Last week, as part of a family medicine rotation, we discussed the importance of bringing spirituality into the hospital. The conversation was led by Stanford Hospital’s chaplain, Dr. Bruce Feldstein, an ER doctor in a former life. We began with definitions of spirituality, discussed personal experiences surrounding a spiritual moment, and concluded with how to take a “spiritual history,” a series of questions that explore patients’ spiritual or religious beliefs. We even got a practice script that we took turns reading aloud. It went something like, “We have been discussing your support systems. In the past, what sustains you in difficult times? … What are your sources of hope, strength, comfort and peace?…What is your faith and belief?…How would you like me as your doctor to address these issues with you?”
Saying the words aloud made me realize how uncomfortable I was broaching this topic with my patients. I had always thought, and I’m not sure why I had this notion, that doctors were not supposed to talk about religion with patients. Much like other polarizing topics such as politics, religion seemed to be a taboo topic that made interactions between doctors and patients more unprofessional. It could either go really well and strengthen the doctor-patient bond, or it could go really badly and push the patient further away from his provider. I think of this from a patient’s perspective. Would I feel comfortable discussing my faith with my doctor of a different religion? I would fear that I may color the doctor’s opinion of me due to certain prejudices he may hold, which somehow could affect my medical care. I’ve also never seen a doctor discuss religion with a patient, so I would worry that the doctor would think I am wasting his time. And what if my doctor were atheist? What would I say to him? How could he possibly understand how and why I am turning to my religion to sustain me through this hospital visit?
I think my takeaway from this class is that the decision to discuss religion depends on what cues I get from my patients. If my patient brings up religion in our discussions, seems comfortable mentioning spirituality with me, or seems to talk about faith and religion with his family when considering medical decisions, then yes, I may explore this topic (though to be honest, I’m not quite sure what it will add to discuss religious topics with me versus with a spiritual figure like a pastor or a chaplain). But if the patient requests it, I will engage. Personally, I still will not actively ask about religious preferences if the patient does not bring the issue up. For now, religion will remain mostly off limits for me in the workplace.
Source for the spirtuality practice script (as adapted by Dr. Feldman):
1 Anandarajah, G and Hightm, H. Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for
Spiritual Assessment. American Family Physician 63(1):81-89, January 2, 2001.
2 Puchalski, C. Taking a Spritual History Allows Clinicians To Understand Patients More Fully. Journal of Palliative
Medicine 3(1):129-137, 2000.
Thank you, Dr. Ho, for writing about this topic so thoughtfully. As an atheist living in the Bible belt, I am constantly aware of the apparent religiosity of all my doctors by the predictable presence of either a Christian Bible or Christian religious literature (especially Bible stories for children) in their waiting rooms. Of course, a zealous patient might have left them there, but since the staff does not remove them, even that’s a message sent to waiting patients. I draw the conclusion that either the thought has not occurred to the doctor that his or her patients might be Jewish, Muslim, Buddhist, pagan, or atheist, or perhaps the doctor has a desire to be evangelical. I do not want to have to appear disagreeable to my doctor if he or she should bring up the subject of spirituality in conversation with me (so far they haven’t), and I don’t think it is the doctor’s job to discuss that anymore than it is to talk about politics, or to leave Republican or Democratic campaign literature in the waiting room. Your plan to let your patients cue you if they want to discuss spiritual matters is an excellent idea.
I would agree completely. I look to doctors for technical information so I can make informed decisions. These days I insist on seeing medical journal articles because doctors put their spin on information, based on their value systems. I want to know the real risks and benefits of tests and treatments. Awhile back when I was unlucky enough to land in an HMO, I declined tests because research published in top journals questioned the value of those tests. Doctors responded emotionally, as in “But you can live longer!” (not true) or, “Well, it’s got to be better than nothing.” So if a doctor brings up anything spiritual, I’d say she’s really crossed the line. I want her to read journal articles and understand relative vs. absolute risk, not offer to pray with people who are more likely than ever to be atheists these days.