Spirituality and Medical Practice
If it is true as reviewed in the article “Spirituality and Medical Preactice” published in the journal ”American Family Physician” January 1 2001 that “95 percent of the Americans believe in God” and that “94 percent of the patients admitted to hospitals believe that spiritual health is as important as physical health” and that “77 percent believe that physicians should consider their spiritual needs as part of their medical care” and that “37 percent want their physician to discuss their religious beliefs more” then there is a mismatch between patient desires and physician behavior when “80 percent of patients reported that physicians never or rarely discuss spiritual or religious issues with them.”
“Spirituality is a complex and multidimensional part of the human experience. It has cognitive, experiential and behavioral aspects. … Many people find spirituality through religion or through a personal relationship with the divine. However, others may find it through a connection with nature, though music and the arts, through a set of values and principles or through a quest for the scientific truth.” Whichever way they find it, it can brighten one’s life and provide an extra support during trying times. It also has been suggested that there might even be therapeutic value toward emotional or physical illness.
What is important, I think, is that the way patients may look at their physical illnesses is not necessarily the way physicians are taught to describe the pathophysiology and the clinical implication of the patient’s illness on the patient. Patients may have an entirely different way of looking at their sickness, why they are sick and what the effect the sickness will have on their life. This is especially true when patients are faced with a life ending illness. I think that when patients are considering factors that are “beyond their body” dealing with emotions, beliefs or religion, it is important that physician recognize these considerations as they evaluate the patient. This is done by communicating with the patient and gaining an understanding regarding to what extent spirituality is playing in their life and how it is being used. Medical school education programs are now stressing that the knowledge of patient’s spirituality and religious thoughts and feelings are as worthy considerations as the patient’s physical exam and laboratory findings. Perhaps in the future more physicians will do what many patients seem to desire, consider spirituality as part of medical care.
Do you have any thoughts about this? Has your physician ever asked you about your spirituality or religious beliefs? Do you think they should? ..Maurice.
posted by Maurice Bernstein, M.D. @ 10:28:00 PM
14 comments
14 Comments:
This is the last thing I would want from my doctor. If I need spiritual help, I would seek out people within my religion and there's no guarantee my doctor is within that. And frankly some people think proseletyzing is the same thing as discussing and that is not something I want to be subjected to by my doctor.
-M
I'm in medical school now and we recently learned about taking a spiritual history from a patient. However, the idea is not new to me.
Like all difficult topics in medicine, this discussion required thoughtful timing and tactful delivery. I don't plan on bringing spirituality up with a patient that has come in with a sore throat. However, I can see the importance of bringing up spiritual issues with a patient who is facing life threatening illness, a challenging life change, or has become disabled in some way. When I worked in an ICU setting, spirituality played a large role in the lives of many patients, even if it was a minor role in the medical aspect of the unit.
I would only feel comfortable asking about a patient's spirituality if I felt that some level of trust had been formed between us. Without that, I think that I might be setting myself up for confrontation.
I see M's concerns as well. However, the big thing is that "spirituality" doesn't necessarily mean "religion." I don't think that asking a patient about his/her religious preferences constitutes a spiritual history. While many medical records include the patient's stated religious preference, that tells us next to nothing about how the patient utilizes those preference in the world around her. It is far more useful to find out how the patient finds meaning in her life and what role that meaning plays in her illness. Who does she go to for support? Is she part of a community? Is she angry at God for making her sick? Does she feel that she doesn't deserve to be healed because of some past wrongdoing? Is she afraid of who will take care of her loved ones if she dies? How is she dealing with a new disability? This information can tell us a great deal about how illness impacts the patient's life. If we only search for pathological issues, we can miss the deeper problems that the patient faces which may be impacting the healing process.
I would fully agree with Alyssa's response. I would also like to add specifically that I would find no therapeutic need for a physician to attempt to convert a patient's religious beliefs to his/her own religion. If some religious practice is commonly accepted by the medical community as harmful to health, it should be so stated to the patient but certainly the patient need not be proselytized to another religion. If the patient requests a procedure that is against the religious directives of the physician’s own religion and is morally unacceptable to the physician, the physician has the right, except in a dire life-saving emergency, not to perform the procedure, but to refer the patient to another physician for the procedure.
Where as Alyssa and I have both written about the value of the physician learning about the spiritual and religious views of the patient, there is the reverse that may be important for the best medical care for the specific patient. Ethicist Robert Veatch has written about the value of a patient selecting a personal physician at the outset with as close to the same spiritual, religious and philosophical views of the patient. This would require that the patient and the physician enter into a conversation about each other's views. Although, in this age of HMOs, hospitalists and time limitations,. the ideal that Veatch suggests may not be realistically reached. But I think it may be something patients might find worthy of consideration as they select their physicians. ..Maurice.
There are a few new doctors in my area who have an interest in yoga, as being a constructive connection between spirituality and the physical body. I know a chap who, in his late 60s, via his family doctor has become very involved in yoga. He has benefited physically, spiritually and socially from being pointed in this direction. It certainly seems a foreign concept for the medical community to approach treating patients in a wholelistic (or holistic if you prefer) manner. This chap’s doctor practices yoga and attained a degree in philosophy before entering medicine so that probably explains why she’s open to viewing patients as whole beings.
In the last year, I have learned an indelible lesson: spirituality is not necessarily attached to religion, or even to belief in any deity. It is, however, a great part of a person's daily life ... and can, and does, have a profound effect on the emotional and physical aspects of life.
Ignoring this is like trying to make a calculation without using all of the data.
Yes, I feel that physicians should broach the subject of spirituality with their patients ... which would at least allow the patient to realize that it's okay to bring it up if they feel a need.
To answer your question - I've never had one of my physicians mention spirituality or religion. In fact, questions about anything beyond the physical aspect have been quite rare.
I am a nurse practitioner with about 24 years in hospital work and now am in med school.
I worked for 15 years in most of the hospitals and varied floors in St. Louis and it was like an unspoken taboo to ever speak about religion, God, or politics! Most of my work was in ER's and ICU's or in life and situations and yet vary rarely was religion or spiritually ever discussed and then only if the patient brought it up would I talk about it. Then it was done every cautiously so as not to offend.
For the last ten years I have practiced here in the South and it is a totally different mentality here in the "bible belt" rural TN. "God" is spoken of freely by patients and staff like He is an integral part of the family. Many doctors pray with their patients before surgery and procedures. I really like it since I am religious myself. It doesn't matter what religion one is--it is the same God. I would like my doctor to pray before surgery and to know they put their trust and belief in "God." I would choose a "religious" doctor over an nonreligious one without hesitation no matter what religion. Just my opinion and the opinion of many of us "religious" people in the South I am sure!
Thank you for bringing up this topic and wish we would address these issues of spirituality more. I think it would help people heal better and relieve their anxiety some.
Spirituality discussion between patients and physicians, in my opinion, is a topic should be chosen by either if they are in a comfortable relationship.
I would prefer let the patient lead the topic, but if the doctor felt it the proper moment, he should limit the question to that to ask whether the patient wanted to discuss religion or spirituality, but in the slighted hinting prosetyzing I would unacceptable.
well, first, to address Ms. Haws: it does matter what religion one is, because they're not all the same God. They don't even all have God. For example, I'm religious - I'm, as my Blogger name undoubtedly reveals, Buddhist. For me, there is no God; the idea that many Christians have that Buddha is just God in another guise is actually quite offensive and ignorant of my religion and religious beliefs. And there are many other religions out there who aren't worshipping the same God in another guise - any of the Eastern religions, Native American spiritual beliefs, Norse pagans, Wiccans, a whole host of multi-deity worshipping pagans, from Egyptian to Greek pantheons and on - the list is pretty long. The only religions that can really say "well, they're the same God" are the Western trinity, and perhaps Zoroastrians and Mithrasism - although I suspec the Western trinity wouldn't want to acknowledge the Zoroastrians and Mithrasts as their own. And even within that Trinity, there are sects that buck wildly at the thought that there is any relation between the groups.
The idea that it's all one God, one mountain with many paths, is a nice concept that tries to be open to everyone, but in the end is really, really misleading, offensive, and ignorant of others religious beliefs.
To answer Dr. Bernstein's question, yes, my previous doctors have queried me about religion - it was necessary in the case of my anethesiologist and pulmonologist, as I saw them in hospital settings, and the hospital policy was to find out what your religious beliefs were "just in case", so they could find you an appropriate clergy-member if it came up (or if you requested). My primary care physician asked out of curiousity one day, which was fine - she and I had a good relationship, and our conversations often went all over the map. And frankly, religion does affect treatment - especially for someone who has a chronic health issue. (For example, being Buddhist limited some of my options for external assistance, since many Christian organizations wouldn't help a heathen out without trying to convert me in the process - rather irritating, when I need to keep the irritations in life down!) There could be other concerns about medications and their side effects, and how you approach life in general can be affected.
That said, the minute any physician tried to convert me, I'd be out of there so fast, and lodging a complaint with the nearest board to lodge a complaint with! I don't mind discussing my religious beliefs, or talking about why I chose them, or answering questions, or discussing how it will impact my treatment, but they're my beliefs that I chose of my own accord, and the last thing I want is a doctor trying to think they can decide what's best for me. If they genuinely think my beliefs will impact my health, they're welcome to tell me that - and I'm welcome to no longer see them as a patient!
If you are so sure of what you believe why are you so offended by what anyone says? Chase that line down to the end and you will find out if you really are a buddha.
I really don't want to be asked about my religious beliefs. This is a very private matter to me, and it is certainly not something that I would like to discuss with a doctor.
I once had a doctor ask me about my religion. When I told him that this was a private matter to me, he went on to try to convert me to his religion (he was an evangelical Christian). Rarely have I seen something so offensive in the medical profession as a doctor trying to use his exam room as a pulpit for an evangelistic outreach.
It's a little odd to hear that some subject might be too "personal" for a doctor to breach with his or her patient. Any personal subject should be broached tactfully and sensitively, between any two people. However, doctors are going to be involved in the most intimate moments of life. We should be able to ask about religious beliefs and offer the appropriate response at the appropriate time. Proselyting would be the appropriate response only very rarely.
It's interesting to see the two anonymous November posts... especially the assumptions apparently made by the first (Nov 10th).
I don't care what your beliefs are, or how confident and secure you are in them -- it's offensive, irritating and time-wasting to listen to someone who doesn't respect what you belief, and who makes you expend effort rejecting their attempts to convert you.
I too have had the experience of people trying to convert me in inappropriate settings. Their efforts usually stop after I've informed them that I'm an ordained minister within my faith, and nothing they say is going to convert me.
But I'd also rather not have to expend that additional time and energy, when I'd rather be discussing the medical reasons that brought me to seek care in the first place. Or to spend time trying to explain (as posters above have noted) that spirituality is not the same as religion, and that just because many religions include some type of belief in a divine power, that doesn't make them all followers of the same God.
It would be truly wounderful if doctors (and other professional care-providers) were able to incorporate aspects of their clients'/patients' spirituality into their practice. But for that to happen, either the doctor and patient already need to be part of the same religion, or the doctor needs to be truly open to accepting and working with beliefs that are different from their own.
Sadly, that is a skill that few choose to develop. And until they do, it's often far less stressful if the subject doesn't even come up.
Im doing spirituality in healthcare as a subject at my uni (im studying nursing) and i must say some of the posts really kind of annoyed me. I cant speak for all, but we, as nurses are taught not to preach or try to change peoples religion, rather to support and help the patient with their own spiritual needs, whether they be of a religious nature or not. I dont think it would ever be the case that you would go to a GO and he/she would try and talk to you about your spirituality. On all of my placements as a pre-admission question, patients are asked if they have any special needs or if they would like any special services in regards to their spirituality. if you said... no.. then enough said. But if you find yourself in a time of need, sometimes just the nurses presence is enough to help them.
people think spirituality automatically means religion. I dont believe in anything (i believe there is something out there, i just dont know what) and i believe myself to be a very spiritual person. Ive found that through yoga and meditation, not to sound corny.. but have found inner peace.
So just to let you all know, that the 'new age' nurses and doctors who will be entering the workforce will have a deeper and better understanding about your spiritual needs and how to support them.
jai
as a futurenurse, i believe that if you include God in all, evrything will be alright.JUst have faith unto HIM.
bythe way regarding with the patients how would it connect, it simply that it helps a lot, to accept at having increased faith,as developed patient-nurse trust relationship also!!
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