The chaplain and the physician cross paths daily in the hospital's halls. Each one has an important role in the healing process, but their functions, although parallel, are seldom integrated. Dr. Harold Blake Walker describes this situation, and the fact that the physician has become the overwhelming authority in the healing process, thus: "Rarely do we question our need for the medical practitioner; frequently we question our need for the clergyman. Indeed, in our secular society, the physician and the psychiatrist have become substitutes for the priest." ¹

Several factors are responsible for this lack of meaningful communication. It is our experience that the main factor ap pears to be the absence of a standardized protocol.

Because of the nature of their training, chaplains and physicians relate to the problem from different perspectives. The chaplain looks for the areas of spiritual need that the patient may have. The physician looks for signs that, with the symptoms described by the patient, will help him to arrive at a working diagnosis.

Interestingly enough, when the physi cian does not find the objective signs that he would expect to be associated with the symptoms, he acknowledges the need for a psychiatric evaluation. He has been taught that when the symptoms shown by the patient are not validated by the objective evidences, the complaints pre sented by the patient are usually of a psy chosomatic nature. Ironically, the same subjective evidences that are used to jus tify the presence of the psychiatrist or psychologist are often turned around and used to reject the presence of a minister or chaplain.²

Bridging the gap

The increasing demands on the pastor to deepen his or her theological under standing and the growing fragmentation via specialization on the part of the physician are widening the chasm of commu nication between the two professions. Who should take the initiative to bridge this communication gap? Ideally, both professions should work at it. But as long as medicine is regarded as a science and theology as a philosophy, neither will likely take the initiative. Since the lack of understanding between the two makes it difficult for the patient to receive total healing, each professional should strive to understand the other's work.

One of the basic and most important steps the clergy can take in that direction is to become acquainted with the lan guage that is utilized by doctors and hos pital personnel to describe patients' con ditions. By learning the meaning of a few simple terms, they can reach out to bridge the gap that separates them from health professionals.

While different physicians and institu tions may give slightly different defini tions to the terms under discussion, a good starting point for developing under standing of hospital terminology may be found in the American Hospital Guide³ and the California Hospital Association Consent Manual.⁴ These books provide information that can help the clergy to design the context and duration of their visits to all patients

Definition of the patient's general condition

According to the Consent Manual, the condition of a patient is described by one of five basic words: good, fair, serious, critical, and deceased. Good indicates that vital signs are stable and within nor mal limits. The patient is conscious and comfortable. Indicators are excellent. Fair indicates that vital signs are stable and within normal limits. The patient is conscious but may be uncomfortable. In dicators are favorable. Serious indicates that vital signs may be unstable and not within normal limits. The patient is acutely ill. Indicators are questionable. Critical indicates that vital signs are unstable and not within normal limits. The patient may be unconscious. Indicators are unfavorable. Deceased: the an nouncement of death is not routinely made by the hospital. However, news of death can become public information af ter the family has been notified or after all reasonable efforts to notify them have been made. The hospital may, with or without consent, release information that is to appear on the death certificate. Because of the legal implications and the fact that the responsibility to inform the family is often part of the function of the doctor or the unit social worker pastors and chaplains need to have proper approval before notifying the fam ily of a death.

Suggested guidelines to be used in patient care

In developing the above chart, we have placed the American Hospital Guide's description of the patient's gen eral condition on the left side of the chart. To make the chart more compre hensive, we have also included the infor mation added by the Consent Manual. The chart provides basic psychological and medical information that can elimi nate the guessing game and apprehensiveness that come when one is not sure of the condition of the patient. Pertinent information related to abnormal psy chology, grief reaction, and psychiatric implications is also included.

The implications for spiritual care on the right side of the chart are the result of our years of father-son professional inter action as well as our experience and clin ical training.⁵ Gerry's participation in the clinical pastoral education program at Loma Linda University Medical Center, has given him opportunity to apply this material and thus has helped to vali date the practical value of the chart.

American Hospital Quide Terminology

The American Hospital Guide uses five main words to describe a patient's condition. Check with a nurse or social worker, if available, for relevant patient information (e.g., condition, religious persuasion, visitors, etc.) that can help you to design the length, content, and process of your visit (or read the chart).

American Hospital Guide Terminology: Implications for Spiritual Care in the Hospital Setting

1. Good

     a. condition excellent

The patient is usually accessible; his/her level of consciousness is good; his/her attention span may vary. You need to assess whether he is receptive to a visit arid whether spiritual talk/support is desirable.

b. indications within normal limits.

Length of visit is based mostly on patient's receptivity, alertness, and attention span. Unless special needs are expressed by the patient, do not prolong your visit beyond 5 or 10, minutes, especially when visitors are there. Include visitors in your interaction, but don't neglect the patient.

c. overall outlook stable.

Don't do all the reading and/or uplifting for the patient. Leave meaningful literature with him, or encourage him. to read a section from his own Bible/Mass book/prayer book and share his thoughts with you next time.

Note: Patients in good condition may reject your visit or challenge your faith. A sincere word of encouragement will neutralize animosity (e.g., "Don't mind my uniform/role; just see me as a person who is visiting you because I care").

2. Fair

a. fair condition

The patient usually allows a meaningful visit. He may express a desire to see his own spiritual leader. If so, make the necessary arrangement to satisfy his request (e.g., call his minister).

b. within normal limits

By observing the patient's facial expression and speech you can form an idea of his affect (feeling tone) and determine whether or not it is stable. Conversation and reading should be determined by his condition and availability (e.g., is not sleepy, anxious, or in pain, is receptive, etc.)

c. patient conscious; may be limits

Assess level of consciousness (arousal); patient needs toh^ve awareness of self andenvironment for the pastor/chaplain to initiate a meaningful and : therapeutic interaction. Patient's ability to talk accurately and lucidly about people and surrounding environment, the time of day, etc., indicates a good level of consciousness, orientation, and memory. He is usually accessible, but attention span may be limited.

3. Serious

a. not within normal limits

The patient's level of consciousness needs to be established to decide the extent and content of your visit. If level of consciousness is cloudy or confused or if patient is In pain, limit your visit; but make every word count (i.e., know/feel what you are saying). Always include the visitors in your conversation and prayer.

b. unstable

If the patient is accessible, limit your conversation to specifics, and be encouraging. Prayer should be brief and "leading" (provide for a positive attitude so die patient will put his "will to live" to work).

c. condtion questionable and uncomfortable 

Your visit should be anxiety-reducing, as anxiety, stress, and fear intensity pain and discomfort. If visitors begin to share their fears,  invite them to the family room to provide them with an appropriate environment to vent their feelings and reduce their anxiety.

d. may be acutely

Be alert to intravenous fluid containers that are empty and disconnected or improperly connected equipment, and inform the nurse. Make sure that the nurse perceives you as one of his/her team, not as another interrupter or outsider. 

Critical

a. unstable

Care should be expressed by leaving your card, a note, etc., that, although it is addressed to the patient, the family will read. This will provide them with support and encouragement as they realize that someone cares personally.

b. unfavorable

The family will need your help to provide them with the assurance that the best is being done, that the staff is aware of the patient's condition, and that, in the final analysis, the good Lord is the healer and He knows what is best for the patient. If you pray with the family, present the life of the patient to the Lord and ask that the family may receive the strength and courage to go together through their moment of trial.

c. out of normal limits

If the patient's condition is life-threatening, try to make the rounds when the family is there. Help take pressure from the doctor and staff by helping the family to understand that doctors, nurses, and staff are the "the gloves on God's hands," and that we should pray that the outcome will be what is best for the patient.

d. life-threatening

If the patient's condition continues to deteriorate (or the patient dies), make sure you inform the social worker. This will facilitate your function, and, by working with him/her, you prevent the overlapping of services from becoming an invasion of his/her territory.

5. Deceased

Concentrate on the family, provide support, and help them through the gieving process by encouraging the expression of feelings. Don't interrupt, interpret, or analyze feelings.