Teaching doctors to talk about faith

Getting a medical education at Penn involves more than learning about the human body and its processes. Every medical student at the University must also learn how to talk to their patients about their religious beliefs.

It wasn’t always this way, explained Gail Morrison MD, who spoke at the 10th annual Spirituality Research Symposium on April 25, an event co-sponsored by Penn’s Center for Spirituality and the Mind and the Pastoral Care division’s Spirituality and Health Special Interest Group.
Morrison, the vice-dean for education and a professor of medicine at Penn Medicine, explained that she and her colleagues became more aware of the school’s deficits in addressing spirituality when a former patient came in to talk about her own near death experience and her inability to discuss it with HUP doctors. The patient challenged Morrison to come up with additions to the curriculum for medical students and a program for current physicians that would make them more comfortable talking about issues of faith and would foster “understanding, respect and appreciation for the individuality and diversity of patients’ beliefs."

Tackling the issue is vital, said Morrison, because patients facing terminal illness frequently use religion and spiritual factors to make decisions on end-of-life issues. According to a recent Gallup poll, more than 75 percent of patients would like doctors to discuss their spiritual beliefs with them, though only about 20 percent of physicians actually do.

The barriers are numerous. Jean Kristeller, who directs the Center for the Study of Health, Religion and Spirituality at Indiana State University, told the audience that surveys she has carried out suggest doctors avoid broaching spiritual matters because of a lack of time (the average patient visit lasts only 15 minutes) and training, a fear of saying the wrong thing and a sense of discomfort in assuming a role they believe more fitting for a pastor or a chaplain.

Doctors also perceive difficulties in talking with patients whose beliefs may differ from their own. But David Hufford, a professor at the Penn State College of Medicine in Hershey and an adjunct professor of religious studies at Penn, said those qualms must be overcome since there are practical reasons for engaging with patients’ beliefs.

“Everything we teach about religion and medicine is things every doctor should know. This is practically important regardless of [a doctor’s] personal beliefs. Atheist or devout, both need to know how to practice good medicine.”

To illustrate his point, Hufford referred to the real case of a Pashtun-speaking Islamic man with stomach cancer. The man refused chemotherapy because the only way it was offered was as a continuous infusion by pump. According to his beliefs, the patient had to pray five times a day and nothing could be entering or leaving his body at those times. If the translator had been more skilled and the physicians had been more knowledgeable, they could have accommodated his religious needs by offering standard chemotherapy or teaching him to turn the pump on and off.

Here at Penn, Morrison explained, medical students now attend panel discussions (with financial support from the patient who brought the issue to their attention) with religious leaders from many different faiths, as well as small sessions on spiritual dilemmas around death and dying. A scholar-in-residence program has also been set up—named after Thorne Sparkman, the one doctor who offered empathetic care to the former patient—to foster greater understanding among residents and current faculty members.

“We’re hoping these tools will make a difference to help them see how important it is in the care of patients,” said Morrison.

Originally published May 10, 2007.

Originally published on May 10, 2007