Becoming a Spiritual Generalist? What Physicians Know About Religion and Spirituality

Most of the physicians I interviewed in the last eight years received little formal training around religion and spirituality in medical school or residency. Some describe learning on the job while others speak of trying to avoid such topics.
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Last year the American Medical Association ran an article on their webpage, "Miracle vs. medicine: When faith puts care at risk." The article begins by describing pediatrician James Lace, M.D., in Salem, Ore., who cared for a 15-year-old girl with severe asthma. Her parents refused treatment saying their religion forbid it. Dr. Lace spent time with this family at their home and his office trying to persuade them otherwise. "'He discussed Bible passages about healing and even prayed with them," the article reports, "'I wanted to show them I'm not opposed to their beliefs. ... I wanted to show them that [doctors] are not negating the power of prayer; we're part of that.'"

Social workers threatened to place the young woman in foster care and -- eventually -- her parents changed their mind and allowed medical treatments. Her health improved, but once she turned 18 she stopped treatment, writing the doctor a letter saying, "'I'm free now. I don't have to see you any more. ... God wants me to suffer.'" The article goes on to describe other cases like this, and related court cases and case law across the country.

Pediatricians, like other physicians, see issues related to religion and spirituality in their work but are not often trained to respond. While some -- like Dr. Lace -- learn on the job, others try to keep more distance from such topics. The George Washington Institute for Spirituality and Health has long worked to change this by training physicians around religion and spirituality. The Program in Medicine & Religion at the University of Chicago is a new such effort. Despite these programs, most of the physicians I interviewed in the last eight years received little formal training around religion and spirituality in medical school or residency. Some describe learning on the job while others speak of trying to avoid such topics called them "too personal" or saying they "wouldn't necessarily know what to do with that information. ... if somebody says 'Well, I'm Hindu' your thought is 'What do I do with that? Does that mean they're vegetarian or we just order up different [cafeteria] trays or what?"

Nurses, more than physicians, engage with patients and families around religion and spirituality and have a longer professional history of so doing. While there are certainly exceptions, the physicians I interviewed mostly wait to see if patients or family members bring up religious or spiritual topics. If they do -- like when making difficult medical decisions or at the end of life -- they try to connect them to other resources. While religion is a barrier to medical care in some cases -- like that of Dr. Lace's patient -- most physicians recognize that it is a source of support in others and a bridge to non-medical comforts.

Patients and families sometimes ask their physicians to pray with them. The doctors I interviewed respond to such requests in one of three ways. A few join families in prayer. Most, instead, stand quietly.

"I remember a case where everyone was standing around a bed and the family wanted everyone to bow their heads with them and I did it out of respect for the family" one told me. In another situation a pediatric physician reframed a patient's prayer request saying, "Of course, everybody will be praying for [the patient]." She told me "I try not to bring myself into it, because I don't want this to be about me, and I don't want them [the family] to think that I have more quote unquote power to cure their child than I actually have. And I don't want them to think that because I'm praying with them that I will be more likely to cure them than if I didn't pray with them."

Some physicians refer patients and families to hospital chaplains, who are increasingly trained -- through masters degree programs and in supervised internships -- to work with patients and families from a range of religious and spiritual backgrounds, including none. Surveys suggest that physicians (more than 90 percent) are satisfied with their work with chaplains, though one-third of hospitals do not have chaplains and little is known about how they actually work together.

Efforts to prepare physicians to better respond to patients' religious and spiritual concerns are mostly likely to be successful if they focus on physicians as well as nurses and other members of medical teams. While training in medical school and residency is important, related undergraduate classes and continuing medical education are also key. Interdisciplinary efforts that include physicians and chaplains -- like the CPE for Healthcare Providers Program at Massachusetts General Hospital -- are essential as are shorter workshops like "On Becoming a Spiritual Generalist" offered through the Institute for Professionalism & Ethical Practice. More physicians need to be better prepared, like Dr. Lace, to respond to religion and spirituality when it is a source of conflict or of support in patient care.

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