Doctors Can Be Doubters
Tuesday, June 10, 2008
My patient is an elderly man with end-stage congestive heart failure, kidney failure and now an infected dialysis line, and he is unlikely to live more than six months. The Bible lies on his bedside table next to his hospital breakfast tray and the morning newspaper. I wonder if I should pray with him.
A neurosurgeon I know often prays with his patients prior to operating on their brains to remove a tumor or on their backs to relieve a herniated disk. In the pre-op holding area, he stands near the gurney and, with the patient's permission, clasps his or her hand and recites a prayer. He usually concludes the prayer with "in the name of our Lord, Jesus Christ."
My friend the neurosurgeon is unusual in this regard. Although studies show that 40 to 60 percent of hospitalized patients want their doctors to pray with them, fewer than 5 percent of doctors say they often or usually pray with patients.
As a doctor, I understand this. Although I am comfortable asking patients about their faith when I question them about their profession and their family or social support structure, I feel awkward, even squeamish, about praying with my patients. That may be because I was never taught how to pray with my patients in medical school, nor did I see my mentors praying with patients. Also, I am of the Jain faith, an Eastern religion based on the principle of nonviolence and the practice of meditation, and most of my patients are of the Christian or Jewish faith. In addition, at times I have seen religious beliefs compromise a patient's health: One young patient of mine died in my intensive care unit because she refused blood transfusions based on her religious beliefs.
My reluctance to pray with patients comes in the face of growing evidence that spiritual practices such as prayer and meditation might be healthy for us. A study published in 2003 found workers who attended a meditation training session had a more powerful immune response to the influenza vaccine than those who did not meditate. Another study has even shown a sort of dose-response curve -- the higher the church attendance, prayer and Bible study, the lower the average diastolic blood pressure -- as if religious practices act therapeutically, almost like a blood pressure pill. Although there's no solid proof of a causal relationship between religion/spirituality and improved health, researchers such as Harold Koenig, an associate professor of psychiatry and behavioral sciences at Duke University Medical Center, are convinced that spiritual practices can help you live longer.
Across medicine and society, there's increasing interest in the link between religion/spirituality and health. Three-quarters of all U.S. medical schools now offer courses in spirituality and medicine, and academic centers such as the George Washington Institute for Spirituality and Health, the Duke Center for Spirituality, Theology and Health, and the Center for Spirituality and Health at the University of Florida are being established across the nation.
Yet many researchers are skeptical about the union of religion/spirituality and medicine. (Or perhaps I should say "reunion" because religion/spirituality has been a part of medicine since ancient times: The words "holiness" and "healing" stem from a common root meaning "wholeness.")
Richard Sloan, a professor of behavioral medicine at Columbia University Medical Center, worries that the linkage oversimplifies and trivializes religion by limiting its value to its effect, if any, on health.
In 2007, the Agency for Healthcare Research and Quality commissioned a research team to evaluate 813 studies on meditation. The group reported mixed evidence from some of these studies; most of the remaining studies had design flaws that made it impossible to assess their conclusions.
I myself was a co-investigator on the largest study on the therapeutic effect of intercessory prayer, an 1,800-patient, six-center, $2.4 million study led by the Benson-Henry Institute for Mind Body Medicine, now at Harvard Medical School's affiliate Massachusetts General Hospital.
Our findings, published in 2006 in the American Heart Journal, showed that being prayed for did not improve outcomes, and it seemed to have a negative effect when patients knew they were the subject of prayers from afar.
Even if prayer were shown to improve outcomes, religious differences make it impractical for doctors to make it part of daily patient care.