5 questions with Kristin Collier, MD
“Physicians are not just technicians taking care of complex machines.”
Dr. Kristin Collier is an assistant professor of medicine at the University of Michigan where she co-directs the program on health, spirituality, and religion and serves as associate program director of the internal medicine residency where she completed her own residency training. She is a graduate of the University of Michigan School of Medicine. She was interviewed by Capita’s Co-Founder + CEO, Joe Waters.
Joe Waters: We are very interested in how we build healthy relationships in the earliest years of a person’s life and across communities that support moms, dads, and guardians. Spirituality and religion have a lot to say about this, I would imagine. What has your attentiveness to spirituality and health taught you about the power of healthy relationships in driving well-being?
Kristin Collier: Relationship is at the heart of the redemptive-historical narrative of the Hebrew and Christian scriptures. We see relationship between God and his people, Jesus and his Father, and among the people of God. Within the vision of reality from my own Christian tradition, we are given the gift of salvation through Jesus Christ in order to restore the most important relationship of all – the one between God and man that was broken through the corrupting power of sin. Without a right relationship with God, through Jesus, we are lost in the way that is most harmful to our health, or as you state in the question, our ‘well-being’. When we hear the term ‘well-being’ – of what do we think? We are shown through the scriptures that this well-being isn’t just about individuals. Salvation has always been a social reality. The letter to the Hebrews, for example, speaks of a ‘city’. When we think about the corrupting power of sin, we know that sin not only separates us from God the Father, but also leads to the destruction of the human race. We should broaden our narrow concept of ‘well-being’ from a biological individual construct to a community reality that includes God in our midst. We first experience the power of relationship and our sense of belonging through our nuclear family. Not all persons, unfortunately, experience positive relationships in their family of origin. Research supports the fact that unhealthy relationships early on in our lives can have adverse effects on our health later on. And of course the converse is also true. The impact of relationship starts so early on that a form of attachment disorder can start in utero if the mother is under duress which can lead to cognitive and emotional impairment in children once they are born. What we see in health outcomes research is that isolation is anti-well-being. We are seeing, for example, more and more research that supports that loneliness is just as strong as a risk factor for poor health outcomes as are obesity and smoking. Researchers such as Tyler VanderWeele at Harvard’s Chan School of Public Health have shown that increased religiosity among women in the nurses’ health study cohort was associated with better physical and mental health outcomes. One hypothesis for these positive outcomes is that the effect is mediated through a sense of deep meaning rooted in the religious community among these women. What we see from these and other examples is that we are not and cannot be well by ourselves.
JW: I think many people have experiences today which suggest to them that healthcare is broken. It is big, corporate, profit-driven, and insufficiently attentive to provider and patient flourishing. How does a physician who values delivering health care that is more than just technical expertise navigate the health care industrial complex?
“The root of the word ‘hospital’ comes from the word ‘hospitality’. The question then becomes — how can we create a culture of hospitality in the health care environment in which we have been placed? ”
Kristin Collier, MD
KC: Physicians are not just technicians taking care of complex machines. Yes, there are many active threats aimed at the sacred space that is the physician-patient relationship, but when it comes down to it, what matters most is the patient and physician face-to-face in an encounter. The “health care industrial complex” is made up of people, so relationships are integral here too just as I discussed in the answer above. Relationship is personally what has sustained me in my job as a primary care physician. My advice to other health care providers is to get to know your patients. Love them. We need to keep in mind the adage that ‘culture eats strategy for lunch’. I truly believe that people can impact culture in a measurable way. The root of the word ‘hospital’ comes from the word ‘hospitality’. The question then becomes -- how can we create a culture of hospitality in the health care environment in which we have been placed? I also recommend that health care workers develop a ‘philosophy’ or ‘theology’ of medicine. My personal theology of medicine revolves around the key principles of non-violence and human dignity. I see my patients as being made in the image of God with inviolable dignity who have lives that are ends in themselves. In this view, with their dignity in mind, my vocation takes on more meaning and anchors me in something larger than myself. I also frequently think about Jesus as the ‘Great Physician’ and think of him taking the blind man by the hand and walking with him out of town before he healed him. Why did he do this? What did they talk about? Jesus got to know the people he healed. This story, and other examples, help refocus me on the essential part of what I’m doing as a physician – engaging with patients, in a covenant of sorts, centered around human dignity.
JW: You have called religion an “underappreciated social determinant of health” and your program at Michigan seeks to develop spiritual competencies in the next generation of physicians. I can imagine that there are lots and lots of barriers to this work, but what are some early successes and barriers overcome?
KC: Religion and spirituality are underappreciated social determinants of health. Research demonstrates that patients desire to be engaged as whole persons, that they want their spiritual needs addressed when they are ill, and desire for their physicians to acknowledge and incorporate their beliefs into their care plan. What patients desire, however, is not always what they receive. Incredible individuals have been working on these gaps in care for decades and there has been an improvement in the attention to the spiritual needs of patients thankfully over the years, but there is much more work to be done. There are barriers to this work, but at our institution, my team and I have been grateful for the engagement of various stakeholders around our endeavors. We have been delighted with the level of engagement with our monthly speaker series on the topic of health, spirituality and religion that we hold at the medical school. We have monthly robust attendance by not only medical students, but by house officers, faculty, nurses, chaplains, post-docs and even lay people from the community. It is our opinion that this is what an ideal learning environment looks like – one in which the participants engage with challenging topics and in which the participants come from various backgrounds and levels of learning. We have been grateful to see our work acknowledged on a national level as well. Our group has presented a workshop on the topic of spirituality and health at a national academic conference, and I lead the interest group on health, spirituality and religion for the Society of General Internal Medicine. We also have been thrilled to have engaged with the spiritual care department at our institution. Our wonderful staff chaplains have participated in activities for the medical students and trainees and are collaborating with our team and students on research projects and wellness efforts. I have been asked to serve on the professional advisory group for our clinical pastoral education program at Michigan Medicine and know that further opportunities exist to enhance opportunities for interprofessional education. The greatest success, however, is when a student or trainee shares with me that our program in some way helped reclaim a sense of meaning for them in their vocational pursuits, or helped them realize that they could have an integrated professional-personal identity as a faith based physician in training, and not have to ‘leave their faith at the door’ to be considered a legitimate scientist.
JW: What is a memory from your own childhood that you are afraid your children may never experience?
KC: I vividly remember some of the major historical events that occurred during my childhood. In particular, what stands out is the fall of the Berlin Wall and the end of the Cold War. I remember the discussions that were had at home and in my school and the resultant hope that I felt about this world. The overall direction was one of optimism. Much of the current news cycle unfortunately is negative with a destructive rhetoric. I am concerned that my children may be entering a time where hope is being lost within our culture for large groups of the population, and tragically, among children.
JW: What does a perfect day look like?
KC: I remember reading that Beth Moore once said something along the lines of, “I pray for a life that saves me from myself” and I couldn’t agree more. Therefore, for me, a perfect day would include a combination of time spent with family and loved ones, service to others, and with time built in at the beginning and end of the day for prayer.