Edward Davies: Keep religion in the consulting room

Edward DaviesFaith and healthcare do not comfortable bedfellows make. The majority of coverage of their convergence is around the tensions and conflict they can cause.

Here in the US, the battleground of contraception coverage is being publicly and aggressively fought between the government and Catholic Church. The BMJ last week published a personal view from an anonymous doctor who described the professional and personal conflict she faced from her desire not to carry out an abortion on religious grounds. One doesn’t have to look far for newspaper articles about doctors who are censured for bringing their faith to their workplace.

And yet there is an essentially spiritual element to much healthcare, particularly in end-of-life care, which is central to the experience of those patients of all religions and none.

It’s to the great credit of the organisers of this week’s Lown Institute conference in Boston that they have not sought to shirk that reality in their discussion of healthcare, and among the dozens of presenters have included a rabbi as a keynote speaker and a panel featuring a local Presbyterian minster. And they did not pull their punches. While both are healthcare campaigners well beyond the confines of their day jobs, both wanted the audience to think in explicitly spiritual terms as well.

“It is a grievous mistake to keep a wall between medicine and religion,” argued Rabbi Richard Address. “Basic questions of existence impact every human being.”

The Rev Burns Stanfield urged the assembled physicians, activists, and health gurus to pray more—not necessarily just to sway the mind of a divine they may or may not believe in, but for the spiritual impact on the person doing the praying.

The subsequent discussion among delegates was a mixed response from the enraged to the enraptured, but it raised a very difficult question.

If we are to treat patients as human beings rather than a collection of diseases, whether we like it or not, patients bring their spirituality into the consulting room with them. It may be in the form of an explicit religious belief, it may be an unspoken feeling, or it may simply be the recognition that the patient in front of you is more than the sum of their anatomy and disease. But if we are to espouse “the centrality of the patient in all our actions,” as Bernard Lown encouraged in his address, we cannot eliminate the spiritual aspect of a great deal of modern healthcare.

As Rabbi Address qualified, that does not mean that the consultation clinic is the right time to talk theology, but he continued: “The spiritual power of listening is one of the most powerful things we can do—the holding of a hand or a hug. The power of presence is often a lot more than a word.”

Talking about faith and spirituality can engender a visceral response in some people, sometimes not without understandable cause. There will be those reading this who think that faith, religion, and spirituality should be kept completely clear of the practice of medicine. I would simply endorse the view that Bernard Lown espoused: healthcare is not just about you, or me, or even about practising medicine—it’s about the patient in front of you.

Edward Davies is US news and features editor, BMJ.