A lot has changed in the nearly two decades since Dr. Christina Puchalski pioneered the country’s first required medical school course on spirituality and health, at George Washington University. Today almost all medical schools have such a course, but many on-the-ground health workers still report feeling uncomfortable when the subjects of faith and spirituality arise on the job.

Puchalski, founder and director of the GWU Institute for Spirituality and Health, came out late this summer with the “Oxford Textbook of Spirituality and Healthcare,” which she hopes will become a must-have reference for medical, nursing and public health students, among others.

Puchalski is a professor of medicine and an internist and palliative care physician. Her background is Catholic and she is a lay member of the contemplative Carmelite order. She meditates and is influenced by Eastern and Native American spiritual traditions.

Washington Post religion reporter Michelle Boorstein spoke to her about the book and where the movement is headed.

Q: What drew you into this field?

A: In the early 1990s there was an article about how people pay out of pocket for spirituality-based treatments like acupuncture, but complain about a $10 co-pay [for traditional health care visits]. It stuck out to me. I was very interested in whole-person care.

Q: How have things changed in the years you have been pursuing this subject?

A: One of the greatest barriers I had to overcome was [the disagreement] about the definition of ‘spirituality.’ It’s very personal for people. That’s no longer a question. If it was we wouldn’t have a textbook. . . . It’s very broadly defined: religion, philosophy, relationship, compassion, love, dignity, respect, a person’s search for purpose, meaning, nature, rationalism, the arts.

Q: How does the typical medical student get taught about this subject?

A: By 2004, three-quarters of medical schools had some element of this. Initially they learn ethics and communication. But by the time they get [into the later years of medical training], this gets lost because our health-care system is so focused on the physical. All the psycho-social stuff gets lost.

We just want doctors and nurses to ask patients about their spirituality. Surveys show patients want this.

Q: What would that look like?

A: Spiritual distress should be a diagnosis . . . spirituality should be a vital sign. If people are in spiritual distress, they shouldn’t suffer alone. And health-care officials should look at their own spirituality.

When we talk about where we at George Washington and others see the future of health care, where we’d like to see it, is a whole-health concept. Wellness is considered as part of the focus. Where patient [care is] dignity-centered. Justice and accessibility are priorities. People deserve not just access to disease management but whole-person care. Medicine is an avocation, not a job.

Q: What reaction do you get from doctors?

A: Most people say, “Of course I agree with being respectful and values play a role.” But they don’t know: How will I actually address this? One person said to me, “I have no philosophy degree, no theological background — what do I say?”

We said, “You don’t need to focus on it all the time. Just ask the question. Primary-care doctors ask about diet, seat belts, domestic violence; it doesn’t mean we’re experts on those things.”

Q: What would clinicians say?

A: It’s just important to listen to the patient’s story. It’s important to know what’s really meaningful to a patient’s life. And not having to do anything about it. Also you want to know if there’s some spiritual stress. If it’s inpatient, they need to be referred to a board-certified chaplain. Or outpatient, their clergy. We need to integrate these people because it becomes a support system. . . . Or it might impact their health-care decisions. End-of-life care is the most obvious, but perhaps the use of blood products, or naturalists who don’t use medications. You need to know that.

Q: The bookstores can seem full of books about things like meditation and yoga and prayer. What’s really new about this, though?

A: Someone wrote to me and said, “This is a very strategic book, it legitimizes your field.” And that’s true. But the other issue is accessibility. People need something tangible. Here’s a textbook they can use to teach it.

More and more we’re recognizing the whole team of [health-care providers], art therapists, board-certified chaplains. Chaplains have much greater recognition.