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'The last taboo'

Making the case for bringing religion to patient care

From the July/August 1997 ACP Observer, copyright 1997 by the American College of Physicians.

By Deborah Gesensway

  • Previously published ethics case studies are available online.
  • For additional ethics resources, visit the College's Center for Ethics and Professionalism

WASHINGTON—As the millennium approaches, a growing body of scientific literature is beginning to convert many in the medical community to what has been a 20th-century heresy in America: Religion may be beneficial to health.

"And if religious belief is good for one's health, should doctors recommend it?" asked Dale A. Matthews, FACP, associate professor of medicine at Georgetown University School of Medicine, speaking at a session on spirituality and medicine at the annual meeting of the Society of General Internal Medicine (SGIM) this spring. Might it even be unethical, he continued, for physicians to ignore or oppose their patients' religious beliefs and practices if these practices aid healing or promote health?

Calling religion "the last taboo" in medicine, Dr. Matthews outlined the findings of recent medical research that he said is helping dismantle the wall that has long separated medicine and religion. Other panelists at the SGIM session discussed some of the ways spirituality and religion are being added to medical school and residency training curricula.

Although religion also can kill—consider cults, religious wars and fundamentalist groups whose members refuse medical care—Dr. Matthews said, "I have come to the conclusion that religious commitment is usually good for your health."

The numbers

He bases this conclusion on a review of 212 studies that looked at the link between religious commitment and health care outcomes. About three-quarters of these studies (160) demonstrated a positive benefit of religious commitment, 7% (15) found a negative effect and 17% (37) came to a mixed opinion or showed no effect.

For instance, in a 1988 study of 383 patients at San Francisco General Hospital's critical care unit, patients who received intercessory prayer from a prayer group had less congestive heart failure, less pneumonia, used fewer antibiotics, were less likely to be intubated and suffered fewer cardiac arrests than patients who were not offered prayer service.

Another study from 1972 involving 92,000 residents of Washington County, Md., found that those who attended church once or more a week had 50% fewer deaths from coronary artery disease, emphysema and suicide, and 74% fewer deaths from cirrhosis.

Much of the literature illustrates a not unexpected connection between religious commitment and alcohol and drug abuse, with regular church-goers or Bible-readers having a much lower risk of using drugs or alcohol, Dr. Matthews said. But the literature has also demonstrated that patients with religious conviction tend to cope better with their illnesses, report less depression and recover more quickly from their illnesses.

Public sentiment

This growing body of research, Dr. Matthews said, is also important because it reflects what patients have been telling the medical profession: Americans overwhelmingly believe in God and many—two-thirds in some studies—believe that their physicians should address spiritual issues and ask them about their faith-healing experiences. Dr. Matthews quoted a 1996 USA Today Weekend poll that found that 79% of Americans believe that faith can help recovery from illness and 63% think physicians should talk to patients about spiritual issues, yet only 10% recall any physician ever talking to them about faith and physical health.

This can be tricky for physicians, many of whom hold very different opinions about the healing power of prayer. But Dr. Matthews said he believes the two traditions must be blended if physicians are going to be able to meet the needs of what he called "the whole person."

"This is not for all patients, but for more than you think," he said. "I believe we can ask patients about spirituality and that you can partner with some clergy."

Christina M. Puchalski, ACP Associate, has come up with a method to do just that. She designed a four-year curriculum for teaching spiritual care to medical students that has been implemented at George Washington University School of Medicine, where she just completed her residency training in internal medicine.

At the SGIM session, Dr. Puchalski said her view of the physician's role in discussions of spirituality is to determine what gives patients' lives meaning and then use that information to help care for them. For instance, doctors can use that type of information to figure out ways of convincing patients to adhere to medical regimens. Talking about issues of spirituality, she said, "is a great way to open up the discussion about advance care planning."

Dr. Puchalski suggested that physicians add just a few questions during the social history part of a medical interview. Her starting question is "Do you consider yourself a spiritual or religious person?" If the answer is no, she follows up with "What gives your life meaning?" or "What is important in your life?" It is also useful to ask if the person is a part of a spiritual or faith community and if the patient would like his or her health care provider to address these issues.

Finally, physicians must also recognize that not all patients will want to discuss these issues. "Don't force someone to talk about this," Dr. Puchalski said.

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