Although a commitment to spiritual care exists in the curriculum of the Royal College of GPs for GP training and in the General Medical Council’s Good Medical Practice, describing what spiritual care is, and how GPs should be trained in it, is quite problematic. Some light has been shed on this recently by two thoughtful research articles by Aviemore GP Dr Alastair Appleby, with Prof John Swinton, Professor of Divinity at the University of Aberdeen and colleagues.
GPs themselves have a wide range of attitudes to spirituality, as you might expect. They surveyed 87 GPs in the North of Scotland, and found that were unclear what spirituality meant as a concept—perhaps they are not alone in this! However, ‘most but not all believed it to be important and to concern a potentially fundamental human and psychological need for meaning and purpose.’ They found that only 8% wished no involvement in spiritual care, 28% had reservations, 46% were willing to undertake this and 12% were keen. However, despite this (58% keen or willing to be involved in spiritual care), 36% reported that they tended not to discuss spiritual matters with their patients. Only 10% said that their training in spiritual care was adequate.
It is clear, therefore, that there is a gap between the willingness of GPs to discuss spiritual matters with patients and their practice in doing so. They feel inadequately trained to provide spiritual care and to deliver this training to colleagues. The authors suggest that the secular scientific basis of medical training may be at the heart of this, and that the current biomedical paradigm effectively discriminates against important approaches to health and wellness based on the humanities.
Their answers include an examination of what learning might help here, being honest about the current failings, admitting that there is a conceptual problem in medical education and practice which needs reform, and integrating training throughout the GP curriculum.
I believe that looking after the patient in a holistic person-centred way must include recognising and attending to spiritual dimensions, if that is what the patient wishes. This is not at all easy in an NHS in which there are great pressures on GP time and on GPs’ own internal resources. However, extension of Chaplaincy and other providers may help here. There is a current move in primary care towards social prescribing; spiritual care could be an interesting and valuable exemplar of this. As well as this, the answer may lie not just in reform of GP training, but in better support and more time for GPs to explore, through supported self-reflection, their own needs for spirituality and meaning in life. The Finnish philosopher Frank Martela has written extensively about meaning. Meaning in life, he suggests, is about making yourself meaningful to others in a way that gives your own life purpose. We should be grateful to Dr Appleby, Prof Swinton and their colleagues for having started the debate.
Professor John Gillies
Dr John Gillies is an Edinburgh graduate who has worked in Malawi and as a general practitioner in rural Scotland, latterly in Selkirk for 16 years. He has been an undergraduate tutor, a GP educational supervisor and a training programme director with NHS Education Scotland.
3 February 2020