Four medical school educators have said that fully to address a patient’s needs, physicians should begin asking questions about the patient’s spirituality and religion.
A May 19 opinion piece in the Annals of Internal Medicine was written by a group of medical educators: Doctors Kristin Collier, Cornelius James, Sanjay Saint, and Joel Howell.
“Is It Time to More Fully Address Teaching Religion and Spirituality in Medicine?” said assessing a patient's religious beliefs is important to understanding fully the person. They also highlighted the significance of spirituality in America.
“Today, approximately 90% of Americans believe in God or a higher power. Furthermore, 53% of Americans consider religion to be ‘very important’ in their lives,” they wrote.
“Because religious commitment is intrinsically connected to cultural, mental, spiritual, and societal aspects of wellness, many patients believe that any authentic approach to health care ought to engage their religious commitments.”
However, physicians often do not discuss spirituality with their patients. Physicians promote a medical education based on quantitative science, which ignores immaterial, spiritual realities, they said.
“Science became an almost unquestioned source of authority. Physicians started seeing patients less as social beings with families and faith being essential parts of their lives, and more as collections of malfunctioning organs defined by microscopic pathology and bacteriologic culture,” they said.
Kristin Collier, an assistant professor and the director of the University of Michigan Medical School Program on Health Spirituality & Religion, said patients want a deeper relationship with their physician.
“I’m a primary care doctor so I have relationships with people over time … As physicians, we are not technicians taking care of complex machines. We are taking care of human beings and we know from research that patients desire to be seen as whole persons,” she told CNA.
She pointed to the example of Cicely Saunders, an English nurse and a founder of palliative medicine. Saunders emphasized four dynamics: physical, social, physiological, and spiritual. Addressing only half of these needs will only acknowledge half of the person, Collier added.
“Patients have social needs, they have spiritual needs. Those needs actually can intersect for the physical. For example, patients who have under-recognized, undertreated spiritual needs at the end of life ... can [contribute to] unremitting physical pain,” she said.
According to the opinion piece, there is a lack of training and mentorship fully to equip upcoming doctors to discuss spirituality. They said 78% of medical students reported that they have rarely or never seen their instructors discuss religion with their patients.
The Association of American Medical Colleges has required a core set of “spiritual competencies” for students to undertake in their medical education. The AAMC defines spirituality as an individual’s search for meaning through a participation in “religion and/or belief in God, family, naturalism, rationalism, humanism and the arts.”
Collier said a lot of medical schools have a curriculum for spirituality and described the curriculum at the University of Michigan Medical School. She said one of the examples is the FICA assessment, a questionnaire that assesses a patient’s beliefs, purpose, and community. Under the program, she said, the school will provide paid actors to play the role as patients and the students will then ask spiritual questions.
However, she said doctors and instructors need to be living out this example with real patients, which is a topic that is rarely discussed. She said that in the past it was taboo for doctors to discuss a patient's sexual history, which is an essential aspect of understanding a patient’s physical health. She said that similarly, doctors will not approach the subject of spirituality because it is too private or considered to be unrelated to health care.
“In some ways, the spiritual history parallels that of the sexual history. For years, the sexual history was considered ‘off limits’ in the clinical encounter, perhaps because it was too private a subject or not relevant for most medical providers, or perhaps because providers were uncomfortable talking about a diverse range of sexual behaviors,” the opinion piece said.
To introduce the topic, she said, doctors could begin with a questionnaire, like the FICA spiritual assessment. But, this important topic should eventually transcend a questionnaire, she said, noting that a deep human interaction extends beyond the paper. She said understanding the whole person will help doctors best understand how to treat their patients.
“I think this best happens in a relationship and I have relationships with my patients… What gives your life meaning? That question can oftentimes open up a lot of really interesting insights into your patients,” she said.
“[These questions] can help inform your decisions when it comes down to end of life or goals of care conversation.”
She emphasized the importance of faith in her own life and how that has given her a valuable perspective on the treatment of patients. She said it is the responsibility of physicians to set an example of a medical practice that honors human dignity.
“I see patients made in the image of God and I want to be able to attend to everything that is causing them distress and to be able to use my team to be able to attend to that,” she said.
“We have a responsibility as medical educators to teach our medical students and residents and fellows how to deliver whole-person care because that honors the dignity of the person. And, we know that patients want to be seen as more than just their disease or their biology.”