Secrets of the ER: Physician Stories From Amersfoort

The Dual Process Model (DPM) of coping with bereavement, proposed by Margaret Stroebe and Henk Schut and published in Death Studies (1999), has become one of the most influential theoretical frameworks in grief research. The model posits that adaptive grieving involves oscillation between two orientations: loss-orientation (attending to and processing the grief itself) and restoration-orientation (attending to the tasks of daily life, developing new roles and identities, and engaging with the future). Research by Stroebe, Schut, and their colleagues, published across multiple journals including the Journal of Consulting and Clinical Psychology and Bereavement Care, has consistently supported the model's predictions.

Physicians' Untold Stories engages both DPM orientations for readers in Amersfoort, Utrecht. Loss-orientation is supported by the book's direct engagement with death—its physician accounts invite readers to confront the reality and meaning of dying, which is essential loss-oriented processing. Restoration-orientation is supported by the hope the book provides—the suggestion that death may not be final, which gives bereaved readers a foundation for rebuilding their worldview and re-engaging with life. Research suggests that books and narratives that engage both orientations are particularly effective therapeutic resources for the bereaved, and the 4.3-star Amazon rating and over 1,000 reviews confirm that Physicians' Untold Stories meets this criterion.

The concept of "moral injury" in healthcare—the distress that results when a clinician witnesses or participates in actions that violate their moral beliefs—has been increasingly recognized as a contributor to physician burnout and suicide. Research by Wendy Dean and Simon Talbot, published in STAT News and academic journals, has argued that physician burnout is often, at its root, moral injury rather than simple exhaustion. The death of a patient can be morally injurious when the physician believes the death could have been prevented, when the healthcare system's failures contributed to the death, or when the physician was unable to provide the care the patient deserved.

Physicians' Untold Stories addresses moral injury by providing a counternarrative to the "death as failure" framework that generates so much of healthcare's moral distress. If death is a transition rather than a failure—as the physician accounts in Dr. Kolbaba's collection suggest—then the moral weight of patient death, while still significant, is shifted from catastrophe to mystery. For physicians in Amersfoort, Utrecht, who carry the moral injury of patients lost, this shift can be genuinely therapeutic—not because it absolves responsibility, but because it places death within a larger context that includes the possibility of continuation and peace.

The gravesites, memorial benches, and sacred spaces throughout Amersfoort, Utrecht are physical markers of the community's collective loss — places where the living come to remember, to grieve, and to maintain connection with the dead. Dr. Kolbaba's book adds a literary dimension to this landscape of remembrance, offering bereaved residents of Amersfoort a portable, personal space of comfort that can be carried wherever grief follows — to the graveside, to the hospital, to the sleepless hours of the night when the absence of the loved one is most acute.

The spiritual lives of physicians themselves are an underexplored dimension of medical practice. Dr. Kolbaba's interviews revealed that many physicians maintain active spiritual practices — prayer, meditation, religious observance — that they keep entirely separate from their professional identities. This separation, while understandable given the professional culture of medicine, may come at a cost. Research published in Academic Medicine found that physicians who integrated their spiritual values into their clinical practice reported higher levels of meaning in work, stronger resilience in the face of patient deaths, and lower rates of depersonalization — a key component of burnout.

For physicians in Amersfoort who feel torn between their professional identity as scientists and their personal identity as people of faith, these findings are significant. They suggest that integration — rather than compartmentalization — may be the healthier path, both for the physician and for their patients.

Faith-based coping — the use of religious beliefs and practices to manage the stress and uncertainty of serious illness — is among the most common coping strategies employed by patients worldwide. Research by Kenneth Pargament and others has distinguished between positive religious coping (viewing illness as an opportunity for spiritual growth, seeking God's love and support) and negative religious coping (viewing illness as divine punishment, questioning God's love). Positive religious coping is consistently associated with better health outcomes, while negative religious coping is associated with increased distress and, in some studies, higher mortality.

Dr. Kolbaba's "Physicians' Untold Stories" illustrates both sides of this relationship, documenting patients whose positive faith-based coping appeared to contribute to remarkable recoveries and acknowledging the reality that faith can also be a source of suffering when patients interpret their illness as punishment. For healthcare providers in Amersfoort, Utrecht, these accounts underscore the importance of spiritual assessment — understanding not just whether a patient has faith but how that faith is shaping their experience of illness — as a component of comprehensive medical care.

Medical missions — organized trips in which healthcare professionals provide medical care in underserved communities, often sponsored by faith-based organizations — represent one of the most visible intersections of faith and medicine. In Amersfoort, Utrecht, numerous healthcare professionals participate in medical missions, combining their professional skills with their spiritual convictions to serve populations that lack access to care. These experiences often transform the physicians who participate, deepening both their faith and their commitment to compassionate medicine.

Dr. Kolbaba's "Physicians' Untold Stories" resonates with the medical missions community because it captures the same spirit that motivates mission participants: the conviction that healing is more than a technical process, that it occurs at the intersection of human skill and divine purpose, and that the practice of medicine is at its best when it is animated by a sense of calling that transcends professional obligation. For medical missionaries from Amersfoort, Kolbaba's book is a testament to the faith that drives their work and the healing that emerges when medicine is practiced as a vocation.

The relationship between physician spirituality and clinical outcomes has been examined in several studies with surprising results. A study published in BMC Medical Education found that medical students who reported strong spiritual or religious beliefs scored higher on empathy scales and demonstrated better patient communication skills than their secular peers. A separate study in the Journal of General Internal Medicine found that physicians who described themselves as spiritual were more likely to discuss psychosocial issues with patients, more likely to refer patients to counseling, and less likely to report emotional exhaustion. These findings suggest that physician spirituality may not be merely a personal characteristic but a clinical competency — one that enhances the therapeutic relationship and improves the quality of care. For the medical education institutions that train physicians for practice in Amersfoort, these findings raise important questions about whether spiritual development should be included in medical curriculum alongside clinical skills and scientific knowledge.

Christina Puchalski's development of the FICA Spiritual History Tool transformed the practice of spiritual assessment in clinical settings. The FICA tool — which stands for Faith/beliefs, Importance/influence, Community, and Address/action — provides physicians with a structured, respectful framework for exploring patients' spiritual lives. The tool was designed to be brief enough for routine clinical use, open enough to accommodate any faith tradition or spiritual perspective, and clinically focused enough to elicit information relevant to patient care.

Research on the FICA tool and similar instruments has shown that spiritual assessment improves patient-physician communication, increases patient satisfaction, and helps physicians identify spiritual distress that may be affecting health outcomes. Importantly, research also shows that patients overwhelmingly want their physicians to address spiritual concerns — surveys consistently find that 70-80% of patients believe physicians should be aware of their spiritual needs, and 40-50% want physicians to pray with them. Dr. Kolbaba's "Physicians' Untold Stories" illustrates what happens when physicians respond to these patient preferences: deeper relationships, greater trust, more comprehensive care, and, in some cases, healing outcomes that purely biomedical approaches did not achieve. For medical educators and practitioners in Amersfoort, Utrecht, Kolbaba's book provides compelling evidence that spiritual assessment is not a peripheral concern but a central component of patient-centered care.