The views and opinions expressed in this collection are those of the authors and do not necessarily reflect the positions of the Association of American Medical Colleges.
Elizabeth J. Berger is an advanced practice board-certified chaplain and a graduate of Columbia University's master of science program in narrative medicine. Named a 2020 Top 100 Healthcare Leader by the International Forum on Advancements in Healthcare, the focus of Elizabeth’s work is spirituality in medicine, clinician well-being, and the connection to patient-centered care. Elizabeth teaches medical humanities and professional formation at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. She is also an ordained member of the Jewish clergy. Contact her at firstname.lastname@example.org.
A tale of two pandemics: Around the time of the coronavirus outbreak, 2019 also marked a full century since the death of Sir William Osler, who revolutionized medical training. Despite some lingering debate over whether Dr. Osler’s pneumonia-related death should be counted among the 50 million lost to the 1918 influenza pandemic, his notes suggest that he believed the flu precipitated his demise.
As a chaplain who teaches medical humanities and professional identity formation in a medical school, I’ve been thinking about how Dr. Osler might have guided medical students during COVID-19. Here, the evidence is a little clearer. Dr. Osler advocated for trainees to “let no day pass without contact with the greatest literature in the world,” and to spend 30 minutes each night reading from a bedside library of ten classics. Included among these recommended texts were the Old and New Testaments and Sir Thomas Browne’s Religio Medici, a physician’s spiritual testament.
What does this mean? Should you, a medical student, be managing the stress from our global health crisis by reading the Bible or other religious texts?
You might, but only if you feel this would be nourishing to you personally. Still, from a less literal interpretation of the reading list, we can certainly infer that Dr. Osler would have advised, as I do, that medical students should be taking special care to attend to their spiritual health.
How this might take shape depends entirely on you. If you believe in God, a universal spirit, or a higher power, then you’re hardly alone: so do 76% of US physicians and 95% of the Americans you will be taking care of. To be clear, these individuals might not be religious—many might never set foot in a house of worship—but they still believe in God or Something.
For others, spirituality might not include identification with any Divine being, faith community or religious practice. My favorite definition comes from an October 2009 consensus report in the Journal of Palliative Medicine: “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” Connectedness, meaning, and purpose are essential human needs that are as true for aspiring physicians as they are for everyone else. These are the keys to spiritual health.
Why is spiritual health so important for medical students now? Three reasons:
- In the mere 100 years of human history since William Osler’s lifetime, Western medicine has become almost synonymous with a Cartesian ideal of scientific mastery. Meanwhile, the scientifically unproven spiritual beliefs held by a majority of doctors have become culturally associated with anti-intellectualism and professional embarrassment. This disconnect can leave us feeling vulnerable and unprepared when we are confronted with existential questions, especially during a pandemic for which we currently have no scientific controls. The struggle to make sense of things is a spiritual concern.
- Whether or not they believe in a Divine being, doctors often feel a special calling. Because they are so highly motivated to sustain life, death can sometimes feel like failure. The CDC predicts COVID deaths in the US will exceed 180,000 by October 1st. Ours is a collective grief compounded by instability, as startling new developments have outpaced our slowly emerging understanding of the disease.
- Medical school was challenging enough before the pandemic, so it’s especially important that medical students feel encouraged to protect against overwhelm, drawing from any and all of their best inner resources in their expressions of self-care.
Some medical students have graduated early to join the effort, while other students have sought to engage in other helpful ways. These are positive steps, because engagement helps identify ways to achieve the sense of purpose that is so integral to spiritual health.
The ability to spiritually connect with ourselves, with others and with whatever/Whoever deeply sustains us is vitally important to our well-being as we scale this unnerving societal hurdle. May we all feel the freedom to attend to our spiritual health. It will help sustain our patients, our peers, our families, and the world.