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Say Two Prayers And Call Me In The Morning
Studies have shown a majority of patients are open to discussing religion with their doctors and want their doctors to at least be willing to explore spiritual issues should the need arise. But a study by John Chibnall, Ph.D., associate professor of psychiatry at Saint Louis University School of Medicine, and medical student Christy Brooks found that a majority of physicians are not comfortable addressing spirituality with patients.
In a survey of 78 physicians, a majority reported they accepted a link between religion and health, yet only 8 percent discussed spirituality in any detail with their patients. Less than a third knew their patients' religious preferences. The study was published in a recent issue of the Southern Medical Journal.
"There's a belief among physicians that when you start talking about non-medical topics with patients, you open a Pandora's box," Dr. Chibnall said. "They've spent seven to 10 years developing highly technical and valued skills, and it's these skills that they want to ply. If you start talking about religion-something everyone has been taught to avoid in social interactions-you have to drop the thing that you are most expert at, and change the whole power dynamic. That's not easy to do."
Dr. Chibnall said physicians also reported they avoid religion because they worry about being perceived as proselytizers. And they worry that non-religious patients might somehow feel guilty about their illness-that it was caused by not being "good" enough.
Other physicians said they feel religion is not the job of the physician and that the clinician should immediately defer to pastoral care for religious concerns. The physicians also noted the lack of clinical research evidence that spiritual discussions have any link to patient medical outcomes.
"These are legitimate concerns," said Dr. Chibnall, "but there are non-judgmental ways a physician can acknowledge that there's more to a patient than a physical body, that the well being of the whole person-psychological, relational, spiritual-can be part of patient care. This can be done without crossing ethical lines, without opening Pandora's box."
Family practitioners, neurologists, internists and surgeons participated in the study. The sample was 80 percent male and 20 percent female.
Some of the physicians reported they did not discuss spirituality in the clinic due to lack of time, but Dr. Chibnall and Brooks found that even if physicians had the time, they still were unlikely to approach the subject. Even the physicians who described themselves as "religious" were no more or less likely to pursue a spiritual discussion with patients than their nonreligious peers.
Dr. Chibnall said future research is needed to examine the role of medical education in creating and/or maintaining physician beliefs about religion in the clinic and whether physician integration of spiritual issues in patient care makes any difference in patient health or well-being.
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first M.D. degree west of the Mississippi River. Saint Louis University School of Medicine is a pioneer in geriatric medicine, organ transplantation, chronic disease prevention, cardiovascular disease, neurosciences and vaccine research, among others. The School of Medicine trains physicians and biomedical scientists, conducts medical research, and provides health services on a local, national and international level.
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