Doctors and prayer: kindness or coercion?

Doctors and prayer: kindness or coercion?

Excerpt from "Should Doctors Be Involved With a Patient's 'Spiritual Care?'," Medscape. October 21, 2011--Science and religion have always had a complicated relationship, so it's not surprising that, as interest in holistic care grows, physicians are trying to come to grips with whether they should play a role in patients' spiritual care. More than half of physicians believe that religion and spirituality affect patient health in some way, according to research conducted by the University of Chicago. In a survey of 2,000 physicians, 56 percent believed that religion and spirituality have much or very much influence on health, but only 6 percent believed they often changed "hard" medical outcomes. Rather, respondents suggested that religion and spirituality help patients cope, give them a positive state of mind, or provide emotional and practical support via the religious community. While doctors might believe religion and spirituality influence health, acknowledging a connection raises some fundamental and tricky questions. The American College of Physicians' ethics manual encourages physicians to explore a patient's religion and spirituality as part of an overall physical. But how are they to do that? What does it mean, and what are they to do with the information?

Research indicates that roughly 80 percent of medical schools now offer spiritual care courses or integrate spirituality into their curricula, according to Christina Puchalski, MD, an internist at George Washington University and director of the George Washington Institute for Spirituality and Health. But what's included and how it's taught differs tremendously from one institution to the next. In an effort to bring consistency to the spiritual history and assessment process, various proponents have development of myriad tools represented by apropos acronyms such as FAITH, SPIRIT and HOPE as well as the slightly less catchy FICA and FACT. Assessing a patient's spiritual health is important, because spiritual issues can not only impact a patient's health, but they can impact a patient's medical compliance and treatment choices as well, says Puchalski. However, not everybody believes spiritual care belongs in the examination room. Indeed, those who oppose the idea present a litany of arguments: Spirituality is a private matter. Over-zealous physicians might abuse their position and proselytize to their patients. Pragmatically, many note that in the real world of 15-minute office visits, taking the time to ask questions about spirituality would come at the expense of addressing clinical issues. Most worrisome says Richard Sloan, professor of behavioral medicine at Columbia University Medical Center and author of Blind Faith: The Unholy Alliance of Religion and Medicine, taking a spiritual history sets a doctor up to be a spiritual guide, "which they are completely untrained and unequipped to do."

Still, fitting spiritual assessments into practice is a hodgepodge. "From what we've seen in our research almost nobody is using those acronyms," says Farr Curlin, MD, co-director of the Program on Medicine and Religion at the University of Chicago. "It's the rare physician who uses these pneumonic tools. Rather they try to pay attention to signs from the patient and then they try to query them to bring those issues out and connect the patient with spiritual resources in the community or their organization's pastoral care department." Carol Taylor, PhD, director of the Center for Clinical Bioethics at Georgetown University, says clinicians are caught in a theory-practice gap. "The problem is we say, 'spiritual care matters,' but we haven't gotten to the point where clinicians can identify spiritual need," she says.

Neurosurgeon, Author of Gray Matter and CMDA Member David I. Levy, MD: "Wherever there is power, there is potential for abuse. If approached correctly, prayer honors, gives comfort and encourages. We are spiritual beings and our awareness of this fact is heightened when we feel out of control or in danger. When a problem arises that is too big to solve with our resources; we pray.

"My desire is to recognize and honor the spiritual aspect of every patient; to give him or her peace, to comfort and to use everything in their armamentarium to help them heal. Asking if someone would like prayer should be done in a sensitive manner without making people feel uncomfortable; patients must feel free to decline without affect to their care or our relationship. Joint Commission guidelines state that a patient’s “spiritual needs should be assessed and accommodated in ways that are meaningful to them.” The only way that I will know if prayer would be meaningful is to ask – and in most cases it is very meaningful.

"Although patients trust me to do the best job possible, we both realize that ultimately I am not in control of their response to medication, the outcome of their surgery or their healing process. No matter how extensive my experience or education, if I am trusted to do something that involves risk, then I believe that an offer of prayer is honest, appropriate and authentic. Given the peace and comfort many patients receive, I believe that withholding prayer from those who would benefit is unethical and even cruel."

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CMDA Ethics Statement - Sharing Faith in Practice