American College of Physicians: Internal Medicine — Doctors for Adults ®

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Letters

From the October 1997 ACP Observer, copyright 1997 by the American College of Physicians.

Spirituality and patient care

I have long felt that the spiritual aspect of my patients' lives are important to their health and to their overall care. Yet the idea that the issue of spirituality in medicine is "taboo" is common among physicians. (Making the case for bringing religion to patient care, July/August ACP Observer). In medical school, during a conference with the hospital ethics committee and the hospital lawyer, we were told that if the issue of spirituality is brought up, it must be handled with "extreme tact," implying that there could be legal ramifications if done poorly. However, it appears that many patients actually desire to discuss these issues, which they consider important in their lives and that may affect their care.

I was once told that in order to heal the spiritual aspect of a person, we must sometimes heal the physical aspect first. I'm beginning to wonder if in order to heal the physical aspect of a person, we must sometimes heal the spiritual aspect first.

Elton Lee, ACP Associate
Sunnyvale, Calif.

One must be careful in discussing religious issues with patients. Patients come to a religion and spirituality for many different reasons. Some seek better health, while some seek an improvement in their social or economic situation. Others seek an understanding of basic questions such as the existence of a creator or creators, the purpose of mankind, and the meaning of life and death. Many see this life as transitory and have a hope of better things to come.

Physicians also come from many different cultural backgrounds, with widely varying beliefs in religion and spirituality. Given the enormous heterogeneity between the spiritual views of physicians and their patients, I am not sure how a method of interaction could be formulated that would benefit both groups.

Frequently in medical school, these topics are treated superficially. Exposing medical students to matters of faith may help broaden their outlook on different religious systems. However, trying to teach the benefits of spirituality is a lot different than formulating a technique of how to use faith and matters of spirituality for the benefit of health. It is not for everyone and should not be taught as a kind of option for therapy.

The article raises some interesting questions. Can it really help for a physician to encourage patients to seek comfort in spiritual things if the physician has only superficial knowledge of a particular religion? For example, can an atheist physician help Christians, Muslims or Buddhists use their beliefs to achieve better health? And should physicians encourage patient beliefs that they feel are an apostasy to their own faith?

Finally, what exactly are physicians to infer from the results of clinical studies that say prayer helps with healing? That prayer by itself has intrinsic qualities that assist with healing? That a supernatural being has interceded in the favor of the praying patron? What if clinical research proves that prayer is ineffective or worsens healing? Proving that patients heal better by praying or going to church services proves nothing. In fact, it belittles faith by presenting it as a kind of positive lifestyle activity, like eating properly or exercising regularly. It bothers me that religion is now being seen by some as something that can be clinically used like a tool.

Unfortunately, faith and spirituality cannot be put in a box. Matters of faith address subjects that the field of medicine can never answer. Patients, and indeed physicians, turn to religion to help answer questions far beyond the scope of medicine. Better health may or may not be a benefit of faith and spirituality, but to look at it in this perspective is to miss its true purpose.

Daniel S. Tamashiro, ACP Member
Wahiawa, Hawaii

Any physician who practices medical oncology knows that out of a given cohort of patients with malignancy, a certain percent will have complete response, a certain percent will have partial response and the remainder will have progressive disease. Lacking any ability to consistently predict which patients will be the responders, I frequently tell my patients that I can give them therapy, but that their course is in the hands of the "man upstairs." (I also tell them this if they wish to give me credit for successful treatment.) While I do not preach any particular religion, I think it is obvious that prayer is a necessary component of dealing with major illness.

Paul I. Roda, FACP
Hazleton, Pa.

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