A discussion of the role of religion in medicine
President Bush's re-election has fomented lively debate about the role of religion in America. Many policy wonks and cultural arbiters have decided that the election means there is increasing interest in all things spiritual. The election is popularly viewed as a mandate for "moral values."
Although there is also some evidence that the moral values election narrative is more media creation than reality, there are discussions in the air about the interplay of morality, religion, and the supposedly secular aspects of life.
Even businesses like software firms and banks are confronting religion. The New York Times Magazine devoted a recent cover to the faith-at-work movement, including an interview with a mortgage banker who prays with his customers.
Religion and healing -- unlike religion and banking -- certainly have had a long history together, but in most private practices these days the attitude is more scientific than spiritual.
That may be changing. Membership in the Christian Medical and Dental Associations has doubled since 1997 to 17,000, according to the group's associate executive director, Gene Rudd, an OB/GYN in Bristol, Tenn.
Rudd credits the growth to physicians who seek a "covenant relationship and not a contractual relationship with their patients," and points to evidence that spirituality improves clinical outcomes.
In Rudd's own practice, religion is expressed quietly; he doesn't want to make any patient feel pressured or uncomfortable. For example, in the restrooms, along with signs encouraging patients to talk to the physician if they suspect they have an STD or have been abused, he posts signs letting them know he will pray with them if they'd like. In preoperative settings, he asks patients if they would like to pray. "In six years, only one has said no," he reports.
Faith also is a part of Robert Purcell's gastroenterology practice in Williamsport, Pa. "Every few weeks someone will make a comment about their faith that I'll agree with in some way to show that I'm there with them," he explains. "I don't use my role as a physician to push my own faith bias," he quickly adds. "I encourage [patients] to rely on whatever their own background is."
It's especially important to understand all aspects of a patient's life when it comes to the lifestyle issues so relevant in gastroenterology, he says. For Purcell, faith is just a part of understanding who he is treating. Business pressures and other factors have made medicine less personal in general, he explains: "We need to get back to [the personal connection] in some way. ... If a physician coming at it has a faith-base, I think that adds another dimension. It's more than just a physician being a nice guy and spending time talking to patients."
Both these physicians are very sensitive to the undue influence they can have on patients. They do not evangelize to patients. They are sensitive to all variations of faith. They stay within ethical bounds.
But what are the long-term implications for physicians and patients if the notion of mixing religion with medicine takes off? What if some doctors are more direct in discussing matters of faith with patients than Rudd and Purcell are? After all, many evangelicals believe they are duty-bound to proselytize. Would a born-again oncologist be able to resist a discussion of heaven and hell with a terminally ill cancer patient who mentions, in passing, being an atheist?
Should he resist? We certainly don't want doctors abusing their influence over vulnerable patients. On the other hand, what if the oncologist suspects the patient is having a crisis of faith as she faces her own mortality and that spiritual support would improve her outcome? Should physicians just ignore their patients' needs and their own spiritual dictates?
The fact is that many patients are religious, and faith is a part of how people face medical crises. It is hard to leave your spiritual views at home. They are a part of practice.
What do you say if a patient wants to pray with you? E-mail me at firstname.lastname@example.org, or chat with colleagues at http://groups.msn.com/PhysiciansPracticeRabbleRousers.
This article originally appeared in the February 2005 issue of Physicians Practice.