Tag Archives: humanism

Should We Pray With Patients?

The patient was abruptly, unexpectedly, and neurologically devastated, leaving his family stunned and grief stricken.  There was little else for the ICU team to offer, even as we worked to do everything physiologically possible to sustain life.  It was late at night and as we stood in the room listening to beeping monitors and the running motors of IV pumps, the family mentioned in passing that many people were praying for him.  So I asked them two simple questions: Are you Christian? Would you like me to pray for you?  They answered yes to both.  I led them in a short prayer, expressing no more in terms of medical prognosis or aspirations for therapy than had already been offered, but also asking for strength, wisdom, and a clearer understanding and experience with God himself.  The family was marginally but visibly relieved and calmed by it, and we continued on with the grueling task of caring for the patient.

As anticipated, the patient passed away several days later.  After the family left, their nurse told me, “They could not stop talking about that prayer.  They said that of the dozens of physicians they have interacted with over many years, not a single one ever offered to pray with them.  It meant a lot.”

Modern healthcare is conflicted about how to approach faith and illness.  On the one hand, rising pressure to improve patient satisfaction must recognize the importance of faith in the lives of patients; in one small family practice study, 48% percent of patients wanted a physician to pray with them (even though 68% never had a physician discuss religious beliefs with them).   On the other hand, the secularization and humanism-ization of medicine can use the ethical mandate to respect patient autonomy as an excuse not to engage in matters that could be controversial (such as faith).  Fear of “abuse of paternalistic power” in the physician-patient relationship or fear of invoking religious ritual and methodologies that are virtually impossible to hypothesis-test can create a “chilling effect” on the inquiry and expression of religious belief by healthcare workers even when no hostility or indifference is there.  It is as if medical practitioners find it hard to believe that faith not only exists, but that it could possibly matter more to patients than the field of medical therapeutics itself.

The earliest practitioners of medicine were clergy members.  In virtually every culture, ministers of medicine began as… well, ministers.  After all, what can be a more compelling reason to drive us to our knees than helplessness in the face of suffering?  Though modern medicine can explain the physiology of how we decay and die in excruciating detail, it is certainly not equipped to answer the question of why we do.  This observation alone should explain why questions of faith contend to occupy the center of a patient’s attention and not simply the periphery.

The next time you are in a small group or a prayer gathering, try to count how many times health-related concerns come up for prayer.  Illness afflicts our minds, hearts, and souls as readily as our bodies.  Healthcare workers are compelled to take hours of training in cultural sensitivity, mindfulness, and meditation; shouldn’t we be similarly compelled to attain and encourage proficiency in spiritual need assessment, willing to offer prayer when requested instead of retreating in indifference?  Shouldn’t this be true in all the “helping professions”?

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Why doctors (and doctor wanna-be’s) should read

I want to challenge my fellow pre-meds and aspiring physicians to read more. I want to suggest that a passage in Plato’s Dialogues, or a verse in a T. S. Eliot poem, is as important for our future medical careers as a chapter in Biochemistry6th edition. We are human beings before we are physicians, and the community of human beings of ages past demands our attention.

This past weekend, I got a chance to attend the 3rd annual Medicine & Religion Conference, hosted by the University of Chicago’s Pritzker School of Medicine. Philosophers, theologians, and healthcare professionals huddled to commiserate and pontificate, with the singular goal of pursuing a more harmonious relationship between (duh) medicine and religion. The Conference was mostly smart-talk – distant babble of academics – but I did come away with one conviction: in medicine, science is not enough.

The same phrase, oddly enough, appears in an address given in 1968 at the convocation ceremony of the American College of Surgeons. Then-President Dr. Preston A. Wade is, I like to imagine, speaking before a room full of recently initiated surgical fellows – eager to prove to the world (and their patients) their hard-earned prowess – only to urge them to undo what years of medical training had sculpted into the marble of their souls. He tells them, no less, to abandon their hardline devotion to science and technique.

I will quote at length from his address, because I think his words are worth noting:

“Today’s medical student makes his choice of profession, in a large measure, because of involvement in varying degrees with human suffering and his desire to alleviate it…Somewhere in the course of his medical education, the student becomes indoctrinated in pure science, or hard science philosophy, and tends to change his outlook, at least as he expresses it to his colleagues and his teachers, and adopts a much more hardened attitude toward medicine. It is obvious to him that anyone who continues to talk about studying medicine to alleviate human suffering may not always be popular with his colleagues. It is sometimes considered weak and rather childish to continue this attitude when one is struggling with intricacies of chemistry, biology, and physiology.”

It’s as if Caesar tells his army before a momentous battle that they’ve readied the wrong weapon (or, more accurately, not enough weapons).

The problem with a merely scientific or merely technical view of medicine is that it fails to recognize medicine as a human art, in which realities transcend neatly bounded categories and predictable outcomes. Even the routine prescription of statins for someone with high cholesterol can veer into the chaotic realm of emotions, spirit, and morality. As much as we would like to think, we – physicians or patients – are not merely material bodies.

To believe this is one thing, but to act on it is another. I have heard many medical students say, “I have to study right now – it’s for my future patients,” to justify why they are staying in with their science textbooks, rather than doing something else. Then there’s the system of ‘rotations’ in which the medical student becomes a nomad, jumping from clinic to clinic, field to field, with little time and space to be human themselves. Medical schools have a powerful set of rituals, and those rituals act as a ceramist, shaping his clay in very particular ways. After all, the decline of “empathy” among medical students by their third year of school is a well-documented phenomenon.

In the end, that is what I’m warning myself and others against: not the dedication of students to learning medical science, but the subtle transformation of that dedication into idolatry, a new religion, complete with its own rituals, merciless to its heretics. Refusing to bow to this new religion, perhaps, is no easier task than the holy defiance of Shadrach, Meshach, and Abednego against King Nebuchadnezzar. For the brave, the fiery furnace awaits, except that fiery furnace is a niggling and pernicious feeling that you aren’t doing enough compared to the others, that you will not make a good doctor.

What, then, does reading have to do with it?

Sherwin Nuland, a surgeon-writer who taught at Yale, famously said “You cannot forget too much science at the bedside.” When patients do not react the way we foresaw, or suddenly begin to cry at being told their diagnoses, or when, despite all of your attempts, they die, physicians will be clawing in the caverns of their souls for resources – for the words to describe what’s really going on, for the words to say back to patients to help them heal. Is a dying patient an impending code blue, or, as poet Dylan Thomas put, a fire, “rag[ing] against that good night”? Physicians must choose their words carefully.

Medicine, as I said, is a human art, and reading is an act of participation in the human community. As human beings, our community is not simply our contemporaries – those with whom we share a common time and space, and, therefore common limitations in perception. God has graced us with History, and the experience of those who have gone before us can color our vague outlines with paints we do not possess.

Every man falls under the cycle of birth, life, sickness, and death. Medicine deals with all of those things, and if we’re not careful to reflect on them and to seek the guidance of others (both present and past) during that reflection, we will very quickly find ourselves helpless to help others. I am not suggesting that reading (and engagement in the arts in general) will negate all of the tendencies in medical education towards disenchantment, jadedness, and science-worship, but it’s a very good place to start.

Daniel Song is attending medical school in the fall, and currently working as an intern at an inner-city primary care center in Chicago.

P.S.: For more details on the 2014 conference mentioned in the post, visit medicineandreligion.com/schedule.html