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Journal of The Association of Physicians of India ■ Vol. 64 ■ June 2016
Point of View
Healthcare Transition and Spiritual Health
Dipak Shukla1, Kaustubhi Shukla2
Background
H
ealthcare across the world is
undergoing a sea change. We
have witnessed this change in thrust
from primary care settings to high-end
tertiary care settings, from subjective
clinical acumen based diagnosis to
empirically supported lab. Medicine
based diagnosis, from general surgical
interventions to high end minimally
invasive or robotic surgeries, from
personal-clinic based consultation
and patient care to big, institutionalbased health care delivery, from low
cost (affordable) health care to cost
intensive “Managed Health Care”,
from countryside healthcare delivery to
metro centric health care delivery, and
many more.
Present Scenario
This paradigm shift in health care
delivery has significantly affected all the
stake holders of health planning and
management in India. In this state of
health care transition and availability
of huge information to patients, there
is an increasing trend to access quality
health care institutions. Those having
compromised affordability approach
public sector hospitals but population
having matching affordability prefers
private sector- quality institutions. It has
helped in the growth of health insurance
sector also.
Planners and promoters of healthcare
facilities have convincing data of
community healthcare requirements
and available facilities.1 On account of
convincing data in this regard, country
has witnessed boom in the health care
facilities of private sector. It is also on
account of limited budget allocation
to health sector by public sector
regulators. However, governments
have evolved a system of Public-PrivatePartnership (PPP), in identified areas,
to serve increasing patient load, in
many clinical specialities.
Analysis of Present
Healthcare Scenario
These changes in healthcare sector
have also affected the attitude of all
stakeholders of this sector. Patients
are more demanding, probing and
quality conscious. Doctors have
become more system-centric, legally
and commercially conscious. Majority
health care institutions (in private
sector) have evolved corporate work
culture in health sector which has
shaped them into cost conscious, profitconscious, work-discipline conscious,
protocol and quality sensitive settings;
transforming the doctor-patient
relationship into provider-customer
relationship. This situational shift in
doctor-patient relationship has invited
many conflicts and contradictions also,
which has created the need to review
medical education, attitude of doctors,
attitude of patients, health facility
planning, institutional care of patients,
work-culture of health care institutions
and doctor-patient relationship.2
Hence circumstantially, patients
believe that today’s health care
is not limited to patient care but is
also influenced by the market forces,
affecting health care institutions.
Therefore they have become increasing
suspicious about diagnostic and medical
prescriptions and doctors approach
to patient care. It has also affected
doctor’s professional attitude and their
relationship with patients. There
appears to be a value system shift.
Role of Spiritual Health in
Healthcare
The special group of the WHO
executive board in 1998, proposed
that the preamble of the constitution
should be amended as- “Health is a
dynamic state of complete physical,
mental, spiritual and social wellbeing
and not merely the absence of disease
or infirmity”. Similar elaboration of
spiritual health has been included in the
medical text books of India.6
After this development, Spiritual
Health is very well considered as the
4th dimension of health. Many more
attempts have been put to crystallize
its definition and components, for
developing learning modules and
health care interventions.12 Spiritual
Health is now an evolving, scientific
approach for changing the perspective
of clinicians, in modifying the
management approach. Many studies
have been conducted in different
parts of the world to include Spiritual
Health in the medical education 14
and assessing the attitude of clinical
experts for absorbing spiritual health
approaches, in managing their patients.9
Such studies have been conducted in
India also, for developing effective
health care interventions.4 Therefore
it may be documented that multicentric, multi-fold, comprehensive
efforts are being made, in India as well
as other parts of the world to define and
explore spiritual health for its teaching,
training and application modules.11,13 It
is on this account that spiritual health
has been integrated in the clinical
approaches, in USA as- “Mind Body
Medicine”, under the broad umbrella
1
Director (Operations), Pushpawati Singhania Research Institute, New-Delhi; 2Clinical Psychologist, Pushpawati
Singhania Research Institute, New-Delhi
Received: 23.12.2015; Accepted: 23.03.2016
Journal of The Association of Physicians of India ■ Vol. 64 ■ June 2016
of “Internal Medicine”. Mayo clinic,
cleavlands clinic and many leading
health care institutions of USA have
the well established dept. of ‘MindBody Medicine”. Spiritual Health is a
part of medical study curricula of more
89 medical schools of USA. 7 All these
facts reveal that Spiritual Health
is now increasingly considered in
existing health care approaches and has
a great promise in developing valuebased, patient-friendly, cohesive
work culture in health care settings.
‘Spiritual Counselling’ is one new
emerging tool in patient-care, in many
health care organizations, including
India. It is a structured approach in
OPD as well as IPD care of patients.
to overcome the present gaps in Health
Care delivery and education. However,
it is yet to be seen mat how much time
it will take for all the stake holders of
health care planning, education and
delivery to integrate Spiritual Health as
an compliment to the existing system.
References
1.
Mckinsey and Co. Report; Oct. 2002 on
Health care status and needs in India.
2.
Dhar Neeia and Nandan Deoki, editorial
note on “Spiritual Health In Public Health
System of India- Need for Integration”.
News letter-National Institute of Health
and Family Welfare; Vol: X No. 2, April-June
2008.
3.
Conclusion
It may therefore be concluded
that challenges and deficiencies of
existing health care system and medical
education are evident to all its stake
holders. On account of realization
for course-correction and developing
desired value system, many efforts
are being made. Integration of Spiritual
Health in medical education and in
clinical approach to patient care, is one
of such efforts.3 In the light of ongoing
researches, across the world and active
participation of health care professionals
and institutions in assessing spiritual
health modules indicates great promise
4.
5.
“Spirituality In Health Care” -Perspectives;
Compilation of the lectures delivered at the
International conference on -”Spirituality in
Health Care”, organized by the Department
of counselling, Sri Sathya Sai Institute of
Higher Medical Sciences, Bangalore; 24
th
– 25th Oct 2009.
“Value of Spiritual Dimension in Health
care system of Chandigarh, Union territory.”
Indian Journal of Community Medicine Vol.
31 No. 4 (2006-10-2006-12).
Neera Dhar and S K Chaturvedi- “Spiritual
Health Scale” a Report published in year
2011 by National Institute of Health and
Family Welfere, New Delhi-110067 as
NIHFWSHS2011
6.
Park’s textbook of Preventive and social
Medicine, 22nd Vol. Chapter-2.
7.
“Mind Body Medicine in United States:
A Mayo Clinic Perspective”. Notes from
the Lecture of Dr. Kavita Prasad, Dept. of
67
Internal Medicine, Mayo Clinic, Rochester,
MN, USA. In International conference,
Whitefield (Bangalore) -”Spirituality In
Health Care”; 24th -25th Oct 2009
8.
Mckinsey and Co. report on “Road Map for
Health Care in India”. A report submitted
by Mckinsey and Co. to the National Health
Committee of Confederation of Indian
Industries (CII), Oct 2002, Delhi.
9.
Michael B King*l and Harold G Koenig2;
Review-”ConceptuaIising spirituality
for mealcal research and health service
provision”; BMC Health Services Research
2009,9:116 doi:10.118671472-6963-9-116;
published: 13 July 2009
10. “Man Management- A Value Based
Management Perspective”, book published
by Sri Sathya Sai Students and Staff Welfere
Society; Aug, 2009 edition, Chapter 1, 3,
28-39.
11. Katherine Gergen Narnett and Auguste
H Fortin- “Spirituality and Medicine- A
workshop for Medical Students and
Residents”. J Gen Intern Med 2006; 21:481485.
12. Christina M. Puchalski MD, MS- “The role of
spirituality In health care”, Proc (Bayl Univ
Med Cent). 2001; 14:352-357.
13. Darpan Kaur, Mohinder Singh and Shaunak
Ajinkya- “Spirituality and Religion In
Modern Medicine”. Indian J of Psychological
Med 2012; 34:399-402.
14. Giancarlo Lucchetti, Allessandra Lamas
GraneroLucchetti, Deniele Corcioli Mendes
Espinha, Leandro Romani de Oliveria,
Jose Roberto Leite and Harold G Koenig”Sptritualhy and health In the curricula of
medical schools in Brazil”; BMC Medical
Education 2012, 12:78 doi:10.11867 14726920-12-78, published- 18th August 2012