EAW: There was a study done a few years ago through the National Institutes of Health looking at people’s health care use. If I remember correctly, it surveyed 32,000 or 34,000 people – a very large sample of the American public. And they asked some questions about how people include complementary or alternative modalities in their health care. When you include prayer, over 70 percent reported that they used these modalities. If you take out prayer – prayer for self, having other people pray for you and so on – it becomes only about 30 percent. This is all faith-based practice. Most of them say it’s in addition to what they do within the western medical model.

But most physicians are not asking their patients what they are doing in this area. So, the first thing is to develop an awareness that this is going on, that this a very important piece of people’s sense of hope, guidance, comfort, what they’re needing and what they’re using to negotiate the complexity of what’s going on. The first thing you’ve got to do is ask them. When I interview any patient or see them for the first time, I ask them, "Do you have a particular spiritual practice or faith tradition that is important to you?" Then I’ll ask them what is their history with the faith tradition or spiritual practice. How is that relevant to their care now? Is it relevant in some way? How would you like me to include that? Do you have a place to talk about that? Would you like help in bringing someone in? Some people will say, "I’d like to talk to my preacher, pastor or the hospital chaplain." Some people will tell you that their faith tradition is negative for them at that time, that they’re struggling with the belief that they got this because they did something bad and they need to talk about that with somebody. So, maybe they would need a psychiatric consultation or maybe a spiritual consultation. But for many people, their time of health crisis raises spiritual questions and issues.

Some doctors pray for their patients. This is a whole area of talk: should you, shouldn’t you, how should it be done. I don’t have a judgment about that. But there are many patients who, if they share a faith tradition with their practitioner, they would like them to be included in their care provider’s prayer. The introduction to my book, Medicine, Mind and Meaning, was written by C. Everett Koop. He was a pediatric surgeon at CHOP and before every case he would pray for help in what he was doing. And he would tell the family members. The family members would often say to him, "Are you nervous?" And he would say, "I’m not nervous because I know it’s not only me in the room." And they would be comforted by that. But you have to find as an individual practitioner the way that you can express this that might be comfortable for your patient population and be very careful not to impose something on them. We’re there to support the healing, not to impose anything. But if we begin to ask: what’s important, what matters to you, how can I begin to include it, are there things you need to talk about, do you need somebody to talk about them with, then we’re going to be empowering that person from the place they live, because they’re doing it anyway. The vast majority of them are doing these things because they believe it will help. And many of them are not telling their doctors because they don’t think they want to know.

EAW: If you ask most people: do they want their doctor to ask them, they will say yes. So that’s one reason – because they feel that this is an important part of their care.

EAW: Yes. We can’t teach what we don’t know. And we can’t provide support we don’t fully understand. There are many different tools that been developed on how to do a spiritual assessment. One of the most frequently used in medical training is one developed by a woman named Christina Puchalski and it’s called FICA. It’s very brief and it’s used in a lot of medical schools to teach students how to begin to ask patients about their faith experiences. The American College of Physicians and the American Society of Internal Medicine have suggested the following four questions be asked a patient with a serious medical illness. Has faith, religion, or spirituality been important to you in this illness? Has faith been important to you in other times in your life? Do you have someone to talk to about religious matters? Would you like to explore religious matters with someone? You don’t have to be particularly sophisticated religiously or spiritually to ask those kinds of questions. And then if the person says, "Yes, I would like to have somebody to talk to," to call the hospital chaplain or do whatever would need to be done to help make that connection.

Statistically, if you look at the degree of religious practices of physicians compared to any other profession, it’s lower. So we’re a little bit out of touch, in that sense, with the vast majority of people that might be coming to us for help. A number of years ago studies were done looking at various types of training. When you look at how many people who enter medical school believe in God compared to when they finish, the training drains out a certain percentage. And in psychiatry residency, if you look at that same question at the beginning and end of training, again that number goes down. A lot of the training not only doesn’t teach how to include spirituality in medical care but in some way is teaching it out of certain people’s experience.

EAW: A lot of the regular practices that people engage in of a spiritual nature, whether it’s going to church on a regular basis and praying, or some other things like regular meditative and yoga practices, have a lot of effects on human physiology. They affect blood pressure, for example; they affect immune function, cardio and so on. In the field of mental health, people who regularly go to church are statistically less vulnerable to being depressed. When they get depressed, their symptoms are less severe and they recover faster. We aren’t sophisticated enough to figure it all out yet. At least for some subset of people, engaging in some of these practices improves their health and even when it doesn’t, they feel better. And my sense of myself, as a physician, is that it’s my job to do what I can to make it better. What I can do to make it better isn’t always about cure. Sometimes we can’t cure. Like a person who has aggressive cancer – we’re not going to cure that. But it’s also about the doctor-patient relationship. It’s about the quality of life. It’s about the experience of that individual and their family and their loved ones and their friends going through that. And for the vast majority of people, aside from health benefits they may achieve through some regular spiritual or religious practice, there’s a great deal of calm and ease that comes from that for themselves and for their family members. If you begin to think about the issues of loss in illness or death – family members become vulnerable also to all the ravages of depression and anxiety with loss. Having a framework of community and practice can help them heal.