The Rev. Dr. Mark LaRocca-Pitts on a model for chaplains working with local clergy

The Chaplain As Hospitalist

A new metaphor is available that communicates well the role and work of chaplains to healthcare professionals and that also sheds light on a problematic nexus facing the provision of spiritual care. This new metaphor is the “hospitalist."

Since Wachter and Goldman first coined the term “hospitalist”in 1996 [1], the hospitalist movement has grown significantly. Supported by research that proves the financial and medical benefits of using hospitalists [2], most healthcare systems now have hospitalists on staff. [3] Hospitalists are physicians, usually Internists, who are hospital-based and whose primary focus is managing the general medical care of inpatients. As opposed to primary care physicians (PCP), who are primarily office-based, hospitalists spend all of their time in the hospital. As a result, hospitalists provide a continuum of care from admission to discharge, and are available 24/7 for emergent care and for consultations. Hospitalists, due to continuous involvement in a variety of hospital-based conditions, are better equipped than PCPs to manage many medical conditions. Finally, as staff members, hospitalists provide teaching, research, and leadership within the hospital. When it comes to providing overall medical care for inpatients and leadership within the hospital context, the hospitalist program is exceptional. [4]

“Hospitalist”as a metaphor for chaplains communicates well with other healthcare professionals whose preconceived notions of chaplains may be influenced by parish-based models, or on chaplains as “harbingers of death.”As a metaphor, the hospitalist compares to the PCP as the chaplain compares to local clergy.[5] That is, among clergy, the chaplain is the “hospitalist.”For example, chaplains are thoroughly and specifically trained in hospital-based interventions. [6]  Unlike many local pastors, the in-house chaplain is available 24/7 for emergent care and for consultations and provides a continuum of spiritual care from admission through discharge. Chaplains, as healthcare insiders, can advocate effectively for the patients’needs. Chaplains understand the spiritual effects of hospitalization in general and many medical conditions in particular. Finally, chaplains, like hospitalists, provide teaching, research, and leadership within the hospital. When it comes to providing overall spiritual care for inpatients and leadership within the hospital context, chaplains are exceptional. [7]

Problems encountered by the hospitalist movement are also informative for professional chaplaincy. For example, upon admission and discharge medical care is transferred between the PCP and the hospitalist. Patients dislike this transfer and the continuum of care may be disrupted. Education concerning the benefits of hospitalists helps facilitate this transfer of care, and good communication between hospitalists and PCPs insures a continuum of professional care. [8]

Complete transfer of spiritual care from local pastor to chaplain will never become standard practice, although it does occur in special circumstances, e.g., when local clergy are unavailable or in an emerging crisis. Yet, the hospitalist metaphor invites us to examine intentionally how spiritual care is shared among chaplains and local clergy. Formalizing and communicating a confidential and effective transfer or sharing of spiritual care will be difficult, but the hospitalist movement provides models that will help.

In summary, using “hospitalist”as a metaphor to describe chaplains has advantages and disadvantages. Within the context and culture of healthcare it is advantageous in providing a clinically based metaphor accessible to healthcare providers. Within the context and culture of faith communities, however, its disadvantage rests in suggesting a transfer of spiritual care between providers. Regardless of this disadvantage, the “hospitalist”metaphor highlights a problematic nexus where authorities, responsibilities and accountabilities overlap among spiritual care providers. Naming and examining this nexus can only enhance the overall provision of spiritual care.

[1] RM Wachter, L Goldman, “The emerging role of ‘hospitalists’in the American health care system,” New England Journal of Medicine 335 (1996): 514-517.
[2] AN Amin, “Identifying strategies to improve outcomes and reduce costs—a role for the hospitalist,”Current Opinion in Pulmonary Medicine 10 (Nov. 2004): Suppl:S19-22; V Parekh, S Saint, S Furney, S Kaufman, L McMahon, “What effect does inpatient physician specialty and experience have on clinical outcomes and resource utilization on a general medical service?”Journal of General Internal Medicine 19, 5.1 (May 2004): 395-401; RM Wachter, L Goldman, “The hospitalist movement 5 years later,”JAMA 287, 4 (Jan 23/30 2002): 487-494.
[3] P. Basaviah, L Goldman, “A new doctor in the house: Hospital medicine in the United States,”Schweizerische Arztezeitung 83, Nr39 (2002): 2045-2051; JL Exline, S Topping, C Baxter, “CEO's perceptions of hospitalists: diffusion of the Strategy,” Hospital Topics  82, 1 (Winter 2004):18-24.
[4] For a good overview of the Hospitalist Movement, see the Society of Hospital Medicine homepage at http://www.naiponline.org/presentation/default.asp?area=faqs&po=0#8.
[5] The author first used this metaphor in an interview with VHA. See, AF Victor, “Like a prayer,”Alliance (October 2004): 18-20.
[6] L Austin, “Hospitals are not houses of worship,”PlainViews 1, 18 (Oct. 20, 2004): http://www.plainviews.org/AR/c/v1n18/er.html.
[7] M LaRocca-Pitts, “Walking the wards as a spiritual specialist,”Harvard Divinity Bulletin 32, 3 (Summer 2004): 20, 29.
[8] SZ Pantilat, A Alpers, RM Wachter, “A new doctor in the house: Ethical issues in hospitalist systems,”JAMA 282, 2 (1999): 171-174.

Do you have thoughts about professional practice you’d like to share with your colleagues? Send an e-mail info@PlainViews.org.

The Rev. John D. Emmart, M.Div., BCC, CEAP, SAP on seeing the sameness in each other

Desiring Diversity

What is ‘diversity’anyway? What does it mean to have a diverse house of worship or workforce? Chances are that if you were to take a survey, you would find the answers to these two questions as ‘diverse’as the people you survey. The Oxford Dictionary defines diversity as “the state of being varied or a range of different things.”This definition conjures up images of color, choices, options, or selections. Diversity defined this way brings to mind a Sunday brunch at a nice restaurant where you have a ‘diverse’array of foods of various richness, texture, taste and color. You find diversity in a library as you encounter a ‘diverse’selection of books varying in size, color, texture, age and style of writing.

Thinking of diversity in this way leaves us with positive images of which we see the benefits. But, do we view our house of worship or workplace diversity as a positive benefit? The fact is that most workplaces are becoming increasingly diverse, while our houses of worship remain fairly homogenous. People from different genders, races, ethnic origins, ages, cultures, family structures, and lifestyles find themselves working together, while we worship with people of the same likeness as us. Desiring diversity is not about being “politically correct”or “doing the right thing.”It’s about valuing and appreciating individual differences. Yet, when you value diversity an interesting things happens: you see more clearly the sameness in each other. Desiring diversity has a way of bringing about greater respect because of the uniqueness and commonality we share together. For the believer our commonality is two-dimensional. First as with all humanity we are made in the image of God, but secondly, for Christians, we share our commonality as Christians, in Christ. The Apostle Paul reminds us “There is neither Jew nor Greek, slave nor free, male nor female, for you are all one in Christ Jesus”(Galatians 3:28-NIV).

Desiring diversity in the workplace and in our house of worship leads to increased creativity. Some of the greatest accomplishments in civilization emerged when people of diverse backgrounds worked together and exchanged ideas. The Renaissance came out of the East meeting the West during the Crusades. America is known for its inventiveness and advancements due in large part to the diversity brought about being a nation of immigrants.

Desiring diversity means that we are willing to:

1.  Come to terms with our attitudes, beliefs, and expectations about others while gaining comfort with difference;
2.  Believe that diversity is big enough to include everyone –young and old, immigrant and native, black or white –and goes beyond race and gender;
3.  Recognize that past inequities are in the past and our focus should be in the present to reduce stereotypes and discrimination;
4.  Acknowledge that we human beings resist change and find comfort in and trust people most similar to ourselves.

Who wants to eat the same food everyday or read the same book? Desiring diversity works! Desiring diversity benefits you and works for all of us in our religious communities and in our workplaces.

The Rev. John D. Emmart’s experience includes working in the healthcare field for 20 years in the areas of employee assistance, pastoral care and social services. As the EAP Coordinator for Mercy Health System he provides direct EAP services including assessments, consultation, training and brief counseling to management and employees. His experience also includes working with management and employees in higher education, public school systems and manufacturing. He is particularly interested in grief and loss, conflict resolution, workplace diversity and stress management. John holds an undergraduate degree in Sociology, a master’s degree in Divinity, and a certificate in EAP services from University of Wisconsin-Milwaukee. Additionally, he has advanced training in Critical Incident Stress Debriefing and Management (CISD), and is a Substance Abuse Profession (SAP). His denominational affiliation is Cooperative Baptist Fellowship. Currently, he is completing a doctorate degree in counseling.

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

Education & Research

Spiritual Development

The Rev. William G. Kalaidjian on the light of knowledge from another's experience The Patient Was Under the Sheet In the afternoon, I visit patients who are facing surgery the next day. One time, I entered a patient’s room and found the patient completely under his bed sheet. I thought back on my time as a police officer, when a body covered over by a sheet was usually a D.O.A. (Dead On Arrival). I observed the motionless patient and said, “Mr. Jones, I am Chaplain Kalaidjian and I am visiting patients who have surgery scheduled for tomorrow. It says here you are to have your left leg amputated. How do you feel about that?” No response. I asked again, “Mr. Jones, how do you feel about having your leg amputated? Are you a diabetic?” Eight fingers appeared at the top edge of the sheet. The sheet was gradually lowered so that I could see first the top of the patient’s head, then his eyes. He said, “I have gone to church all my life and now I am going to lose my leg.” “Going to church,”I responded, “does not mean you will not lose your hair, your teeth, maybe your eyesight, or your leg. You go to church so you do not lose your soul. Are you a diabetic?” “Yes, I am,”he replied. “You have a family?”I asked. “I have a son who is a lawyer and a daughter who is a nurse,”he replied. “You know,”I said, “having your leg amputated will extend your longevity. You will be able to enjoy your son and daughter. You will live longer. By the way, in the next room is a patient I have been visiting for several weeks. He traveled down the same path you are going to travel. He had his leg amputated. He got around in a wheelchair for a time. He got his artificial, plastic limb. I watched him walk with his walker. He now walks with a cane and is planning on going home in a day or two. Would you like him to come visit you and tell you how it was for him when he faced his amputation like you are doing?” “Yes,”he replied, “I would love to speak with him.” “Let me see if he is in the next room,”I said, and went next door. The patient was there, sitting in a chair. I explained what I had just experienced with the first patient and asked if he would come speak to him and share his experience. This patient said, “I’d love to meet him. Maybe I can help him. I wish I had someone to help me when I faced my surgery.” Together we went next door and I introduced the two patients. They shook hands and my patient thanked the other for coming and speaking. The other patient tapped his plastic leg with his cane and said, “Tomorrow, I am going home, and in due time I think I won’t need to use this cane either.” My patient sat up and listened to the other patient. After a while, he turned to me and said, “You know, Chaplain, with the help of God, I’m all ready for the surgery tomorrow. I was thinking about what I was losing, not what I was keeping!” Both patients smiled. They shook hands, and I offered a prayer for the medical profession, the doctors who treat the patients and do the surgery, and the therapists who get the patients back on their feet, or who train patients to handle a wheelchair. Patients can help patients to understand, and in that understanding, the patients are grateful for the chaplain who brought them together. They feel the light of knowledge from one another’s experience, and they feel the love of God offered through God’s servant, the chaplain. The visiting chaplain, the praying chaplain, the chaplain who can help the light of the world overcome the darkness of lying under a sheet. Yes, “With the help of God, I’m all ready for surgery tomorrow.” The Rev. William G. Kalaidjian is a graduate of Nyack Public Schools, a veteran, US Navy, WWII, Aerologist 3/c on staff of Admiral Rosenthal, Lakehurst, NJ. He graduated from Adelphi College in 1950 with a BA in Sociology and from Union Theological Seminary in May 1953 with a B.D. and M.Div., majoring in church and community. He was ordained a Congregational Minister (now UCC) in May 1953 and installed as pastor of The Bedford Park Congregational Church, where he served for 43 years. He was sworn in as a Protestant Police Chaplain in April of 1957 and served the police department for 41 years. Bill became an intermittent chaplain at the Bronx VA Medical Center in July of 1976 and part-time staff one year later. He is presently in his 30th year of service to the U.S. Government. Bill is the chaplain for two wards of spiral cord patients as well as being the organizer and founder of the Bronx VAMC Wheelchair Chorus. Do you have thoughts about spiritual development you’d like to share with your colleagues? Send an e-mail of any length to info@PlainViews.org.
EthicsWalk EthicsWalk addresses spiritual care as an ethical enterprise. It explores why relationships between spiritual care providers and those they serve need protection, and examines what that protection entails. PlainViews invites our readers to share their responses to each EthicsWalk column, which will be published in the following issue. If you’d like to respond to EthicsWalk, please send a comment of no more than 100 words. You can use the e-form below (click on "hearing from you," link) or submit your commentary to the editors in the body of an e-mail (or as a Microsoft Word attachment) sent to Info@PlainViews.org. Please put the phrase “EthicsWalk” in your subject line. We look forward to hearing from you. Examining Our Own Limits Establishing, tending, mending, navigating boundaries in the work of chaplaincy and spiritual care has been the focus of EthicsWalk the past nine months. Intentionality in the formation and maintenance of professional relationships is the crux of healthy boundaries. The healthy wholeness of the person(s) served is the focus. One’s own soul and psyche are nurtured through mature relationships with colleagues, friends, family and religious community. They provide the bedrock on which professional care can be provided with joy and committed abandon. This is possible only when the relationship is intentional and centered on the other’s needs rather than one’s own. Within the Christian tradition, Lent is a period of personal and communal reflection and, often, redirection. The self-examination Lent invites is not limited to Christianity (or to Lent!). The Days of Awe issue the same summons each autumn. Indeed, the discipline of every religious and spiritual tradition demands it. Whatever your tradition, this Lenten month discuss with a trusted colleague, mentoring, peer or CPE group these questions. Assess your understanding and practice of boundary issues as they apply to your work. Questions: How do you visualize a boundary (“limit”)?       A brick blockade (impenetrable)?       A picket fence (light shines through; can see other side)?       A barrier to intimacy?       A safe enclosure for intimacy? Why are there limits on personal or professional behavior?      From where do those limits come?      Are limits external, internal, eternal, temporal? Do the same limits apply to all people in the same situations?       What might be the exceptions to general limits?       How would you recognize those exceptions: for yourself, for another? What common good might a limit promote?      What harm might it obviate? What is the reason for a particular limit set by your faith tradition?      What would be consequences of its breach? What is the reason for a particular limit set by your program or employer?      What would be consequences of its breach? What is the reason for a particular limit you have set?      What would be consequences of its breach? “Limits”may be transgressed in relation to those whom the chaplain or spiritual care provider serves. They also may be transgressed with colleagues. Both are betrayals of trust. The former is betrayal of the needs of those vulnerable within a situation of differentiated power. The latter is betrayal of the expectations of colleagues to treat each other with decency and respect. In your discussion, share something you would not do in your work -- with those served or colleagues - - a boundary which for you is unconditional. What situation might challenge you to navigate this limit beyond your present practice? With whom would you discern the wisdom of the navigation? This marks the last meditation on the issue of boundaries unless readers pose specific questions or requests that it be raised anew. Future columns will address confidentiality, conflict resolution, and whatever else strikes the fancy of readers or the writer. Please be forthcoming with your suggestions! Anne Underwood has an undergraduate degree in religious studies, a master’s degree in rural sociology and a mid-life law degree obtained after working over a decade as a college administrator. She has mediated for the Maine family courts since 1983. Currently she serves as an advisor to the ethics commissions of ACPE, APC, the CCAR (Central Conference of American Rabbis), and NAJC, and consults with a variety of Protestant faith communities on issues of power, fair process, and congregational conflict management. Her articles on mediation and restorative justice have appeared in the ACPE News, The APC News and on the ACPE web site. Articles on clergy accountability and judicatory processes are published by the Alban Institute and The Journal on Religion and Abuse. A chapter, “Clergy Sexual Misconduct: A Justice Issue,” appears in Body and Soul: Rethinking Sexuality as Justice-Love, Marvin Ellison and Sylvia Thorson-Smith, editors, The Pilgrim Press, 2003.
Reviews Macky Alston reviews the film series Origin of Christianity Origin of Christianity Origin of Christianity, a compelling 10-episode series, is the most entertaining and substantive recent series we have viewed on early Christian history. The documentary series recounts the emergence of the religion between the years 30 AD and 150 AD, a historically obscure period. More than twenty international specialists in Christian history and literature examine the surviving New Testament texts that bear witness to the birth of this religion, primarily the Epistles of the Apostle Paul and the Book of Acts. Examination of these sacred texts is intercut with contemporary research regarding the origins of the Christian movement. This series brings to the forefront a range of existing questions and explores surprising hypotheses that will both entertain and inform pastoral caregivers who care for individuals of the Christian faith. The series takes the form of an international symposium that begins with the death of Jesus and follows the subsequent division of Christianity and Judaism. Experts including Pierre Geoltrain in Paris, who specializes in the history of Christianity and Moshe David Herr, a professor of Jewish History at the University of Jerusalem, Graham Stanton of the University