medical ethics, and the existential realities of suffering, but I did not know how to find a patient's room. I did not know aneurism from angina.
Fortunately, I began my ministery as an Associate Pastor, and the Senior Pastor was very understanding in showing me around the hospital, introducing me to key personnel, and giving me a good outline of the do's and don't's of hospital visiting. The key to that first learning experience was finding the right information at the right time. I had to learn, and Russ Ayre, the Senior Pastor, gave me clear, practical information.
That was fifteen years ago. The teachable moments have continued. There was the first encounter with a sick child, the dying patient, the need to consult with a physician, the time it was necessary to help a patient get a second medical opinion. There was the move to the community with the university teaching hospital, and the continued need to understand new medical terms. Sometimes the information was easy to get in order to deal with these hospital situations. Sometimes it was not. I wanted a Hospital Handbook to provide practical information for those critical times in pastoral care.
Jim Wagner is the insider at the hospital, the director of pastoral care who is an expert on keeping people like me informed on what is going on in the hospital and how to relate to these developments. I am the outsider, the parish minister who is an expert on reminding the insiders that we need simple, practical assistance in keeping up with our role in patient care.
Lawrence D. Reimer
INTRODUCTION TO THE REVISED EDITION:
We are grateful for the opportunity to do a revised edition. In the four years since the Handbook was published, we have maintained a careful file of suggestions from users and reviewers, as well as new material which we believed would strengthen the book. The growing number of readers deserves the best we can offer and Morehouse-Barlow agreed.
One dimension of the revision is to update some of the rapid changes occurring in the health care field. Most of these are reflected in Chapter One, sometimes accomplished by changing a verb from future to present or past tense. The issue identified at the end of this chapter, making health care available to all persons, remains a central focus of debate in America.
New material is to be found in several places. Chapter Four has been expanded with additional prayers, scripture references, and an order for the administration of the sacramemt of Holy Communion in a hospital setting. Chapter Five is considerably lengthened by sections which focus on the adolescent as well as the AIDS patient. Admissions of adolescents to specialized centers for the treatment of substance abuse and psychiatric problems are increasing. Ministry to adolescents in these special facilities as well as general hospitals involves unique issues addressed here. As hospital admissions for AIDS patients increases, ministry to these patients and families is clearly an important new pastoral concern. We invite readers to contribute their perspectives on the usefulness of this material. Charles Williams, M.D., has expanded the Glossary and polished all of the definitions.
A new chapter focuses the subject of Medical Ethics. The reader will find a helpful introduction to most of the situations relevant to hospital ministry. Familiarity should enhance the pastor's usefulness. As is true with the other chapters, readings in the form of an annotated bibliography are found at the end.
The Handbook is an effort to add new construction to the bridge connecting the pastor and the hospital. We hope the result will be an easier path for the minister in delivering pastoral care to parishioners. If the book proves useful and fulfills its limited goals, the authors will feel gratified. We made the decision long ago that the effort was worth it, because we believe strongly in the value of spiritual care during illness and its place in the delivery of wholistic health care.
We also hope this book encourages further cooperation between chaplains and pastors. Either of our names could appear first in authorship as the contributions of each have been similar. A small section of this book addresses the appropriate need and probable benefit of more frequent collaboration, particularly in critical life events such as illness.
No single book is adequate, however, to prepare a minister for the specific concerns which might be experienced. This book is directed to those situations most commonly encountered. Even then, it provides a general guide. For more specific information the reader is directed to the annotated bibliography at the end of each chapter as well as the glossary at the end of the book.
1
Today's Hospital
It's Not Like Where You Were Born
A Revolution You Ought to Know About
Hospitals are experiencing radical changes, some occurring even as you read this book. This revolution is of interest to pastors, lay-persons, and the Church for several reasons. A significant portion of your ministry is carried out in relationship to illness events. Understanding the nature and structure of hospitals can aid you toward working effectively within that system. Second, you and your parishioners utilize health care facilities as patients and being aware will assist you toward becoming an informed consumer. Third, it may be that some of these changes call for the Church to become more active, at least educationally, in the health care endeavor.
At the heart of this revolution are two central questions. Is health care a right to be afforded to all persons or is it available to the privileged only? Privileged usually means that you and/or a third party (insurance) will pay the bills. The second question is: Who is going to pay for the services? In our society the prevailing political answer1 to the first question is that Americans should have unlimited access to the best available health services. In order to provide the service, however, health care costs currently consume 10.7% of the gross national product.
This wasn't such a problem as long as the family doctor got in his car and drove to your home when you were ill. S/he usually had everything required for treatment in a black bag, predictably a tongue depressant, a stethoscope to listen to heart and lungs, a light to look in the ears or eyes, and, finally, a penicillin shot. As technology developed, however, a clustering of services resulted. Physicians preferred to locate offices near hospitals, which became the centers for the treatment of illness. You now go to the physician's office for care and, if necessary, can be admitted to the nearby hospital, reducing travel time between office and hospital for the doctor.
It has been theorized that when physician house calls became uncommon,2 the sanctity of the physician-relationship changed forever. In its place emerged a less personal, more technological approach which can save lives, but also can prolong life unnecessarily, always at a high cost. There is the resulting need continuously to refurbish and replace outdated hospital facilities and to have the latest piece of new technology. Physicians’ salaries have skyrocketed, yet patient-physician relationships have grown even more impersonal, which contributes to a litigious climate. This climate results in higher malpractice insurance premiums, the ordering of more tests for defensive purposes, and higher costs for the patient. The spiral of increasing costs has been staggering. Controlling these costs and preserving the availability of health care has become a national concern.
Private For Profit Not-For-Profit
To address these problems, changes are occurring, both within and without the hospital. Externally, a recent change (October 1983) was made by the Federal Government. Previously, Medicare reimbursed hospitals for
