Taking Your Spiritual Pulse (cont.)
Researchers at the University of Pennsylvania surveyed 177 outpatients at the university hospital and found surprisingly high support for such "spiritual intakes." Some 94% of those who had religious or spiritual beliefs felt physicians should ask about those beliefs, according to the study published Aug. 9, 1999, in the Archives of Internal Medicine. And more than half of those who professed no significant beliefs still thought doctors should at least inquire. In comparison, just 16% of patients said they would not welcome such questions from their doctors.
Yet despite these strong sentiments, only 15% of the patients surveyed said a doctor had ever asked about their religious or spiritual convictions.
The Medical Benefits of Faith
There are sound medical reasons to take these beliefs seriously. An analysis of 42 studies involving 125,286 patients, published in the June 2000 issue of Health Psychology, found that those with some sort of religious involvement live longer -- though no one knows whether longevity is due to their faith or their community ties.
Moreover, two-thirds of the patients in the University of Pennsylvania study said that being asked questions about their beliefs would increase their trust in a doctor, which has also been linked to better medical outcomes in some studies.
"We're not doing our jobs if we ignore these questions," says Daniel Sulmasy, MD, director of the Bioethics Institute at New York Medical College, a Catholic university. "After all, it's not just bodies that become sick. Any illness raises issues of spiritual or religious meaning and values."
The point of a spiritual history is not to quiz patients on their formal religious affiliation, says Puchalski, who is medical director at the National Institute of Healthcare Research, a group promoting the integration of spirituality and health care. "We're really just trying to understand what's important to a patient and how those beliefs and values might affect how the patient copes with illness."
The "Spiritual Intake"
Puchalski has developed a series of four questions that attempts to get at a patient's belief system, which could include nature, philosophy, family, and community -- along with formal religion. Such so-called "spiritual intakes" have been taught at 64 medical schools in the United States, including Johns Hopkins and Harvard.
"Physicians are not being trained to be spiritual directors," she says. "The idea is simply to open the door to discussion." If a more in-depth exploration seems warranted (for instance, if a patient believes that an illness is a deserved punishment from God), a doctor might then refer the patient to a clergy member or counselor -- in the same way physicians refer patients who bring up issues of domestic abuse or family troubles. Puchalski calls her system FICA; here's what the letters stand for:
F: Faith or beliefs. Do you consider yourself spiritual or religious? What things do you believe in that give meaning to your life? (If the patient doesn't want to discuss such questions, this is the time for the doctor to end the spiritual history interview.)