The Secular Physician and the Religious Patient: Overcoming Religious Discordance in the Clinical Setting

Deciding how best to respond to a patient’s spiritual devotion can raise complex ethical challenges. This is particularly true for medical students and residents who may have little formal training in the area of religion and spirituality. This article explores the challenges inherent to the encounter between a secular physician or medical trainee and a religious patient. A clinical vignette is used to highlight common mistakes made by medical trainees and to suggest more optimal communication strategies when these trainees deal with a patient who raises religious issues. First, the medical trainee or professional can follow the patient’s lead in delving into how these issues shape their decisions about medical care. Second, by appreciating the limits of their training and role, physicians can appropriately listen, ask questions, and explore the patient’s feelings in a manner that avoids “converting” patients, engaging in theological discourse, or inviting patients to partake in religious rituals. Third, physicians need to uphold their integrity and not engage in actions that infringe upon their own spiritual or religious views. “I know that you will do fine because God and your hands are working together,” I said to the doctor just before she went ahead with the tap. She rolled her eyes and said that what she was about to do had nothing to do with God. I felt sick to my stomach.” These were the words of Y, a young HIV positive patient that our team had admitted the night before for work-up of a non-resolving pneumonia. He had come to cope with HIV and all of its devastating complications through his church and through God. He seemed to have placated his apprehension about the thoracentesis he was about to undergo by expressing his faith in God. Yet the senior resident, Dr. L., had managed to dismiss what seemed to be the very crux of his coping with one disapproving phrase. As I listened to Y’s grievances the next morning, I found myself caught in a personal dilemma. Religion had never been an important driving force in my life. In some ways I could identify with Dr. L. – I had no reason to believe that the procedures I performed on patients were influenced whatsoever by a higher power. But it was obvious to me that this young man’s faith in our care went hand in hand with his faith in God... How could I, as a responsible medical student, reconcile my obligation to tell the truth the best I knew it without contradicting his spirituality? As a team, we could not guarantee that God would ensure the best outcome. Indeed, I was not even sure if this is what he meant – perhaps he was content knowing that God was with him regardless of the outcome. I simply did not understand. My uncertainty allowed me to stay neutral and somewhat distant. I listened as Y pointed towards his church through the hospital room window with a peaceful smile. As I left the room, the discordance in our religiosity culminated in a request: he asked me if I would pray for him. Stumbling over my words, I apologetically told Y that I would not feel comfortable doing so, quickly changed the subject to his upcoming ultrasound-guided thoracentesis, and left the room discontented by my