Asking questions is the key to understanding a patient’s religious and spiritual needs, says the Rev. Peter Yuichi Clark, PhD, chaplain administrator at Alta Bates Summit Medical Center in Berkeley, Calif., who works closely with medical teams to assess and respond to these needs.
“I don’t assume I know what a patient’s religious needs are—even if I know what religion they profess to be,” Clark says. “Some patients may be very devout but do not practice certain aspects of their religion, while others follow a religion in name only but look for religious support during a time of crisis.”
Manish Patel, MD, a hospitalist and assistant professor with the division of General Internal Medicine at University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, says it is impossible to predict an individual’s religious beliefs and how that may affect their hospital stay—even when the physician practices the same religion as the patient. For example, Dr. Patel knows that some, but not all, Hindus observe a strict vegetarian diet and that Vitamin B12 deficiencies are more prevalent in vegetarian populations. However, diet may not be the cause of this deficiency if the patient is not a vegetarian. Rather than assume, it’s important to ask Hindu patients if they observe a vegetarian diet, Dr. Patel says.
Some hospitalists find it difficult to engage patients in conversations about religion. In a study published in the June 2007 edition of the Journal of Palliative Medicine, researchers found physicians’ knowledge of factors relating to end-of-life care, which included patients’ religious and spiritual concerns and whether they affect decisions regarding end-of-life care, is poor.1
Hospitalists don’t have much time to get to know the person, so it’s even more important for them to have conversations about religion and end-of-life-care, says the study’s lead author Susan DesHarnais, PhD, of Pennsylvania State University’s Hershey Department of Public Health Sciences, Milton S. Hershey Medical Center College of Medicine. As important as these conversations are, Dr. DesHarnais learned hospitalists rarely have them.
When asked why she thinks these conversations rarely occur, Dr. DesHarnais said the research did not directly address that question, but she suspects the physicians don’t have a lot of time. Also, end-of-life decision-making is difficult, and some people are not comfortable talking about it, she says.
“Another factor may be that hospitalists are used to using technology for medical intervention more than they are used to working with people when not much more can be done,” she says.
Dr. Holler, who worked as a social worker before attending medical school, agrees that many physicians are uncomfortable with end-of-life decisions.
“Many physicians are 25 to 30 years old during their training,” says Dr. Holler. “They have been in school for many years. Some are discovering their own spiritual identity at the same time they are dealing, or learning to deal, with patients and families and where they are spiritually or religiously. Many haven’t dealt with these issues in their own personal lives yet.”
While Dr. Holler says she believes most doctors are caring and compassionate, end-of-life and religious discussions use different skill sets than those that preserve and extend life. “Often times we are not taught when enough is enough and how to convey that to patients and families,” says Dr. Holler. “Many doctors are afraid that they are conveying that they are giving up or that it isn’t worth it in the long run. So, many physicians find it easier to ‘keep going.’ ”
The Medical Community’s Response
The medical community is responding to shifting cultural and religious demographics, and more doctors are paying attention to religious diversity, Clark says. But a 2003 Joint Commision study of 60 public and private hospitals across the country, “Hospitals, Language and Culture: A Snapshot of the Nation,” found that hospitals still have work to do in this area.