Wednesday, January 6, 2010

Faith and Medicine: What is the Doctor's Responsibility?

If Wendy Cadge is saying with this article that because 3/4 of Americans believe God can cure those with no chance of survival, doctors should entertain that belief and stop being so technology-oriented, this article at the Christian Science Monitor is not only irresponsible but silly. She writes:

Modern medicine, with its profound dependence on technology, often seems nothing short of miraculous. But even the best medicine sometimes falls short of offering a successful treatment or cure. It is in these situations that recent national surveys show many Americans think God can help.

Indeed, three-quarters of Americans believe God can cure people who have been given no chance of survival by medical science. More than half of Americans regularly pray for their own health or the health of their family. Yet many physicians are unwilling, or ill-equipped, to support patients and families on this level.

Many doctors see religion and spirituality as a barrier to medical care or, at most, a useful crutch when medicine has no more answers. But healing involves more than just medical diagnosis and treatment. Often patients and families see spirituality as a source of support when they are ill, or appear to be dying.

A holistic approach to medicine requires physicians to understand the complex role of spirituality and religion in compassionate patient care. The best prescription: Integrate these topics throughout medical education.

Appear to be dying?" Doctors ill-equipped to encourage families for a holy miracle? Godly healing is the new frontier in medicine? Medicine "sometimes falls short of a cure"? Um, statistically, we all die. So 100% of the time, medicine is eventually going to fall short of a cure. While faith is an enduring and credible support in grief, it cannot heal a patient. (Millions of federal dollars have been spent the past decades to prove that prayer aids healing. They all proved it doesn't.)

Cadge talks to a number of physicians - about 30 - and finds that few really know what to do when patients want to discuss their faith or pray with them. She concludes that this is a problem, caused by poor "faith" and "spirituality" training in medical school:

This may be changing, however, as a growing number of medical schools – many with the support of the George Washington Institute of Spirituality and Health (GWish) – started offering courses about spirituality and religion during the past 20 years. These courses try to prepare students to engage in a broad range of conversations about spirituality and religion. Individual courses vary significantly, however, leading GWish to collaborate with medical schools to develop six core competencies in spiritual and health education and to design a uniform way to measure and evaluate them.

While such top-down efforts are a good beginning, it’s clear that most practicing physicians have at least some level of discomfort regarding spirituality in their work, and some consider it a real source of conflict. Our bottom-up research approach – based on talking to physicians in the field – convinces us that a more nuanced, flexible approach to helping doctors and medical students navigate the spiritual shoals is needed.

That bottom-up approach was talking to 30 doctors informally about religion and spirituality. And she then recommends how lack of spiritual understanding in doctors it can be remedied:

First, physician educators must pay attention to the way they and their colleagues act around spirituality and religion in their work. Too many debates about spirituality in medicine are focused on what physicians should do rather than what they are actually doing now.


Second, doctors should pay more attention both to people’s religious traditions and to their broader senses of spirituality and meaning.


Third, it makes sense to systematically include hospital chaplains and nurses in educational initiatives. Two-thirds of American hospitals have chaplains, and nurses have a much longer tradition of talking with patients about spirituality and religion at the bedside than do physicians. Nurses also often spend more time with patients than do physicians

I don't even know what the first point means.

The second, in a broad sense, has validity. All humans should be sensitive to other's religious and spiritual beliefs.

The third is a great recommendation - but one that is already addressed at the 624 Catholic hospitals in the US and all others, despite secular or denominational affiliation who employ chaplains, priests, and buddhist guides.

The doctor's job, however, is a science-based job. And while doctors are required, by definition, to focus on science, they are also members of society, a society that is infused with religion and spirituality.

What I suspect Cadge's concern is about is end of life counseling. Elsewhere in the article she asserts that, "A holistic approach to taking care of people, one that will most help those who seek healing, means that more doctors will have to begin to understand patients’ complex relationships to spirituality and religion, rather than ignoring them."

She never clearly defines what she means by a "holistic approach to taking care of people."

If she means participating in religious practices like prayer or helping patients to look to God for a cure when medicine fails, I think she is misguided in her assignation of responsibilities for doctors.

Yes, doctor's notoriously need to improve their people skills but sympathizing with a patient's faith is not the same as helping them to pray for a miracle.

I know I'll get a lot of criticism for this post, particularly from my more "discerning" readers who will find it more proof that I'm anti-Christian or anti-relgion or that I don't believe in miracles. They'll be right with the latter point. And I find encouraging terminal patients to believe in miracles only an exacerbation of an already dire problem in the medical field: inability to talk realistically about unfavorable diagnoses or impending death.

Despite what Cadge claims, the medical profession has long abandoned dying patients to their pastors and priests. Medicine and faith have been intertwined from the beginning (as she inadvertently notes with her opening sentence about miraculous medicine.) They have recognized that when their science no longer works, it is easier to allow a patient who does not want to accept death to take up entertaining miracles with their faith leader.

Cadge's diagnosis that doctors should encourage hope for miracles is letting doctors without the personal skills to speak frankly with dying patients off the hook. I'm not at all saying that all patients can accept impending death. Some choose to fight on, to pray for reprieve from God and their disease, to forego the preparations for death in lieu of eternal hope. That's fine.

Although studies have shown that issues of grief are often better handled by families whose loved one accepted death and prepared for it. A doctor's role is not to encourage nor discourage such belief but to report his findings as accurately as possible and in a manner that does not cause emotional or physical harm to the patient.

Expecting spiritual guidance from doctors is asking too much. Clear discussion of diagnoses, compassion, scientific dexterity and sticking around til the end are a doctor's duties.

UPDATE: With regard to the questionable quality and accuracy of another Christian Science Monitor article, I linked to this post and the Cadge article on a listserve I subscribe to (feminist topics). One person replied saying that I was misreading Cadge, that she was petitioning for spiritual and religious sensitivity for doctors. I replied with the below. Am I off the mark on this one? Let me know in email or comments:

I agree that doctor sensitivity to faith is absolutely necessary. But informed consent implies the doctor ethically informs of options, the patient consents according to his/her conscience. My point is that sensitivity to faith and reticence to addressimpending death should not blur those roles.

A March study shows that devout patients are 3 times more likely to receive futile care at end of life than the less devout. A NYT article from August says due to lack of training on how to talk about death doctors are bad at prognosticating because they "view it as a personal failure. Most predictions are overly optimistic...and the sicker the patient, the more likely the doctor is to overestimate the length of survival." Futile care often leads to a more painful death, and great emotional challenges for the family. Rampant patient over-treatment is preventing our medical system from addressing those most in need.

The CSM piece laments that "only a quarter of the physicians surveyed reported having received any formal training at the intersection of spirituality, religion, and medicine."

Not to be obtuse but what is that intersection for a doctor? Does it mean that the medically sound diagnosis for pancreatic cancer is any different for a Atheist or a Muslim than it is for a Christian? And why is increased spiritual or religious sensitivity necessary for, say, palliative doctors but not OB/GYNs?

How information is conveyed is a matter of sensitivity. What information is conveyed is not.

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Blogger L A Neumann said...

Sorry about the formatting. I guess my blogspot has a little glitch today.

January 6, 2010 at 8:17 AM  

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