Balancing a surgeon’s beliefs with the needs of the practice

Not long ago, we interviewed a physician for possible partnership in our practice. After showing him around our town, some of us partners had dinner with him to discuss business. He was a quite pleasant fellow, well trained, and seemed to be a good ‘fit’ for our practice. As dessert was being served, he said he needed to get one more thing off his chest: he prays aloud in the operating room before starting each surgical case. If we couldn’t allow him to do this, it would be a “deal-breaker.”

So, what would you have done?

Ultimately, there were a number of unrelated reasons why this doctor decided not to move to town and join our group. But it brought up an interesting topic of discussion: how does a medical practice balance the needs of the individual to express his beliefs with the needs of the practice to maintain a work environment tolerant to all? In part, it depends on just who that individual is.

According to federal legislation, reasonable accommodations must be made for employees to express their religious beliefs. Those accommodations can be considered reasonable if they do not have a significant impact on the functioning of the business. Unfortunately, this is wide open to interpretation.  Each state differs when it comes to employees’ rights – some states require greater accommodation than others – so you should consult with an attorney who specializes in labor and employment law in your state for specific advice.

The rules are different if you are the owner of a business. Using our story as an example, a physician-owner of a practice can, by virtue of expressing his religious beliefs, create a workplace which could be considered ‘hostile’ to an employee who doesn’t share the same beliefs. Hostile may sound like a harsh word, but that is the term used in this area of employment law. Interestingly enough, this does not apply to patients, since they have the freedom to walk and take their business elsewhere. Employees, on the other hand, are compelled to work in the environment created by their supervisors. To complicate things even further, employees who are in a supervisory role can fall within a gray zone: as employees they should have allowances made for their beliefs, but as supervisors they should not impose these beliefs on their subordinates.

To most doctors not acquainted with the issue of religious accommodation in the workplace, this might seem like employees get all the rights while the business owner gets none. In essence, this is true. Perhaps, like many things in this country, the pendulum has a habit of swinging to one extreme or the other. But, whether we like it or not, it is the reality of running a business.

All of this can put the physician-owner or administrator in a tough situation, balancing the needs of the individual with the need to maintain a ‘non-hostile’ workplace. The best advice is to get good legal advice. Following consultation, you should have a formal policy as part of your employee manual so that there are no misunderstandings or worse.

Peter J Polack is an ophthalmologist who blogs on medical practice management and electronic medical records implementation on Medical Practice Trends.

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  • rlbates

    Is there any reason the surgeon who wants to pray with or for his patient can’t do so privately in the preop holding area? By doing so there, the other employees (yours or the hospital’s) religious or non-religious beliefs are not in conflict.

    I don’t pray aloud with patients unless they ask me to do so. I always gratefully accept any prayers they send my way. I will participate in any prayers they or their family or pastor/minister/etc want to say in the private preoperative area.

  • Dr. Mary Johnson

    I would suppose whether or not you let the man pray before his operates depends on how badly you need his services in the OR.

  • Peter J Polack MD

    One of my partners, who considers himself ‘evangelical’, asked him why he couldn’t just pray in silence or somewhere in private. His response was that his “interpretation of scripture” obliges him to do so in the presence of others. And that was non-negotiable.

  • jsmith

    I had arthroscopy last summer and my orthopod wanted to pray with me before the operation, so I prayed with him. No big deal. We have to be sensitive to minorities, gays, people from foreign countries the disabled and non-Christians, and rightly so. Being sensitive to other people’s wants and needs, even if they don’t match ours, is the right thing to do. Should we not also make reasonable allowances for conservative Christians? I think we should.
    Aggressive or persistent proselytizing at work is not reasonable, but a prayer now and then is fine.

    • Molly Ciliberti, RN

      I had a physician offer to pray with me before surgery and I wanted a different surgeon. I am an atheist and quite offended. I went to him for his services not his god.

  • Mark

    Red flag. If this was the only odd request he would ever have maybe it wouldn’t be a big deal. But of course you know it won’t be.

  • Patrick

    You either have a good reason for your beliefs and behaviors, or you don’t. Praying because the patients asks you to or because the patients family perceives a benefit from the practice (calming, a sense of pease, relief of anxiety), I think most people would consider those good reasons. His interpretation of scripture is not a good reason, as it is not evidence based, and it appears to be to benefit himself, not the patient. I wonder if his practice of medicine would be evidence based or based on his interpretation of the literature.

  • boundbyinsurance

    Before a surgical procedure in a day surgery center, I had an evangelical nurse. She had extreme difficulty starting my IV and began praying loudly to Jesus before each stick after she missed the first time. I politely pointed out I was Jewish and already nervous. She informed me that my faith believed in prayer too and that this would help both of us when she was guided to the right spot to insert the needle. It took five tries. The whole experience made me very uncomfortable, both physically and mentally.

  • Ms. Beck

    Tolerance takes tolerance on both sides. During my nursing education I was taught about other views in religion and how to be encouraging to allow expression from the patient on those issues. Spirituality is one of the Maslow’s Heirarchy of needs and they do not end just because you are a professional. People often are offended because they are not comfortable in their own spirituality.
    I have often had long discussions with both patients and doctors of various religions to include Islam, Judaism, and various types of Christianity. Even though I may not agree with them, listening to them allowed a better relationship and trust bond between us so I could better advocate on their behalf.
    I feel most people just really don’t have any tolerance in them. They want everyone to tolerate them without returning that tolerance. It’s actually a lack of respect for other views and results in ethnocentric judgments.

  • prudence runyan

    As a potential patient I will weigh in on one aspect of this. If my surgeon feels he is required to pray before operating on me, by golly he or she should absolutely be allowed to do it. I want him or her to get every advantage they need conferred by God or otherwise!

  • Matt

    Many good points were already made, but I’ll add the following–what about the physician’s professional autonomy? When a surgeon is in the OR, it is her/his room (unless the patient is crashing & anesthesia has to jump in). By practice, the surgeon figuratively owns the room; all the support staff are there to support the surgeon in their work. In the example given, the surgeon is not forcing anyone to join hands and pray; he is simply praying out loud in his work space. For patient safety, the surgeon is in charge of the OR from the second they enter it. Who is anyone to tell the surgeon what they can & cannot due to prepare themselves for a case? He did not force the patient to pray with him, nor his co-workers. They simply may overhear his prayer, so what? No one says anything when a surgeon curses up a storm, throws tantrums, or berates an assistant. Bad behavior is routinely tolerated as part of surgical culture. Why would people suddenly decide to be offended by a good-intentioned surgeon b/c his words include God instead of the f-bomb?

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