaplain at Saint Anne’s Hospital and Saint Anne’s Regional Cancer Care in Fall River, MA, which are part of the Steward Family Hospital System. Sandra Lucas is the regional director of spiritual care, Humility of Mary Health Partners, Youngstown, OH. Both serve on the NACC Editorial Advisory Panel.