How religion influences the doctor-patient relationship

It was my turn to be on call during Christmas. I held the long list of patients signed out to me, and began my rounds early that morning in the hopes that I could be home in time to open presents with my family that evening.

I went from room to room on the surgical floor, talking to patients. I knocked on one door and pushed it open. A white male in his sixties lay in bed, with a younger, twenty-something man at his side. The patient was grimacing and seemed to be in pain. I introduced myself to the two men. The younger gentleman proceeded to introduce himself as the man’s son.

I had already read through the patient’s records. He had undergone surgery a few days earlier. I asked him how he was doing.  Sounding slightly irritable, he responded, quite bluntly, “I’ve been miserable.” I inched closer to his bed and leaned forward.

He seemed uncomfortable with my proximity. “Can you tell me what’s going on?” I asked. I was not prepared for his next question.

“Doctor, are you a Christian?” he asked, looking into my eyes. I was taken aback. I could sense the son shifting in his chair, his body stiffening. I replied that no, I was not a Christian.

He continued to look at me with some uncertainty on his face, and I could tell he hadn’t finished asking. “Are you from India?” he inquired.

“Yes, I am originally from India.”

“So, you are a Hindu?” He waited intently.

“Yes, I am a Hindu,” I said, unable to hide a smile, given the unusual interaction. He settled back in bed. Beside him, his son relaxed back into his chair with an almost-audible sigh of relief.

“He loves India,” the son said. “He thinks it’s a very spiritual place.” Relief flooded through me, and I was glad my answer seemed to have averted what could have been an awkward and uncomfortable encounter. I couldn’t help but wonder what would have happened if I had responded differently. What would he have done if I had said I was a Muslim? Would he have refused treatment from me? In doctor-patient relationships, patients can terminate the relationship during treatment for any reason. It is much harder for physicians to end it though, as noted by Bruce Patsner (“Refusing to treat: Are there limits to physician ‘conscience’ claims?”). Not only they feel the sense of duty as established in the ethical principal of beneficence but also there are limits placed by federal and state laws. Laws do allow termination by a physician under conscious circumstances, which many times includes religious beliefs although they have to execute it very carefully.

In this older patient’s room, I began to wonder: Immigrant physicians should be more prepared to face such interactions and discuss beforehand with the hospital administration and leadership on their rights to terminate a relationship if they feel that ongoing interaction could interfere in proper clinical care.

Satisfied with my answers to his questions, the patient continued to tell me his problems, including his poorly controlled pain and sleepless nights. I asked a series of questions, finished the exam, and discussed his treatment plan.

Later, I returned to visit the patient. He was sitting up in a chair watching TV. He gestured at the screen. “You’ll see how great Trump is going to make this nation. He’ll get rid of all the illegal immigrants. They all need to go back to where they came from,” he told me. I smiled uneasily and went on to describe his lab results and vital signs adding that I had discussed the treatment plan with the surgical team.

“Can you tell the surgery resident to shave his beard?” the patient asked suddenly. “He looks like a terrorist.” I knew who he was talking about.  The surgical intern, a young Indian American man, tended not to shave, probably preferring to catch a few additional minutes of sleep rather than go through the tedious, daily ritual of shaving.

I moved on to other patients, but I couldn’t shake his comments from my mind.

It was almost 6:00 in the evening before I finally finished all my work. As I was getting ready to leave, I was paged to come and evaluate a patient who was having difficulty breathing. I ran to her bedside, where the rest of the care team was mobilizing quickly around her. We treated her, and in about half hour she was feeling better. Happy with her stabilization, I finally left the hospital. As I was driving home, I suddenly smiled. The patient was a Hispanic female. Of course, no one had asked her immigration status or religion. The nurse was Asian American, while the respiratory therapist was African American. Her surgical resident was white, and I was her medicine physician. We all worked together to help save a human life, no questions asked. I liked it this way.

Sarita Khemani is a neurosurgery hospitalist.

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