In a small room in Children’s National Medical Center in Washington, D.C., Motl Brody’s body grew tired. The 12-year-old from Brooklyn, N.Y., had been at the hospital for almost five months being treated for brain cancer, and his family had held a nonstop vigil by his bedside. Already in a coma, Motl’s brain stopped functioning on Nov. 4, 2008, and his team of doctors declared him legally dead. But his family said their faith, Orthodox Judaism, didn’t define death as such and sought a court order to keep him on life support. But in the end, even as the conflict began to draw media attention and before the court made its decision, Motl’s heart stopped beating on its own on Nov. 15, ending the debate.

While religion and medicine don’t always collide so dramatically, the two realms do coexist — and the intersections between them are frequently uncomfortable. Raymond Barfield, associate professor of pediatrics and Christian philosophy at Duke University, recalls a story about a fellow doctor who once found himself in an unexpected and potentially uncomfortable situation.

“This doctor was one of the best pediatric neurologists around and a truly warm and kind-hearted man,” says Barfield. “He was getting ready to treat a child for seizures, had the whole family in his office explaining the treatment, when the grandmother stood up and said, ‘I think I understand everything, doctor, but all I need to know now is whether you’re a Christian.’”

Unfazed, the doctor (who was Jewish) handled the situation gracefully by saying, “Ma’am, I’m as Christian as you need me to be.” Luckily, that answer sufficed.

It’s … complicated

Religion is a deeply emotional and personal topic, and some may argue that a person’s faith and his health are unrelated. No wonder so many physicians find religion a tough subject to broach.

“Religion is hard to talk about because it’s felt so deeply and matters so much. When you talk about an issue you run the risk of disagreeing. And disagreeing about religious beliefs can be painful for a lot of people,” says Farr Curlin, assistant professor of medicine at the University of Chicago Medical Center. “Medicine is a practice that applies science in ways that depend on your moral and spiritual ideas about what it means to be human. There are areas where patients and doctors disagree, or even doctors and doctors disagree how to apply that science.”

According to a 2006 study by Curlin and others, 91 percent of physicians said it was only appropriate to discuss religion with patients if the patient brought it up, and 45 percent said it was never appropriate to talk about their own religious beliefs.

Physicians haven’t been provided much guidance on navigating such a touchy issue. While the AMA requires medical schools to teach students how to at least inquire about a patient’s religion, and more than 80 percent of medical schools address spirituality in their curricula, this training is usually embedded in an ethics or humanities course and is sometimes an elective.

“I would say that the vast majority of people have at least a loose affiliation with a faith, and that most [Americans] would say they are Christian,” muses Barfield. “I would also say that most probably have their decision making affected by this fact, but that they are not necessarily aware of this all the time.”

In the clinical setting this can mean many things. For example, if a patient presents with symptoms of depression, would he be better treated with a prescription or by speaking with a counselor, perhaps one who counsels from the patient’s faith perspective? Or both? Suppose you have a patient whose religion includes observances that incorporate fasting. Now suppose the patient is diabetic, suffers from migraines, or has some other condition for which a regular, consistent eating schedule is part of her health maintenance. You might need to adjust her treatment, right? That’s why you can’t just tell yourself that religious and spiritual matters are none of your business — if your patient’s religious views could complicate her treatment regimen, and you’re unaware of it, she could suffer a serious problem.

You also can’t assume that the patient will raise these issues if you don’t make the first move. “What happens is that the patient doesn’t know they are permitted to go there,” says Richard Payne, a professor of medicine and divinity at Duke University. “We teach students they have a responsibility to have a conversation with their patients.”

Try these techniques to help reduce the discomfort:

Open-ended questions. Ask open-ended questions as part of taking the patient’s history or follow-up that allow her to easily venture into the topic without feeling cornered. For example, “So, Mrs. Jones, I recognize this is a serious illness and you must have thoughts about what this now means in terms of your life and how important things like religion are in your ability to help you cope with this. What do you think?”

Intake forms. If oral histories aren’t an option (or are uncomfortable for either you or the patient), include religion on one of your patient intake forms that new patients fill out. You can also have existing patients fill this out at their next appointment, as you would with any new form. By covering it in the original documentation, you know ahead of time what religion a patient follows (if any) and how it may affect his treatment. Also, update this form yearly — say, as part of an annual physical. Spirituality, after all, is a moving target. What gives a person meaning and fulfillment could change over time even without changing religions.

“It’s like sexual histories that used to be seen as so personal in the ’60s. You don’t just ask if someone is active now and assume they always will be,” says Christina Puchalski, founder of the George Washington Institute of Spirituality and Health. “Same with spirituality. Something may have happened — an illness, an operation — that causes people to rethink these questions.”