Respectful Insolence

Over the years, I’ve learned that a lot of surgeons are very religious. Actually, a lot of doctors are quite religious. Indeed, long ago in the history of this blog, back when I used to write about evolution a lot more than I do these days, I’ve pointed out that at least as many physicians as the general public accept “intelligent design” creationism as a valid description of the origin of life. Indeed, 15% of physicians believe that states should be required to teach ID and 50% believe that states should be permitted to teach it. In other words, approximately 65% of physicians are in favor of or neutral to teaching ID in the science classroom, a problem that has at times resulted in some bad biology finding its way even into surgical meetings. I have witnessed it myself. Moreover, there are a lot of doctors out there who even advocate for promoting religious beliefs as part of their treatment of patients.

At major surgical meetings, there is always the presidential address. It is usually, but not always, relatively early in the meeting and represents an opportunity for the outgoing president to reflect on his or her tenure leading the surgical organization and provide a vision for the future. It is not particularly uncommon that the outgoing president of a surgical organization will wax philosophical, and frequently the philosophical wax applied to the presidential address is religious. Indeed, I remember one presidential address at a Society of Surgical Oncology meeting a few years back that was a veritable swamp of religiosity, to the point that I remember being particularly annoyed. What did any of this have to do with surgery, science, or medicine? Nothing. Yet there it was.

As annoying as that address was, though, at least the then-president of the SSO didn’t try to justify his religious beliefs using science. Unfortunately, via Pharyngula, I learned the other day that the outgoing president of the Midwest Surgical Association, Dr. Donn M. Schroder, was unable to resist the temptation to do just that in his presidential address, which was just published in American Surgeon last month under the title Can prayer help surgery? The religion flows right from the very beginning:

Surgeons use chemotherapy and radiation as adjuvant therapies to surgery, working synergistically to cure cancers. We believe that neoadjuvant therapy can help our surgical outcomes. Despite the good results we have achieved, our patients want better. There has been a plethora of Internet searches by our patients looking for ways to improve their surgical results. Like other alternative therapies to aid surgery, prayer has become increasingly popular among patients in the United States.

There’s a huge difference between using chemotherapy and radiation therapy as adjuvant therapies after cancer surgery in order to reduce the risk of recurrence. We know what they are. Science can demonstrate that they work, how they work, and how effective they are for various clinical situations. This is in marked contrast to intercessory prayer, which has never been shown to work. Of course, I’d ask Dr. Schroder what his opinion of “alternative” therapies is. does he think science supports them? If so, how? And, if so, what science supports his assertion that prayer can help surgery? No, wait. Stop. I bet that he probably does, at least if the reasoning he uses to evaluate alternative medical therapies is anywhere near a sloppy as his reasoning in arguing for surgeons to use prayer as an adjunct to surgery.

Unfortunately, that’s what Dr. Schroder’s speech is all about, and he makes what can only be described as a highly embarrassing case. Worse, I consider it inappropriate in the extreme for a president of a major surgical or scientific organization to abuse his position to regale the membership of his organization with his sectarian religious beliefs disguised as science. Yet that’s exactly what Dr. Schroder does ad nauseam. For instance, after pointing out how the “historical foundation for prayer to aid in healing is replete in the Torah, the Bible, and the Qur’an,” that there are “42 accounts of healing by Jesus in the Gospels alone,” and that Gospel writer Luke was a physician, in order to be ecumenical (apparently), Dr. Schroder then points out that healing through prayer is integral in Islam as well. No doubt Dr. Schroder is a Christian; so his invoking Islamic beliefs fools no one. One wonders why he doesn’t invoke Buddhist, Hindu, or other major religious traditions. He does, however, use the standard ploy used by religious physicians to justify using prayer, namely using it alongside science-based medicine. He also can’t resist the “bandwagon” argument, or argumentum ad populum, lamenting how during the Renaissance, prayer and healing started to diverge, but rejoicing over how now the “pendulum is swinging back”:

Articles in Time and Newsweek reflect the explosion of manuscripts published in the medical and surgical literature. A MEDLINE search from 1950 to 1995 revealed only 212 articles published about prayer aiding healing, compared with 855 in just the past 15 years. There are 46 prospective randomized series on prayer aiding medicine and surgery in the Cochrane database. Studies that show benefit to prayer and healing do not favor one religion over another. Equal healing benefit has been demonstrated whether the prayer is Hindu or Buddhist, Catholic or Protestant, Jewish or Muslim.

I suppose that’s one way of putting it. All forms of prayer do work equally–equally poorly (as in not at all) when tested in rigorous trials. In fact, Dr. Schroder even admits as much:

Can medical science prove the benefit of prayer to im- prove the result of an operation? I refer you to the latest Cochrane review on this topic.5 This 69-page manuscript is a meta-analysis of 10 prospective randomized studies on intercessory prayer to help the efforts of modern medicine involving over 7,000 patients. Some studies in this meta- analysis showed benefit, while others did not. The conclusion of the authors was that there is no indisputable proof that intercessory prayer lowers surgical complications or improves mortality rates.

Not quite, actually. What the Cochrane Review actually says is:

The authors conclude that due to various limitations in the trials included in this review (such as unclear randomising procedures and the reporting of many different outcomes and illnesses) it is only possible to state that intercessory prayer is neither significantly beneficial nor harmful for those who are sick. Further studies which are better designed and reported would be necessary to draw firmer conclusions.

And what it concludes is:

These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.

Do you realize how incredibly rare it is for a Cochrane review ever to conclude with a recommendation that no further studies be done? Seriously! Even in the Cochrane Review of homeopathy and laetrile, the authors recommend more studies. Yet in the case of intercessory prayer, the authors recommend exactly that, arguing in essence that it would be a waste of resources. And so it would be. Whether he realizes it or not, Dr. Schroder has said exactly the same thing, although he tries desperately to try to spin it otherwise, deemphasizing how many studies were negative and how few were positive. So instead of asking the right question (why were the vast majority of the studies negative?) and getting the right answer (because intercessory prayer doesn’t work), Dr. Schroder asks, “Why is it that not all studies demonstrate prayer benefit?” and gives a wildly off-base answer:

Unfortunately, most of these studies have flaws in their methods. The investigators as- sume that while the “prayed-for patients” receive distant intercessory prayer from assigned prayers, their “control groups” are not prayed for by anyone. Wait a minute. Do patients not pray for themselves? How can researchers re- ally think that a patient undergoing open-heart surgery is not going to pray for his or her health before and after the operation? Do the investigators think that the patients’ mothers and fathers, sisters and brothers, and their children or friends are all struck spiritually mute during this time of need? The point is that there is no control group. Somebody prayed for all of these patients. Thus, there can be no valid scientific comparison of so-called prayed-for and not- prayed-for surgical patients. Furthermore, are there factors that, as humans, we may never understand about prayer that affected the results of these prayer studies? For instance, does the religious devotion of the prayer intercessor or the holiness of the patient have any bearing on how God re- sponds to prayer? Does God take into account the worthiness of the cause? What happens when the outcome being prayed for is not in accord with the will of God? If it’s the time for a person to die, does prayer defer destiny? Reli- gious scholars are still wrestling with these questions. So where does this leave us? The scientific foundation for prayer is not solid. There is no indisputable proof that prayer can aid in healing. Those who believe do so by faith alone.

All of which has to be the most tortuous way I’ve ever seen anyone try to justify intercessory prayer through science and end up coming to the conclusion that there is no evidence and that those who use prayer do so by faith alone, which is a trivial conclusion larded with Dr. Schroder’s tortured justification for why science doesn’t support the contention that pray has health benefits.

Being utterly unable to demonstrate scientifically that prayer heals, Dr. Schroder falls back into more argumentum ad populum by citing studies that show that large numbers of neurosurgeons believe in it, as well as large numbers of the general public. Well, duh! When the vast majority of Americans are religious, most of them Christian, I would be shocked if surveys didn’t show that most surgeons and most patients believe in prayer. None of this stops Dr. Schroder from offering up anecdotes, cherry picked fMRI studies about the salutary effects of prayer on various neurological functions, and a description of his own practice when it comes to praying with his patients. One of these is a study Dr. Schroder himself did in which he purported to study his prayer practice, which is:

It is my practice to say a silent preoperative prayer for my patient at the scrub sink. I do extend an offer to pray with my patients in the preoperative area as well. After discussing the operation and answering any questions the patient may have, I say, “I know that some patients like to pray before surgery. If you would like me to pray with you, just ask.” If they ask to pray, then I respond, “Would you like to lead?” I hope not to be coercive and realize that prayer in this instance must benefit the patient more than the surgeon. We then pray together in whatever manner the patient chooses.

Does Dr. Schroder really believe he’s being non-coercive? I mean, seriously. Think about it. Let’s say you’re an atheist. You’re about to go under the knife for, let’s say, a cholecystectomy. Your surgeon, after explaining once again the risks and benefits of surgery, asks you if you want to pray with him? Do you refuse? Or are you intimidated because you don’t want to piss off the man who is about to cut into your body in order to forcibly rearrange your anatomy for therapeutic effect? Whenever I hear surgeons like Dr. Schroder claim they are not being coercive, I can’t help but ask, “Oh, really?” In reality, Dr. Schroder probably really does believe he’s being noncoercive, and he even has his very own survey that showed that few none of his patients felt coerced. He did note that, out of 186 patients, 10 did refuse and that of these two were agnostics and six were atheists, with two of this group being atheists. Among the comments was, “”I don’t pray and it made me think it was really bad going into surgery.”

Indeed.

Of course, the vast majority of Dr. Schroder’s patients were Christian, and the response among them was overwhelmingly positive. Does that mean it’s OK? Personally, as a surgeon myself, I have a real problem with Dr. Schroder’s approach. It is coercive, whether he realizes it or not, whether he admits it or not. It’s one thing if the patient asks the surgeon if he wants to pray with him, completely unprompted. In that case, I don’t see a problem. In fact, even I would probably join in (after trying to beg off once perhaps), because in the end to me it’s all about the patient and I’m not about to do anything that makes the patient feel uncomfortable or lose confidence in me, my heathen tendencies notwithstanding. But that’s not what Dr. Schroder is talking about. When the surgeon asks the patient about prayer, he makes it more about him than the patient, no matter how much he tries to tell himself otherwise. If it were truly about the patient, Dr. Schroder would not in any way try to advertise his religion or to make himself feel better by using his religion to bond with his patients before surgery. Indeed, a physician should not even be mentioning this to his patients, because there is a power differential that makes it incredibly difficult, if not outright impossible, for such a request to leave the most patients truly free to decline it.

Rather like the way the members attending the annual meeting of the Midwest Surgical Association weren’t free to decline Dr. Schroder’s pontifications about the power of prayer used right before surgery. I hope the chairs in the lecture hall were comfortable; snoozing would have been mandatory.

Comments

  1. #1 JohnV
    April 20, 2011

    “The investigators as- sume that while the “prayed-for patients” receive distant intercessory prayer from assigned prayers, their “control groups” are not prayed for by anyone. Wait a minute. ”

    The preceding argument was brought to you by the fine folks who sponsored “maybe that study found new acupuncture pressure points” and “maybe the Adventures of Huckleberry Finn was divinely inspired and it too contains a hidden code”.

  2. #2 ZDoggMD
    April 20, 2011

    On a marginally related note, when I was in high school I played a lot of electric guitar. It was in the very religious, very conservative Central Valley of California that I grew up, and I never quite “got” religion since it made no scientific sense to me. I went to a guitar contest and sat in the audience, probably about 500 people there. The guy who won was very charismatic and injected a lot of humor and smarts into his performance. When he went up to accept his prize and said “I’d like to thanks Jesus Christ for this” I therefore reflexively laughed very hard out loud, thinking he was making fun of the type of winner who would make such a ridiculous statement (what, Jesus hates all the other contestants and hence allowed YOU to win something as stupid and trivial as a local guitar contest?)

    499 eyes turned around to look at me. The closest pair in front locked on mine and said, “Nice job, asshole.”

    Sadly, that was probably the highlight of my teen years.

  3. #3 aek
    April 20, 2011

    Tangentially,on hospital admission assessments, there is a routine question about patient’s spiritual beliefs and their perceived desires and needs to support them while inpatient. If one answers atheist or agnostic, the recorded response is that there is no spiritual need/support required.

    Relative to (direct) prayer, I’d be interested in the neuroscience underpinning the activity. My guess is that it focuses attention and is related to evoking a positive emotional state. A calm and positive focus going into surgery for both patient and operator would seem to be a good thing (but certainly not by coercion). Other modalities for achieving this would include meditation, listening to music and receiving/providing comforting touch.

    How about an RCT assigning patients to TAU preop, with meditation, prayer and comfort (music/touch) arms and looking at post op outcomes such as pain control, wound healing, inflammatory markers and ambulation, for example?

    Has anyone looked at pre and post op outcomes for atheists vs self declared religious patients?

    But back to your terrific post. It is frustrating to continue to see religion insinuated into clinical medicine, science and research. The US seems determined to re-enact the Dark Ages. At what point will bright flight tip the scales and leave the US bereft of enough scientists and clinicians practicing science-based medicine that the country won’t be able to recover?

  4. #4 Jojo
    April 20, 2011

    Let’s say you’re an atheist. You’re about to go under the knife for, let’s say, a cholecystectomy. Your surgeon, after explaining once again the risks and benefits of surgery, asks you if you want to pray with him? Do you refuse? Or are you intimidated because you don’t want to piss off the man who is about to cut into your body in order to forcibly rearrange your anatomy for therapeutic effect?

    This pretty much hits the nail on the head.

  5. #5 alopiasmag
    April 20, 2011

    Great post Orac…

  6. #6 Calli Arcale
    April 20, 2011

    It is perfectly fine for a surgeon to say a private prayer for his patient and for strength during the procedure. It is NOT fine, at all, to confront the patient on the table and offer to lead him in prayer. The time and place for that would be at church/temple/whatever, if patient and surgeon attend the same one. It is absolutely not when the patient is at his/her most vulnerable. It will turn out okay only in the happy coincidence that he and the patient share religious views, and could be quite bad in other cases.

    I know I’d be weirded out if my surgeon did that, and I’m a Christian. It’s inappropriate, and I prefer to pray privately anyway. (Public prayer is acceptable in limited circumstances only; otherwise it’s just grandstanding to show how wonderfully faithful you are.)

  7. #7 Denice Walter
    April 20, 2011

    It’s difficult for me to get into this topic because, as an atheist, I don’t want to rain on anyone else’s parade.

    Obviously people find comfort in prayer- I think of it as a self-soothing, internal mechanism using speech (self-regulation via inner speech**): a child learns to mimic the parent’s calming words, an athlete ramps herself up, a student uses language means to focus himself when presenting- it’s a way to inspire self-confidence, ward off fears, and calm nerves. You can re-capture and control “mindspace” ( for lack of a better word) from unwanted intrusions and scary thoughts. Sometimes we create meter as an emotional outlet( with a few drinks, I can sound properly Coleridgean, even though I’m only talking about my car). The problem lies when we attempt to attribute any efficacy beyond the *purely* psychological.

    In the early 1990′s, Larry Dossey made a great splash with his “studies” about prayer and patients’ progress; he’s been de-constructed of course, but remains another fave of woo-meisters who quote “hard data” and “scientific studies” (lots of refs to Dossey in NaturalNews). This stuff persists because people like it and want it to be “true” and the positive psychological effects I discussed above reinforce its usage. And, intermittently, prayers appear to be “answered” : you get what you ask for.

    ** we have a resident Vygotskyan @ RI.

  8. #8 Jarred C
    April 20, 2011

    “I will be your surgeon. Would you like to pray with me?”

    “Why? Is your skill that bad?

  9. #9 Scott Cunningham
    April 20, 2011

    The point is that there is no control group. Somebody prayed for all of these patients. Thus, there can be no valid scientific comparison of so-called prayed-for and not- prayed-for surgical patients.

    This is definitely not a point in favour of defending prayer in surgery with science.

    For instance, does the religious devotion of the prayer intercessor or the holiness of the patient have any bearing on how God re- sponds to prayer? Does God take into account the worthiness of the cause?

    Blame the victim. Classy. And easily answered “no,” given good people die all the time and even death row prisoners can undergo successful open-heart surgery. Perhaps prison chaplains are experts?

    What happens when the outcome being prayed for is not in accord with the will of God?

    Special pleading gives you a perfect out if malpractice insurance is involved? “That staphylococcus must’ve been introduced by the Unwashed Hand of God!”

    The scientific foundation for prayer is not solid. There is no indisputable proof that prayer can aid in healing. Those who believe do so by faith alone.

    Absolutely right. Why then did you waste time looking at the Cochrane reviews?

  10. #10 DW
    April 20, 2011

    OT- but Mercola’s been busted again by the FDA re his claims on thermography ( Quackwatch/ new additions/ 4/19/11)

  11. #11 Dr. le Petomane
    April 20, 2011

    Remember, first do no harm. You might think prayer does no harm (aside from annoying atheist or agnostic patient), and that’s probably the case. However, the existence of an all-powerful, all-knowing, and all-loving God is ruled out by the very need for surgery or intercessory prayer. Not so for other kinds of supernatural creatures. The infinitesimal likelihood that praying to God will help the patient is outweighed by the slightly less infinitesimal likelihood that you will annoy the local wood sprite or provoke Loki into causing post-op ileus. This is exactly how Pascal blew his savings in Atlantic City.

  12. #12 Rene Najera
    April 20, 2011

    Yeah, I’m pretty much going to leave this one alone. I still have the emotional scars from the last time I commented on something religious around these here parts.

  13. #13 Sigmund
    April 20, 2011

    “Among the comments was, “”I don’t pray and it made me think it was really bad going into surgery.”"
    I guess that in the cases that it really WAS very bad going into the surgery the patients may not, afterwards, have written bad comments (or good comments, for that matter).

  14. #14 James Sweet
    April 20, 2011

    I’m not sure what the hell I would do if a surgeon asked me if I wanted to pray with him right before being anesthetized. Depending on the seriousness of the surgery and my mental state at the time, I might seriously ask for a different surgeon. How creepy!

  15. #15 Anton P. Nym
    April 20, 2011

    I think there may be benefit in praying with the patient… but I think it’s the same benefit that would come from any other method of treating a patient as a person rather than a disease condition or a hunk of meat to be cut up.

    Y’know, that school of traditional medicine that used to be called “bedside manner”?

    — Steve

    PS: Of course, treating your patient as a target for religious conversion probably obviates the “bedside manner” benefit…

  16. #16 Daniel J. Andrews
    April 20, 2011

    I think the real value of prayer lies in what it does for the person doing the praying. A long prayer session is like meditation. You have all these worries you can’t do a lot about, you talk to your God about them, you recite a few verses that promise God will look after you, you hand the problems over and ask God to help, and just hand the problems to God. You come out of a 20-30 minutes session feeling very still and peaceful inside, and anytime a worry tries to crop back up you just remind yourself that you’ve done all you can do (if you could have done anything at all), and God will take care of the things that are out of your hand.

    There are times I wish I could still reach that state…I need to learn some ‘atheist’ meditations, me thinks. :)

    btw, Jarred C’s response @8 is the one I’d give too. See if I can make my doc laugh…that’s gotta be good for his/her state of mind….long as doc doesn’t later snicker around delicate nerves and blood vessels.

  17. #17 plutosdad
    April 20, 2011

    What a horrible thing to do to a patient right before surgery. It’s deliberately causing more stress. He doesn’t know what the patient believes or thinks. If he cared that much, he could have asked long before (assuming its not an emergency). Asking the week before when it’s being scheduled might annoy me, but not scare me right before.

  18. “Do you realize how incredibly rare it is for a Cochrane review ever to conclude with a recommendation that no further studies be done?”

    No kidding! My jaw dropped when I read that paragraph. I didn’t think there was anything for which a Cochrane review would recommend against further study.

    I wonder if Dr. Schroder realizes that many of the things he points out as problems in studying intercessory prayer are also the seeds of problems with the concept of intercessory prayer.

    I might be a little concerned as to how it might unconsciously affect my surgeon’s performance if I declined to pray with them, especially if I told them that I was an atheist or agnostic. I might assume my surgeon was a bit of an evangelical, and they might get a little demoralized at the thought that I wasn’t strong with their god.

    Since I am of the understanding that the power of prayer is all psychological for the person who prays as well as the people who know they are being prayed for, I would probably be very uneasy if my surgeon offered to pray with me if I declined, which I would.

  19. #19 Thos Cochrane
    April 20, 2011

    The main problem I have with his retrospective “study” of his pre-op prayer practice is that there’s no control. The best you could do for a control would be to have him meet with all patients for the same amount of time in pre-op, say some reassuring but secular things to all of them, and then offer a randomly selected 50% of them an additional prayer. Then you’d compare outcomes.

    Of course, this couldn’t be blinded, so it might be confounded by the surgeon’s expectations (mightn’t he try extra hard, subconsciously, not to make a mistake for the patients he prayed for?) Also, you’d need a blinded observer to measure outcomes.

    The whole thing is unadulterated twaddle, of course–this is just the scientific objection to his study. If he presented data of this quality about a non-religious intervention, the audience would seriously question his competence.

  20. #20 Nicole
    April 20, 2011

    “When the surgeon asks the patient about prayer, he makes it more about him than the patient, no matter how much he tries to tell himself otherwise. If it were truly about the patient, Dr. Schroder would not in any way try to advertise his religion or to make himself feel better by using his religion to bond with his patients before surgery. Indeed, a physician should not even be mentioning this to his patients, because there is a power differential that makes it incredibly difficult, if not outright impossible, for such a request to leave the most patients truly free to decline it.”

    BINGO!!! Excellent post!

  21. #21 DT35
    April 20, 2011

    I had a couple of procedures performed by Dr. Schroder a few years ago, one in the office and one in the OR. He said nothing to me about prayer on either occasion, and we never discussed anything remotely connected to religion; perhaps he can recognize a reprobate on sight.

    He did spend a long time at the sink before the office procedure, but I assumed he was just extra conscientious about scrubbing, not that he was praying.

    He did a good job with my surgeries and was pleasant and professional in our dealings; too bad about this embarassing load of codswallop.

  22. #22 Orac
    April 20, 2011

    Interesting. Maybe he’s become more devout with age. Your anecdote does make me wonder about selection bias in his little “study”/”survey”/whatever you want to call it.

    In any case, I’m glad to hear your story.

  23. #23 Calli Arcale
    April 20, 2011

    It could also be that he only invites the patients to pray if it’s a very serious procedure, and doesn’t bother for outpatient procedures done under local anesthesia. It’s reassuring to learn he doesn’t do it to all of his patients, though. Maybe he only feels the need under extraordinary circumstances. Still, somebody ought to talk to him about it, because if there’s one time to keep the conversation neutral, right before going under anesthesia is definitely it. Don’t discuss religion, politics, or sports at that point.

  24. #24 Jojo
    April 20, 2011

    I was just looking at the website for the hospital he’s associated with. They provide chaplains for patients and family of any faith. I wonder if the chaplains know he’s encroaching on their business?

  25. #25 Fleegman
    April 20, 2011

    How do you think he’d feel if a pilot came over the speakers asking everyone if they’d like to pray for the safe landing of the plane?

  26. #26 Sigmund
    April 20, 2011

    Just to keep things fair I think atheist surgeons should wait till their devout christian patients are on the operating table and then, just before they are given anesthetic, ask them to repeat:
    “I deny the holy spirit, God doesn’t exist, it’s all a fairy tale!” Pardon? No atheist surgeon would ever think of doing such a thing?

  27. #27 PsyberDave
    April 20, 2011

    I’m not terribly surprised by the incidence of religiosity among surgeons. When I was considering medical school during college, one sense I got about the medical education process and the kind of students getting a medical education was that the approach to medicine was akin to memorizing a cookbook. It struck me that med students were concerned with being told how things worked so they could memorize it and regurgitate it. Understanding underlying principles, critical thinking, logic, and validity didn’t seem to matter so much.

    I wanted to be a scientist and understand things from first principles. I suspect medicine is full of people who use the findings of science, but they have not internalized the process of science for their own practice and life. So maybe as a group, surgeons aren’t much more science minded than the general population.

    I am only speculating, of course. But I am interested to hear from others who have been through the medical school process. Does it generally impart the values and purpose of the scientific method such that it is taken to heart by the students?

  28. #28 Dangerous Bacon
    April 20, 2011

    I’d really like to know if there are particular types of operations that make Dr. Schroder especially prone to prayer. Bowel obstructions? Cancer surgeries? Hemorrhoidectomies?

    If I’m going in for excision of an inflamed cyst and the surgeon asks beforehand if I want to lead a prayer session, I’m out of there.

    “How do you think he’d feel if a pilot came over the speakers asking everyone if they’d like to pray for the safe landing of the plane?”

    A nice example, though probably Dr. Schroder would be indignant about surgery being completely different in some way.

    In a similar vein, how many patients are solicited for “therapeutic touch” by nurses and how many consent for fear of offending the nursing staff?

    There need to be hospital and professional society guidelines to protect patients from these subtly (and not so subtly) coercive situations.

  29. #29 Jojo
    April 20, 2011

    This isn’t just a concern for atheists. I can’t imagine that a Jewish or Muslim patient would feel all that comfortable with a Christian surgeon asking them to pray either. Or imagine it the other way around. Can you imagine what would happen if a Muslim doctor asked a Christian patient to pray together?

  30. #30 JayK
    April 20, 2011

    @PsyberDave: I can’t speak of medical school, but I can talk about engineering, where everything is a recipe to the majority of students. There is a reason christianity is huge in engineering majors, it doesn’t challenge them by forcing them to learn the scientific process. The only reason engineers might read a journal was because they needed a new recipe, and it better have pictures!

  31. #31 Rene Najera
    April 20, 2011

    Just to keep things fair I think atheist surgeons should wait till their devout christian patients are on the operating table and then, just before they are given anesthetic, ask them to repeat:
    “I deny the holy spirit, God doesn’t exist, it’s all a fairy tale!” Pardon? No atheist surgeon would ever think of doing such a thing?

    Can you imagine what would happen if a Muslim doctor asked a Christian patient to pray together?

    It would depend on the patient, wouldn’t it? Pat Robertson would probably not let anyone with an Arab-sounding last name near him for a surgery.

    I, on the other hand, am comfortable in that a surgeon is a surgeon is a surgeon, and that, somehow, the system by which surgeons are trained and licensed/certified in the US is a good system overall. Open heart surgery? You did how many years of thoracic surgery residence? Alright, take it away, my Hindu friend!

    If I were infested with cancer, I’d go to the best oncologist, believer or not…

    Worries like that depend more on the level of (ir)rationality in the patient, no?

  32. #32 Matthew Cline
    April 20, 2011

    I’ve never understood intercessory prayer. I mean, being omniscient, whatever plan God has developed must be perfect, so why would He change that plan just because you asked nicely?

  33. #33 David D.G.
    April 20, 2011

    Here in the northeast Texas region, we’ve had a spate of billboards up advertising for a particular conglomeration of hospitals. One of them bore the following question: “What good is medicine without FAITH?”

    Obviously, this was intended to be a rhetorical question. But when I first saw it, after I finally shut my slack-jawed mouth, I answered it thusly: “Medicine without faith is every bit as good as medicine with faith — probably better, since it doesn’t include demonstrably baseless assumptions.”

    I still cannot understand how this ad was run on billboards and other venues for months. It is hard to imagine a greater insult to the doctors, nurses, support staff, and medical technologies and research of the hospitals that the ad was supposedly promoting!

    ~David D.G.

  34. #34 rob
    April 20, 2011

    srugeon: “I will be your surgeon. Would you like to pray with me?”

    me: “get the fuck away and bring me a different surgeon.”

  35. #35 Calli Arcale
    April 20, 2011

    Matthew — nearly all religions revolve around either fitting you to God’s plan* or bending God to your will. (Interestingly, there’s a lot of alt med which actually follows a very similar pattern. This is clearly something pretty primal to the human experience.) There have been a lot of very clever people through the past six or so thousand years of civilization** and so of course there are a lot of answers to your question. Whether any of them are right is another question, and quite a few people have died attempting to sort that out.

    One theory goes like this: God is omniscient and all powerful and everything that happens is according to a plan. Including your prayer; God answers it because that’s what He was planning to do all along. In this model, free will is illusory. God answers your prayer (or doesn’t) because God made you say it in the first place.

    Another theory is that God is omniscient and all powerful but *chooses* not to exercise his ultimate power for the most part, allowing the world to go its own way. However, being all powerful and all knowing doesn’t mean He doesn’t have a heart, necessarily, and one can prevail upon his scruples — or, if we’re hypothesizing a cruel or capricious God, you can get rewarded for performing the right obsequies by having your prayer granted.

    That’s just two that work in a monotheistic framework. One perhaps shouldn’t assume that God is alone, or all-powerful. The Zoroastrians were dualists, and believed there were two perfectly balanced deities, Ahuru Mazda (the creator) and Angra Mainyu (the destroyer), locked in a constant struggle for the fate of the world. Either might be all-powerful if the other one wasn’t hanging around. (Notably, Christianity has sometimes taken this approach, giving Satan rather more influence than perhaps is scripturally justified.) Either may grant your requests if you perform the right rituals to appease them, or if your request pleases them in some other way.

    This gets even more complicated when you throw in polytheism. If you’ve got dozens of gods battling for attention, none of which are omniscient or omnipotent, there’s clearly no contradiction. And there’s no reason one can’t believe in a single creator God who is *not* actually omniscient.

    * Substitute with name of deity or pantheon of deities or various supernatural entities as applicable.

  36. #36 Jojo
    April 20, 2011

    @Rene

    Sorry for sucking you in, I know you wanted to stay clear of this post. Although I always love your posts, so I’m kind of happy in a selfish way.

    I agree with you that it’s irrational for a patient to judge a surgeon’s capabilities based off of their religious beliefs. Like you, I’m concerned about their training and skill.

    However, I feel, like Orac and other’s on this post, that it’s inappropriate for a surgeon to ask a patient if they want to pray right before surgery. Because of the power balance of the situation (patient submitting to unconsciousness and surgery under the doctor’s control)it is impossible to avoid the possibility that the patient may feel uncomfortable and coerced. My point with the comment about a Muslim doctor asking a Christian to pray was simply to highlight the fact that it’s not only atheists that may find this disconcerting, but any patient who has a different faith than the doctor.

    I probably should have used a Protestant and a Catholic in my example instead because of all of the other baggage like racism and xenophobia that is often tacked on to the religious differences between Christians and Muslims.

  37. #37 Sastra
    April 20, 2011

    Indeed, a physician should not even be mentioning this to his patients, because there is a power differential that makes it incredibly difficult, if not outright impossible, for such a request to leave the most patients truly free to decline it.

    Exactly. Thank you for this.

    And I will add another concern that I don’t think has been mentioned yet: religious people believe that religious people have resources that non-religious people don’t. Once spirituality has been brought into the relationship, the expectations for the patient are therefore suddenly and subtly altered. Patients who can tap into faith are seen as calmer, wiser, happier, easier — and they will heal better. Miracles are more likely. Positive outcomes are more likely. They have God on their side.

    And if you’re not a person of faith, your doctor now expects the opposite. You will be less calm, wise, happy, and easy. You won’t heal as well, and are less likely to have a positive outcome. you’ll complain more. Your religious surgeon, as a man or woman of faith, will be on the lookout for this.

    Because when an atheist doesn’t do as well as a theist — on whatever level you pick — this only reinforces their faith. The importance of faith, and the importance of God. And it makes a good story.

    Trust me: you do not want to ever be placed in a position where you suspect that doing poorly might help solidify your doctor’s belief in God. And that he or she knows this … and is watching for it. He or she is all set to put you forth later as an anecdote, an anonymous weak “atheist” who is then contrasted with the pious, strong patient.

    If I refuse to pray, I would be afraid that, deep down, Dr. Schroder would now be either expecting, or hoping, that his atheist patient would fail. Consciously, or subconsciously — because that is how the religious storyline goes.

    So this positive spin put on prayer in the surgery is like the positive spin put on the “Good News” that not all will be damned. If you’re one of the damned, you know you’re not the audience being addressed. And it can only end up “better” for the main character with spiritual resources if it ends up “worse” for the supporting character without: you.

    If I’m going into surgery, I don’t need this additional stress. Whether there is any importance placed on whether I agree to pray or not will depend on exactly how important my surgeon thinks God really is. Oh, joy.

  38. #38 JohnV
    April 20, 2011

    Sastra are there any reports of evil theistic surgeons slyly murdering their atheist patients in order to prove that their god or gods exist?

  39. #39 stripey_cat
    April 20, 2011

    Don’t be disingenuous, JohnV. No-one is suggesting that a surgeon would consciously treat patients differently, but that their unconscious expectations and cognitive biases could be dangerous. Even if your refusal only rattled the surgeon before surgery, would you want a disturbed and distracted surgeon cutting into you? And then if there is a possibility that he unconsciously expects you to be a troublemaker, the post-op care could be less than perfect. In the same way, a mental-health diagnosis makes a lot of doctors take your physical complaints with a pinch of salt.

  40. #40 Rene Najera
    April 20, 2011

    @Jojo

    It’s a very touchy subject, and I agree with Orac and yourself that the patient is put in an uncomfortable situation, to say the least**. Going back and reading my comment, it reads as if I’m saying, “suck it up and stop worrying about it.” I’ve never been under the knife, so I shouldn’t just think that people will be completely rational when their lives may very well hang in the balance.

    Speaking of touchy:

    srugeon: “I will be your surgeon. Would you like to pray with me?”
    me: “get the fuck away and bring me a different surgeon.”

    It’s that kind of irrational reaction that worries me about people (humanity in general) when discussing these things. One big spectrum, vociferous folks at either end, drowning out those of us that want to talk about it like adults. (Who say’s “get the fuck away” to a surgeon? Hope your liver’s not lacerated.)

    Instead of a good discussion and general agreement that surgeons should follow the whole “pray to me in silence” principle so as to not really get their patients all up in a fuzz at a moment that is least convenient (like when livers are lacerated)… Instead of that, we end up liberally throwing around angry words, as if praying is the absolute worst thing that anyone could do to another person.

    There’s no evidence that it is.

    ** I bolded that part because, inevitably, someone will want to pick a comment fight with me, stating that I’m all for asking a patient for a moment of prayer.

  41. #41 Vicki
    April 20, 2011

    JohnV: Given the number of people who die in hospitals every year, it would take a while for such a hypothetical murdering surgeon to be noticed. Note that one of the most prolific serial killers in history was a British doctor who murdered more than 200 of his patients. I don’t think most doctors who offer to pray with their patients would deliberately neglect patients of the wrong religion: but it only takes one.

  42. #42 Sastra
    April 20, 2011

    John V #38 wrote:

    Sastra are there any reports of evil theistic surgeons slyly murdering their atheist patients in order to prove that their god or gods exist?

    No, but that wasn’t really what I was suggesting — or, rather, worried about. Stripey_cat is right, in that my concern was over a cognitive bias with a perhaps unconscious influence. Doctors usually try very hard to be objective, and I suspect religious doctors are no different — but suddenly a very powerful interpretive scheme is being introduced into a situation which has an awful lot of judgment calls. And at least some of those judgment calls could have effects on my health. Important effects? I don’t know. But it’s a worry. Religion makes people go a bit crazy: how crazy, looks to me like a matter of chance.

    I’ve noticed though that people sometimes seem to treat me differently after they learn that I’m an atheist. They also react differently I think to things I tell them about my personal life. My subjective sense is that they’re now trying to fit what I tell them into a preset “atheist” role. If a physician thinks that religion is a really, really important aspect of one’s health this does not bode well for this physician being neutral on belief vs nonbelief.

    (Anecdote: I knew a man who was convinced that his admission of being an atheist before his surgery in a Catholic hospital resulted in a serious reduction in pain medication/anaesthetic both during and after. He claimed that the nuns/nurses had smirked when he told them he was an atheist, and smirked afterward when he complained about being in agony — making some comments about leaning on the Lord or calling Him or some such. Yes, he might have been mistaken. His own doctor though was apparently concerned enough that he suggested pursuing it legally — but the man just wanted the hell out of that hospital. Again, just an anecdote — but illustrative of at least one of the darker possibilities. It would cross my own mind, today, if religion was brought up: some theists think the purpose of suffering is to bring sinners to the realization that they need God. Uh oh time.)

  43. #43 Mephistopheles O'Brien
    April 20, 2011

    @dmfmab,
    Say, what?

  44. #44 Anthony McCarthy
    April 20, 2011

    at least as many physicians as the general public accept “intelligent design” creationism as a valid description of the origin of life.

    As a valid, extra-scientific description because they believe that God created the universe would be one thing, that’s been believed by some pretty fine scientists.

    Believing in the product of the ID industry which is mostly pseudo science, that would be quite another thing. If they believe that science could be used to do anything but gather and elucidate physical evidence, their science education left out something pretty significant. Though it’s hardly ID folks only who do that as it’s widely believed within science that things like that can be the subject of science.

    Indeed, 15% of physicians believe that states should be required to teach ID and 50% believe that states should be permitted to teach it.

    And this is, yet, another thing. Public schools, as official, governmental entities cannot teach religion, they would immediately run into a sea of competing religious beliefs and would inevitably choose among them for either teaching or validation. That is absolutely wrong and shouldn’t be tolerated. That so many highly educated folks would have such an abysmal knowledge of history and civics that they wouldn’t understand the demonstrated necessity of that to produce democracy is a lot more disturbing than the unscientific belief in a created, designed universe.

    About the rest of it, I doubt that it would be possible to study any possible effects of something so undefinable and unverifiable as prayer. How would they know that the “prayer” they were trying to study was present? How would they know if even any two people who were “praying” were, actually, doing the same thing? How would they know that the kind of prayer they chose was the “right kind” of prayer, prayer that would work? There are so many things wrong with the idea, up to and including that even believers admit that miracles are rare and not part of the natural order and so the application of probability, which is only known to work within the natural order, would be a valid measurement of it.

    And that doesn’t get to the whole basis of most prayer, that its effectiveness is dependent on the will of God who can withhold a cure for reasons that people can’t discern. I’d like to know how you’d set up a control group who God is supposed to ignore or who are supposed to be shielded from the effects of unauthorized prayer, perhaps prayer from the members of the control group, themselves.

    I figure if people want to pray, that’s their right and their business. If doctors want to, that’s their right and their business. Preventing doctors from praying would be as absurd an idea as forcing them to. Grousing about it will be ignored.

  45. #45 Militant Agnostic
    April 20, 2011

    at least as many physicians as the general public accept “intelligent design” creationism as a valid description of the origin of life.

    In other words a large fraction of physicians have no deep understanding of biology.

    If doctors want to, that’s their right and their business.

    Not when they impose it on a patient as described in the post.

    Callie @6

    It’s inappropriate, and I prefer to pray privately anyway. (Public prayer is acceptable in limited circumstances only; otherwise it’s just grandstanding to show how wonderfully faithful you are.)

    This – especially the grandstanding.

  46. #46 Skeptiverse
    April 20, 2011

    For myself if a surgeon asked me to pray with them before a procedure i would start thinking about the confidence of the surgeon.

    ANECDOTE ALERT
    Having had a few procedures, the types of surgeons who have instilled the most confidence whether justified or not have been the brash overconfident assholes. i may not have liked them but the way i see it surely they cant be that confident if they stuff up all the time.
    //END

    Now going by Oracs stats chances are that some of those overconfident surgeons are pretty religious but i just cant see them praying for soem divine being to help them when they so obviously believe in their own skill.

  47. #47 nybgrus
    April 20, 2011

    most of the topics I would have commented on have been pretty well hit, so I don’t exactly have much to add. However, in response to post @27 – yes, I find that the true understanding and use of the scientific method is significantly lacking in medical school. However, I would contend that is the case across all education, except those specifically in research (i.e. a focused research PhD – and even then you can find exceptions). The reality is that you cannot teach a person to be a scientist – you have to teach them science and show them how it works and then it is upon the person to become a scientist. The human mind is amazingly capable of holding two completely opposite ideas at the same time in a state of blissful and well separated cognitive dissonance. I’ve even seen bio undergrads who will vehemently claim they do not believe in evolution, wholly ascribe to creationism, and then go and write reports, do lab work, and get A’s in classes where the foundation of understanding is evolutionary theory. They ape the motions and apply the theorems without ever fully understanding and owning it on first principles. That allows them to be comfortable in their cognitive dissonance because they intentionally wield their knowledge in a way that never confronts their core belief in creationism.

    In medical school, just as any education, you can thusly get by and learn the necessary clinical applications whilst deftly and (relatively easily) skirting the first principles upon which they are based. Plus, you needn’t be an expert in everything to get through med – embryology challenge your notions on creationism? Then don’t bother learning it all that well. Just a few facts to get you a pass on the section is easy enough. What about resistance patterns for bacteria? Learn that it happens, call the “micro-evolution,” and move on.

    Lastly, I would say that if I were about to go in for surgery and my surgeon suddenly asked me if I wanted to pray, I would be immensely uncomfortable. The rational part of me would tell me just to go ahead, pray, appease the surgeon, and move on. I know there is nothing to prayer and that me participating in it does me no harm as a result. Maintaining the surgeon’s focus would be much more pertinent and logic would dictate that would be fine. However, when in such a vulnerable position, my own emotions may come into play and I would be worried he could tell I wasn’t genuine in my prayers (after all I have been agnostic all my life, quite solidy atheistic now, and the handful of times I ever went to church I thought I was witnessing the strangest thing in the world – so how am I supposed to know how to pull it off right?). What if I rejected it and asked for a new surgeon? I reckon that would have repercussions since it is fair to say other surgeons are religious and so are nurses and staff there. I would be immediately branded as the “trouble-making atheist” and would never have the opportunity to know if future interactions might be (consciously or not) tainted by that. In short, it is most certainly a power play – one that a physician should be well aware of. And even if it effects only a tiny handful of your patients, as a physician, you should try your damndest to avoid that. If asked to pray by your patient, great. Otherwise, people like me will be very uncomfortable, I will try and fake it as best I can, and then after I am recovered from my surgery I will write the surgeon a letter explaining why he is no longer my doctor.

  48. #48 Anthony McCarthy
    April 20, 2011

    Appease the surgeon. I thought that was what you did when you told them what insurance you had.

  49. #49 Militant Agnostic
    April 20, 2011

    @48 – Only in America – the civilized world has some form of socialized medical care.

  50. #50 Richard
    April 20, 2011

    I believe that doctors should not preach to their patients about religion and I agree with you that doctors should not offer to pray with their patients before surgery or at any other time. I believe that doctors and hospitals should accommodate their patients’ religious needs as much as possible, such as allowing clergy to come visit them if patients request it. I don’t know that this happens often, but maybe some forms of alternative medicine could be allowed if a patient requests them. Such altmed services should only be brought in upon request of a patient and should never be a part of regular hospital procedure. Just a thought.

  51. #51 Comrade Carter
    April 20, 2011

    I think, personally, that allowing altmed inside the hospital is extremely bad and just offers another reason why Patient A is getting “something” and Patient B is not… And the “something” can be anything: A hamburger from Culvers or a wandering monk.

  52. #52 Ben S
    April 20, 2011

    The real question is, what’s his opinion on semen?

  53. #53 Mattand
    April 20, 2011

    I had a incident with a nurse over religion a few years ago. I was getting an injection for a bulging disk and the nurse asked me what my religion was. I still gave lip service to the existence of God at the time, but for all intents and purposes I was done with organized religion.

    I instructed her to put “none”. Apparently, that wasn’t an acceptable answer. She became a bit agitated until I relented and told her to put “Catholic” (my family’s religion of choice).
    Looking back, I wish I had held my ground. As people have pointed out, though, I started getting worried that upsetting the medical staff was jeopardizing my health care.

  54. #54 augustine
    April 20, 2011

    I have no interest in this topic. I abstain.

  55. #55 C. Sommers
    April 20, 2011

    Then don’t post at all you fucking imbecile. (aug)

  56. #56 lilady
    April 20, 2011

    I’m blown away that doctors are “going there”. It makes the patient uncomfortable…a terrible thing to do to any patient awaiting surgery.

    I don’t expect a pastoral counselor to examine me, offer up a medical opinion or operate on me. If the surgeon wants to pray silently on my behalf while she is scrubbing up, that’s okay if it steadies her hands and she applies her surgical skills.

    What’s going on with these doctors? First Orac blogs about the doctor who managed to offend women, lesbians and the surgical community, now we have the evangelist doctor who wants to interject his beliefs in the healing process.

    We should be questioning the ethics of physicians who engage in the tactics.

  57. #57 C. Sommers
    April 20, 2011

    Then don’t post at all you fucking imbecile. (aug)

  58. #58 Marcus Ranum
    April 20, 2011

    Consider the last couple thousand years as a population study regarding the effectiveness of intercessionary prayer. If it worked for, say, buddhists, we’d be able to measure appreciable differences in buddhist longevity, wealth, accident mortality, etc. Indeed, over the course of thousands of years, any intercessionary prayer-regime that conferred an advantage would have probably taken over the world simply by dint of many small cumulative successes. I.e.: it would be incredibly adaptive if it worked. Which it doesn’t, clearly. The existence of Las Vegas is strong evidence against psychic powers of any sort – including prayer – anything that could alter basic probability by even a percentage point would put Vega$ out of business.

    Given that prayer has been shown, for thousands of years, to be at best a placebo, why is anyone still wasting their time studying the topic? That case should have been closed by the 9th century at the latest.

  59. #59 Marcus Ranum
    April 20, 2011

    Religion, while it is a “lifestyle choice” is an intellectual impairment. I’d rather have doctors that live in the here and now, because any problems I bring them are in the here and now.

  60. #60 mxh
    April 20, 2011

    You’re about to go under the knife for, let’s say, a cholecystectomy. Your surgeon, after explaining once again the risks and benefits of surgery, asks you if you want to pray with him? Do you refuse? Or are you intimidated because you don’t want to piss off the man who is about to cut into your body in order to forcibly rearrange your anatomy for therapeutic effect?

    Actually, if it’s even remotely elective, I’d cancel the surgery right away. In fact, I wouldn’t trust a religious doctor, whether they were obvious about it or not. I just can’t trust someone who willfully ignores science (and reality) to make decisions about my health.

  61. #61 Marcus Ranum
    April 20, 2011

    In defense of the doctor: it might be that the doctor is practicing a good bedside manner and is going be clues about the patient. Perhaps a doctor might observe a patient wearing a crucifix, or having a bible, and be trying to comfort a patient. I wouldn’t loudly accuse such a doctor of being a liar or a hypocrite if that were the case. (Although, things would be interesting if the doctor noticed a patient was reading ‘The Dunwich Horror’ and cried out “Ia! Ia! Cthulhu fhtaghn!” while the patient was going under the anesthesia…)

  62. #62 julian
    April 21, 2011

    Is there no limitto how entitled most believers feel? How arrogant and self absorbed do you have to be to make that many assumptions about your patient?

    Ditto what Sastra said. Way back when I was a wee little motard on my way to Parris Island, the flight attendant struck up a conversation (yes it is anecdote time) with me about life, the universe and everything. She waas warm, kind and very eager to tell me about how great what I was doing was. When she learned I wasn’t a believer she became distant, made no eye contact and definitely failed to bring me my Sprite.

    Responses like hers are the reason I’m so uncomfortable contradicting the beliefs of people I am in some way dependant on. Because it’s my welfare on the line, I can’t just trust how professional they’re going to be.

  63. #63 Bruce Gorton
    April 21, 2011

    Answer: Okay, sure, but did you remember to bring the live chicken that we may sacrifice to our infernal master?

  64. #64 realinterrobang
    April 21, 2011

    Sastra: My friend Rustin has a suite of similar stories relating to being in the clutches of a murder of fundamentalist Christian nurses while he was in the burn unit at St. Vincent’s in NYC. So I have approximately zero doubt that it can and does happen.

    If I’m ever in hospital in the US (*shudder*), I’m gonna play my cards very close to the vest in terms of religion…

  65. #65 Tim
    April 21, 2011

    @63–Very good, my exact thoughts “I’ll be happy to pray with you if you brought the chicken and the rum for the voodoo rites” .

    Alternatively, “I follow the tantric religious practicies, I’d be happy to pray while you suck on this”

  66. #66 Poodle Stomper
    April 21, 2011

    I realize I’ll be fairly lonely in this mindset but I wouldn’t really care if a surgeon asked me if I wanted to pray with him. I’m not religious but I do realize that others are and that in most cases a person’s religion has little or nothing to do with their skill in surgery. I’ve known quite a few scientists (I’m in research, btw) who subscribe to the idea of a creator and still perform excellent science, even in the field of evolutionary-related biology. The bottom line for me is that if the Doc can remove my appendix, fix a hernia, or give me an arm transplant with the same care and competence as an atheist doctor then who am I to complain or judge him for his beliefs? Now if he proposes to swap prayer for the current best medical care then yes, we would have a problem. Just my $0.02.

  67. #67 speedwell
    April 21, 2011

    I was so fortunate to have a surgeon remove my hopelessly infected kidney whose faith was placed firmly in his own fingertips. I recognized the look and attitude of a real artist, and felt much like a piano might feel in front of a concert pianist. But I spent a lot of time in the run-up writing “no religion please” on forms. I worried about this exact issue. I was already freaked out enough by a previous experience many years ago with a lazy anesthesiologist. (By the way I have nothing but good to say about the anesthesiologist for the kidney procedure.)

    During my recovery, though, I did have to call Patient Advocacy on one particular nurse who neglected me and treated me abusively after she understood I was an atheist. (My doctor told me she was quickly fired; I understand it wasn’t the first time she did it.) I also had to dismiss a “helpful” chaplain who took “no religion” on my forms to mean “hooray a conversion opportunity”. Narcotics make me cranky, so I had a lot of snarky fun treating the chaplain like a rude telemarketer calling during dinner.

  68. #68 mxh
    April 21, 2011

    I’m not religious but I do realize that others are and that in most cases a person’s religion has little or nothing to do with their skill in surgery. I’ve known quite a few scientists (I’m in research, btw) who subscribe to the idea of a creator and still perform excellent science, even in the field of evolutionary-related biology.

    I would question the skill of the surgeon (or at least their skill in applying reality-based evidence to patient care). Same with the evolutionary biologist, who ignores a whole body of evidence because it conflicts with their religious beliefs. Sometime surgeons have to think on their feet, and I’d rather have them thinking about modern science than imaginary friends.

  69. #69 speedwell
    April 21, 2011

    Oh, and what would I have said if my surgeon said he wanted to pray with me before the surgery?

    [deep sigh] “I don’t care if you have to stand on your head, whistle Dixie, and rub your lucky rabbit’s foot. Just do whatever your experience says helps you do a perfect job.”

  70. #70 Jojo
    April 21, 2011

    @Rene – I see. Then we are in agreement. If a surgeon asked me to pray before surgery I’d would most likely say something like, “Oh, I’ve already taken care of that, but thank you for offering”. If I was still that upset about it after the fact, I’d probably complain to the hospital and copy the doctor. Then, if I needed a surgeon in the future, I’d probably find someone different.

  71. #71 Poodle Stomper
    April 21, 2011

    mxh,

    would question the skill of the surgeon (or at least their skill in applying reality-based evidence to patient care). Same with the evolutionary biologist, who ignores a whole body of evidence because it conflicts with their religious beliefs. Sometime surgeons have to think on their feet, and I’d rather have them thinking about modern science than imaginary friends.

    If the surgeon were replacing medicine with surgery I would agree completely. However,as in your example of the evolutionary biologist, if they conduct their research in a way that is based in science it doesn’t matter if they believe in a secular evolution or guided evolution. If their results state “phylogenetic analysis indicates that gene B evolved from a duplication of ancestor gene A when humans split from apes…” then it doesn’t matter to me whether they think this had an intelligent cause behind it or not. The data speaks for itself and if it is reproducible then their research is as reliable as any by secular biologists. Now if they include in their conclusions “thus proving that God wanted humans to be distinct from apes” then yes, there would be a problem but otherwise, data is data (and a good medical care track record is a good medical care track record).

    In the case of a doctor, I think any intellectually honest person would have to look at the doctor’s record with the surgery in question before judging his/her merit as a physician. Personally, I’d take a Doc with a great record for open heart surgery over one with a poor record regardless of religious beliefs.

    Again, just my $0.02.

  72. #72 mxh
    April 21, 2011

    if they conduct their research in a way that is based in science it doesn’t matter if they believe in a secular evolution or guided evolution.

    I just don’t think that most people can live two separate lives like that. If you believe in creationism, then I would have a hard time believing that you can conduct research in a way that your belief about the origin of life doesn’t come into play (at some point or another). Same with physicians, let’s say an end-of-life issue comes up (or for that matter, a pain control issue), I wouldn’t want the doctor’s religious beliefs influencing my care.

  73. #73 Blasphemous_Kansan
    April 21, 2011

    Surgeon: “Would you like to pray with me?”

    Me: “Sure, but can you help me get out of the bed and help me face qibla? Do you want to recite the niyyah, or should I? I don’t have my Qur’an, so I hope you brought yours!”

    Would be interesting to see the reaction.
    (Edit response as appropriate for whatever faith the surgeon is likely not, as much as this can be determined.)

  74. #74 Mu
    April 21, 2011

    My first thought was “do you think it’s appropriate to sacrifice a black rooster right here in the operating room?”

  75. #75 Calli Arcale
    April 21, 2011

    mxh:

    I just don’t think that most people can live two separate lives like that. If you believe in creationism, then I would have a hard time believing that you can conduct research in a way that your belief about the origin of life doesn’t come into play (at some point or another).

    That’s just it, though — being a Christian doesn’t mean you are a Creationist (and of course there are a great many religions other than those which use the book of Genesis — Hindus, for instance, probably do not believe the world was created 6,000 years ago by a single god, the only god). You are assuming they hold beliefs which contradict science, and then concluding that they cannot be unbiased on any scientific issue. And I’m sorry, but that’s ridiculous. Science stands on its own; it doesn’t matter what religion the scientist is. If they’ve been biased, they’ll be found out. It’s how it works.

    As far as religion influencing end of life decisions, sure it can. So can non-religious philosophy. I’ve known atheists with strong pro-life attitudes, and I’ve known Christians who favor euthanasia. Truthfully, it doesn’t matter where a strongly-held opinion or prejudice comes from; it will influence your thinking on an issue. If you think that just going for an atheist doctor will avoid bias in your care, you’re wrong. Sure, you’ll avoid *religious* influence, but that’s not the only sort of influence in the world.

    Blasphemous_Kansan — as funny as that is, I think I’d avoid making my surgeon uncomfortable right before I put my life into his/her hands. I’d settle for a simple “no, I’m fine, thank you” and file a complaint later — or, if I was really uncomfortable, call the procedure off.

  76. #76 Blasphemous_Kansan
    April 21, 2011

    Calli: You are correct, of course, and my comment was intended as a %100 joke. I would not treat my own surgery so casually, nor would I recommend that anyone else. In all honesty, when put on the spot, I have no idea what I would do in this situation.

    Anxiously awaiting the invention of a “joke” font :)

  77. #77 Blasphemous_Kansan
    April 21, 2011

    However, if a situation actually did arise where something like this was said, in earnest or jest, and the surgeon was made uncomfortable I would hope that the surgeon would reflect (later) on exactly why being confronted with a faith other than his own made him uncomfortable. Perhaps he would think twice before needlessly confronting others with his faith.

    As you said, though, under the knife is not the proper time and place to deliver an introspective life lesson, no matter how profound.

  78. #78 Anglachel the Common Sense Pagan
    April 21, 2011

    Wow! Yeah, if my surgeon asked if we could go into prayer before an opperation, I would go from nervous to terrified right quick, fast, and in a hurry! It would make me thing the guy was going to mess things up…

    Medicine and religion should be seperate. What a person does on their own time and what they believe is one thing. But a person’s religion should be their private affair. It has no place in politics, in science, or medicine! Period!

  79. #79 Calli Arcale
    April 21, 2011

    Anxiously awaiting the invention of a “joke” font :)

    I think most professionals would agree that Comic Sans MS is a joke.
    :-D

    You’re right, though, that it could be a good learning experience for the surgeon. If he continues to do this sort of thing with some of his patients, he may eventually get just that when he meets an actual person of a different faith, depending on how ecumenically minded he and the patient happen to be.

  80. #80 Sastra
    April 21, 2011

    Calli Arcale #75 wrote:

    Science stands on its own; it doesn’t matter what religion the scientist is. If they’ve been biased, they’ll be found out. It’s how it works.

    I agree. Even though I think religious belief is itself inconsistent with a scientific approach, I recognize that most religious people compartmentalize their religion from their science. An epistemic concern, yes, but a topic for discussion at a different time. Under the circumstances, I don’t care what religion my surgeon is, as long as he or she is skilled. It’s irrelevant.

    That is, it should be irrelevant. The minute this neutral surgeon brings religion up and asks if I want to pray, it’s now an issue. And here comes all the emotional baggage, intellectual concerns, and possible problems. Their feelings on the importance of religious belief — or “spirituality” — are strong enough to bring it up out of nowhere (for I would not be clutching a rosary or leafing through a Bible.) At best, it’s unprofessional.

    (I know you agree with this, btw)

  81. #81 mxh
    April 21, 2011

    @Calli, You’re right, if they can keep their religion from interfering with their work, that’s great (though Orac’s polls about MD’s kind of says that most doctors have trouble doing that) and if they’re biased, they will be found out. My point is that I don’t want to be the patient that finds it out.

  82. #82 Denice Walter
    April 21, 2011

    @ Sastra: re ” religious belief is inconsistent with a scientific approach.”

    I couldn’t agree more and it’s hard for me to fathom how religious people are *able* to reconcile the differences especially when we get to neuro/ bio for which I have to resort to my base materialism to even stay in the game ( it’s way too difficult for me).

    On the other hand, I *can* reconcile ideas about “spirituality”, the so-called “cosmic ( or oceanic) feelings”,”re-incarnation”,”spirits”, “eternity”, and the “soul” as metaphor for our emotional life and interpersonal experiences. If we all start out at personal experience and then postulate something lying “beyond”- which some might call the “realm of the spirit” ( or God’s territory) and I might call the “realm of language” or suchlike, well at least we can talk a little- hopefully- without a fight breaking out.

  83. #83 Anthony McCarthy
    April 21, 2011

    Religion, while it is a “lifestyle choice” is an intellectual impairment. Marcus R

    Funniest non sequitur I’ve read since last week when some idiot said “I thank God for Ayn Rand.” Bigotry is an impairment, stereotyping adds on laziness and ignorance.

  84. #84 Anthony McCarthy
    April 21, 2011

    Denice Walter, are scientists who buy a lottery ticket or play poker violating the sanctity of science? I’m sure that just about every night you can find many a materialist who works in and around science who indulges in a demonstrated faith in luck.

    How about those who maintain political beliefs that aren’t able to be fit into science? How about those who are sexists or racists, who have been inserting their ideas into science practically since the beginning of it?

    I wonder how it is that the one area which would have to be absolutely blatant in order for it to be inserted into science that is fixated on to the exclusion of those things which are far more subtly inserted into it. Could it be far less an interest in the integrity of science and far more a desire to use science as a tool in an extra-scientific assertion of ideological materialism if not anti-religious bigotry? I’d say it’s pretty obviously the case.

  85. #85 Sastra
    April 21, 2011

    Denice Walter #82 wrote:

    If we all start out at personal experience and then postulate something lying “beyond”- which some might call the “realm of the spirit” ( or God’s territory) and I might call the “realm of language” or suchlike, well at least we can talk a little- hopefully- without a fight breaking out.

    I’m not as hopeful. I think the only reason a fight is going to be avoided in the situation you describe is because people are apparently refusing to engage ideas directly by hiding behind equivocation and a superficial sort of harmony. That will only work as long as the subject is then more or less avoided in the future and you work on something else.

    I consider “spirituality” to be similar in some ways to what’s been called “integrative medicine.” There are, as you point out, rational secular interpretations and ways of approaching or using sacred language and terms. An atheist can be “spiritual” if you simply make the term broad enough. Yet there are also interpretations that are pure woo, making extravagant or pseudoscientific claims about reality (as you know all too well…)

    The loose term “spirituality” too often fails to distinguish these different meanings, deliberately confusing them in order for to grant an unearned credibility to the nonsense. This is not all that different in my opinion from integrative medicine mixing up what is evidence-based and scientific with what is neither in order for the latter to get a free ride on the back of the former.

    It’s also not that different from alternative medicine’s tendency to co-opt diet and exercise into the “alternative” category. If I agree and admit that I also embrace alternative medicine because I take walks every day I’m not really finding a happy middle path that satisfies the science-based side as much as reiki and homeopathy advocates. Words won’t do that if the ideas behind the words are supposed to mean something.

  86. #86 Catherine
    April 21, 2011

    I recently had several tests/procedures at a catholic hospital (I’ve since changed for other reasons) and they kept asking me, every single damn time, about what my religion/religious preference was. I repeated told them that I was an atheist and please stop asking me. Later when I looked at my admission papers I was somewhat amused to see that I was marked as a “Unitarian/Universalist”. I guess this was as close to atheist the clerk could come in the dropdown box choices! Someone actually designed the interface to have those choices without nonbelief as an option!

  87. #87 Denice Walter
    April 21, 2011

    @ Sastra: I probably shouldn’t have invoked the “s” word- I don’t think that there *is* anything _at all_ beyond the physical except abstractions like language- all those words-”spirit”, “soul”, etc are purely metaphors for emotional, perceptual, memorial, ideational, or sensate experiences that people can’t quite put their fingers on expression-wise and thus drift into supernaturalism steered by tradition. Unfortunately, I am forced to use their words if I talk to them, albeit heavily qualified. Still, I do talk to others who don’t share my own “night-time” view- maybe I read too much Wm James. It isn’t easy.

  88. #88 mxh
    April 21, 2011

    @catherine,

    I’ll be working at a Catholic hospital next year (couldn’t help it). It’d be interesting to see if that is really the case.

  89. #89 Rogue Medic
    April 21, 2011
    I say, “I know that some patients like to pray before surgery. If you would like me to pray with you, just ask.” If they ask to pray, then I respond, “Would you like to lead?” I hope not to be coercive and realize that prayer in this instance must benefit the patient more than the surgeon. We then pray together in whatever manner the patient chooses.

    Perhaps I would respond with, “No thank you. I’d like a surgeon who actually understands coercion, doesn’t practice coercion, and doesn’t try to turn the OR into an altar.”

    Imagine if as alternative prayer, this coercion were for something else? Be as scatologically creative as you like. Would Preacher Schroder think that these other by the way, as we’re going in to surgery, offers are not coercive?

    I know that some people like to get their affairs in order before surgery.

    If you have no will, would you like to have me draw one up for you?

    Would you like to include me in your will?

    I hope not to be coercive and realize that to split up property in this instance must benefit the patient more than the surgeon. We then split up his/her property together in whatever manner the patient chooses.

    As long as the surgeon gets less than any other individual, can the surgeon be said to benefit more than the patient? How many non sequiturs can dance on the head of a pin?

    Why would anyone consider such a generous offer to be in any way coercive?

    Or –

    “I know that some patients like to find out their horoscope before surgery. If you would like me to read your horoscope to you you, just ask.” If they ask for their horoscope, then I respond, “Would you like to hear my horoscope?”

    “I know that some patients like to roll the dice for luck before surgery. If you would like me to roll the dice with you, just ask.” If they ask to pray, then I respond, “Would you like to roll the dice for me, too?”

    .

  90. #90 Jud
    April 21, 2011

    Catherine writes:

    I recently had several tests/procedures at a catholic hospital (I’ve since changed for other reasons) and they kept asking me, every single damn time, about what my religion/religious preference was. I repeated told them that I was an atheist and please stop asking me.

    I find the request to stop asking works better, or may not even need to be made, if one responds to the question about religious preference by saying one is a “Motherf**ker.”

  91. #91 Sastra
    April 21, 2011

    Denice Walter #87 wrote:

    Still, I do talk to others who don’t share my own “night-time” view- maybe I read too much Wm James. It isn’t easy.

    I know. I always look forward to reading your comments, though: you have some of the most interesting, thoughtful and articulate analysis of new agey woo I’ve come across. I salute you.

  92. #92 Calli Arcale
    April 21, 2011

    Catherine:

    Someone actually designed the interface to have those choices without nonbelief as an option!

    As a software engineer and an afficianado of the blog The Daily WTF, I’m more inclined to assume incompetence. The screwups in interface design are positively mind-boggling; leaving out an option for “atheist” is mild by comparison. Things like “select state” which only list 42 states, for instance. The worst is dialog boxes which ask a question but do not offer any means of answering it — things like “Do you want to delete the data or copy it?” with the only option being “OK”. Seriously, sometimes I’m not sure it’s worth trying to figure out the logic behind a bad interface.

    (And half the problem is the companies who accept this sort of consultant-built software with defects like that.)

  93. #93 Denice Walter
    April 22, 2011

    @ Sastra: The feeling is mutual. I am , BTW, a product of a liberal, international, elitist education from a largely agnostic-atheistic family and have a “past” in activism.

  94. #94 Stewiegriffin81
    April 22, 2011

    @Rene:

    I don’t agree at all with your characterisation of rob’s statement (about telling the surgeon to “get the fuck away”)as being irrational.

    Wanting another surgeon because the current surgeon has definitively shown that he/she cannot ethically interact with their patients is entirely rational.

  95. #95 Vicki
    April 22, 2011

    Calli–

    Definitely. A friend of mine considered changing his name in part because of the number of databases that couldn’t handle the apostrophe in his last name. In Ireland.

    My hunch is that the specific “no option for nonbelief” came from someone thinking of a bunch of religions, and putting them all in: and if you’re thinking “name lots of sports teams” you won’t come up with “I hate hockey” as an answer.

  96. #96 ArtK
    April 22, 2011

    Calli–

    Welcome to my nightmare. I’m the chief architect for a commercial software product — not even some consultant-written one-off. One of my “favorite” activities is to go to a junior developer and ask: “If you were a user, who didn’t know the guts of our product, would this message mean anything to you? Would you know what to do to correct the problem?” The answer is almost inevitably “no.” Then they go and edit the message, adding “… and call tech support.” %@$^&*!!!!

  97. #97 Beamup
    April 22, 2011

    @ ArkK:

    The other side of the equation, of course, is that customers usually don’t bother to read error messages.

    “You have FNEEBLE mode set, which is not necessary with your OS version. Please go to the Settings menu and select the FNEEBLE option to turn FNEEBLE mode off.”

    Inevitably leads to an email saying, “I got this error message. What do I do about it?” Well, gee. I’m quite sure that the answer is NOT to go to the Settings menu and select the FNEEBLE option to turn FNEEBLE mode off.

    (You can probably guess at what part of the process I’m sitting.)

  98. #98 René Najera
    April 22, 2011

    @Stewiegriffin81

    It wasn’t the wanting another surgeon that I criticized. Go back and read my comment again. I’m not up for a lengthy discussion on this, though.

  99. #99 augustine
    April 22, 2011

    I don’t know if an atheist want’s to know if his doctor is a believer but anyone might want to know if their doctor is an atheist.

    http://www.guardian.co.uk/society/2010/aug/26/doctors-religious-beliefs-terminally-ill

    “Atheist doctors ‘more likely to hasten death’”

    Terminally-ill patients would be well advised to find out the religious beliefs of their doctor, according to research showing the effect of faith on a doctor’s willingness to make decisions that could hasten death.

  100. #100 Beamup
    April 22, 2011

    Lil augie still hasn’t managed to learn that newspaper articles are not reliable sources of information on scientific topics. In this case it’s easy to find the referenced paper (score one for there actually BEING one) – PMID 20739708 – but the full text doesn’t seem to be available free so I can’t meaningfully evaluate it. The abstract does bear out the description in the article, but rather shockingly doesn’t mention any statistics. Which definitely makes one wonder how significant the claiming findings really were.

    Of course, the odds that AUGIE has meaningfully evaluated it, as opposed to simply accepting it blindly because it happens to comport with his prejudices, are effectively zero.

  101. #101 ArtK
    April 22, 2011

    Beamup — yes, software engineering is a race between software engineers trying to build bigger and better idiot-proof software and the Universe in building bigger and better idiots. The Universe is winning.

  102. #102 nybgrus
    April 22, 2011

    are scientists who buy a lottery ticket or play poker violating the sanctity of science? I’m sure that just about every night you can find many a materialist who works in and around science who indulges in a demonstrated faith in luck.

    Anthony- uh, no. Both are quite well within statistical understanding. The fact that winning the lotto is extremely unlikely means you may not be choosing to apply your statistical knowledge very well, but it does NOT mean that you believe in magic sky fairies governing over the universe. Big difference there mate.

  103. #103 Denice Walter
    April 22, 2011

    @ nybgrus: * merci beaucoup* for responding to that (# 84) which I seemed to have missed.

    @ 84: Anthony, psychology addresses the extremely entertaining phenomenon of “subjective probablity” wherein individuals’ hopes and fears lead to distortions in realistic assessment of probabilities- including the psychology of luck ( as part of attribution of causation) Old news.

    No one ever said that people, including scientists, are realistic and fact based at all times as children in a particular Piagetian stage are not “at stage” across all tasks or areas of development. Executive function and its lack, anyone? pre- 1980′s.

    I suppose I, as an atheistic, materialistic modernist, am concerned with getting down to the nitty gritty of *truth*, as far as I can know it, in all of its gory details *in this life* because I believe that it’s all that there is. Similarly for “morals”: I don’t believe that wrongs to other people can be somehow be “forgiven” via supernatural means, or “paid for” in the afterlife, or through subsequent reincarnations- so I’d better act right and be fair to others now. For *their* sake, not my “soul’s”.”Do unto others….”

    As an atheist I couldn’t care less if others believe or not-it’s not my conern- or part of any agenda, political or otherwise. I don’t proselytise.

  104. #104 Stewiegriffin81
    April 22, 2011

    @Rene

    I read your post. I don’t think you fully understand exactly what you yourself stated in it. You criticised Rob’s statement as being irrational, even though he *explicitly* states that he would want another surgeon.

    You then go on to state your concern about individuals irrationally rejecting surgeons on religious beliefs alone.

    However, you cannot derive your second claim from what Rob said, as he did not say that. All you can derive is that Rob would not want a surgeon that asks for prayer, which you have now just claimed is not a problem.

    You then conflate the (probable) harmlessness of prayer with the harmful act of a surgeon asking a patient for prayer. That is in itself an irrational statement.

    Thus, unless you have something else to say, your claim that Rob is being irrational is a baseless assertion.

  105. #105 Rene Najera
    April 22, 2011

    Alright, Stewie… One last time. What I found unreasonable in Rob’s statement was not that he would demand another surgeon. It was in the use of profanity as a reaction and in the use of profanity to demand another surgeon, hence my comment of “who says “fuck” to a surgeon?”

    Got it? Thanks.

    And I’m sorry if I come off condescending, but I’ve had the week from hell, and I’m done with having to explain myself numerous times when what I write is (to me) very clear.

  106. #106 davep
    April 23, 2011

    RenĂ© Najera@105: “Alright, Stewie… One last time. What I found unreasonable in Rob’s statement was not that he would demand another surgeon. It was in the use of profanity as a reaction and in the use of profanity to demand another surgeon, hence my comment”

    He said something here as a comment. It’s a far reach to assume that he (or anybody) would actually say that in the event.

  107. #107 Stewiegriffin81
    April 26, 2011

    @ Rene

    What davep said.

    Additionally, if you had initially said in your first post about Rob that his comment was a little over the top, or rude, or inappropriate, I wouldn’t have made any comment, as that would be a fairly straightforward subjective opinion.

    However, you claimed that it was irrational. Strictly speaking, there is nothing at all irrational about swearing or being rude. It may well (subjectively) be inappropriate and/or non-productive, but it is not in any way irrational.

    With regards to your comment about “who says fuck to a surgeon”? I’d say the answer to that would be a proportion of patients who are ethically mistreated by their surgeons. Being asked to pray by their surgeon is an excellent example of such ethical mistreatment.