Magazine article Clinical Psychiatry News

A Survey Shows That Religious Physicians More Often Refer to Clergy Members Than to Psychiatrists. What Explains These Practices, and How Can They Be Changed?

Magazine article Clinical Psychiatry News

A Survey Shows That Religious Physicians More Often Refer to Clergy Members Than to Psychiatrists. What Explains These Practices, and How Can They Be Changed?

Article excerpt

Religion should be a private matter. Unfortunately for those physicians who are deeply religious, it is often difficult or impossible for them to separate their public physician role from their private belief system. We see this phenomenon in the case of abortion, contraception, and issues related to helping patients die in peace and with dignity.

It is clear to me that religion and religious training create a substrate upon which most of life's thoughts, actions, and experiences are built. Even though physicians as a group are intelligent and intensively trained, rarely does that training intrude on the deep-seated religious beliefs that a doctor may hold.

In the best of situations, the doctor is able to separate himself from religion in carrying out his daily medical tasks. If he is unable to do so, he should recuse himself from the situation rather than impose his beliefs on a patient or family--who should receive the soundest and best advice possible on the treatment of an illness or condition.

The study cited below clarifies the way in which U.S. doctors of different religious affiliations deal with patients who present with psychiatric disorders and who would benefit from a proper referral to a psychiatrist (Psychiatric Services 2007;58:1193-8). One sentence in the article reads, "The mismatch in religious beliefs between psychiatrists and patients may make it difficult for patients suffering from emotional or personal problems to find physicians who share their fundamental belief systems."

However, it is important to point out the psychiatric care is not based on beliefs. In fact, I am not sure how such belief systems would even come up in an encounter between the psychiatrist and the patient. If the patient has anxiety or depression, for example, I am not sure how God would even get into the conversation.

The doctor's task is to reduce the patient's pain and, hopefully, bring the patient back to a state absent of anxiety or guilt. If the authors believe that psychiatry is based on the doctor's beliefs rather than a science, that basic premise is flawed--and that needs to be dealt with first.

Psychiatric diagnosis and treatment is research- and evidence-based, and the psychotherapeutic and psychopharmacologic interventions should be absolutely independent of the psychiatrist's religion or personal attitudes. There are lots of doctors who, despite getting a great deal of psychiatric training in medical school, are still deeply prejudiced against the specialty.

The stigma against the mentally ill and their caretakers also remains alive and well, and this stigma is the most virulent and vitriolic among nonpsychiatric physicians. It starts with the nasty jokes and snide remarks by fellow classmates and/or residents and supervisors, and becomes part of the early socialization as a physician. That is just how it starts. Psychiatrists often help perpetuate the stigma by making inappropriate remarks about psychiatry, colleagues, or patients.

Some medical students also turn off their minds to psychiatric information because of their own religious beliefs, other beliefs, and experiences that occur before entry into medical school. One case stands out starkly around this issue.

When I was chairman of the department of psychiatry at Thomas Jefferson University in Philadelphia, I gave a weekly seminar to all of the junior medical student clerks on psychiatry. During one 6-week block, one student seemed very angry and uncomfortable in the class. I noted that whenever this student spoke, his classmates either giggled or made some negative remarks.

Finally, I asked him to come to my office, and when he arrived I told him that I thought he was uncomfortable in my class and asked what might be the matter. He then said, in a strident and angry voice, "I am a Christian, and I don't know how you can talk about the human mind and never mention God. …

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