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In this episode, we sit down with John T. James, a patient safety advocate, to discuss the intersection of spirituality and health care. We delve into John’s personal experiences with loss and how they shaped his understanding of Christianity’s role in coping with medical setbacks. We also explore the importance of community and support in times of medical crisis, as well as how clinicians can incorporate spirituality into patient care. Join us for an insightful conversation on the vital role of spiritual care in health care.

John T. James is a patient safety advocate.

He shares his story and discusses his KevinMD article, “Healing through love and spirituality.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome John James. He is a patient safety advocate. His KevinMD article is titled “Healing through love and spirituality.” John, welcome to the show.

John T. James: Thank you, Dr. Pho. Thank you for inviting me to do this.

Kevin Pho: We’ll get into the article a little bit, but first off, just briefly share your story and journey to where you are today.

John T. James: OK, thank you. I’m a scientist, a medical scientist, and a Christian mystic, which makes me a little strange, so I’ll talk about the two tracks that flow from my story. I was a scientist from a very young age. I was intrigued with astronomy and decided early on, probably by the time I was a fifth or sixth grader, that I wanted to be an astronomer. I pursued that through college, and then got a master’s degree at UVA and enjoyed some really neat astronomy experiences.

So I got a job at NASA in Houston, and it was a great time. NASA was moving out with a lot of things. The shuttle was new, and we were starting to think about going to Mars, which we’re still thinking about. But my responsibility was to make sure air and water quality standards were up to snuff, and there I also began to work with a lot of MDs and get a sense of what they were like and what they were about.

So fast forward a little bit. In 2000, my son had turned 17, and we began to run together and do a lot of things. And this is the worldly side, by the way, of who I am, the medical scientist. Anyway, I really had a seminal experience with medical science in 2002. He died while running on his college campus, and when I looked at the care he received in the five days before he went back to running, I realized mistakes had been made. I used my pathology experience to tease those out, and I wrote a book called A Sea of Broken Hearts: Patient Rights in a Dangerous, Profit-Driven Health Care System, which, as you might imagine, didn’t make some doctors happy. But I had some doctors back me up too. Yeah, they said it needed fixing.

Anyway, I became a patient safety activist. As part of this, I started reading major medical journals. At NASA, I could get into the library, and I could get JAMA, and I could get the New England Journal of Medicine, Annals of Internal Medicine, and what was then Archives of Internal Medicine, and look at those journals and find articles I could adapt for reading by non-experts. I started Patient Safety America in 2008 specifically to be able to do that, and I’ve got maybe about six or seven hundred followers now that I send my monthly newsletters to.

But what I also found as I was going through the medical journals and scanning them, at least, is that the issue of physician burnout was growing, and certainly in the days of the pandemic, that phenomenon got even worse. My sense is that we really haven’t recovered from that.

In 2013, I wrote a seminal article in JPS, the Journal of Patient Safety, in which I made an estimate, based on what little credible data there were, that about 4,000, 400,000 people, I’m sorry, die prematurely each year because of mistakes made in hospitals. Not necessarily that they died in the hospital, but that something they did or didn’t do during hospitalization caused a premature death. In 2019, I published an article in BMJ Open that dealt with what patients want to know when they’re facing the possibility of an invasive procedure while hospitalized, and it turned up a lot of things that patients are never given in terms of information before an invasive procedure is recommended to them. I became an advocate for shared decision-making, hard over.

So that’s my journey as a worldly person, dealing with stuff on the surface, fixing things, and so on, what broke, and all that. Now I want to go into my faith journey. I’m going to fast forward through a lot of years of being kind of a nominal Christian, in and out of the faith for a while, testing this, testing that. But as you might imagine, in 2002, when my son died, I really had a catharsis about my faith. I’d been taught that God was omnipotent and could control things, all things on Earth. And after he died, even though there were hundreds of prayers at least for his survival, including my own, and I had prayed “God’s will be done,” well, God’s will, in my opinion, was not done. For about three weeks I was livid. I was burning.

And then I began to realize, yeah, God was there all along, in this response that scores of people gave to me and my family while my son was dying. They drove three and a half hours to be with us, and they stayed with us till the end. And then once we were back in my home church, they really loved on us. So there was God’s will, not in fixing my son.

The spring after he died, I had a seminal experience in the cemetery where he’s buried. I hesitate to try to characterize it with words, but remember, at this point I’m still kind of a worldly person. I’m not spiritual. But by golly, I had a Holy Spirit experience that was beyond words to describe, and that turned me around. That made me realize, OK, I’m going to be in the world, but I can be not of the world. I can be a spiritual person.

And what I realized is those two things run on separate rails, but the connection between the two is that my spirituality drives what I do in the world. And that’s what I would say to physicians too: To the extent that you can be spiritual and get in tune with the spirituality in your patients, you will be more of a healer to them than you would otherwise be if it were just a worldly fix of their heart arrhythmia or so on.

And so I might want to say what impelled me to write the article. I had a friend in my Sunday school class who had been on, I could tell, a downhill track over the last couple of years. He’d have an arrhythmia, they’d fix it, he’d have another, and they’d fix it, back and forth. I thought, yeah, this guy, who’s a good bit younger than me, is headed for trouble. And sure enough, his heart failed. Through all of this, David, whose name I use in the article, but it’s not really his name, was a person of deep faith. He really carried a positive attitude all the way till the end. When I wrote the article, he was still struggling, waiting for a heart transplant, as he had been for several months.

I thought, OK, so that’s spirituality working on the patient’s side. Now what about on the physician side? I looked at the AMA site, and lo and behold, there was a piece in there called “Training Physicians as Healers,” and this was about spiritually training them. They emphasized the importance of physicians somehow getting spiritually in touch with their patients. My wife has friends who say that when they were facing a serious crisis in their health care, their physician prayed with them. It doesn’t mean that you have to be the same faith as the patient, I think, but just to acknowledge their spiritual needs and, if necessary, get help. And there is a platform that offers spiritual assessments that physicians might give to patients to see where they are, and if they’re struggling with their illness, and so on.

Anyway, a brief background to this, I guess, is that I wrote a book recently called Response Theology: Agape Love Powered by Holy Spirit. I used that presentation of my theology, which really took about 20 years after my son’s death to fully mature, to say, first of all, I think the Christian church needs some course corrections, and secondly, that there is a basis, through spiritual wellness, on which a lot of religions can be connected. They need to be. They’ve all got their worldly ideas about the way things are, but spiritually, I think a lot of world religions are connected to the idea of healing.

And finally, I might add, in 2018 I listened to a lecture by Dr. Victor Montori, who’s now at Mayo Clinic, and I think he’s pretty well known. He wrote a book called Why We Revolt, and I thought, OK, I used it in my book Response Theology; I’m going to use it here too. And so I briefly told the story. He’s in Peru. He’s a young doctor, he’s on a ward where a lot of women are, and one young woman is dying. He called her Amanda, and he held her. I would suggest you read that book, that story. If that doesn’t get you, nothing will. So she’s dying right as he holds her, and then once she’s dead, he asks the question, “Did she feel love?” That’s the important question. That’s the important question, I think, for physicians, for all of us, in our relationships with other people: Do they feel the love that I have for them?

And before I forget it and run my mouth too much, I want to say what agape love means. Agape is the Greek word for love used in a lot of the New Testament, and it’s used as the fruit of the Spirit. It’s the first fruit of the Spirit, agape love, and the Apostle John says that God is agape love. Now, what does agape mean? Love is almost meaningless in English, but in Greek, agape means unconditional, sacrificial, selfless love. Now, that is tough. That is tough to deliver in your human relationships, I think, for people, but that’s what I think physicians are called to try to do, as best they can, in the setting of the hospital, or even in the clinic.

Kevin Pho: From your perspective as a patient safety advocate, what are some ways that physicians can incorporate spirituality into that patient encounter?

John T. James: I think perhaps the first step, and I learned this interacting with physicians at something called the Health Professions Educator Summer Symposium, where we patient advocates work with doctors and nurses and so on, and we had one summer session on reflection. The emphasis was reflecting on how your care has been, not only technically or in a worldly sense, but spiritually. So I would say to doctors, try to find time, a little time, and I know time is precious, to reflect. Did you do this patient right in a worldly sense, that is, physical healing? And did you miss a chance for some spiritual healing with this patient?

As I said earlier, I’m a proponent of shared decision-making. I actually got that to happen with an orthopedic surgeon who was going to do a laminectomy on me. We had 50 minutes of discussion, and I sort of directed it around shared decision-making questions I wanted to know, and he was very forthright in answering them. So shared decision-making, I think, is a chance to get spiritually connected with your patients.

Kevin Pho: What are some sample questions, for physicians or patients, to kind of inject more of a spiritual component?

John T. James: Well, the first question is, “What are my choices?” And you’ve got to be careful asking that of a surgeon, you know, because they’re going to be biased towards surgery. I’d been through physical therapy, and I was pretty sure, after looking through the medical literature and all, that the next step was some kind of laminectomy or something, and so he showed me on the MRI.

But I think the precious thing that enables some spirituality is time. He took 50 minutes, five-zero, not 15, and really answered my questions, and I knew him personally when it was over. He was a runner, and he was willing to be a little bit vulnerable and talk about his career, and how he used to work at Johns Hopkins and all that, and why he came to Houston to be a physician. I just felt like he was opening up, and that’s the basis for a spiritual connection, to be open that way.

So there again, I know time is a curse, if you will, in medicine, but if you can do it, do it. And tell your administrators, “I want more time with my patients, and you figure out how to keep the profits, because I don’t want to be a part of it.” I know that’s ideal.

Kevin Pho: But tell us a story from the patient perspective about how spirituality can move the needle when it comes to patient care.

John T. James: OK, this is thirdhand, but I got it from my wife, who got it from one of her good friends whose husband had to have coronary artery bypass surgery. She is a very devout Catholic, as is he. It turned out that when my wife’s friend’s husband had his bypass surgery, they had to replace six arteries, and he was touch-and-go with life for at least a month and a half. There were a lot of prayers for him, of course, but I know that his wife told the stories of spiritual connections with his surgeons and his other doctors that were bringing him through all the setbacks and the challenges of his unexpectedly large surgery. And in the end, he’s come out alive, changed, but well. So there was the spiritual platform there.

Kevin Pho: We’re talking to John James. He’s a patient safety advocate. His KevinMD article is titled “Healing through love and spirituality.” John, tell us some of your take-home messages that you want to leave with the KevinMD audience.

John T. James: I think there’s a couple of take-home messages for physicians. I’ve already alluded to pushing back against administrators who worship, and I hate to use that word, worship, profits rather than the patient’s needs. I see a lot more profit motive in hospitals and nursing homes coming along, and in hospice care, and that worries me. Anyway, try to push back on the profit motive if it’s really compromising your ability to have contact with patients.

The other thing I would say to physicians and clinicians is, don’t abide a dangerous colleague. I live in Texas, and I’m sure many of your listeners know about the Dr. Duntsch story. As I understand it, his colleagues knew he was a danger to his patients, but there wasn’t a good way to make that known until he had harmed a whole lot of people, and somehow that’s got to not happen. And so I would plead with doctors: If they know something’s going on that presents a danger to their patients, they need to act on it. It may take a lot of courage to do that, and I would say spiritual courage. The idea of the Holy Spirit in Christianity is counsel and power, and that power means that you don’t worry about yourself. You go ahead and do what you find needs to be done to foster justice.

Kevin Pho: John, thank you so much for sharing your time and insight. Thanks again for being on the show.

John T. James: Yeah, thank you, Dr. Pho. It’s nice to meet you, by the way.

Kevin Pho: It’s nice meeting you as well. Thank you.