By Wendy Cadge
associate professor of sociology, Brandeis University
When I started researching religion and spirituality in health care a few years ago, one hospital required that I get a TB test before spending time on the hospital floor. In registering at the hospital like any other patient, the clerk asked me for my home address, phone number, emergency contact and — after a few more questions — religion. I was surprised, “Do you ask everyone that question?” Yes, he explained, so the hospital knows who to call in case you die.
Registration clerks are not the only hospital staff members who ask about religion and spirituality. Nurses sometimes ask similar questions in nursing assessments and chaplains do in the course of conversations. Of course, doctors also make decisions about whether and when to ask patients and their families about religion and spirituality. But very rarely has any study of physician behavior actually probed how and when doctors incorporate religion and spirituality into their medical work.
With sociologist Elaine Howard Ecklund of Rice University and Nicholas Short of the Baylor College of Medicine, I interviewed 30 pediatricians and pediatric oncologists who work and teach at top American medical centers. Instead of asking them what they think about religion and spirituality, we asked them how they act.
Despite increasing numbers of medical schools offering courses about religion, spirituality, health and medicine, these physicians received almost no formal training in these topics during their medical education. About a third described learning about religion and spirituality informally through conversations with colleagues during medical school or residency, or by getting to know hospital chaplains.
Today, these physicians tend to avoid asking patients and families direct questions about religion and spirituality. The majority prefer to ask broad, open-ended questions or–more commonly–wait for patients and families to bring up these issues if they wish. I remember a physician who cared for children with a chronic disease, developing ten- and fifteen-year relationships with them in the process. Although she routinely asks about family dynamics, sexual practices and other topics many would consider private, she does not ask about religion, saying it is too “personal” and she does not want to “pry.”
Are religion and spirituality relevant to physician-patient relationships? Like the medical clerk, the physicians I interviewed take a pragmatic approach, seeing these areas as most relevant when families are making difficult medical decisions and especially when a patient is dying. Indeed, physicians often talk about religion and spirituality in the context of death and dying. As one pediatric oncologist explained, religion usually comes out “early in the course of diagnosis, when families feel devastated…or later in the course when a patient takes a turn for the worse or…the disease comes to a point that, as their providers, we can longer provide curative means.”
At each of these points, physicians say, some families draw from their religious or spiritual traditions as they try to answer the “why” questions — why their child is ill, why something so rare hit them, why there has been a recurrence of the disease, why they are faced with this crisis. In these situations, especially in end-of-life situations, physicians see religion and spirituality as a bridge to understanding, helping patients and families make sense of illness, adjust to difficult news, and answer questions that medicine cannot.
Yet physicians also see religion and spirituality as a barrier to medical care, especially for Jehovah’s Witnesses, Christian Scientists, Orthodox Jews, and members of other traditions that have historically existed in some tension with medicine. One pediatrician described people’s beliefs as a lot of “old wives tales” and convictions that get in the way of good medical care.
My research suggests that some physicians, like some patients, see a role for religion and spirituality on hospital wards, at least at the end of life. But many patients and their families believe religion and spirituality are important in life, not just death. Physicians and hospitals might see an opening here to think more deeply about the place of religion and spirituality on their hospital floors.
Wendy Cadge is an associate professor of sociology at Brandeis University in Waltham, MA and author of the forthcoming book, “Paging God: Religion in the Halls of Medicine.”