Acute renal failure associated with use of contrast in the biliary tree in an 82-year-old woman.

To the Editor: This letter reviews this author’s response to Dr. Rousseau’s case of a patient and the role of spirituality in healing. It explores possible reasons more physicians do not incorporate spirituality in their approach. Spirituality, family, and values appear to positively affect one’s recovery from a life-threatening illness. The literature supports the concept that medical care needs to focus on healing that incorporates spirituality and that relationshipsFparticularly those between patients and their physiciansFaffect healing. It appears that physicians, particularly psychiatrists, appreciate that the role of spirituality is a positive one in influencing healing. This raises the question that, if healing is seen as extending beyond the medical approach and requiring inclusion of spirituality, why do more physicians not address it? Perhaps the issue is related to evidence. As in the case described by Rousseau, there is no direct evidence that culture and religion directly affected the subject’s recovery; it is easy to suggest, but difficult to prove, that unexplained recoveries are a result of divine intervention. The mere presence of the subject’s brother may have been the essential factor that resulted in his rallying for recovery. Alternatively, physicians may feel ill equipped to address spirituality. Even osteopathic physicians, who are trained to be holistic in their approach, have wide variability in their instruction in spirituality; there is inconsistency in terms of number of hours of instruction, content, timing, and context. Follow-up to this article may prove beneficial in directing patient care. It would be useful to know whether this experience changed the approach of the medical team that provided the subject’s care and the results of this altered approach. Also, because the literature supports a positive relationship between spirituality and healing, research is needed to determine how to better equip healthcare professionals in addressing spirituality and incorporating it into patient care. Furthermore, if spirituality and healing are to become part of the core educational curriculum, there needs to be some consistency in the training of healthcare providers. Finally, research is needed for cost–benefit analysis; insurers will need to be convinced of the financial benefit in overall cost reduction if time spent addressing spirituality is to be reimbursable. Rousseau’s case highlights that the incorporation of physical, emotional, and spiritual attributes into intervention plans appear to correlate with a better physical, psychological, and functional outcome. Spirituality provides purpose and meaning by defining what is important and valued. Spirituality is gaining recognition in the literature and at educational institutions as an important component for consideration in assessing client needs and values and influencing positive outcomes. Best practice is now the standard of care, and this requires a client-centered approach; it appears that healthcare providers will be required to embrace the big picture.