Thursday, July 02, 2009

On Professionals Praying With Patients

 In an off-topic response to my last post, Frank asked this question:


My dad has been in a discussion on another blog about whether a doctor should ask a patient if he could pray for the patient. My mom and dad are very much opposed to a doctor asking a patient if he can pray for the patient. Others think it is fine for the doctor to ask that. Are there any rules at hospitals on this subject?


I have two experiences that I think about with this question.  One is the story of a colleague, who spoke of a pre-op visit with a patient.  The patient commented that she hoped her surgeon was a good Christian.  He answered, “At the moment, ma’am, you’d better hope he’s a good technician.”


The second is the portion of my orientation of new staff that addresses our System’s policy, “Protection of Religious and Cultural Rights and Beliefs.”  I comment that my goal is that the hospital be a “spiritually safe place;” which is to say a place where each person can be the same person spiritually in the hospital that the person would be elsewhere.  I then note that I’m not the only person who pays attention to spiritual care.  I note that many professionals pray for patients; while a few besides me also pray with patients.


Part of that discussion is the need to really think “protection” when we think of a spiritually safe place for patients and/or families.  It might seem trivially true, but it has also been studied.  Patients are anxious, and don’t want to upset the people taking care of them.  That raises the risk that they will say what they think we want to hear.  For the hospital to be a “spiritually safe place,” we really do need to think about protecting that space.


That said, I find in my own work that many folks can accept as an expression of good will the thought that someone might pray for them, even if they would not pray themselves or want the other person to pray with them.  Sometimes, too, they will ask for prayer or indicate that they value prayer.  My own thought is that if they ask, and the person asked is both free to accept or decline, and also feels appropriate participating, praying with the patient, or being present while the patient prays, is okay.  Now, if you think that through, that in most circumstances suggests that the patient from his or her position of vulnerability can ask the staff; but the staff person from his or her position of power cannot ask the patient.


Now, there is another dynamic in play here.  In the last decade or so health care professionals other than chaplains have been thinking about how the spiritual lives of both patients and professionals affect both relationships and outcomes in health care.  Nurses have actually been including this in their professional discussions for some time.  However, physicians, psychiatrists, social workers, and counselors have also been thinking about the effects of spirituality in their work.  In most instances this isn’t a discussion of faith or miraculous healing.  Rather, it’s recognition that for many individuals spiritual beliefs influence how they live their lives and make decisions.


One consequence has been that physicians of faith have felt less pressure to hide.  They have been prepared to acknowledge that prayer is an important part of their lives, and that they pray for their patients, and for help carrying out procedures.  Again, for many patients this is simply a statement of good intention, and they’re not offended.  Some do indeed find it comforting.  So, consider this conversation:


Patient: I know things are in God’s hands, and that things will be all right.


Physician: Well, I will be praying for that as we go to the OR.


Patient: I’m glad to hear that.  Could we pray together?


Contrast it with this conversation:


Physician:  I just wanted you to know that I pray before all my surgeries.


Patient:  That’s good.


Physician: May I pray with you?


I think the latter conversation verges on manipulation.  Again, if we consider that the patient might well say what we want to hear (and what patient wants to offend his surgeon, however slightly, just before the procedure?), the second conversation is questionable.  But is the first?  The doctor has responded to a comment from the patient with a statement about his own practice, with no expectation of the patient.  If the patient then makes the request and the doctor feels comfortable participating, is this a bad thing?  It arguably strengthens the doctor-patient relationship.  It supports the patient’s hope and lowers stress, both of which have been shown to support health and wholeness.


There are some hospitals that have a culture that discourages professionals other than chaplains or clergy from praying with patients.  Those institutions feel that’s necessary to respect and protect the spiritual beliefs of the patient.  They may or may not have an explicit policy; but corporate culture can be very clear and very powerful.  In some environments chaplains feel they have to be the clearest enforcers of such policies.  They distrust the judgments of the other professionals around them, fearing that they will jump too quickly to suggest their own spiritual perspectives instead of respecting the patients’, mostly because they simply imagine that everyone will agree with them, or at least understand them.


In my own setting, I don’t have that fear.  New staff members do get orientation from me on the subject, including explicit directions against evangelizing or proselytizing.  They also get diversity training as part of their orientation; and I connect to this by noting that our religious and cultural beliefs are simply another category of diversity that the System expects us as employees to respect. 


Now, doctors don’t have that orientation.  At the same time, they are offered opportunities for diversity training, and hear regularly that respect for diversity is a central tenet of the System.  My sense is, both in my own institution and in others, physicians praying with patients are uncommon (although I can well imagine that many are praying for patients).  For those who do, if they do that in a context that’s not manipulative and that satisfies the patient, I’m comfortable.  If I were to learn that is was manipulative, that would be another thing altogether – one that I’d probably find myself in the middle of, at least in my institution.


Like so many things that happen in health care, prayer with a patient is one that can be done appropriately or inappropriately.  More doctors feel free to be authentic about their own faiths, and I think that’s a good thing.  If they can be authentic about their own faiths, and also respect the faiths of their patients, that’s even better.


Anonymous said...

You will get two responses from here. This is old Jack. I am going to respond first and then later Frank will respond. Frank will be free to answer as he thinks best. He is out playing tennis now ("rich brat"):) but will come in this afternoon.

First let me say that the discussion on the other blog wasmost interesting, but was erased because the blog owner did not like some of the responses. The blog owner had posted about an English doctor who got in a little trouble because he ask a non-religious patient if he could pray for the patient. The blog owner thought the doctor was right in doing so. Curiously enough, the majority of responses said the doctor was wrong. Then the discussion got deleted.

For most of my life I have had great health, but now in the seventies I am getting used to hospitals. Two Catholic hospitals and one non-affiliated hospital. I might note a personal doctor I had for several years was president of our local "Christian Doctors Association." He never asked if he could pray for me.

I oppose a doctor asking such a question. I think your point about the difference between the doctor(the 'expert') and the the patient(the 'subserivent' one in this situation) is important.

If my doctor, just before cancer surgery---which I have had---were to ask if he could pray for me, would I not have to say "yes." The doctor is human and would not my "no" answer lessen his interest in me even just a fraction?

Or, reverse it. Assume my doctor is a non-believer and I ask him to pray for me and he says he is a non-believer what position does that put me in?

It seems to me, then, that the doctor should be left out of this and the chaplain used if a person desires prayer.

I am not hard nosed on this. When my father died of cancer when I was 15, the sisters at the hospital ask if they could baptize him just before he died because as one said: We don't want to be anyplace where Mr. H..... isn't. My mother was pleased. My parents were not Catholic. My dad had been baptized, but still....

Frank has had two surgeries since he has been with us. One minor, and one a bit more serious because of some abuse in underwent when he was 15.I think he might have been confused had doctor ask him if he could pray with Frank. Maybe, it would have scared him; I don't know. I'll let him say later.

BTW, one paragraph in your response was a little confusing to me. In the paragraph beginning "That said..." I got a little confused on who "they" was.

Thanks for your time and ideas. Frank will respond when he comes in. Jack

Marshall Scott said...

"That said, I find in my own work that many folks can accept as an expression of good will the thought that someone might pray for them, even if they would not pray themselves or want the other person to pray with them."

In this case, Jack, "they" are patients. That is, many patients accept the thought that someone might pray for them as an expression of good will, even if not one they would think. There are, of course exceptions - patients who don't want anyone to pray with them, nor to think that anyone might pray for them. But most folks appreciate good will in almost any form.

Anonymous said...

Just got in from Tennis. Our university has one of the best tennis complex in America.

I have not seen what my dad said but here is what comes to me.

In our part of the country there are very active and agressive religions that try to convert you to their church.

I have had three experiences with this matter. When I was in the accident that broke my toes, the hospital filled out a form for me and ask my religion. I put Baptist which I was at the time. There was a Baptist minister in the hospital at the time though the hospital was catholic. The minister was nice but he ask me if I had accepted Jesus as my personal savior. I was very embarrassed. I was only 19 and there were other people standing around like a nurse and a couple of people getting me ready.

After that I have been in the hospital twice. I was catholic then, but one of the surgeries, maybe both, were hard to talk about. I was 21. A priest came by both times and talked to me (about football)and ask if he could make a sign on my forehead.I said yes, and it meant something to me. I was glad he did it. But if he had ask if he could pray for me I think it would have scare me. Maybe like, I might die.

I was young and still embarassed when a nurse saw parts of me. Maybe now I am older and would react differently.

I really think this can be a problem for young people especially. Do you think it makes any difference because of the age of the patient? Frank

Anonymous said...

Let me add just a bit, then I'll go away.

I know some doctors personally. They all have some theological/non theological beliefs. When I go to a doctor I very much feel he is the 'dominant' one. If he ask me the prayer question I would try to guess his religious sentiments and to at least half way agree.Sure, candy ass! I would NOT feel that way with a Chaplain. I would assume the Chaplain had been trained to the sensitivity of this situation. Also, the Chaplain doesn't carry a knife:) Jack

Marshall Scott said...

Frank, it can be a problem, although I don't know that's it is so much associated with being young. Indeed, I know many senior Catholic patients who are anxious if they see clergy. They were raised with the concept of "last rites" - the thought that the sacrament of anointing was given only to those who were dying to secure their entrance to heaven. Really, anointing was and is a sacrament for healing (notwithstanding that sometimes the most complete healing can only come in the Kingdom). The Catholic Church in the Second Vatican Council emphasized this again, and it's what the Church teaches. But, some of those older Catholic patients are just too familiar with the understanding that they grew up with - you only got anointed if you were going to die. So, if they see someone in a clerical collar, they can panic. Or, members of their family might expect them to panic, and so not want to call a priest or chaplain for them.

So, people can be anxious if they don't know what to expect from a priest, or if they have too specific an expectation.

No, Jack, a chaplain doesn't carry a knife. On the other hand, I do try to have incisive comments....

Anonymous said...

I would like to add one thing. Prayer is important I guess we all know. But physical touch can be so important too. I wrote once on my dad's blog that to be touched by a person who cares for you is so important at least to me. I am not really talking about the romantic touch, that is fine too, but the touch from my mom and from the priest who placed one hand on my dumb head and made a cross on my forehead when I was in the hospital. That is not prayer but I felt the priest really cared for me when he touched me. Sounds crazy.
Thank you for letting me be in this discussion. Frank