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The Forgotten Ally in the Fight Against COVID

Mena Mirhom, MD

Disclosures

September 02, 2021

"But ma'am…if you don't do this, you're going to die," I said in a last moment of desperation. Here I sat in the ICU with a 45-year-old woman with no psychiatric history, who was refusing life-saving surgery for what seemed to be no apparent reason. When all else failed, psychiatry was called. "There's nothing you can say to convince me. I don't trust any of you." The surgical and medical team were at a loss and so was I. After speaking with her husband, he offered a simple but surprisingly effective solution. "Doc…we have to call in the big guns here. I need to call our church. She trusts some of the elder women there and I think they can help." I was admittedly skeptical. Here was a team of veteran doctors and nurses pleading with this woman to have lifesaving surgery and we got nowhere for days.

Could her faith community be the missing link?

Indeed, it was.

Once we collaborated with the patient's faith community, we were able to build an alliance with the patient that seemed impossible before. This forgotten but powerful ally was hidden in plain sight. They were able to bridge this gap that stemmed from several unfortunate encounters with healthcare in the past along with a misconception in her understanding of her own faith. This collaboration even changed her view of the COVID-19 vaccine.

In our battle against misinformation, we could certainly use all the help we can get. Couldn't we?

But how do we meaningfully engage with this potentially helpful resource in our patients' lives in a way that is respectful and considerate?

Recently, Pope Francis urged all Catholics to receive the COVID-19 vaccine as an "act of love" and a moral imperative. This once again emphasized that the faith community can echo the scientific community and add a perspective that is vital to our patients.

A Brief Spiritual History Goes a Long Way

Although our bedside time has been increasingly limited due to our extended electronic health record clicking, we know how to elicit key information in a short amount of time. A brief, evidence-based spiritual history can offer us a wealth of useful clinical information that can ultimately save us a lot of time later on. There are several evidence-based tools such as FICA and HOPE. This can be simplified into an initial screening question: "Do you have a faith background that is important to you?" If the answer is no, we can simply move on. If it is yes, it prompts a bit more inquiry. We can ask about a faith community or faith practices that are important to the patient.

Research also tells us that by this brief screening, we can identify both potential protective factors as well as significant risk factors. For example, negative spiritual attitudes, such as the belief that the patient is being punished by God or a higher power, can actually pose a risk to their health.

Consider a Consult

One of the reasons we call consults from other specialties is to gain clinical expertise and collaborate on the patient's care. A spiritual consult can also do just that. Research tells us that our patients are interested in having their clinical team ask about their spiritual background. This shows that we want to understand the patient more. We sometimes find it to be uncomfortable or an intrusion, despite the data showing the opposite perspective from patients.

If we see the patient's faith community as a potential critical member of the care team, we may be able to collaborate with them on situations that can benefit the patient in the hospital setting. A simple phone call can sometimes offer insight into how to approach the patient's care.

Community Collaboration

Our community campaigns to increase vaccination and promote wellness can be rooted where patients already have a trusting relationship. It may be surprising to us that a patient would be more likely to listen to their priest, rabbi, or imam than their advocate in a white coat. But perhaps we can remind patients that they don't have to choose one over the other. We can show our patients that faith and medicine often can work hand in hand for the common goal of the patient's well-being. Many faith communities are awaiting this kind of invitation to collaborate.

When patients hear a cohesive message regarding the vaccine from their trusted healthcare professional, along with their trusted spiritual guide, it can give them an opportunity to reconcile their fears regarding the COVID-19 vaccines.

We may not be comfortable confronting misinformation that is rooted in spiritual reasoning, but with the help of an ally, we can help clarify these concerns for our patients and reach our mutual goal together.

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About Dr. Mena Mirhom
Mena Mirhom, MD, is an assistant professor of psychiatry at Columbia University and teaches writing to public psychiatry fellows. He is a board-certified psychiatrist and a consultant for the National Basketball Players Association, treating NBA players and staff.
Connect with him on Twitter @drmirhom, Instagram (@drmirhom), or at Drmirhom.com

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