When Francis of Assisi founded the Franciscan order in 1209, his first work was tending to the physical and spiritual wounds of lepers.
Daniel P. Sulmasy, a Franciscan friar and a doctor of internal medicine at Johns Hopkins Hospital, wants to see the spiritual needs of the sick elevated to a key priority of modern medical care.
At the American Public Health Association's 118th annual meeting last week in New York, Sulmasy presented a study finding that the Hopkins medical staff generally failed to meet those needs in a sampling of 96 cases during August 1988 and June 1989.
"Not a single [medical] chart showed evidence that a patient's spiritual concerns were addressed. Since the focus was on the care of terminal patients, physicians have a responsibility to see that the patients' needs are considered, especially when they may be at the point of meeting their maker," Sulmasy, 34, said last week in his address to about 5,000 health practitioners, educators and policy-makers.
Doctors and nurses should uphold that responsibility, "even if they themselves don't have religious concerns," he said in a recent interview. "They should see if patients want a priest or a rabbi. On the charts we studied, we saw no evidence that that was done."
Known as "Doctor Sulmasy" in medical circles, "Brother Dan" in religious settings and -- Sulmasy says -- "usually just 'Dan' most of the time," the Flushing, N.Y., native initiated his study in 1988, a year after he joined the internal medicine staff at Hopkins. His goal was to do an ethics study that would be "concrete and constructive for the health staff here," he says.
He created an ethics course for the Hopkins medical school, in which the class analyzed the medical staff's behavior in the 96 cases and how it measured up to hospital policy, particularly in providing a minister or rabbi for a patient and clearly informing patients of all their medical options. In general, Sulmasy found, the staff's behavior fell short of stated standards.
As he said in his address last week, "People complain, 'I have no relationship with my doctor -- he doesn't seem to care about me as a person.' The interest in the person really needs to be rediscovered and reinstituted in the practice of medicine. . . . I think that's the heart of a lot of the current dissatisfaction in the American health-care system -- we do so much more technologically than spiritually."
Most of the 96 patients had terminal illnesses. One-third had malignancies, another third had AIDS and the rest had other life-threatening ailments, such as congestive heart failure.
The findings of the study have already been used in the ethics education program at Hopkins. And, despite the criticisms in his study, Sulmasy praises Hopkins for offering ethics training that constitutes about one-sixteenth of each student's course load in a semester.
"That's a significant chunk of time, and I know it's more than
most medical schools do," says Sulmasy, who was a pre-medical student at Cornell University in Ithaca, N.Y., and then earned his doctor of medicine degree in 1982 from Cornell University Medical College in New York. Currently he is a doctoral candidate in bio-ethics at Georgetown University in Washington.
He plans to repeat his study at Hopkins within a year or so, "to see if the situation gets better. The staff has admitted that medical ethics and meeting patients' spiritual needs are important concerns, and that their performance in those areas can be improved."
Sulmasy first experienced a religious calling as a senior at St. Anthony's Roman Catholic high school in Smithtown, Long Island. He determined that he would wait and see if the calling was still strong at the end of his four years at Cornell, a secular university "where religion would sort of be on the back burner," he explains.
Four years later, the calling was as powerful as ever. He decided to pursue it, along with a career in medicine.
"Being a friar is more a statement about who I am than it is a vocational choice, and being a physician is what I do ministerially as a friar," he says.
"Some friars teach, some work in soup kitchens. I hope to contribute to God's people as a doctor. I very much consider myself part of the Franciscan tradition of seeing the practice of medicine as a ministry."