Training Doctors to Heed Patients' Spiritual Histories ; in Medical Schools, More Future Physicians Learn of Link Between

Article excerpt

Physician Dale Matthews still remembers the woman who came to his office, complaining of shortness of breath. What he most recalls, though, is how taken aback he was by his patient's response after he diagnosed a serious heart problem.

"She looked me square in the eyes," he recounted, "and, holding her prayer book, she said, 'I'm not going to go to the hospital. I have to go home and pray.' "

Nothing in his medical-school training had prepared him for that moment, says Dr. Matthews, who teaches at the Georgetown University School of Medicine in Washington. Two weeks later, he reported, the woman returned to his office, healed.

Today, medical students are more likely to receive training on gathering patients' spiritual histories - a trend that has evolved in tandem with the growing body of clinical research linking patients' spiritual beliefs to physical health.

Preparing doctors to deal with the spiritual histories of their patients and to recognize faith as part of the healing process is still a fairly new development. But over the past five years, these ideas have become more integrated into medical-school training, says Christina Puchalski, director of clinical research at George Washington University, who has developed guidelines for doctors to use in discussing spiritual issues with patients.

Of 125 accredited medical schools, 61 offer a course on spirituality in medicine - and as many as 40 of those introduce future doctors to Dr. Puchalski's guidelines, known as FICA.

Still, there can be a reluctance to address spiritual concerns, Puchalski says. This stems in large part from lack of time and training, and doctors' uncertainty about how to identify patients with spiritual needs.

FICA, which stands for Faith, Influence, Community, and Address, is a formula doctors can use to ensure that patients' spiritual histories become part of their medical records. Using it, doctors will ask questions such as: Does religious faith or spirituality play an important role in your life? How does your religious faith or spirituality influence the way you think about your health or the way you care for yourself? Are you part of a religious or spiritual community?

"I knew I would have to come up with some sort of tool to make it easy for them [to do a spiritual assessment]," Puchalski says. …