By Julian Lim and Cheong Pak Yean
We often talk about the biopsychosocial model of care. Perhaps we should add a spiritual component to the equation as well!
To Comfort Always
A mother was overwhelmed when told that her child, born with inoperable complex heart deformities, would not survive infancy. Yet the family doctor did not refuse to provide the infant with routine vaccinations and developmental assessment. The day came when the infant was brought in dead to the clinic. The doctor performed a brief resuscitation, lest the mother blame herself for not bringing the child earlier. An umbrella was then used to shelter the deceased child to the ambulance as the superstitious believe that the soul would otherwise wander to the open sky. This doctor attended to more than the child alone.
——-Dr Julian Lim
Witch Doctor
A man inflicted with recurrent gouty arthritis was unshakeable in his belief that it was caused by datuk, the malevolent earth spirits he had stepped on, and refused medication. He only agreed to take allopurinol when the doctor convinced him that the pill when taken daily was the magic talisman that would prevent those spirits from intruding. The man did not have anymore gouty attacks!
——A/Prof Cheong Pak Yean
Commentary
At times, doctors deal with paranormal phenomena. Patients may report seeing ghosts in their homes and even hear ghosts talking to them. Relatives may be “demon-possessed”, hexed by black magic. If there are manifestations of psychiatric illnesses, referrals to psychiatrists should be promptly made. Sometimes though, these may be spiritual or cultural problems of living, and not psychiatric in nature. One example is a wife insisting that her straying husband is possessed by black magic cast by the other woman.
The medical students who drew the picture were so impressed by My all-powerful GP attending to one such patient that they bestowed upon him a super-hero costume, a glowing halo, and a medical mace. Skills to handle such situations are not specifically taught in medical school. It requires understanding of the culture, religion, superstition, and beliefs of the patient, a strong therapeutic alliance, and an ability to think and act out of the box and from experience.
Respect for the patient’s worldview is of utmost importance, while also focusing on the therapeutic objective. The distraught mother in the first vignette is given hope so that she remains grounded to continue caring for the child. Many parents blame themselves for bringing a malformed child into the world and doctors can help alleviate this guilt. In the second vignette, the medical priority is that the patient takes the allopurinol.
Beyond the biomedical and psychological, patients at times do consult their family physicians on problems of living that may be spiritual and even paranormal in nature. The compleat family physician attends.
—— Dr Julian Lim
Dr Cheong Pak Yean is an internal/family physician and psychotherapist. He is an SMA Honorary Member, past president SMA, College and adjunct associate professor of NUS. His current interest is in medical communication and humanities.
Dr Julian Lim is in private practice. He actively teaches in the College graduate diploma and fellowship programmes and is the long-suffering and longest-serving past director of the College Master of Medicine programme.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes commentaries based on the pictures.
