When you visit a doctor for the first time, you expect him or her to ask about your health history: past surgeries, illnesses or injuries.
Now, your doctor might ask questions about your religious beliefs as well.
A small but growing number of physicians are taking patient “spiritual histories,” according to Dr. Harold G. Koenig of Duke University. By collecting information about each patient’s religious or spiritual beliefs, he thinks doctors can make more informed treatment decisions and help patients rally spiritual resources to aid healing.
“Neglecting the spiritual dimension is just like ignoring a patient’s social environment or psychological state, and results in failure to treat the ‘whole person,'” Koenig said.
Koenig described the emerging technique in a manual for health care professionals, “Spirituality in Patient Care” (Templeton Foundation Press).
A spiritual history might include questions such as: Does the patient rely on religion or spirituality to help cope with illness? Is the patient a member of a supportive spiritual community? What spiritual questions, if any, does the patient find most troubling?
Dr. Robert Fine, director of clinical ethics at Baylor Healthcare Systems in Dallas, thinks spiritual histories can help. He cited an example of a patient who insisted on aggressive treatment, even though her advanced breast cancer was clearly terminal and she was in terrible pain. Puzzled, her doctors called in Fine, who learned that fear of going to hell kept her from accepting the inevitable. After a conversation with a chaplain, she was able to face death peacefully.
Not everyone agrees with the notion of physicians delving into the spiritual. Some worry that doctors — with their expertise rooted in science — aren’t equipped to navigate the gray areas between faith and medicine.
Dr. Jeffrey P. Bishop, who teaches a course on spirituality and medicine at the University of Texas Southwestern Medical Center, said the example of the woman with breast cancer poses tricky questions.
Should doctors tinker with a patient’s beliefs, even with the best of intentions? The ends of spirituality and the ends of medicine, he added, don’t always agree — one example being the beliefs of Jehovah’s Witnesses, who refuse blood transfusions even in life-threatening situations. Nonetheless, he advocates taking patient spiritual histories because he believes that doing so gives patients comfort.
Jeff Flowers, director of pastoral care at the Medical College of Georgia Health System, lectures medical students on taking “patient spiritual histories” as part of a required course on clinical medicine.
He urges doctors to use caution. Some patients won’t want to talk about spirituality and should be allowed room to easily refuse; doctors must tread especially carefully when the patient’s beliefs might seem to hinder medical care.
“I tell the students that we need to honor the person’s right to believe what he or she chooses to believe,” he said. “It’s never our job to dissuade them of their beliefs.” He invites representatives of different faith groups to speak to the medical school class, so that the future physicians can understand that people of less familiar traditions “are not crazy, just devout.”
Koenig estimated that between 5 percent and 10 percent of doctors take some form of spiritual history; he expects the number to grow as graduating students join the field. Nearly two-thirds of American medical schools in 2001 taught courses on religion, spirituality and medicine.
Most doctors don’t take histories, however, due to lack of time or fear of being intrusive.
“Doctors don’t feel comfortable bringing it up,” he said. “We’re at the place we were 20 years ago when doctors were asked to take a sexual history.”
Koenig thinks spiritual histories are especially useful with patients facing surgery or life-threatening, chronic or disabling conditions. With so much recent research pointing to potential benefits of spirituality to physical health, a spiritual history gives the doctor a practical way to harness those benefits.
“If I know a person’s spiritual background, I might ask something like ‘Would a short prayer help in this situation?'” he said. “Knowing that a person is religious frees me to be more forward in using a spiritual intervention that might bring comfort.”