Friday, August 14, 2015

Doctors Fail to Address Patients’ Spiritual Needs

NY Times   Religious beliefs also often affect patients’ wishes when it comes to choosing aggressive end-of-life treatment or palliative care.

I was raised Jewish, and had no idea about when to call a priest, or what doing so might imply. I feared that if I raised the issue, she and her mother would feel that I was giving up on her. So for a few weeks, I did nothing. But every time I visited her, I felt bad.

“Do we ever call a priest?” I finally asked my resident one day in the hall, trying to be casual. I felt uncomfortable asking – as if I should somehow know better. I occasionally noticed priests in white collars and rabbis wearing yarmulkes or black hats riding the elevators and walking the halls, but was surprised to find that other doctors and I simply ignored them, never speaking to them. They operated in an entirely different world.

My resident looked at me as if I were nuts. That is simply not something that we did as physicians. Senior physicians and I never mentioned religion and spirituality on rounds with any patients. In the world of scientific medicine, these topics were taboo. Yet it felt odd to do nothing. I sensed her aloneness and terror in that room – even though she was with her mother – but none of us ever tried to address these feelings in any way.

Religion was never discussed in my medical training. In medical school, a priest maintained a small lounge, providing coffee and tea, where students could sometimes drop in to get coffee, but that was wholly optional, and most students never did so.

Yet studies have documented the importance of religion and spirituality to many patients. Seventy percent of dying patientswant their doctor to ask them about their religious beliefs.

Consequently, in 2001, The Joint Commission, which accredits healthcare organizations, decreed that health care providers “receive training on the value of spiritual assessment.” Partly as a result, the number of medical schools with some education on spirituality and health has increased from 13 percent in 1997, to around 90 percent in 2014.

But many medical schools provide only a single lecture on the psychological aspects of end-of-life care, often involving a chaplain who discusses how religion can be important in end-of-life case.[...]

Over the years, however, I have increasingly seen how many patients, especially when confronting the end of life, value their emotional, existential and spiritual feelings over further medical treatment when it begins to seem futile. [...]

I still regret my silence with that patient, but have tried to learn from it. Doctors themselves do not have to be spiritual or religious, but they should recognize that for many patients, these issues are important, especially at life’s end. If doctors don’t want to engage in these conversations, they shouldn’t. Instead, a physician can simply say: “Some patients would like to have a discussion with someone here about spiritual issues; some patients wouldn’t. If you would like to, we can arrange for someone to talk with you.”

Unfortunately, countless patients feel uncomfortable broaching these topics with their doctors. And most physicians still never raise it.

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