Health care providers are often uncomfortable discussing issues of religion with patients, despite studies that indicate nearly 9 in 10 Americans believe in some sort of spiritual power. As a medical student, I have noticed that religion plays an important role in many patients’ lives, and that conversations about spirituality can build rapport between doctors and patients.
As the United States becomes increasingly diverse across religious lines, it is imperative for physicians to have a working knowledge of the health care-relevant practices of major religions, a concept known as religious literacy. In other words, while religion or spirituality may not play a major role in our own lives, we must become familiar with it in order to better understand our patients. The best way to create doctors involves educating medical students about religious practices. Here are some strategies for integrating discussions of religion and/or spirituality into medical school curricula.
1. Frame religion as a social determinant of health. Medical education around health disparities and issues of diversity has become increasingly popular over the last several years. Therefore, one method of discussing religion in a non-threatening manner involves integrating it into lessons about social determinants of health. While there is a relative paucity of research into the specific question of the effect of religion on various health outcomes, existing research has suggested that patients’ religious practices can have both negative and positive effects on health. While beliefs in “divine intervention” can deter patients from seeking time-appropriate cancer screening, organized religious communities can serve as focal points for culturally-tailored patient education programs around chronic conditions such as diabetes.
2. View religious community organizations as public health partners. Surgeon general Dr. Vivek Murthy has stated that he wants to move American health care further toward preventive medicine, and that faith-based organizations have an important role to play in supporting these efforts. Indeed, multiple studies have shown that religious organizations engender a high level of trust in communities, and that religious leaders can be important advocates that build bridges between local communities and health providers. From my anecdotal experience on the South Side of Chicago, I have noticed that decades of discrimination and disenfranchisement have caused many populations to thoroughly distrust the health care system. Some doctors lament that this historical legacy means that patients choose the county hospital with a six-month waiting list rather than receive care at our hospital. Therefore, partnerships with local faith-based organizations would go a long way towards regaining our community’s trust.
3. Educate medical students about major religions, but avoid generalizations. Medical students should receive foundational training on practices in major religions that impact health care delivery. For example, topics might include the fact that Jehovah’s Witnesses decline blood transfusions, Muslims often fast during Ramadan, and that Sikhs often decline to cut their body hair. Such knowledge may become helpful when treating an increasingly diverse patient population, especially when working directly with communities.
However, we must avoid one of the major criticisms against the “culturally-competent care,” and avoid making assumptions about a patient’s behavior based solely on their cultural background. Therefore, medical students should be educated to have a basic understanding of various religions, but always be encouraged to take cues from patients in terms of the importance of religion and spirituality. This can be elicited by non-judgmental questions in the history-taking process, such as, “How important would you consider religion/spirituality is in your life?” Normalizing these questions and asking them to all patients may encourage more patients to speak up about religious beliefs or practices that impact their lives.
I conclude with a story about the dangers of delegitimizing doctor-patient conversations about religion. Ms. P is a veteran who has struggled to quit smoking. She tried numerous tactics such as nicotine patches, but was unable to stop. However, one day, she said that after praying to God for help, “He made the cigarettes taste awful in my mouth, and then I knew that I could never smoke another one.”
Unfortunately, since her physician did not take her story seriously, she felt that her experience was invalid. Within a few days, she was back to smoking. Ms. P is still interested in quitting, and she feels that she can do so with the help of a health care provider who encourages her to stay in touch with her faith. In this situation, it did not matter whether Ms. P’s doctor shared her religious convictions. Religion had helped Ms. P quit smoking, and her doctor should have worked within that framework to maintain her non-smoker status.
Educating medical students about religion and helping them become comfortable with these conversations will go a long way towards strengthening doctor-patient communication and attempting to rebuild trust in the health care system.
Aamir Hussain is a medical student.
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