When I began medical school 40 years ago, I was worried that while I loved the beauty of anatomy, and the wonderful orchestration that underlies how our bodies work, and the amazing chemical engineering achieved by our livers and kidneys, I was losing the forest for the trees. And, to me, the “forest” was the people who are occasionally known as “patients.”
To counter the reductionism of the first two years of medical school, I applied to and was accepted into a 12-month chaplaincy training program. I had no notion of becoming a minister or priest but I did understand that the spiritual domain of health was important to many people and that the year away would give me a focus to explore what I could bring to my patients as a doctor and a person.
Once accepted I then had to get permission from the dean of students to take a leave from my studies; after I laid out my plan and the rationale behind it he replied, “Well, you might be the dumbest student we’ve ever had, or the wisest. Time will tell. You have my blessing to try this.”
That year was a formative experience and one I hope impacts the care I provide patients to this day.
After a career as a family doctor and then a long detour into leadership in several roles, including in the former Fairview Medical Group, I did a late career fellowship in palliative and hospice medicine. I’ve worked since 2020 as a full-time palliative care doctor in the MHealth Fairview system. As a palliative care doctor I work with patients and their families with serious, life limiting illnesses. I seek to ease their suffering whether it is physical, emotional or spiritual. By its nature palliative medicine is interdisciplinary and on our team are a group of talented clinical social workers, chaplains, advanced practice providers and doctors.
In my leadership roles at Fairview I was responsible for managing my budget and I was blessed with a strong leadership team that would often tell me when they thought I was getting close to or crossing “the stupid line” — making cuts in some areas that were too onerous or unjust or failing to make investments that would improve our quality or access to our teams. I’m not privy to the discussions that occurred with the recent staff cuts in the Spiritual Health area but it seems to me they crossed the stupid line.
M Health Fairview says that they don’t need a robust SH department because patients can turn to their own spiritual leaders. Really? Since the University of Minnesota sees itself as a regional referral center, how can we expect a patient’s pastor from outstate or Iowa or the Dakotas or western Wisconsin to be able to come to attend to them or their family? And not every pastor has the specialized training that our chaplains possess.
Even in the metro area it can be a burden for a pastor to come visit a patient getting care. When I had elective heart surgery at M Health St. John’s in Maplewood 17 months ago, I received a beautiful blessing from my pastor a few days before my surgery and then on the morning of my surgery a staff chaplain was there to offer a prayer for my wife and me. There is no way my pastor, a mother of two small children, could have been at St. John’s at 6:30 that morning. A skilled and compassionate chaplain named Jessica was there and then a couple of days later she was present to celebrate the success of my surgery and recovery.
M Health Fairview leadership also seems ignorant that about 30% of adults in the U.S. don’t have a religious affiliation or don’t consider themselves to be part of a “church.” They often tell me they are “spiritual but not religious.” And many tell me their connection to their church shrunk during COVID lockdowns and they’ve struggled to reconnect and so they might not know their pastor very well. These patients don’t have someone to call on. For them, our staff chaplains may provide the spiritual comfort they desire or an ear to hear their fears that their illness or injury may be some kind of punishment. Our chaplains often are the staff who have time to “just listen” as people sort out their new reality when faced with new diagnoses or a bad prognosis.
I’ve also spoken to many families who are religious and can’t routinely visit their relatives who readily accept my invitation that someone from the SH team will stop outside their room and offer silent prayer. Since the chaplains are well known I often see them make their rounds stopping outside one ICU room after another and often with other staff stopping to join them.
Fairview leadership also suggests that there isn’t a need for chaplains to comfort and minister to hospital staff. After all, they explain, they offer a robust Employee Assistance Program (EAP). I’m not here to knock EAP programs — I’ve used them several times, but I’ve never seen an EAP person in the break room or nurse’s station immediately after a bad outcome or tragedy while I’ve often seen chaplains right in the thick of that misery — comforting and supporting teams so they can go care for the next patient and then the next one and the next one.
Since the murder of George Floyd, Fairview has made a lot of investments and gotten a lot of good press for their diversity, equity and inclusion efforts. It is nothing short of a tragedy that with their proposed cuts they plan to lay off their Muslim chaplains and others who have been important cultural brokers for many patients and clinical teams.
The deep cuts that M Health Fairview leadership is making in its Spiritual Health department are deplorable and I suspect were made without understanding the interdependencies that exist across its complicated system.
One trait of good leaders is to acknowledge when they’ve made a mistake and correct course in open and transparent ways. This approach fosters trust across their organizations — even in difficult and challenging times. The leaders at M Health Fairview need to reframe how they see spiritual health — not as a “cost center” to be managed and slashed when needed, but as a unique asset that is valued by those they care for and their staff.
Patrick Herson, M.D., is the medical director for Palliative Care at M Health Fairview. He is employed by UMPhysicians; these thoughts are his own and don’t represent UMPhysicians or anyone else.