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Integrating the Biopsychosocial Model: Addressing Spiritual Distress in Pre-Surgical Military Patients

May 30, 2024, 10:30 AM by User Not Found
A future military doctor discusses insights from retired Army Chaplain Robert Carter on providing spiritual support, building resilience, and addressing issues like spiritual distress and survivor's guilt.

Samuel Baule, OMS-2 '27 | May 30, 2024

The osteopathic medical profession is built on five models: Biomechanical, Neurological, Respiratory-circulatory, Metabolic, and Biopsychosocial. Throughout medical school, the Marian University College of Osteopathic Medicine encourages us to intertwine these models in our clinical approaches—to think of patients holistically. As a future military physician, I wondered about the implications of the biopsychosocial model in the treatment of patients with heightened anxiety or stress. More specifically, I was interested in the roles of doctors and other staff in treating such patients. Prior to treatment, specifically surgical interventions, there is a phenomenon known as spiritual distress, where patients become apprehensive regarding the treatment.

Army Chaplain (COL) Robert CarterTo understand more about this, I contacted retired Army Chaplain (COL) Robert Carter and had a great conversation about the role of chaplains in both hospital and military settings. Chaplain Carter went into great detail about the specifics, including many examples from his experience. He explained that treatment anxiety is a normal response to any unknown outcome. In his experience, the influx of stress is normally due to the inefficient practice of resiliency in daily life, and the best way to overcome this reaction is the prophylactic practice of resiliency through education.

Chaplain Carter discusses how spiritual and emotional support systems work with all new residents at his hospital. By doing this, he explained that it gives new physicians tools to cope with unknown outcomes and that gaining the skills necessary to overcome setbacks is fundamental to building resiliency. During his tenure, more people present without a lived or practiced faith tradition. As a result, patients are approaching tragedy, sorrow, and difficulties without the resources to combat their struggles.

Fundamentally, he explained that his role primarily supports the patient's decisions, whatever brings them peace. As a doctor is there to explain the details of treatment and possible outcomes, the chaplain’s role is to support the patient’s perceptions of that outcome. He described this concept by relating a story about a patient.

The patient was in the ICU for a ten-day period where they were intubated and declining. Suddenly the patient went into multisystem organ failure and was at the end of their life. He explained that the physician’s role was to explain the course of the disease and the likely outcome for the patient to the family, while his role was to stay with the family and support them in any way possible—mainly by praying for the best outcome for the patient. Attaining peace for the patient was his goal, one that often results in the patient's passing on; but sometimes it means supporting the family in a search for experimental treatments while facing overwhelming odds.

With a better understanding of the chaplain’s role, I inquired about the spiritual depression of patients in a pre-surgical setting. Chaplain Carter explained that this phenomenon is prevalent and largely due to the patient's perceived past sins. In his military capacity, he divulged that ‘survivor's guilt’ was a key factor in this situation. The idea that a veteran survived an incursion overseas while their fellow service members did not, creates survivor's guilt. In surviving against overwhelming odds, they see themselves as unworthy of reaching peace in this life. For this reason, a treatment that has the chance of failing, specifically surgical interventions, brings these feelings to the surface and heightens the levels of anxiety within the patient. To combat this, Chaplain Carter explained that relying on the completion of past challenges is vital. This is resiliency that the patient has already developed, and those same habits need to be reapplied to the current challenge.

A patient is more than just a disease or problem that needs to be solved. In understanding the roles of supportive positions in hospital settings, new physicians can be emboldened with a sense of purpose to treat all aspects of the patient. As a future physician, I hope you remember to listen to the narrative of your patients' lives and the sorrows they carry, so that the whole person can be treated, and you gain an understanding of the heightened stress patients feel when seeking treatment.

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