Should Physicians Conduct Spiritual Histories of Their Patients?

Article excerpt

YES There is growing research that religion makes a difference in physical and psychological health, prevention, and recovery. It also gives patients a more optimistic view of death and illness, and is a powerful source of meaning and purpose.

But that's not the best reason to inquire about a patient's spirituality. A much better reason is that religious beliefs influence medical decision making.

The physician-patient relationship, as it has evolved in the last few decades, has moved from paternalism, where the focus has been the good of the patient as judged by the physician, toward one based on partnership, in which respect for the patient's values and beliefs has become a leading factor in decision making.

With a complex and stressful illness, it is important to understand the patient's resources for dealing with the stress. Taking not just a medical history. but also a "spiritual history," helps physicians grasp what's important to their patients and what may drive decisions about accepting or rejecting treatment.

Although less than 10% of physicians now conduct these assessments, I expect that the practice will increase over the next 5 years in medicine, especially in treating serious and chronic illnesses such as stroke, cancer, and arthritis.

I am not encouraging physicians to counsel patients on spiritual issues or to try to provide answers to their spiritual dilemmas. We are simply not trained for that. But we should be aware of spiritual views and be prepared to refer troubled patients to counselors or chaplains.

Traditionally, the idea of discussing spirituality with patients has been accepted largely as part of treating dying patients. But the health benefits of spirituality can be seen far beyond the scope of death and dying. Physicians treating any patient with an illness that challenges his or her ability to cope should consider taking a spiritual history.

Physicians should make note of the spiritual history in the medical record, just as they would information about immunizations or previous medications.

Asking patients about their spirituality in a natural and non-intrusive way can offer a great opportunity for the physician to better understand the patient's values and motivations. However, the key is to keep the conversation focused on the patient. The spiritual history should not be a forum for the physician to impose his or her own beliefs, or to make the patient feel uncomfortable or coerced. …

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