Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Do Not Miss


While volunteering in a chaplain’s office as an undergrad, I learned that patients can gain strength from many sources. As a clinician, I ask all patients, “How can we support your spirituality within the healthcare system?”  

When I was an undergrad, I volunteered as a clerk in the spiritual care department at the university hospital. I sat alone in the basement near the spiritual care offices on early Sunday mornings and transcribed brief notes for the persons who would see the patients later in the day. My job  was to identify Catholic patients who wanted visits from priests, chaplains, or ministers for prayer and support. On Sundays, we tried even harder to ascertain which patients wished to receive the sacrament of Holy Communion.  


We had learned from patients’ previous hospitalization communications, that many considered the sacramental request to be extremely important. To signify this added importance on our list of notes, we wrote “do not miss” by their names. 


Reflecting on this practice, I wondered: “What is a vital sign? And who defines them?” 


In the traditional sense, vital signs are measurements of physiologic activity that offer crucial insights into the patient’s health status. During every patient encounter, they’re meticulously checked and recorded and then trended over time. If abnormal, providers promptly investigate and seek to correct the related underlying problem. But what if patients could add to this standard list of physical findings? What if there was something else vitally important to them that they wanted frequently assessed and addressed?  


For those “do not miss” patients, specific religious rituals were central to their identity and indicators of their spiritual health, on par with vital signs for their physical health. If we hadn’t checked and recorded their wishes, we couldn’t meet their needs in spiritual care.  


There are many ways for us to support patients that don’t involve the physical body. Ask about their spirituality, family, support systems, coping mechanisms, and home life. Some of us may feel uncomfortable with certain questions if we’re not religious, or feel the task belongs to someone else. Of course, many other medical professionals, including chaplains, social workers, child life specialists, and therapists, play invaluable roles in addressing these concerns. But we shouldn’t assume that another staff member will ask. Moreover, we should all conduct a basic spirituality screening for patients. Potential screening questions include: “Is religion or spirituality important to you? What gives you strength? Do you have specific beliefs that might affect decisions about your health? Is there a community or group of people who support you? How would you like us to support your spirituality within your healthcare?” (For a more detailed summary of the spiritual history tool just briefly demonstrated, see this website.)  


Together, we can help patients have a say in what’s considered vital for their care. Indeed, we should ensure that this is something we do not miss.  






This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.