Monday, September 22, 2008

JAMA on medicine and spirituality

JAMA recently had a clinician's corner piece about spirituality and patient care.  It's somewhat of a narrative review of the topic, mostly focused on what the physician's role is in addressing patients' spirituality.  The main message is summarized well here:

Koenig notes that multiple studies have revealed that a majority of patients not only would not mind but would even want their physicians to ask about their religious beliefs. At a time when they are vulnerable because of illness, many patients want physicians to know what gives them meaning, comfort, and support. This does not imply that physicians must agree with those beliefs. Physicians must listen respectfully and, if the patient seems to be in distress because of those beliefs, inquire as to whether the patient has spoken to or wants to speak with a chaplain or member of the clergy. Indeed, that is all most physicians are prepared to do, but it is something that they should be willing to do. To franchise this responsibility to a nurse or social worker is to practice something short of the art of medicine, no matter how expert the practice of the science.
All well and good.  I took pause however with this paragraph:
Although many physicians can appreciate the importance of religion and spirituality for patients, far fewer believe that they must be the ones asking the questions, convinced that others are better suited to this task. ...Far fewer physicians are likely to initiate prayer with patients,believing that to do so intrusively imposes their beliefs or style of praying upon vulnerable individuals. For example, even if a physician politely asks, "Would you like me to pray with you?" this might present a quandary for a patient. If the physician really wants to pray, does the patient under his or her care really have the liberty to decline?
Given that the author in the first quoted paragraph clearly advocates physicians asking patients about spirituality, the rhetorical structure of the second quoted paragraph (...far fewer...far fewer) would seem to imply that s/he thinks in fact we should offer to pray with patients (which we clearly should not, other than in very limited circumstances such as the doctor and patient are both members of the same congregation and also pray together outside of the doctor-patient relationship etc.).  I read this about 5 times now and have decided that s/he's likely not advocating such a practice but it's a little unclear....

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