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Most Psychiatrists Open to Discussing Spiritual Concerns

They're more likely to broach the topic with patients than are other doctors, study finds

THURSDAY, Dec. 27 (HealthDay News) -- Many doctors avoid issues of spirituality and faith when interacting with patients, but that's not true for most psychiatrists, a new study finds.

In fact, more than 90 percent of psychiatrists surveyed said it's always or usually appropriate to ask patients about their religious faith or spirituality, while just 53 percent of other doctors thought so.

On the other hand, psychiatrists were much more likely to report that crises of religious faith can worsen a patients' suffering.

"Although psychiatrists are not [typically] religious themselves, they are the doctors most comfortable with talking about spiritual issues," said study lead author Dr. Farr Curlin, an assistant professor of medicine at the University of Chicago.

According to Curlin, there has long been a tension between psychiatry and people of faith, in no small part because the father of modern psychology, Sigmund Freud, was deeply skeptical of religion. In addition, psychiatrists have "for a long time tended to associate religious belief and practice as being a sign of, if not mental illness, at least delusional behavior," Curlin contended.

The study does support the notion that, compared to other types of clinicians, psychiatrists are more dubious of religion. For example, 18 percent of psychiatrists surveyed said they were not religious, compared to 10 percent of other doctors. And, on a measure of "intrinsic religiosity," 47 percent of psychiatrists were rated as "low," compared to 36 percent of other doctors.

There have, however, been efforts to repair this "breach" between spirituality and psychology, said Curlin, who studies the roles of religion and spirituality within the context of medicine.

In the new study, researchers randomly surveyed 2,000 physicians about patients and religion, including 100 psychiatrists. A total of 1,144 doctors responded.

The findings were published in the December issue of The American Journal of Psychiatry; other findings from the survey were reported earlier this year.

"We found that if you look at doctors in general, the less religious they are, the less likely they think it's appropriate for them to address spiritual issues at all," Curlin said. "The opposite seems to be the case among psychiatrists. They're the least religious doctors, but they're the ones who basically see this is as part of their bailiwick, part of what they do."

Eighty-two percent of psychiatrists thought religion leads to increased suffering in some cases, compared to 44 percent of the other doctors.

"We observe that some patients really go through existential crises when they get sick -- they wonder if they've been abandoned by God, and they relive old sins," Curlin said.

On the other hand, about three-quarters of both groups said religion can help patients cope with and endure sickness.

Also in the survey, 36 percent of psychiatrists and 28 percent of other doctors said patients "sometimes" used religion or spirituality as a reason to avoid taking proper care of themselves.

Curlin believes it's appropriate for doctors to bring up religion or spirituality "anytime they think it's relevant to the patient's experience of illness or decision-making regarding course of treatment or response to that illness."

But to some doctors, he said, "there's still a strong sense that the spiritual is personal and that the practice of medicine is professional, and those two domains ought to be kept apart as far as possible."

Richard P. Sloan, professor of behavioral medicine at Columbia University, said it is disturbing that doctors believe that spiritual beliefs can lead patients to delay or refuse treatment.

Should doctors ever ask about religion in the first place? Sloan, who's written skeptically about the study of religion's role in medicine, said it can be appropriate in certain contexts.

"You need to know what characteristics of your patients might interfere with your ability to treat them well," Sloan said. Patients who are fasting during Ramadan, for example, might not be able to take four doses of a pill per day.

"The concern that I have is a number of physicians who go way beyond what's necessary and run the risk of manipulating their patients, even coercing them, invading their privacy, taking on spiritual matters as objects of intervention," he said. According to Sloan, appropriate inquiries are fine, but proselytizing has no place in the doctor's office

More information

For more on spirituality and health, visit the U.S. National Center for Complementary and Alternative Medicine .

SOURCES: Farr Curlin, M.D., assistant professor, medicine, University of Chicago; Richard P. Sloan, Ph.D., professor, behavioral medicine, Columbia University Medical Center, New York City; December 2007, The American Journal of Psychiatry

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