Nov 13, 2009
From Wendy Cadge, a professor of sociology at Brandeis University:
Every day, doctors have to decide whether and when to ask patients and their families about religion and spirituality—but research studies on this topic often rely on hypothetical situations, rarely asking physicians what they actually do. With my colleagues, sociologist Elaine Howard Ecklund of Rice University and Nicholas Short of the Baylor College of Medicine, I interviewed 30 pediatricians and pediatric oncologists who work and teach at top American medical centers. Instead of asking them what they think about religion and spirituality, I asked them how they act.
As a group, these physicians received almost no formal training about religion or spirituality during their medical education. About a third described learning about religion and spirituality through informal conversations with colleagues during medical school or their residency, or by getting to know hospital chaplains. Usually, these conversations would focus on specific topics, such as death and dying, decision making, or how to respond to particular religious groups. Rather than asking patients and their families direct questions about religion and spirituality, the majority of doctors told us that they prefer to ask broad, open-ended questions or —more commonly—wait for patients and families to bring up these issues themselves. Several describe religious topics as “personal,” saying they do not want to “pry.”
The majority of the doctors I spoke with see religion and spirituality as most relevant when families are making difficult medical decisions or when a patient is dying. Rather than talking about how religion and spirituality might shape decisions for Protestants, Muslims, or Catholics, doctors focused on Jehovah’s Witnesses, Christian Scientists, Orthodox Jews, and other traditions that have historically existed in some tension with biomedicine. Many perceive religion as acting as a barrier to medical care for members of these groups.
Most commonly, physicians talk about death when they’re asked about religion and spirituality. As one pediatric oncologist explained, religion usually comes out “early in the course of diagnosis, families that feel devastated … or later in the course when a patient takes a turn for the worse or … the disease comes to a point that, as their providers, we can longer provide curative means.” At each of these points, physicians say, families draw from their religious or spiritual traditions as they try to answer the “why” questions—why their child is ill, why something so rare hit them, why there has been a reoccurrence of the disease, why they are faced with this crisis. It is in these situations–especially in end-of-life situations—that physicians see religion and spirituality acting as a bridge, helping patients and families make sense of illness, adjust to difficult news, and answer questions that medicine can’t.
Overall, the doctors interviewed see religion and spirituality as relevant to their work at its fringes. They decide how to act around religion and spirituality not based on formal training, but by watching the patients and families with whom they work. They see religion and spirituality as a barrier when it inhibits medical care for members of particular groups and as a bridge when it helps patients and families make sense of things, especially when physicians have no more medical options—or explanations—to offer.