Community Discussions

Folks---I have been doing quite well up to about a week ago.  Now for some reason, about every other day I have to take a couple of emergency pills to control my blood pressure.  It just starts climbing and my regular medicine won,t bring it down.    It seems my regularly prescribed medicine , my Cardiologist prescribed, is not doing it,s job.   Makes me sweat it out for 2 or 3 hours until my emergency pill, Clonidine, starts working.  Please pray for me and ask the almighty God to help my Drs, and the medicine to regulate this problem.  I feel good and am gradually gaining my strength but I need some help---Thank you all and may the almighty God bless you and your family and keep you, now and always--Your friend Will

You got it Will.

Thank you Lord for happy hearts and rain and sunny weather
Thank you Lord for this our food and that we are together
Please keep Mr. Will and help him get better
Amen.

Sunday night is my son's turn at dinner. I think he likes it because it is quick, and gets to the point. I'm sure it will help.

Will, keep up the good spirits and gaining your strength.  My grandmother went through something similar 8 years ago and then again about 6 years ago.  So I will keep you in our prayers here too.

Sherri

Hello Will,

Of course I will pray for you.

I want you to know that what is happening with you is not uncommon for someone that has had a procedure done such as yours.  It is the heart and surrounding pulmonary system literally trying to "figure out" how to work right again.  All of a sudden they are able to function better than they have been able to for years.  The result?  an increase in Blood Pressure.  I know it is alarming to you but that is what the Clonidine is for, if you become anxious it is like adding gas to a fire.  This stabalization process where your body is literally trying to figure out how to work right again may take up to a year.  Keep your cardiologist informed of your progress, adjusting the medications can be a very time consuming and arduous process for both them and you.  Be patient.  I know, easy for me to say but really, relax and work your way through this.  Of course do not ignor chest pain or pressure, shortness of breath (SOB) either with or without exertion, neck pain, left arm pain, shoulder blade pain, jaw pain, nausea and possibly vomiting, and inexplainable weakness especially with activity, even lite activity, also alteration in mental status and of course confusion.  When in doubt always error on the side of caution and call you cardiologist for guidence.  Of course call an ambulance for serious symptoms of chest pain/pressure, SOB, and confusion.  Never be shy about calling for "the rig", that is what they are there for and get paid for.  If they are volunteers then you make there night by giving them something to do lol....

Prayers are coming Will, you hang in there my friend.

C

I am sorry all that you are going through. I did not understand why untill Chris told us. I will pray for you as well.

Please get better soon!

Will, my prayers are with you and I have faith all of our prayers are being heard. You're getting better.

Your friend,
Marshall

Hang in there Will

Just remember sometimes its two steps forward, and one step back....but you ARE making progress and this is only one minor step in your overall recovery!

You are in my prayers

Paula

I understand how it is when you don't feel well and you are short of breath.  I do hope this gets straightened out and you get all better.  I will certainly keep you in my prayers list. 

Prayers were just said for you Will, please get better soon...

Robert

Folks I am crying my eyes out while I am reading all of your prayers.   You don,t know how I appreciate all of you.  Chris--you told me something I had not thought of.  I am doing so well in every other way I had not thought of what you stated, but it makes sense.   Strange, I did not realize it but about a month ago when it started my cardiologist told me much like you stated.  I had had several days where the BP ran away until I treated it. He was not alarmed and he told me to continue and not be afraid to take the clonidine. He thinks I am doing great and I think now he is right---again thank all of you and God bless you now and always---Will

How's Devon, Scooter and Fluffy doing Will?

Will

 

Something else to think about.  Some sadness and “blues” can be a very normal part of the recovery process, especially when you have had to restrict some of the activities you so enjoy as you get your strength back, especially for people who are used to being active like you .  And I think knowing that feeling sad, sometimes seemingly for no reason, can be a very normal part of your recovery, helps ease things a little too….knowing that what you are feeling is very, very normal and that it will pass.  If you are struggling with it, talk to your doctor about it too….some doctors tend to focus so much on the physical part of recovery they forget about the other part (the emotional and mental part of recovery) which to me is just as important. 

 

Just something else to consider and so you know that what you are going through is very normal. 

 

Keeping you in my prayers Will

 

Paula

Paula--I think you are right and I appreciate your kind words---Will

take good care Will...

there are a lot of good people here wishing you the best.

Sherri and i are are hoping you will be better soon too.

later chris 

Hi Will,

You are in my prayers.

What you are going through (as Chris said) is normal. I bet that after you figured it out from Chris's post, your anxiety level dropped down quite a bit. So now it's less fuel for the fire. Just keep on top of your BP checks and you should be fine with the meds at hand.

Take care.

-Patrick-

pecanmanwill wrote:

I am glad my words were able to help you Will.  I can say this, I know our prayers will.  Even the American Medical Association (AMA) has admitted through studies that prayer helps people.  They don't understand how but they now accept that it does and many doctors today encourage prayer by patients and their family and friends. 

I have been following you as best I can Will and from what I have been reading you are doing simply fantastic.  Heck I am hard pressed to think of someone who has been through what you have been through and DID NOT have variations in their blood pressure at times. 

Again you relax and hang in there, your body is just figuring things out again.  You are going to be just fine.

C

Dear Will,
Our continued prayers are with you.
As you know far better then I, in unsteady times a good Bible verse gives us strength to keep pressing on.
Here is one I know you already know and love.....

"Let your gentleness be known to all men. The Lord is at hand. Be anxious in nothing, but in everything by prayer and supplication, with thanksgiving, let your requests be known to God; and the peace of God, which passes all understanding, will guard our hearts and minds in Christ Jesus."   Philippians chapter 4, verses 5-6

Between Chris's good advice, your good Dr's care, and the prayers of those who you have been a blessing to, you cannot help but to have only good days ahead of you.

I pray that someday I could be half the man of God as you have shown yourself to be..........we are all enriched by your friendship, and you can bet you have our prayers.


Keep us posted Will,

In His grip of Grace,

Frank D.

I did not know that the AMA decided to accept prayer.  That's just plain great. 

Yes, the exact studies escape me now.  They don't understand it but they admit that patient's that have faith, pray, have family and friends pray for them have better outcomes, get better faster and have a more positive attitude than those that do not. 

C

These are just a few articles from the Journal of the American Medical Association (JAMA), the first is just a portion, the other two are complete.  There are many more in this and other medical journals, these are just what I was able to quickly find tonight....I had to cut and paste them as three different posts as I could not get them to cut and paste together correctly.

Relationships between mental health and strong faith, devout prayer, and religious socialization may have consequences that are far-reaching and perhaps greatly underestimated. Religious involvement is associated with improved attendance at scheduled medical appointments,³⁸ greater cooperativeness,³⁷ better compliance,^39-41 and improved medical outcomes.^42-43 A number of well-designed prospective studies have found that those who are more religious or spiritual have lower blood pressure,⁴⁴ fewer cardiac events,⁴⁵ possible regression of coronary artery obstruction,⁴⁶ better results following heart surgery,⁴³ and longer survival in general.^47-48

Pathways exist to help explain why religious beliefs and practices like prayer could influence physical as well as mental health. Sympathetic and parasympathetic nerve tracks connect thoughts and emotions in the brain to the circulatory system, coronary arteries, lymph nodes, bone marrow, and spleen.^49-50 If religious beliefs and prayer help patients cope better with illness and result in less stress, anxiety, and depression and greater social support, then they may counteract stress-related physiological changes that impair healing. Preliminary evidence suggests that religious involvement may be related to stronger immune functioning^51-54 and lower cortisol levels.^{51, 53} Religious involvement is also associated with less substance abuse (98/120 studies), less cigarette smoking (23/25 studies), and more exercise (3/5 studies), which adds to the health effects of social and cognitive factors.¹ Although randomized clinical trials that demonstrate causality are lacking, such studies are now under way among patients with breast cancer and will soon be undertaken in patients with congestive heart failure.

Toward Meaning

Chaplain Bruce D. Feldstein, MD
Stanford, Calif

JAMA. 2001;286:1291-1292.

When I came on duty at 3 PM, it seemed like the most ordinary of days. At the time I was a senior physician in a high-acuity emergency department at Kaiser-Permanente Medical Center in Santa Clara, Calif, chair of the Peer Review and Quality Improvement Program, and faculty in the Stanford-Kaiser emergency medicine residency program.

I took sign-out from Dr Koscove, who told me, "I've got an 86-year-old woman, Mrs Martinez, in room 17 with nausea, vomiting, and dehydration and a history of metastatic lung cancer previously treated with chemotherapy and radiation. She was discharged from the hospital two days ago for the same thing. I controlled the nausea and vomiting with IVs and ordered a CT scan to look for brain metastases and signs of increased intracranial pressure. I told her you're taking over. You'll need to review the scan, and see if she can tolerate oral fluids, before discharging her."

I walked over and introduced myself to Mrs Martinez (not her real name) and her son. She was sitting quietly on the gurney.

"Hello, I'm Dr Feldstein. I'm taking over for Dr Koscove. I see that you're feeling better. I'll have the nurse bring you some water while I review the blood tests. If you can keep the water down and the tests are OK as I expect, then I can discharge you home to follow up tomorrow with your oncologist, Dr Post" (also it is not a real name).

At that moment the nurse interrupted. "Dr Feldstein, there's a call for you." I excused myself. The ward clerk handed me Mrs Martinez' CT result: "Multiple brain metastasis. No shift." Sobered, I put the slip in my pocket to give to Dr Koscove. It was a good pickup.

After I took the call, I asked an intern who was going into radiation oncology to look at the scan and to accompany me, since he'd be seeing patients like Mrs Martinez. We headed back to her room.

"Mrs Martinez, I'm glad to see you're keeping down the water. Your blood test results are normal. I'm going to give you a stronger medicine to control the nausea and vomiting and arrange for you to see Dr Post tomorrow."

Before I could continue, Mrs Martinez looked directly at me and asked, "Doctor, what was the result of the brain test?" I was taken aback. I had been planning to let her regular oncologist tell her the news, but she spoke with such forthrightness and courage.

I pulled up a stool next to the gurney and sat down. "Mrs Martinez, the CT scan is abnormal," I said. "It shows that the cancer has spread to the brain."

Mrs Martinez looked down. Her face became pale and stricken. I was keenly aware that this was not the kind of test result one simply tells a patient and walks out.

Gently, and after a long pause, I asked, "What is your reaction?"

"This is a death sentence," she said, looking away.

"What do you mean ‘death sentence'?" I asked.

Mrs Martinez explained. "I knew that with the cancer one day I would die, but I did not expect it so soon."

I tried to reassure her. "Mrs Martinez, Dr Post is very experienced in this situation. Tomorrow you will discuss with him the kinds of treatment that will help you." She did not seem reassured. I thought about saying "I know how you feel," but I did not know how she felt.

I then noticed her wearing a large crucifix around her neck and recalled a story about a cardiologist praying with his patient.¹ I knew what I had to do. I felt very uncomfortable. I have talked about spirituality and religion with my patients on previous occasions, but the thought of explicitly praying with a patient, that was another matter. How was I to proceed?

"Are you a prayerful person?" I asked with hesitation.

Mrs Martinez nodded. "Yes."

Awkwardly I offered, "Well, then, would you like to have a prayer together?"

She immediately looked up at me. "Yes, I would."

Now what? We were from such different worlds. She was Catholic, originally from Mexico. I am Jewish, originally from Detroit and, at 43, half her age. We had only just met. She prayed to Jesus. I did not pray to Jesus. What would I say? I certainly had not been prepared in medical school for a situation like this.

I took her hands in mine. We closed our eyes. I waited for her to begin, but I soon realized she was waiting for me to begin.

I began to speak, trusting the proper words would come and she would find comfort in them.

"Oh, God, You Who are the Great Healer."

I paused for a moment, thinking of what to say next when Mrs Martinez repeated, "Oh, God, You Who are the Great Healer."

She was repeating after me! Now I had to find the right words that she could repeat.

"Who guides us through life," I said.

"Who guides us through life," she repeated.

I continued and Mrs Martinez repeated.

"In your wisdom . . . "

". . . may you guide Dr Post and all the other doctors and nurses to provide the best care."

"Provide us all with Your comfort and guidance . . . "

I brought the prayer to a close. "Thank you for hearing our prayer."

"Thank you for hearing our prayer," she echoed.

"Amen."

"Amen."

Relieved, I opened my eyes. But hers remained closed. She didn't let go of my hand and began the Lord's Prayer: "Our Father, Who art in heaven, hallowed be Thy name . . . " I joined in as best I could.

Then Mrs Martinez began to pray in Spanish to Saint Jude—the patron saint of hopeless cases, as I later learned. She finished and we both opened our eyes. Mrs Martinez appeared visibly calmer. She looked directly and deeply into my eyes. "Thank you," she said softly, a tear falling across her cheek. Her son's eyes too were filled with tears.

"Thank you," I replied. I too was tearful and filled with a profound sense of gratitude.

Mrs Martinez gave my hand a last squeeze. Our prayers had taken only a few minutes, but it seemed much, much longer. Finally, I stood to say good-bye, telling her I would arrange for her discharge.

The intern appeared stunned. "What did you think?" I later asked him. He did not seem to know what to say. "I have to admit to you," I continued, "I was not even planning to tell her the CT results, let alone pray with her. I've never prayed with a patient before, but her question required an answer and I had to take care of her reaction." We discussed how Mrs Martinez had not seemed to be reassured that Dr Post was experienced, how psychological and philosophical approaches were inadequate, and how I arrived at prayer.

Praying with Mrs Martinez felt so completely right. But was it? It truly comforted her and her son. As for me, I walked out feeling "well used," not bleak or hopeless, as I would have felt otherwise. But praying with a patient? Is it ethical? Is it legal? What if someone complained and referred it to the Peer Review and Quality Improvement Committee? Wait. I was the chair of Peer Review and Quality Improvement. Would I be reported to my own committee?

That episode was never brought up, but I could not stop thinking about it. Later, as a visiting scholar at the Stanford Center for Bioethics, I examined this case in detail under the ethical microscope with Professor Ernlé Young, ethicist and codirector.

Dr Young and I looked at it in terms of core ethical principles: to do good (beneficence), to do no harm (nonmaleficence), and to respect a patient's autonomy. We examined it in terms of the duties of truth telling (veracity), loyalty and putting the patient first (fidelity), of confidentiality and privacy. We contemplated the virtues of compassion and professionalism. We reflected on the goals of a physician to relieve pain and suffering and to provide comfort, as well as the value of the Golden Rule: "Do unto others as you would have them do unto you." A prayer that is supportive and comforting for the patient, that has his or her permission, and is mutually respectful is ethical. One that is proselytizing, coercive, and unrealistic is not.

As Professor Young discussed, the prayer was appropriate on all counts. "Your intentions were ethical," he said, "to tell the truth and to provide comfort, what physicians pledge to do. Mrs Martinez asked you specifically for the test results. You answered truthfully. You were aware how your pronouncement could provide harm and suffering and you followed the Hippocratic principle First, do no harm. Conventional medical, psychological, or philosophical explanations were insufficient or problematic, so you considered a spiritual approach. Prayer is a tremendous source of comfort for people who are prayerful. Although new for you, in the world of spiritual care, offering a prayer is as straightforward as recommending an antibiotic.

"A physician praying with a patient may not be standard practice," he went on, "but this does not make it unethical unless you do not have the permission of the patient or if you conducted your prayer in an unethical way. You identified a cue—the cross—that it would be appropriate to offer a prayer and trusted your deep intuition and judgment. You could have called a cleric if one was available, but then there is the question of timing, to make the right intervention in the right moment. You asked her first if she was a prayerful person. She said yes. Only then did you ask her if she wanted to have a prayer together. She could have said no. You found a common language. You did not tell her what faith to have and did not pray for a miracle."

I was satisfied that that as a physician, praying with Mrs Martinez was right.

In the intervening years I have become a full-time hospital chaplain at Stanford Medical Center. I am more aware than ever how human beings are spiritual beings—whether or not they are religious—concerned with meaning, hope, relationship and love, suffering, and life's mystery. Spirituality is linked to health and spiritual care is a core element of health care. Spiritual care is not something that should be left only to the chaplain.

As with so much in medicine, timing is key. There are many crucial moments that call for a spiritual presence—a listening ear, a gentle touch, a compassionate word, and sometimes a blessing or prayer. So often the physician or nurse or other health care provider is the one who is available. That is why I believe it is not only appropriate but sometimes necessary for them to provide a spiritual response.

As I learned in taking care of Mrs Martinez, doing the right thing means addressing what really matters, sometimes stretching us beyond our professional role as it is currently defined into the further realms of spirituality and meaning.

I took sign-out from Dr Koscove, who told me, "I've got an 86-year-old woman, Mrs Martinez, in room 17 with nausea, vomiting, and dehydration and a history of metastatic lung cancer previously treated with chemotherapy and radiation. She was discharged from the hospital two days ago for the same thing. I controlled the nausea and vomiting with IVs and ordered a CT scan to look for brain metastases and signs of increased intracranial pressure. I told her you're taking over. You'll need to review the scan, and see if she can tolerate oral fluids, before discharging her."

I walked over and introduced myself to Mrs Martinez (not her real name) and her son. She was sitting quietly on the gurney.

"Hello, I'm Dr Feldstein. I'm taking over for Dr Koscove. I see that you're feeling better. I'll have the nurse bring you some water while I review the blood tests. If you can keep the water down and the tests are OK as I expect, then I can discharge you home to follow up tomorrow with your oncologist, Dr Post" (also it is not a real name).

At that moment the nurse interrupted. "Dr Feldstein, there's a call for you." I excused myself. The ward clerk handed me Mrs Martinez' CT result: "Multiple brain metastasis. No shift." Sobered, I put the slip in my pocket to give to Dr Koscove. It was a good pickup.

After I took the call, I asked an intern who was going into radiation oncology to look at the scan and to accompany me, since he'd be seeing patients like Mrs Martinez. We headed back to her room.

"Mrs Martinez, I'm glad to see you're keeping down the water. Your blood test results are normal. I'm going to give you a stronger medicine to control the nausea and vomiting and arrange for you to see Dr Post tomorrow."

Before I could continue, Mrs Martinez looked directly at me and asked, "Doctor, what was the result of the brain test?" I was taken aback. I had been planning to let her regular oncologist tell her the news, but she spoke with such forthrightness and courage.

I pulled up a stool next to the gurney and sat down. "Mrs Martinez, the CT scan is abnormal," I said. "It shows that the cancer has spread to the brain."

Mrs Martinez looked down. Her face became pale and stricken. I was keenly aware that this was not the kind of test result one simply tells a patient and walks out.

Gently, and after a long pause, I asked, "What is your reaction?"

"This is a death sentence," she said, looking away.

"What do you mean ‘death sentence'?" I asked.

Mrs Martinez explained. "I knew that with the cancer one day I would die, but I did not expect it so soon."

I tried to reassure her. "Mrs Martinez, Dr Post is very experienced in this situation. Tomorrow you will discuss with him the kinds of treatment that will help you." She did not seem reassured. I thought about saying "I know how you feel," but I did not know how she felt.

I then noticed her wearing a large crucifix around her neck and recalled a story about a cardiologist praying with his patient.¹ I knew what I had to do. I felt very uncomfortable. I have talked about spirituality and religion with my patients on previous occasions, but the thought of explicitly praying with a patient, that was another matter. How was I to proceed?

"Are you a prayerful person?" I asked with hesitation.

Mrs Martinez nodded. "Yes."

Awkwardly I offered, "Well, then, would you like to have a prayer together?"

She immediately looked up at me. "Yes, I would."

Now what? We were from such different worlds. She was Catholic, originally from Mexico. I am Jewish, originally from Detroit and, at 43, half her age. We had only just met. She prayed to Jesus. I did not pray to Jesus. What would I say? I certainly had not been prepared in medical school for a situation like this.

I took her hands in mine. We closed our eyes. I waited for her to begin, but I soon realized she was waiting for me to begin.

I began to speak, trusting the proper words would come and she would find comfort in them.

"Oh, God, You Who are the Great Healer."

I paused for a moment, thinking of what to say next when Mrs Martinez repeated, "Oh, God, You Who are the Great Healer."

She was repeating after me! Now I had to find the right words that she could repeat.

"Who guides us through life," I said.

"Who guides us through life," she repeated.

I continued and Mrs Martinez repeated.

"In your wisdom . . . "

". . . may you guide Dr Post and all the other doctors and nurses to provide the best care."

"Provide us all with Your comfort and guidance . . . "

I brought the prayer to a close. "Thank you for hearing our prayer."

"Thank you for hearing our prayer," she echoed.

"Amen."

"Amen."

Relieved, I opened my eyes. But hers remained closed. She didn't let go of my hand and began the Lord's Prayer: "Our Father, Who art in heaven, hallowed be Thy name . . . " I joined in as best I could.

Then Mrs Martinez began to pray in Spanish to Saint Jude—the patron saint of hopeless cases, as I later learned. She finished and we both opened our eyes. Mrs Martinez appeared visibly calmer. She looked directly and deeply into my eyes. "Thank you," she said softly, a tear falling across her cheek. Her son's eyes too were filled with tears.

"Thank you," I replied. I too was tearful and filled with a profound sense of gratitude.

Mrs Martinez gave my hand a last squeeze. Our prayers had taken only a few minutes, but it seemed much, much longer. Finally, I stood to say good-bye, telling her I would arrange for her discharge.

The intern appeared stunned. "What did you think?" I later asked him. He did not seem to know what to say. "I have to admit to you," I continued, "I was not even planning to tell her the CT results, let alone pray with her. I've never prayed with a patient before, but her question required an answer and I had to take care of her reaction." We discussed how Mrs Martinez had not seemed to be reassured that Dr Post was experienced, how psychological and philosophical approaches were inadequate, and how I arrived at prayer.

Praying with Mrs Martinez felt so completely right. But was it? It truly comforted her and her son. As for me, I walked out feeling "well used," not bleak or hopeless, as I would have felt otherwise. But praying with a patient? Is it ethical? Is it legal? What if someone complained and referred it to the Peer Review and Quality Improvement Committee? Wait. I was the chair of Peer Review and Quality Improvement. Would I be reported to my own committee?

That episode was never brought up, but I could not stop thinking about it. Later, as a visiting scholar at the Stanford Center for Bioethics, I examined this case in detail under the ethical microscope with Professor Ernlé Young, ethicist and codirector.

Dr Young and I looked at it in terms of core ethical principles: to do good (beneficence), to do no harm (nonmaleficence), and to respect a patient's autonomy. We examined it in terms of the duties of truth telling (veracity), loyalty and putting the patient first (fidelity), of confidentiality and privacy. We contemplated the virtues of compassion and professionalism. We reflected on the goals of a physician to relieve pain and suffering and to provide comfort, as well as the value of the Golden Rule: "Do unto others as you would have them do unto you." A prayer that is supportive and comforting for the patient, that has his or her permission, and is mutually respectful is ethical. One that is proselytizing, coercive, and unrealistic is not.

As Professor Young discussed, the prayer was appropriate on all counts. "Your intentions were ethical," he said, "to tell the truth and to provide comfort, what physicians pledge to do. Mrs Martinez asked you specifically for the test results. You answered truthfully. You were aware how your pronouncement could provide harm and suffering and you followed the Hippocratic principle First, do no harm. Conventional medical, psychological, or philosophical explanations were insufficient or problematic, so you considered a spiritual approach. Prayer is a tremendous source of comfort for people who are prayerful. Although new for you, in the world of spiritual care, offering a prayer is as straightforward as recommending an antibiotic.

"A physician praying with a patient may not be standard practice," he went on, "but this does not make it unethical unless you do not have the permission of the patient or if you conducted your prayer in an unethical way. You identified a cue—the cross—that it would be appropriate to offer a prayer and trusted your deep intuition and judgment. You could have called a cleric if one was available, but then there is the question of timing, to make the right intervention in the right moment. You asked her first if she was a prayerful person. She said yes. Only then did you ask her if she wanted to have a prayer together. She could have said no. You found a common language. You did not tell her what faith to have and did not pray for a miracle."

I was satisfied that that as a physician, praying with Mrs Martinez was right.

In the intervening years I have become a full-time hospital chaplain at Stanford Medical Center. I am more aware than ever how human beings are spiritual beings—whether or not they are religious—concerned with meaning, hope, relationship and love, suffering, and life's mystery. Spirituality is linked to health and spiritual care is a core element of health care. Spiritual care is not something that should be left only to the chaplain.

As with so much in medicine, timing is key. There are many crucial moments that call for a spiritual presence—a listening ear, a gentle touch, a compassionate word, and sometimes a blessing or prayer. So often the physician or nurse or other health care provider is the one who is available. That is why I believe it is not only appropriate but sometimes necessary for them to provide a spiritual response.

As I learned in taking care of Mrs Martinez, doing the right thing means addressing what really matters, sometimes stretching us beyond our professional role as it is currently defined into the further realms of spirituality and meaning.

Religion, Spirituality, and Medicine: Application to Clinical Practice

Harold G. Koenig, MD
Duke University Medical Center and GRECC VA Medical Center, Durham, NC

JAMA. 2000;284:1708.

Patients want to be seen and treated as whole persons, not as diseases. A whole person is someone whose being has physical, emotional, and spiritual dimensions. Ignoring any of these aspects of humanity leaves the patient feeling incomplete and may even interfere with healing. For many patients, spirituality is an important part of wholeness, and when addressing psychosocial aspects in medicine, that part of their personhood cannot be ignored. In this article, I use spirituality and religion interchangeably, since the vast majority of Americans do not make distinctions between these concepts. Furthermore, most research linking spirituality to health has measured religious beliefs or practices.

Many seriously ill patients use religious beliefs to cope with their illnesses.¹ Religious involvement is a widespread practice that predicts successful coping with physical illness.^2-3 In fact, high intrinsic religiousness predicts more rapid remission of depression, an association that is particularly strong in patients whose physical function is not improving.³ More than 850 studies have now examined the relationship between religious involvement and various aspects of mental health.¹ Between two thirds and three quarters of these have found that people experience better mental health and adapt more successfully to stress if they are religious.

An additional 350 studies have examined religious involvement and health. The majority of these have found that religious people are physically healthier, lead healthier lifestyles, and require fewer health services.¹ The magnitude of the possible impact on physical health—particularly survival—may approximate that of abstaining from cigarette smoking⁴ or adding 7 to 14 years to life.⁵ However, religious practices should not replace allopathic therapies. Also, while many people find that illness spurs them to ask metaphysical questions and helps them rediscover religion, no studies have shown that people who become religious only in anticipation of health benefits will experience better health.

What does all this mean for clinical practice? While no research exists on the impact of physician-directed religious assessments or interventions, some recommendations based on clinical experience and common sense can be made. First, what should physicians not do? Physicians should not "prescribe" religious beliefs or activities for health reasons. Physicians should not impose their religious beliefs on patients or initiate prayer without knowledge of the patient's religious background and likely appreciation of such activity. Except in rare instances, physicians should not provide in-depth religious counseling to patients, something that is best done by trained clergy.

What should physicians do? Physicians should acknowledge and respect the spiritual lives of patients, and always keep interventions patient-centered. Acknowledging the spiritual lives of patients often involves taking a spiritual history. A spiritual history is not appropriate for every patient, although for those with illness that threatens life or way of life, it probably is. A consensus panel of the American College of Physicians⁶ recently suggested 4 simple questions that physicians might ask seriously ill patients: (1) "Is faith (religion, spirituality) important to you in this illness?" (2) "Has faith been important to you at other times in your life?" (3) "Do you have someone to talk to about religious matters?" and (4) "Would you like to explore religious matters with someone?" Taking a spiritual history is often a powerful intervention in itself.

The physician may consider supporting the patient's religious beliefs that aid in coping. Religious patients, whose beliefs often form the core of their system of meaning, almost always appreciate the physician's sensitivity to these issues. The physician can thus send an important message that he or she is concerned with the whole person, a message that enhances the patient-physician relationship and may increase the therapeutic impact of medical interventions.

Should physicians pray with patients? Post and colleagues⁷ provide guidelines for this issue. They suggest that physicians should not pray with a patient without his or her explicit request, and further state that physician-led prayer is appropriate only when a religious professional is not available, or when the patient prefers this. Alternatively, prayer can always be led by the patient. Our calling as physicians is to cure sometimes, relieve often, comfort always. If a distressed and scared patient asks for a prayer and the physician sees that such a prayer could bring comfort, then it is difficult to justify a refusal to do so. The comfort conveyed when a physician supports the core that gives the patient's life meaning and hope is what many patients miss in their encounters with caregivers.

Many seriously ill patients use religious beliefs to cope with their illnesses.¹ Religious involvement is a widespread practice that predicts successful coping with physical illness.^2-3 In fact, high intrinsic religiousness predicts more rapid remission of depression, an association that is particularly strong in patients whose physical function is not improving.³ More than 850 studies have now examined the relationship between religious involvement and various aspects of mental health.¹ Between two thirds and three quarters of these have found that people experience better mental health and adapt more successfully to stress if they are religious.

An additional 350 studies have examined religious involvement and health. The majority of these have found that religious people are physically healthier, lead healthier lifestyles, and require fewer health services.¹ The magnitude of the possible impact on physical health—particularly survival—may approximate that of abstaining from cigarette smoking⁴ or adding 7 to 14 years to life.⁵ However, religious practices should not replace allopathic therapies. Also, while many people find that illness spurs them to ask metaphysical questions and helps them rediscover religion, no studies have shown that people who become religious only in anticipation of health benefits will experience better health.

What does all this mean for clinical practice? While no research exists on the impact of physician-directed religious assessments or interventions, some recommendations based on clinical experience and common sense can be made. First, what should physicians not do? Physicians should not "prescribe" religious beliefs or activities for health reasons. Physicians should not impose their religious beliefs on patients or initiate prayer without knowledge of the patient's religious background and likely appreciation of such activity. Except in rare instances, physicians should not provide in-depth religious counseling to patients, something that is best done by trained clergy.

What should physicians do? Physicians should acknowledge and respect the spiritual lives of patients, and always keep interventions patient-centered. Acknowledging the spiritual lives of patients often involves taking a spiritual history. A spiritual history is not appropriate for every patient, although for those with illness that threatens life or way of life, it probably is. A consensus panel of the American College of Physicians⁶ recently suggested 4 simple questions that physicians might ask seriously ill patients: (1) "Is faith (religion, spirituality) important to you in this illness?" (2) "Has faith been important to you at other times in your life?" (3) "Do you have someone to talk to about religious matters?" and (4) "Would you like to explore religious matters with someone?" Taking a spiritual history is often a powerful intervention in itself.

The physician may consider supporting the patient's religious beliefs that aid in coping. Religious patients, whose beliefs often form the core of their system of meaning, almost always appreciate the physician's sensitivity to these issues. The physician can thus send an important message that he or she is concerned with the whole person, a message that enhances the patient-physician relationship and may increase the therapeutic impact of medical interventions.

Should physicians pray with patients? Post and colleagues⁷ provide guidelines for this issue. They suggest that physicians should not pray with a patient without his or her explicit request, and further state that physician-led prayer is appropriate only when a religious professional is not available, or when the patient prefers this. Alternatively, prayer can always be led by the patient. Our calling as physicians is to cure sometimes, relieve often, comfort always. If a distressed and scared patient asks for a prayer and the physician sees that such a prayer could bring comfort, then it is difficult to justify a refusal to do so. The comfort conveyed when a physician supports the core that gives the patient's life meaning and hope is what many patients miss in their encounters with caregivers.

Chris--Thanks so much.  I firmly believe that the almighty God in heaven can intervene.   I have put my trust in him and my Doctors and the medicine they prescribe and I feel real good about my recovery.   All the rest of you , I thank you so much---keep me in your prayers---put me on your churches prayer list and may God bless you and your families now and always---Will

That's the best thing you can do.  God Bless you Will. 

You are welcome Will.

C