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Training doctors to heed patients' spiritual histories

In medical schools, more future physicians learn of link between

Physician Dale Matthews still remembers the woman who came to his office, complaining of shortness of breath. What he most recalls, though, is how taken aback he was by his patient's response after he diagnosed a serious heart problem.

"She looked me square in the eyes," he recounted, "and, holding her prayer book, she said, 'I'm not going to go to the hospital. I have to go home and pray.' "

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Nothing in his medical-school training had prepared him for that moment, says Dr. Matthews, who teaches at the Georgetown University School of Medicine in Washington. Two weeks later, he reported, the woman returned to his office, healed.

Today, medical students are more likely to receive training on gathering patients' spiritual histories - a trend that has evolved in tandem with the growing body of clinical research linking patients' spiritual beliefs to physical health.

Preparing doctors to deal with the spiritual histories of their patients and to recognize faith as part of the healing process is still a fairly new development. But over the past five years, these ideas have become more integrated into medical-school training, says Christina Puchalski, director of clinical research at George Washington University, who has developed guidelines for doctors to use in discussing spiritual issues with patients.

Of 125 accredited medical schools, 61 offer a course on spirituality in medicine - and as many as 40 of those introduce future doctors to Dr. Puchalski's guidelines, known as FICA.

Still, there can be a reluctance to address spiritual concerns, Puchalski says. This stems in large part from lack of time and training, and doctors' uncertainty about how to identify patients with spiritual needs.

FICA, which stands for Faith, Influence, Community, and Address, is a formula doctors can use to ensure that patients' spiritual histories become part of their medical records. Using it, doctors will ask questions such as: Does religious faith or spirituality play an important role in your life? How does your religious faith or spirituality influence the way you think about your health or the way you care for yourself? Are you part of a religious or spiritual community?

"I knew I would have to come up with some sort of tool to make it easy for them [to do a spiritual assessment]," Puchalski says. "Otherwise, they wouldn't do it."

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Patients' desire to talk to their doctors about faith is widespread, according to recent surveys. In a 1996 USA Weekend Faith and Health poll of 1,000 adults, 63 percent said physicians should talk to them about spiritual health. Yet only 10 percent reported that their physicians had actually done so.

The evidence is overwhelming that an individual's spiritual life has a marked effect on health, according to speakers at a three-day meeting of health-care providers and clergy in Boston this week. The gathering explored the connections between spirituality and healing in medicine.

Herbert Benson, a cardiologist and president of the Mind/Body Medical Institute in Boston, who organized the first such conference in 1995, said that "60 to 90 percent of visits to physicians are in the mind/body realm."

Aside from the survey, Puchalski says, there are sound medical reasons to bring up spiritual relationships: "[They] have real impacts." The FICA system, she adds, has an added result of addressing "a broader concern, which is really just respect for the other person. It's not so much what [the patient's] beliefs are but learning to listen,... and learning to let go of an agenda."

The Rev. Joseph Driscoll, a Roman Catholic priest from Boston who represents 14,000 professional spiritual caregivers in the US, echoes her comments. "None of us in health care has the right to go to someone without reverence."

At the same time, Dr. Benson emphasized that encouraging a patient's faith practices is only one part of overall health care. Medicine and surgery were the other two essential legs, he said.

The conference also looked at the healing practices of world faiths, including Buddhism, Hinduism, Catholicism, Judaism, Islam, Hispanic-Pentecostalism, and Christian Science.

Virginia Harris, chairman of the Board of Directors of The First Church of Christ, Scientist, which publishes this newspaper, spoke of her own healing through prayer after a car accident 20 years ago, when doctors gave her little hope of survival. "Medicine and religion are entering a new dynamic of mutual respect and inquiry," Mrs. Harris said.

(c) Copyright 1999. The Christian Science Publishing Society

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