I recently posted a blog on those things that a doctor should never say to a patient. Many of you commented on your personal experiences and added them to my list. A highly respected colleague of mine sent me an email taking exception to one of the items on my list of topics. He has practiced in primary care for many years and has a diverse practice. Here is a portion of his comment:
I have to disagree strongly about the item to never talk about politics, lawyers, insurance co., etc. ... I feel most strongly about sharing my faith as a Christian. In our current society, although it worships at the altar of "neutral" secularism, I would feel morally corrupt if I could not discuss my faith. Again, it is not an agenda item and I only discuss it when I get strong cues from the patient. I have many items up on my walls -- crosses, icons and prayers in a sensitive format that serve as a non-verbal invitation to further discussion. Many patients have never discussed these with me, as the topic did not come up or I did not deem it appropriate. I have never, to my knowledge, had a patient respond that I was inappropriate in this regard. But I can assure you that many patients have received strong spiritual healing form the Lord as a direct willingness on my part to be a faithful disciple. I am not special in that regard, just dedicated to my calling as a physician and witness.
This physician's comment caught my eye and I asked myself, "What do we know about physicians' and patients' attitudes toward religion and their place in the practice of medicine?" We know that patients present themselves at our offices and hospitals with their own set of values, beliefs and life experiences, which may be radically different from our own values. People have studied the role of religion and spirituality from the viewpoint of the patient, but there is very limited medical literature that asks the question, "What difference does a physician's religious beliefs and practices make in their clinical practice?"
What Do Doctors Believe?
Dr. Farr Curlin has written several papers on the religious and spiritual beliefs of physicians. [1, 2, 3] He stresses that given our society's religious and ethnic diversity, physicians must be attentive to the ways in which a patient's fundamental values may conflict with a physician's own deeply held convictions. The physician must also look inward at their own spiritual and religious beliefs and examine how those beliefs might influence the manner in which they deliver care. We like to think of physicians as unbiased practitioners of the science they learn while, in fact, they are influenced by many of the same forces as the laymen they treat.
The survey was given to 2,000 physicians in the United States and is packed with information on physician attitudes and beliefs, but here are a few:
- 55 percent believe that their religious beliefs influence their practice of medicine.
- 76 percent believe in God as opposed to 83 percent of the general population (not a significant difference)
- 59 percent believe in life after death
- 58 percent state they carry their religious beliefs in all dealings of their life
- They attend religious services as frequently as non-physicians
The truth is, we do not know all the details of the relationship and interactions of physicians' religious beliefs and the people they care for, let alone nurses, therapists, aides and administrators. We do know that physicians and patients must work together in the face of either shared or divergent moral and religious beliefs.
Boundary Lines
Dr. Russell D'Souza from the University of Melbourne wrote in his paper on spirituality in medicine, that "as doctors we have been trained to be "objective" and to keep our beliefs and practices separate, but over time we have strayed into keeping patients' beliefs, spiritual/religious needs and support separate from their care." [4] He goes on to say that we may be ignoring an important part of their coping and support systems. The key is finding that boundary line. Dr. D'Souza goes on to say that "doctors and clinics should not impose their religious or spiritual beliefs on patients or initiate prayer without knowledge of the patient's religious background and whether the patient would appreciate such activity." Finding that boundary line can be difficult and requires great skill on the part of the health care professional.
In this regard, the American College of Physicians Consensus Panel on End of Life suggested four questions that physicians could ask patients. [5]
- Is faith (religion, spirituality) important to you?
- Has faith been important to you at other times in your life?
- Do you have someone to talk to about religious matters?
- Would you like to explore religious, spiritual matters with someone?
Although these questions are particularly important to patients with critical or terminal illnesses, they can be adapted and applied to almost any patient.
What Do You Want From Your Doctor?
We have talked about what physicians and organizations believe are the appropriate boundary lines. I would like to ask you to think about and comment on what you find acceptable or want from your physician in the areas of spiritual and religious health.
1.Do you want your physician to ask you about your spiritual and religious beliefs?
2.Do you actively seek out a physician with shared moral and religious beliefs? Do secular patients seek out secular physicians?
3.Do you want prayer or other forms of spiritual practice to be part of the care you receive from health care professionals?
4.Should health care professionals take any initiative regarding spiritual care or should they wait for the patient to introduce the possibility?
5.Surveys tell us that 77 percent of physicians are willing to pray with a patient. Should the other 23 percent of physicians refer those patients wanting prayer to a spiritual leader or hospital chaplain?
We still have many more questions than we have answers, but we can all agree that a dialogue is needed on these topics between health care providers and their patients.
References
1.Curlin FA, Lantos JD, et al. Religious characteristics of U.S. physicians: A National Survey. J Gen Intern Med 2005;20:629-634.
2.Curlin FA, Sellergren SA et al. Physician's observations and interpretations of the influence of religion and spirituality on health. Arch Intern Med 2007;167:649-654.
3.Curlin FA: A case studying the relationship between religion and the practice of medicine. Acad Med 2008; 83:1146-1152
4.D'Souza R: The importance of spirituality in medicine and its application to clinical practice. MJA 2007;188:S57-S59.
5.Lo B, Quill T, Tulsky J: Discussing palliative care with patients: Ann Intern Med 1999:130;744-749.