The association of physicians' religious characteristics with their attitudes and self-reported behaviors regarding religion in the clinical encounter

Although more than nine out of ten doctors believe it is appropriate to discuss religious or spiritual issues when a patient brings them up and three out of four encourage patients' religious beliefs and practices, only half inquire, even occasionally, about a patient's faith, report researchers from the University of Chicago in the May issue of the journal Medical Care.

Only one out of ten physicians routinely mentions his or her religious beliefs and experiences to patients. Fewer than one out of three endorses praying with patients. Four out of five say they do so "rarely or never."

But if half of physicians do not inquire about religious belief, the other half do. Ten percent of them do so "always." And if four out of five physicians rarely or never pray with patients, one out of five do, "sometimes or often."

"We found no consensus among physicians about what is customary or appropriate," said study author Farr Curlin, M.D., assistant professor of medicine at the University of Chicago. "Despite efforts to standardize many aspects of the doctor-patient relationship," he said, "patients are likely to encounter very different approaches."

These differences in attitude and behavior closely reflect physicians' personal religious and spiritual characteristics, the study found. "The close ties between belief and behavior," Curlin said, "suggests that physicians are unlikely to reach agreement any time soon about what is suitable."

The researchers surveyed 2,000 practicing U.S. physicians from all specialties about their own attitudes and how they affected the clinical encounter. They asked physicians about their religious traditions, the extent to which they try to live out the teachings of those traditions, and about barriers that might hinder discussion of religious or spiritual topics with patients.

Of the 1,144 responding physicians, 18 percent described themselves as being neither religious nor spiritual, and 17 percent identified themselves as being both highly religious and highly spiritual. Thirty-nine percent of the physicians were Protestants, 22 percent Catholics, 16 percent Jewish, 13 percent other religion, and 11 percent reported no religion.

Physicians who said they were highly religious and spiritual differed from less religious and spiritual doctors on every attitude and behavior. Seventy-six percent of the most religious doctors ask about their patients' beliefs compared to 23 percent of minimally religious physicians. Seventy-six percent of highly religious doctors pray with patients compared to 30 percent of less religious physicians.

Although the level of religious commitment was more important than the particular religious tradition, Protestants were the most likely to inquire about a patient's beliefs and the most likely to pray with patients.

For patients, religion often comes to the fore during an illness. Some doctors have argued that physicians should honor those feelings as a part of patient-centered care, maintaining that such discussions, and even prayer, can be attentive and comforting. Thirty-eight percent of those surveyed thought doctors spent too little time addressing spiritual needs.

Others see it as a violation of boundaries. Because religion, like politics, can be divisive, many insist that physicians should avoid such topics. Nevertheless, only one percent of doctors thought they spent too much time in such discussions.

A previous study by Curlin's team found that physicians were more religious than expected. Seventy-six percent of doctors believe in God, 59 percent believe in some sort of afterlife, and 55 percent say their religious beliefs influence how they practice medicine. Most doctors, though, were hesitant to "apply their religious beliefs to other areas of life," the researchers found. Sixty-one percent said say they "try to make sense" of a difficult situation and "decide what to do without relying on God," versus only 29 percent of the general population.

"What this survey told us," said Curlin, "is that we don't entirely agree." Perhaps that is OK, he suggests, presenting patients with options. But other than by word of mouth, patients would have no way of choosing physicians who shared their beliefs.

Discussions of the appropriateness of such matters in the clinical encounter, the study's authors conclude, "will need to grapple with these deeply rooted differences among physicians."