"My patients used to ask me to pray for them," an elderly doctor told me a few years ago. "Yeah, sure," he would tell them dismissively as he walked out of the room. He "pooh-poohed" their requests. Then, he developed cancer himself. "Now," he sighed, "I realize how important religion is."
His words still haunt me.
I spoke with him, and other physicians, while writing a book, When Doctors Become Patients, a few years ago. Again and again, these doctors told me how they became far more aware of the crucial role of spirituality in medicine - only when they became sick themselves.
Through my medical training, I never received a single lecture about religion.
Luckily, medical schools are beginning to include the topic in their curricula. But it remains unclear how often, or how -- what students read, are taught, or told.
Doctors should in no way force their own beliefs on their patients, or discuss the topic with those who aren't interested in doing so. But physicians do need to become more aware of the critical role it plays in most patients' lives and illness. After all, spirituality can help patients cope in many ways.
Still, for decades, American medicine has not only ignored religion, but actively opposed and denigrated it. Confusion about it still abounds.
A few years ago, I visited Epidaurus in Greece -- famous for the largest intact theater from the Ancient world - considered to have perfect acoustics. All 15,000 audience members can still hear mere whispers on the stage. Off to the side of the grand tiers of seats sat a small, rarely visited museum. Surprisingly, the museum was filled with carved inscriptions, statues, and tools - all related to medicine, surgery, and healing.
The Greeks believed that Epidaurus was the birthplace of Apollo's son, Asclepius -- the God of Medicine and Healing. The "rod of Asclepius" -- a snake entwined around a pole -- is still often used as a symbol of medicine. The theater had been built as part of a center for healing -- the most well-known hospital in the Ancient World.
For hundreds of years, patients traveled to this sanctuary of healing. Inside the compound stood an area where physicians interacted with patients, a temple, a large hall where patients slept, and the theater. Here, Greek tragedy, with emotional catharsis, and comedy were performed. Healing involved not just the body, but the mind, spirit, and soul.
This inclusiveness -- this 'holistic' approach -- seemed right in many ways.
Yet American medicine has lost much of it. Slowly, we are regaining small elements, but have a long way to go.
In the 19th Century, as science rose, with research by Louis Pasteur and others, the medical profession in the United States fought to differentiate itself from various kinds of quackery. Hence, the field emphasized its scientific basis, and actively rejected any trappings of religion.
Clearly, this science is vital, but the field, in its understandable efforts to separate itself, may have gone too far. The pendulum may need to swing back a little. Healing for serious diseases should, I think, not involve only science, or only spirituality, but rather, an integration of the two.
How these seemingly opposing approaches should be joined depends on the diagnosis, the severity of symptoms, the patient's beliefs, and the provider, but a key first step is to encourage medical students and physicians to recognize these issues more fully.
Additional medical school classes are important, and will hopefully help future doctors, but doesn't aid current providers and patients. Doctors today should recognize these issues as well. But meetings of medical professions generally include little, if anything, about spirituality. Resistance persists.
Part of the problem is that religion and spirituality largely remain taboo topics in medicine, and discussions about these areas become polarized, with extreme opinions on either side. Some supporters of spirituality in medicine insist, for instance, that having someone pray for you, even if you don't know about it, can directly alter the biological diseases processes in your body. I am dubious.
On the other hand, opponents of spirituality in medicine excoriate the possibility of "doctors ramming their own religious beliefs down patients' throats."
I think that doctors should be able gently to open the door to possible discussion with patients, if patients wish it, saying something like, "religion and spirituality are important to many patients. If you would like, we could talk about that, or I could arrange for you to talk to a clergy person." Unfortunately, evidence suggests that only 10% of patients have had a doctor ever mention spirituality or religion to them.
The situation is starting to improve slightly, but not enough. We need to pay more attention to these issues, and be more sensitive to patients' beliefs -- even if we don't share them. Supplementary lectures are important, but we don't know, for example, what they include about other religions than one's own. Doctors who are not Catholic are often unsure whether to ask a patient if he or she wants to see a priest, since they fear that the patient will interpret the question as meaning that the doctor is giving up. Unfortunately, most physicians I know and I have little understanding of Islam, and the beliefs and practices of Muslim patients who come to the large medical centers where many of us work.
Moreover, medicine needs not only to increase students' knowledge, but alter deep attitudes and biases. We need to think about how we treat patients, besides frequently simply prescribing drugs. Here, too, complementary and alternative approaches are making some in roads in areas where they may be helpful. But more work is needed.
Alas, in the increasingly fractured health care system, patients and their families may at times also have to take the initiative themselves, and ask to speak to clergy -- or help educate and sensitize a doctor on their own.
"Doc, will you pray for me?" patients ask each day.
The time has come to pray for the doctors, too.
Follow Robert Klitzman, M.D. on Twitter: www.twitter.com/cubioethics