Doctors Can Be Doubters

I asked my neurosurgeon friend how he prays with patients who are Jewish, Muslim or Hindu. Does he end with the phrase about "our Lord, Jesus Christ"? He paused and then told me that it depends on the patient. I suspect that there is a selection bias and that he is more likely to offer prayers to Christian patients than others. He admits he feels uncomfortable offering a prayer in another faith or using the words "Allah," "Om" or "Shalom" because for him the prayer would not feel authentic.

In the end, this is what prompts my discomfort with praying with patients. If a doctor is using prayer because he feels it will help to heal a patient and not just to improve the doctor-patient relationship, then I believe it is unfair, even discriminatory, for a doctor to offer a Christian prayer with a Christian patient and not offer another prayer to patients of other faiths.

Because the research literature is equivocal on the benefits or drawbacks of prayer and meditation, I explored my own heart and soul for an answer.

Without hesitation, I believe that practices such as prayer and meditation offer benefits in addition to medication and surgery and the doctor-patient relationship. I have seen it myself. On several occasions, I have meditated with my patients.

Once, a young HIV-positive woman complained of shortness of breath after recovering from severe pneumonia. Medically, nothing helped, and no cause was obvious other than anxiety. With some hesitation, I offered to do a session of meditation with her. She agreed and subsequently improved.

Often, I wonder how I can incorporate spiritual practices in my routine therapeutic recommendations, just as I recommend exercise and a nutritious diet. I believe it's possible. But doing it, I believe, requires understanding two critical concepts.

First, we need to distinguish between religion (an organized institution with social boundaries, rituals and membership) and spirituality (the sense of the sacred within us and our relationship with a greater force). Spirituality may or may not be rooted in religion, but the core of all religions is spirituality. Once we can relate to the spiritual core of each patient, we do not have to agonize about finding the "appropriate" prayer and "politically correct" words for patients of different religions.

I think I could pray (using a generic prayer) or do a meditation exercise at a critical moment with my patient. At times, if this is uncomfortable or if there is not enough time, I could simply encourage the spiritual part of patients' lives.

This is what I did with my patient suffering from end-stage congestive heart failure. I touched his Bible and said, "Many patients find this very helpful. I am glad you are using it."

"Couldn't make it without it, Doc," he replied with a tone of hope and optimism.

Second, we doctors need to expand beyond medicine's traditional body-mind focus. Most of my patients see themselves as having a soul and a spirit, and if I, as a doctor and a scientist, wish to treat them in a holistic manner, I need to take this thinking into account.

I was reminded of this recently on morning rounds. I walked into a room, saying, "Hello, Mr. Jones." My patient was sitting in a chair in the corner, head bowed, lips moving silently.

I realized that I had interrupted his prayer. I bowed my head to join him. He continued. "Lord, I want to thank you for helping me heal and decreasing my pain . . . and now, Lord, I have to cut my prayers short this morning because my doctor is here."

We both said, "Amen."

Manoj Jain is an infectious disease physician in Memphis and a medical director of Medicare's quality improvement organization in Tennessee. Comments:health @washpost.com.