How can physicians approach spirituality in their profession?

Those unfamiliar with spiritual assessment raise questions about how to approach the area of spirituality, the timing of the inquiry, which patients are candidates for a spiritual history, and what should be asked. Frequently the patient opens the door to spiritual inquiry by directly mentioning his religious faith.¹ A comment such as "I have been praying that God will heal me" is an open invitation to the healthcare provider to explore this area. This opening seems to give the healthcare provider tacit approval for further inquiry regarding spiritual and religious issues.

It is not sufficient, however, to wait for the patient to provide this opportunity. The spiritual history should be a structured part of the physician's initial conversation with a patient. King² suggests that taking a spiritual history should be part of the social history obtained by the doctor as part of all outpatient physical examinations, as well as for all patients admitted to the hospital. This is a responsibility that the physician should not delegate, even if nursing, social work, and the chaplaincy service are also inquiring about spiritual issues. Doctors need to know about any factor that has as powerful an effect on the patient's medical decision-making as their religious or spiritual beliefs.³

Although several studies report that many patients also support the need for the physician to conduct a structured spiritual history, the reality is that very few patients ever experience this.⁴ It is important that the physician be sensitive to the possibility that the patient and family may seem surprised and even a bit uncomfortable when the topic of spirituality is first introduced. This can be handled by an introductory comment by the physician such as, "I want to ask you a few questions about your spiritual and religious beliefs. This may seem like an unusual topic for us to discuss, but research shows that for many patients this area is significant to their healing. Since I am interested in your well-being, I am interested in whatever supports you in maintaining health and getting better."

Notes

1. King, D. (2000), Faith, Spirituality, and Medicine (New York: Haworth Press), 54.
2. King, Faith, Spirituality, and Medicine, 54.
3. Ehman, J., et al. (1999),"Do Patients Want Physicians to Inquire About Their Spiritual or Religious Beliefs If They Become Gravely Ill?" Archives of Internal Medicine 159: 1803-1806 and Silvestri, G. A., et al. (2003), "Importance of Faith on Medical Decisions Regarding Cancer Care," Journal of Clinical Oncology 21: 1379-1382.
4. Koenig, H. G. (2002), Spirituality in Patient Care (Philadelphia: Templeton Foundation Press), 13-15.

From Verna Benner Carson and Harold G. Koenig, Spiritual Caregiving: Healthcare as a Ministry (Philadelphia: Templeton Foundation Press, 2004), 91.