Tuesday, May 08, 2007

What Doctors Think About Religion

I've been traveling recently. This is the kind of thing I do on airplanes....

I've been looking at the recent article from the Archives of Internal Medicine, titled, "Physicians' Observations and Interpretations of the Influence of Religion and Spirituality on Health” (Arch Intern Med. 2007;167:649-654; April 9, 2007. You can find the abstract here. Full text requires a subscription, but your local reference librarian should be able to get you a copy.) It shouldn't surprise anyone that as a chaplain I would find it interesting.

Some of its more interesting conclusions have been reported elsewhere. However, let me highlight a few. First,98% of responding physicians believed that the experience of illness increases patients' awareness and focus ("sometimes/often/always") on religion/spirituality (abbreviated in the article as "R/S"); and 76% say patients have mentioned R/S issues ("sometimes/often/always"). 91% believe R/S has some influence on patients' health ("Some/much/very much"); and 85% believe that influence is positive. While most believe R/S does not provide protection from what the study calls "'hard' medical outcomes like heart attack, etc." (61% "rarely/never"), 96% believe R/S gives patients a positive, hopeful state of mind; and 54% believe "God or another supernatural being intervenes...."

The researchers also included questions to measure religiosity. It will come as no surprise that doctors who were themselves more religious were more likely to see R/S as beneficial to patients. They also sorted responses by region. Again, it is not a surprise that physicians in the South and Midwest were marginally more religious than in the Northeast or West, and more likely to see R/S as beneficial

Now, there were several other results that interested me. First, the response rate was 63% (1144 of 1820 eligible physicians). Even using several invitations as they did, that's quite a high response, and even more so when you consider the questionnaire was 12 pages. True, they were also offered $20 to participate, but the high rate still suggests that as a group physicians thought this an important topic. Also interesting is the fact that those with a poor opinion of R/S responded early; so, even those who thought R/S might be harmful thought it important to respond to the questions.

More troubling, at least for me, was the finding that 55% have noted patients receiving emotional or practical help from the patients' religious communities. Now, for the study that's positive - at least it's a majority. However, from my perspective as a priest and chaplain that's a disappointing number. Perhaps religious communities haven't been as visible as they might have been. Perhaps this is a detail patients didn't discuss with the physicians, or that physicians didn't ask about; but that seems unlikely in light of how many did have patients mention religious/spiritual issues. It seems more likely that physicians, even those who are religious themselves, have not seen religious support at the bedside as frequently as we might like. Too, this was a survey of physicians. We can only hope that more than 55% of patients would say they receive support. The thought that 45% would say they hadn't received support from their faith communities is troubling.

Those concerns notwithstanding, this is an interesting study. Often when spiritual care of patients is discussed, there is come concern that physician will be skeptical, if not outright hostile. This study suggests that doctors appreciate the importance of spiritual concerns to patients and to their wholeness, regardless of lack of "hard" benefits. I have long found most doctors to be respectful of my work. It's nice to know that their attitude is the rule, and not the exception.


Andrew Gerns said...

Given the world we live in and the assumptions we parish clergy carry around, I am surprised that the reported support level was as high as 55%. I wonder how "Support" was defined.

Still, the study is very useful and it jives with my experience when I was a clinical chaplain. Since I have returned to FT parish ministry from clinical chaplaincy post-HIPPA and can compare it (anecdotally) to when I was in FTPM back in the eighties and early nineties, I have some thoughts about that 45%.

Parish clergy of all stripes grouse about the relative inaccessibility to their patients since HIPPA, and the regs have made hospitals that were already asleep to (or hostile to) spiritual care even worse. Since I watched these regs evolve and come into play from inside the hospital world, my question is this: Have congregations and their clergy figured out yet, five to ten years on, how to live in a post-HIPPA world?

In other words, most parishes operate out of a model that does not match the health care world today. Which means we don't meet what most of our congregants experience.

In the old days, hospitals let clergy see the patient lists every day. I could go to the local community hospital, browse the list and visit people I knew even if they weren't listed as "Episcopalian" or in my parish. No more. Hospitals can't even call clergy w/o pt permission. Most hospital systems handle religious data using 1950-60's technology of print outs, pieces of paper and the telephone staffed by volunteers. Most patients don't think to contact their parishes on their own, because getting care for even major things is rarely a one-stop, one-time, under-one-roof event. How have parish clergy adapted to this environment? We haven't!

Most of us sit in our offices and wait for the hospital or patient to call us. Most of us are driven by a model that says we go and pray or annoint when the person is in crisis. We feel guilty and angry when we "miss" a patient who we might have assisted.

What we don't realize is that we are still operating with a model that assumes stays are long and where all services happen under one roof in a discreet Hospital-event.

Except for serious trauma or some kinds of rehab and palliative care, this is not the norm anymore.

I believe this study shows that we need to re-think how we care for our members who are patients in a defused, de-centralized, market-driven system. We need to lead our parishes into a different ways of thinking about pastoral care using the the strengths that we have as local religious communities.

My take on the study, at first glance and only having read your summary, is that we in the church have some fundamental work to do on how we define, develop and carry out pastoral ministry, because repeating the old model in a new world ain't working.

Marshall Scott said...

Andrew, I certainly think you have a point. Old models don't work.

More accurately, I think, there is no longer one basic model to follow. When I was a young priest in a parish the four hospitals in our city could account for 90% of the patients from the parish. Now I live in a county with seven hospitals within roughly fifteen minutes of one another, with four more within another fifteen. There is no way a minister can simply "make the rounds," looking at censuses and hoping to catch parishioners. That's assuming censuses are available; and, thanks to HIPAA (and the anxieties of attorneys) most of the time they aren't.

Congregations are different, too. With the rise of the "megachurch" model (even if the congregation hasn't gotten there yet) the assumption is that the congregation is too large for the old model.

At the same time, in some smaller towns the model still obtains. So, how might we guide our colleagues?

Our system made an effort to educate area clergy about what HIPAA did and didn't allow, and how our hospitals would respond. We also provided model letters to share with members, whether as a mailing or as part of a newsletter. The letters encouraged members to let clergy know when they were or would be hospitalized. It had some effect, at least for a while. And I rarely find now someone who expected the congregation to be notified. But I'm pretty sure folks aren't yet consistenly informing their clergy.

So, perhaps a combination of efforts from health care institutions and congregations might remind folks. I don't know how effective it will be against, "I didn't want to bother pastor;" but it wouldn't hurt.