Heaven can wait, or maybe it can't

Some doctors feel that their patients' spiritual history is just as important to treatment as their medical record. Others don't agree

By Tony Craig

Dr Harold G Koenig, an associate professor of medicine and psychiatry at Duke University in North Carolina, strongly believes that taking a patient's spiritual history is just as important as reviewing his or her medical history.

A colleague, Richard P Sloan, professor of behavioural medicine, disagrees just as stoutly.

Writing in a recent issue of Internal Medicine News, both doctors agree that a terminally ill patient's religious beliefs can affect overall health and outcome. "But a much better reason for inquiring about a patient's spirituality is that religious beliefs influence medical decision making," states Dr Koenig.

Dr Sloan counters: "No one disputes that for a great many people, religion and spirituality provide comfort in times of distress. But whether we can add to this in the clinical setting is another matter altogether."

Today, fewer than 10% of American doctors inquire about patients' spiritual beliefs, says Dr Koenig, but he expects the practice to increase over the next five years, especially where chronic or serious diseases like cancer, stroke or arthritis are concerned. "Taking not just a medical history but also a spiritual history helps physicians grasp what's important to their patients and what may drive decisions about accepting or rejecting treatment."

INVASION OF PRIVACY?
This is tantamount to intruding on the personal freedom of patients, according to Dr Sloan. "The idea of linking religion and spirituality to clinical medicine raises significant ethical concerns, including manipulation, invasion of privacy and causing harm. Asserting that religion and spirituality are associated with better health is the same as implying the opposite: that poor health is due to the absence of religious involvement."

Dr Koenig disagrees. "I am not encouraging physicians to counsel patients on spiritual issues to try to provide answers to their spiritual dilemmas." He adds that "spiritual histor[ies] should not be a forum for the physician to impose his or her own beliefs, or to make the patient feel uncomfortable or coerced."

PRIORITIES FIRST
For Dr Sloan, all this is beside the point. "Given the brief amount of time we spend with patients, I would much prefer that we inquire about smoking, diet, exercise and even depression, all of which are much more strongly linked to health outcomes than religion or spirituality."

Has this issue come up in your practice? Let us know what you think.

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