Respectful Insolence

Separating doctoring from doctrine

You may recall how I’ve criticized the infiltration of woo into medical school and medical education in general. Such an infiltration threatens the scientific basis behind the hard-won success of so much of modern medicine over the last century. Unfortunately, woo isn’t the only threat to scientific medicine. Now, there is a growing movement that insists that doctors should ask you about your spiritual life and make religious practices a part of medicine, as Dr. Richard P. Sloan described in an editorial in the L.A. Times that I can’t believe I missed:

HOW WOULD you like your doctor, at your next examination, to ask not only about your diet and symptoms but about your spiritual life?

How would you like your surgeon to ask, while you’re on the gurney ready to be wheeled in for an operation, if you’d mind if he says a quick prayer?

Or if he suggested that perhaps you should?

These questions are not far-fetched these days. A concerted effort is underway to make religious practices part of clinical medicine. About two-thirds of U.S. medical schools now offer some form of training on the role of religion and spirituality in medicine, according to Dr. Harold Koenig of Duke University.

With support from the National Institutes of Health, researchers are now studying the effect of third-party prayer on cancer patients. Research on the connection between religious activity and cardiac health was published in the Lancet, one of the top peer-reviewed medical journals. The John Templeton Foundation, whose annual prize on spiritual discoveries exceeds the amount of the Nobel Prize in medicine, has funded dozens of medical researchers, some at top-tier institutions, who claim an association between religious devotion and better health.

Some prominent physicians are calling for the wall of separation between religion and medicine to be torn down. They declare that the future of medicine is prayer and Prozac, and they recommend that doctors take a “spiritual history” during a patient’s initial visit and annually thereafter. Walter Larimore, an award-winning physician, for instance, has declared that excluding God from a consultation should be grounds for malpractice.

I started to grind my teeth when I read that last line, my face contorted into a hideous grimace, and my hand twitching as it wanted to throw something at the computer screen. Some ScienceBloggers and a few other physician bloggers may be on the verge of becoming apoplectic when they see that line. In fact, I would think that even highly religious people would see what a potentially frightening statement that is.

Religion and God should have little or nothing to do with how a physician operates. Don’t get me wrong. I’m not at all opposed to hospitals’ asking patients what their religion is, if they have one, and providing chaplains to counsel them and pray for them. This brings comfort to the patient and the family and has a legitimate role in any hospital, as long as it doesn’t go overboard, as the Veterans Administration is alleged to have done. I just find the contention that doctors should somehow be obligated to ask a patient about religious practices (except in very specific cases where a patient’s religious practices may impact on his disease or treatment, such as the case of Jehovah’s Witnesses, for example, who refuse all blood products based on their religion) to be unsupported by evidence and that bringing too much religion into the physician’s end of the practice of medicine could lead to all sorts of problems. Even worse, it’s the height of hubris to assert that not asking a patient about religion and God during a consultation is “malpractice.” That is, in essence, making a claim for the value of religion in medical care for which there is little or no evidence, as Dr. Simpson points out:

But before organized medicine decides that religion has any value in physical healing, several things ought to be considered. First, the scientific evidence supposedly linking religious practices with better health is shockingly weak — so bad, in fact, that if we were discussing drugs, the Food and Drug Administration would have to find them unsafe and ineffective. Most research studies that claim to show how religious involvement is associated with better health fail to rule out other factors that might account for the relationship.

We all agree, for instance, that there is a real connection between lung cancer and carrying a cigarette lighter in your pocket, but no one thinks that the lighter causes cancer. The lighter is a marker of another factor — smoking — that has been scientifically proved to cause the cancer.

In precisely the same way, religious practices are likely to be markers of some other factor — for example, social support from family, friends or the community or, perhaps, the absence of behavioral risk factors — that may lower the risk of disease.

Studies that show, for example, the health benefits of attending worship services or reading the Bible often make this mistake. A study of residents of Washington County, Md. — the largest study ever to demonstrate that church attendance was associated with reduced mortality — made precisely this error; it failed to recognize that attendance itself was a marker for good health.

I believe this is the study to which Dr. Sloan is referring. I noted a couple of potentially obvious confounding errors right there that could account for the difference. Those who smoked cigarettes and/or drank more than 45 alcoholic beverages a month were considerably likely to attend church regularly (the odds ratio being 0.4 and 0.45, respectively), and those who attended church were more likely to quit smoking or drinking over the 28 year study period. That alone could potentially explain the most of the results and supports Dr. Sloan’s contention that frequent attendance at church services may be a marker, rather than a cause of the observation of decreased mortality. Another point is that the decrease is not that large, with an mortality odds ratio of less than two for the non-attenders, and in any epidemiological study we’re always a bit wary of odds ratios less than two. One can speculate that it is possible (or even likely) that attendance at religious services promotes smoking and drinking cessation, but that does not mean that religion itself is the reason. Any large group activity that fosters social connections and makes a point of reinforcing healthy behavior would likely have the same effect.

Then, of course, there’s the infamous intercessory prayer study, published earlier this year. This study examined the effect of intercessory prayer on the recovery of patients undergoing coronary artery bypass grafting (CABG), and its findings were that intercessory was not associated with a decrease in complications or mortality. Indeed, patients who received intercessory prayer and knew they were being prayed for tended to do somewhat worse. The authors speculated that a patient who knew he was being prayed for might assume he was in worse condition and that that attitude might affect the outcome, but that was just speculation. (My speculation on this latter result is that it was probably a statistical fluke, but I have to consider the reasonable possibility that it was not.) Indeed, there is another intercessory prayer study that found no difference in length of stay, cardiac arrest, hypertension, or pneumonia attributable to intercessory prayer on patients in the coronary care unit, although there was a just barely statistically significant trend to fewer complications overall.

The bottom line, though, is that studies trying to link religiosity and/or prayer with better health or better outcomes are plagued with methodological difficulties. For one thing, in many of them, the primary relationship being studied has nothing to do with religion at all, and correlations between religion and outcomes are buried in the text or a small table as a side issue. In addition, these studies look at correlation, and correlation does not necessarily equal causation. Some of them even try to correlate lots of variables to religious observance without doing the statistical correction necessary. (When one looks at multiple potential correlates, looking at more variables increases the chance of picking up a spurious “correlation” by random chance alone, and statistical corrections are necessary to account for this tendency.) Also, to demonstrate causation, some sort of interventional trial needs to be done. (The CABG study was an interventional study.) Epidemiological studies alone aren’t enough. Finally, publication bias could well be at play here, because studies that find a positive correlation between religious observance and health are inherently more “interesting” and would be more likely to be published, and published in better journals, than studies that fail to find such a link.

There are even other confounding variables, some of which can be shockingly simple and one of which Dr. Sloan described in an earlier article:

In 1971, George Comstock, a very senior epidemiologist at Johns Hopkins, published a paper showing that attendance at church was associated with reduced mortality at a follow-up seven years later. This study is cited over and over by proponents of this position. What these proponents never report is that seven years later, in 1978, Comstock retracted that finding, on the following basis. He said that he failed to account for the fact that by looking at people who go to church and contrasting them with people who don’t go to church, he missed the effect of previous illness. That is, people who are already too sick, i.e., are functionally incapacitated, can’t go to church, and people who are already too sick die at a higher rate than people who aren’t so sick. So the effect of church attendance on mortality was entirely wiped out by considering functional status. Comstock publicly retracted this finding in a paper published in a major journal in 1978.

Thus, the state of the evidence supporting a link between church attendance or religiosity and better health or better health outcomes is tenuous, but there may indeed be such a link. Such a correlation may even indicate causation. However, there is a paucity of evidence that would allow us to make either conclusion with any confidence at all. Given that, what must take overwhelming precedence in considering whether physicians should be inserting themselves into the religious lives of their patients, except in extreme circumstances are the bioethical implications:

More problematic still is the actual effect on patients when physicians abuse the privileged authority inherent in the role of the doctor by manipulating the religious sentiments of frightened and vulnerable patients. Physicians risk transgressing other ethical boundaries when they tell their patients that religious practices can improve their health. Asserting that prayer can promote recovery can lead patients who fare poorly to question their spiritual devotion and to experience guilt and remorse over their supposed religious failures.

This is not at all unlike the Hoxsey quacks telling patients that the Hoxsey therapy can cure 80% of cancer patients, while saying that the ones who weren’t cured had a “bad attitude“; i.e. didn’t believe in the treatment enough!

Here’s another aspect of this to chew on. If you are a Catholic, would you feel comfortable having a Muslim or a Jewish doctor asking about your religious beliefs? What about the other way around? If you’re an atheist, I’d be willing to bet that you’d find such questioning intrusive and offensive. And think about this: If a doctor believes that religiosity is truly good for your health, it won’t be long before he starts trying to determine which religion is better for health outcomes. What if, as is likely, he concludes it’s his religion , and what if his religion is not your religion? Or what if it is “determined scientifically” that belief in God is more effective in promoting health than belief in Allah, or vice-versa? Should doctors then start urging their patients to convert to the more “healthy” religion? Then there are logical problems advocates of inserting religion into the doctor-patient relationship face:

They say…that they would not force religion onto anybody. They will only recommend religious activity, or engage in religious activity, with their patients, if the patients clearly indicate a willingness to do this. But then they also assert that the evidence is overwhelming that religious activity promotes health. It seems to me that by taking the former stance, that they will only engage in religious activity if their patients are open and receptive to it, they are derelict in their duties as physicians. It’s like saying to a patient: “You’ve got pneumonia. What’s your feeling about antibiotics? Are you in favor of them, or not?” Physicians don’t do that. They say: “I recommend that you take antibiotics,” because there’s a consensus that antibiotics are an appropriate treatment for pneumonia. Nobody disputes that. If they’re saying the evidence is so strong that religion is associated with good health outcomes, then they’re derelict in their duty by not recommending religious activity to every patient, regardless of their feelings!

The second ethical problem…is the limits of medical intervention. There is no end to the number of factors, personal and socioeconomic, that influence health outcomes. For example, it is well-established that marital status confers benefits to health. While this marital effect may be stronger for men than for women, in general people who are married live longer and they are more healthy than people who are not. If you as a single person were to visit a physician, what would you say if the physician said, “You know, Bob, there’s this massive amount of evidence suggesting that marital status is good for your health, so I as your physician recommend that you get married.” …The reason physicians don’t do it in the case of marriage, and in the case of financial and socioeconomic status, which are also associated with good health, is because we believe there are certain aspects of our lives that are private and personal, and even if they have an impact on health, are out-of-bounds from medicine.

Even in this age of the patient who comes into the doctors’ office armed with a folder full of printouts of the latest research culled from the Internet, of patients who are far more proactive in asking questions of their doctors than even 10 or 20 years ago, we as physicians still have enormous prestige and power, whether we still realize it or not. No other profession is granted the privilege of being allowed to prescribe drugs or treat diseases. In the case of surgeons, no other profession is granted the power to cut into living human flesh legally, the better to rearrange their anatomy for therapeutic effect. If doctors started meddling in the religious life of their patients, they could, believe it or not, still be largely influential. Do we really want that?

None of this is to say that doctors don’t have a responsibility to ask patients about factors that impact their health, like, for example, drinking excess alcohol or smoking. Unlike religious observance, these are factors that can be quantified and for which abundant evidence exists to indicate that these activities impact negatively on a patient’s health. Diet is another such factor. However, there are only relatively rare instances where it is appropriate to ask about a patient’s religion. For example, in my field, we know that Ashkenazi Jews have a much higher rate of breast cancer than most other groups, but even in this case, it’s not so much the Jewish religion as the ethnicity that is important. In the previously mentioned example of Jehovah’s Witnesses, we usually do not ask if the patient is a Jehovah’s Witness. Usually, the patient volunteers the information as justification for refusing a blood transfusion.

Religious belief is very important to a large number of people, and many of these people find comfort in it during trying times, particularly during serious illnesses. Even so, barring far more convincing evidence on a general benefit to health or improvement of outcomes of disease or injury that can be attributed to religion, physicians should attend to evidence-based medicine and leave a person’s religious beliefs (or lack thereof) to the realms of the patient, family, community, and/or church. Doctors are not, nor should they try to be, chaplains, ministers, priests, imams, rabbis, or preachers.

Comments

  1. #1 Rainman
    December 18, 2006

    Nice Blog.

    As a “highly religious” internist, I’m not ready for malpractice claims filed for failure to do a spiritual assessment. Our office H&P forms have a section for the patient to elaborate as much as they want regarding their particular spiritual beliefs. I can just see it now:

    Do you consume alcohol? Yes or No
    Do you smoke cigarettes? Yes or No
    Have you accepted Jesus Christ as your Personal Savior? Yes or No

  2. #2 Mustafa Mond, FCD
    December 18, 2006

    Walter Larimore, an award-winning physician, for instance, has declared that excluding God from a consultation should be grounds for malpractice.

    I’d personally be rather upset if a consulting physician consistently failed to show up for exams.

  3. #3 Samantha Vimes
    December 18, 2006

    How would you like your surgeon to ask, while you’re on the gurney ready to be wheeled in for an operation, if you’d mind if he says a quick prayer?

    Or if he suggested that perhaps you should?

    I would immediately ask for a surgeon with greater confidence in his ability to bring me out alive. Seriously, if my surgeon said something like that I would be frightened by the implication of heightened risk.

  4. #4 jba
    December 18, 2006

    I have to agree with Samantha, it would not inspire confindence. Plus I have to wonder if this would be inclusive to all religions or just Abrahamic ones. Im pretty sure my doctor is Hindu, I wonder how he would feel about this.
    And I can see this turning into one big attempt to convert. If I go to see a doctor about frequent headaches I dont want him saying to take two advil and three hail marys and call him in the morning.

  5. #5 Ruth
    December 18, 2006

    When I had surgery 2 years ago, my surgeon discussed medicine and the nun who visited me brought Eucharist and prayer. That is how it should be. Surgeons already think they are gods anyway : ).

  6. #6 libretta
    December 18, 2006

    Augh! Who know we’d ever have to agitate for separation of church and medicine?

  7. #7 Greg P
    December 18, 2006

    I see spirituality as being intricately intertwined with our patients’ psychological makeup, so if you believe that the psychological aspect of the patient is worth addressing, then that spirituality also needs addressing.

    But medicine should never become some proselytizing exercise, where we explicitly or implicitly advocate one religion or any religion necessarily.

    I worry about patients who repeatedly defy all medical advice in spite of one problem after another related to that noncompliance. This is where the hard science of medicine has no answers, so we must try to find the psychological/religious/spiritual avenue that might reach the patient.

    I will sometimes tell people after they’ve had a stroke and not taken care of themselves, “This stroke is God trying to speak to you. He’s not going to speak anymore clearly than this. So you can decide whether you’re going to listen or not.” And it doesn’t matter what religion they adhere to, or whether there is any at all.

  8. #8 Baratos
    December 18, 2006

    If that intercessory prayer study showed that the people who were prayed for were worse off, couldnt you argue that praying for a patient is unethical? I am going to have to say that when somebody tries praying for me.

  9. #9 drb
    December 18, 2006

    Greg, as a doctor, I’m begging you, please don’t speak like that to patients. It is childish, counterproductive and an egregious insult to the intelligence of the victim and to the reputation of God, whatever you might conceive Him to be.

  10. #10 Steve Watson
    December 18, 2006

    I will sometimes tell people after they’ve had a stroke and not taken care of themselves, “This stroke is God trying to speak to you…..

    I hope you find out first whether the patient is an atheist or not. While I’m sometimes willing to use “God” in the quasi-Spinozan sense of “all the crap the universe does that we can’t control”, I don’t think I would appreciate having it assumed.

  11. #11 Sid Schwab
    December 18, 2006

    Conversely, it was always uncomfortable when a patient asked me if I am a Christian (I’m not.) I assumed that if the answer were no, they’d figure I’d in some way take less good care of them. Or worse. Interjecting religion into the relationship when not invited by the injectee is like stepping off a cliff. On the other hand, I do note that many religious families were able to find comfort in the horrible news I’d given them, by accepting it as God’s will. It made my job easier. Except, as on a few occasions, when a very religious person completely decompensated, finding it inexplicable that God could treat them in this way, after all they’d done for God…

  12. #12 AgnosticOracle
    December 18, 2006

    Greg:

    If my doctor said something like that to me it would piss me off. I’d be less likely to trust ANYTHING else the doctor said. The really sad thing is you could make much the same arguement by replacing the word “god” with the word “universe.” “This stroke is the universe’s way of telling you that you need to change your behavior [insert medical evidence about behavior and stroke here].” You can then help both the believers and the non believers, isn’t that better?

  13. #13 bones
    December 18, 2006

    If prayer is so important and a “stroke is God’s way of speaking to you”, then we can do away with scientific medicine and surgery and just pray over our patients. Lord knows (sarcasm) you wouldn’t want to do a CABG or carotid endarterectomy on someone who God wants to send a special message to.

  14. #14 M
    December 18, 2006

    Well, asking me about religion and so on in a consultation would both raise my blood pressure and result in me asking for another doctor. Which are healthcare outcomes, but even so.

  15. #15 quitter
    December 18, 2006

    I think my medschool had a pretty balanced way of looking at it.

    Basically, they taught us as if we were all secular humanists how to deal with religious patients, prayers etc. They basically said, you don’t have to believe in it, but you’ll encounter it, and here’s what you do even if you’re religious (because it won’t always be your religion). Kind of the whole, everybody is an atheist about something argument.

    They taught us some simple things you can say as prayers if the patients ask you to, how to answer the “are you a Christian/muslim/saved” question (i.e. it’s ok to lie, just make it believable and consistent cover story), and how to deal with religious observance in the hospital. For the most part, it’s just a matter of being hands off, polite, and careful not to upset people, because after all, as a doctor it’s important not to give people reasons to avoid medical care. If they feel like they’re dropped into the hands of heartless satanic atheist heathens who will eat their organs, they will avoid hospitals. Now, these ideas are ridiculous, and stupid, but a hospital or other professional medical setting is not the place to fix people’s racism, sexism, or religious bigotries. It’s a place to provide care to everybody no matter how obnoxious they are. That can be hard, and sometimes you have to draw lines, but those should be rare instances.

    Another useful thing is to ask if patients go to church or synagogue or mosque, whatever, because it does give you an idea of the support structure they have in the community. It is inappropriate to suggest that they go to church because you think they need religion, but it isn’t always a bad idea if you know they have some religion and the social services that the community provides can help with people’s growing infirmities, drug problems, day care, whatever.

    Any attempt to prospectively engage patients spiritually should be done with great care or not at all, because most people do not want to be proselytized in their hospital beds, and many will just put up with very uncomfortable situations out of pure politeness while just thinking you’re a crackpot the whole time. It can seriously undermine confidence in care (it would for me), and alienate patients. I say it’s a minefield best avoided.

  16. #16 JohnnieCanuck
    December 18, 2006

    Greg P.

    This atheist might get so agitated by your proselytising condescension that he’d have a cardiac event on the spot. Certainly I would be so busy trying to discard the chaff and keep the grain, that I would likely miss the next few sentences.

    You seem to have done an ‘ends justify the means’ calculation here. Maybe if the patient had first volunteered their theism, you could use this approach in good conscience.

  17. #17 HCN
    December 18, 2006

    I think that I would evoke the comment “By the Hammer of Thor! Which god?”. Or perhaps work on my nerdiest Star Trek bit and evoke either Klingon or Bejoran beliefs.

  18. #18 jba
    December 18, 2006

    HCN:

    That is awesome. If you dont mind, Im stealing that Thor bit. Heh, now I almost hope a doctor says ‘god is sending you a message’

  19. #19 stogoe
    December 18, 2006

    By Grabthar’s Hammer, your stroke shall be avenged!

  20. #20 Renee
    December 18, 2006

    “Another useful thing is to ask if patients go to church or synagogue or mosque, whatever, because it does give you an idea of the support structure they have in the community.”

    No, it does not. A person could have good relationships with their family and friends, and never set foot inside a house of worship. What if a person grew up in a non-religious home? What if they grew up in an interfaith home, where religion wasn’t emphasized? Why do you assume that attending services = good support structure? And it appears that you also assume the converse: no attendance = poor support structure.

    Besides, I know plenty of people who rarely miss church or synagogue, but they still have awful marriages and lousy relationships with their relatives.

    I do think it is ok to talk about available community social services, both secular and the religious ones, such as Catholic Family Services, Jewish Family Services, Lutheran Family Services, etc. Most of these will provide help to anyone, without regard to their religion. As well, these services are not just for those who are observant. I myself have dealt with Jewish Family Services and an assisted living facility that was run by the Methodist church; I’ve never been asked about our family’s religion, or how often we attended services.

    The ‘God’ comment to the stroke patient – I agree with others here that this is an inappropriate remark. Besides, if having a stroke is God’s work, then why should a patient bother to try getting well? If one believes in God, especially to this degree, then there’s no point in going against the good Lord’s will.

  21. #21 quitter
    December 18, 2006

    No, it does not. A person could have good relationships with their family and friends, and never set foot inside a house of worship. What if a person grew up in a non-religious home? What if they grew up in an interfaith home, where religion wasn’t emphasized? Why do you assume that attending services = good support structure? And it appears that you also assume the converse: no attendance = poor support structure.

    A little hostility here? I’m an atheist too, don’t freak out. I’m not saying that going to church gives them more stable homes, better marriages or any of that crap, but when you’re dealing with people who need support, especially the old folks, it’s good to know what venues they can exploit for continuing human contact and social services. I didn’t mean to suggest that those are better venues or that people who aren’t religious don’t develop their own. It’s just one more bit of information that helps you figure out how your patient is doing outside the examining room. A person who has a bridge club or a church choir is better off than a shut-in with no human contact to determine if patient is fine or has been lying on the bathroom floor for three days eating kitty litter. If they have no human contact a good physician will figure out a way to get them some, make sure people are monitored and supported etc. That’s all.

  22. #22 HCN
    December 18, 2006

    jba, Steal away! I think I stole it from a Saturday morning cartoon several decades ago.

  23. #23 Sid Schwab
    December 18, 2006

    quitter: I’m curious about having been taught that it’s ok to lie to a patient, when asked about your religion. I’ve been tempted, in the interest of not giving a person in need of confidence something to worry about. But I never have, because in the end, it just never felt right to do so. I’m not arguing: I’m curious what you were taught…

    P.S: enjoyed my trip around your blog.

  24. #24 decrepitoldfool
    December 18, 2006

    Last time I went in for surgery, I remember feeling vulnerable and really scared. Many people feel that way, I suppose. If that isn’t a reason to reign in the urge to proselytize…

    But questions about diet, community, and ethnicity do sound OK.

  25. #25 quitter
    December 19, 2006

    I just recall from my days that it’s not about spinning some long tale and confabulating your wild tale of conversion. Just that it’s not a big deal if they ask, “have you found Jesus” and you just say, “yes”. It just short-circuits the conversation and usually has not follow-up. Besides it’s not necessarily a lie, you could be remembering when you met Jesus at the mall, you know, Jesus Hernandez, you looked for him all afternoon then found him by the Gap.

    The other tactic I’ve heard about is to just say your Jewish. Apparently that deflects a lot of the proselytizing, but I could be wrong. Alternatively, in response to the “have found Jesus” you could always reply, “I am Jesus” but that’s risky.

    In the end it’s not really about your own comfort but the patients’. That doesn’t mean they can walk all over you, but it does mean that your professional responsibility isn’t to make a big deal about belief or religion when you’re at work. Just make them comfortable, reassure them, if they want to pray with you bow your head and deal with it. It doesn’t hurt, and it’s your job to be helping them, not making a stand for your belief system. There’s a limit, a time and a place for anti-religious advocacy too, but a good doc will be pretty chill with most of what’s thrown at them even if you think it’s total garbage.

  26. #26 quitter
    December 19, 2006

    Sid,
    Ditto.

  27. #27 Tina
    December 19, 2006

    I also agree with Samantha, if my surgeon asked if s/he could pray, I would be asking for a different surgeon. It’s quite disconcerting to think the person cutting you open would need to get support or reassurance from ‘God’.

  28. #28 G. Tingey
    December 19, 2006

    This is unbelievably dangerous ground.

    Would you TRUST a christian doctor who knows you are an atheist?
    Who now has a really good opportunity to send you to hell.

    Would you TRUST a christian doctor who knows you are the wrong sort of “christian” atheist?
    Who now has a really good opportunity to send you (an heretic) to hell.

    ARRRGGGH!

  29. #29 Justin Moretti
    December 19, 2006

    This is unbelievable stupidity – leave things to the experts in their field! Ask if they practise a religion, ask if any taboos affect treatment, and ask if they want a minister of their faith to come and visit, but for God’s sake leave the rest alone!

  30. #30 Renee
    December 19, 2006

    “The other tactic I’ve heard about is to just say you’re Jewish. Apparently that deflects a lot of the proselytizing, but I could be wrong.”

    I’m not certain what this means. Do you mean that if a doctor is Jewish, that they could tell a patient this, if the patient is trying to proselytize? Or do you mean, in an effort to stop the proselytizing, that a doctor can just say they are Jewish, even though they really are Christian, or some other faith?

  31. #31 bones
    December 19, 2006

    “The other tactic I’ve heard about is to just say you’re Jewish. Apparently that deflects a lot of the proselytizing, but I could be wrong.”

    I would go one better, present yourself as a Jedi (see link) of the UK Church of the Jedi, I want to see them proselytize now:

    http://news.bbc.co.uk/2/hi/uk_news/1589133.stm

  32. #32 bones
    December 19, 2006

    “The other tactic I’ve heard about is to just say you’re Jewish. Apparently that deflects a lot of the proselytizing, but I could be wrong.”

    I would go one better, present yourself as a Jedi (see link) of the UK Church of the Jedi, I want to see them proselytize now:

    http://news.bbc.co.uk/2/hi/uk_news/1589133.stm

  33. #33 quitter
    December 19, 2006

    I think the Jewish (I heard saying Catholic works too) works because they have experience knowing that it’s very difficult to convert them. The worst is saying something like you’re unchurched, or tell them that you haven’t been since you were a kid, then they think they need to bring the sheep back into the flock.

    This really doesn’t come up that often, only once to me so far, but I hear lots of other people’s experiences on the wards with this stuff.

  34. #34 Calli Arcale
    December 19, 2006

    In fact, I would think that even highly religious people would see what a potentially frightening statement that is.

    I don’t consider myself *highly* religious, but I have a fervent faith in God. And yes, I find that statement very disturbing. The whole thing is a very very bad idea. Religion is a subject best not discussed in this context. It has the potential to seriously screw up the doctor-patient relationship. At most, I would expect a nurse (not the doctor) to ask me if I would like any arrangements made for religious services, such as asking the hospital chaplain to come around or calling my usual clergyman, simply as a matter of practicality. I would fully expect that the hospital would not care what my religion is, because it’s generally unimportant. (Although I could see inquiring about religious objections to particular medical procedures as part of the consent to surgery. Again, it’s a matter of practicality, not spirituality. It’s best if the medical staff know if you don’t want a transfusion should the bleeding become more severe than expected during surgery.)

    I would not object to my doctor praying before surgery. I understand that surgery has inherent risks, and if it helps him to focus, that’s perfectly reasonable. On the other hand, it would feel strange and awkward to me if he asked for my permission to pray. Perhaps it’s because I’m Minnesotan, but up here we don’t tend to be very demonstrative about faith. It’s not really any of my business if he chooses to pray. So if he asked me about it, I’d immediately start asking myself what the question implies. Is he trying to proselytize? (I really don’t like that. I find it ruder than the rudest telemarketing.) Or is he trying to tell me that he’s a believer and I should feel good about that? If so, why? Does this mean he’s intolerant of unbelievers? I wouldn’t like that in a doctor. And why is he asking me about this anyway? Shouldn’t he be concentrating on the matter at hand?

    Frankly, religion is a very personal business. Inquiries about religion must be done very delicately and only when neccesary. For most doctor-patient interactions, it’s not neccesary. It’s sort of like asking a patient their preferred sexual positions — very rude, and usually irrelevant.

  35. #35 jba
    December 19, 2006

    “At most, I would expect a nurse (not the doctor) to ask me if I would like any arrangements made for religious services”

    That would be better, I agree. I worked at a hospital for several years and I found the way they had to be pretty good. When you registered there was a question in the paperwork for “do you want a visit from a chaplain” if you said yes then you could discuss your religous issues with the religous person and the medical staff didnt get involved.

  36. #36 Inquisitive Raven
    December 20, 2006
    Walter Larimore, an award-winning physician, for instance, has declared that excluding God from a consultation should be grounds for malpractice.

    In fact, I would think that even highly religious people would see what a potentially frightening statement that is.

    As a member of a minority religion, i.e.
    neo-paganism, I find that a very frightening statement. It seems to me that most people who’d ask that as part of an evaluation would be, shall we say, less than tolerant of non-mainstream religions.