February 9, 2010

Prescribing Medication/There is no balance

We had a lecture today on religion and spirituality and their roles in medicine by one of my favorite professors. He began the lecture saying "If there was a risk-free intervention that was associated with >10 years of additional life expectancy, would you be interested in learning about it?" He then proceeded to show us research that supported praying for people who are sick increasing health outcomes, correlations between attending religious services and better health, and that ordained people are healthier then the average non-religious person. The data were very convincing but there were so many questions left unanswered including:

-Is bringing religion into medicine actually "risk free"?
-How do you standardize prayer?
-What efforts were made to control for confounding factors such as the effect of having a community or a strong family structure on health - both associated with religious people and good health; showing a relationship, but not causality (one did not cause the other, necessarily)
-If we do buy into this enough to at least say it couldn't hurt and may help some patients, how do we talk about religion and spirituality with patients?

Our professor left us with the idea to open up the conversation to those questions - to take a "spiritual history" and ask how the patient thinks this will affect her/his medical care and/or health. I'm still not quite sure I could talk about this smoothly, without clouding the conversation with my own judgment about specific religions (and organized religions, more generally). Plus, what if someone has religious beliefs that really don't jive with me? Many religions are patriarchal and even misogynistic - an association with those sorts of beliefs would be a hard thing to support in one of my patients. But maybe prescribing something more general, like meditation - or clearing moments for reflection - or attending a support group or community gathering regularly (regardless of whether it's neighborhood softball or a book club or church).

On another note, tonight I attended a panel of Family Medicine Ob-Gyns who talked about their career paths and the choices they've made. They agreed that there is no balance, only tilting to one extreme and then the other - but that they love it and couldn't imagine being happy doing anything else. One of the physicians brought her ten year old daughter who talked quite candidly about what it's like to have a mom who is a physician, especially one who leaves in the middle of the night to deliver babies. The daughter said that it was hard because she missed her mom, but that there were some times that her mom kept as sacred (her birthday, for example) and that overall, she was really proud to have a mom who is a doctor and thinks it is inspiring her to want to be a doctor too. Hard to argue with that.

“As Galen says, 'confidence and hope do more than physick – he cures most in whom most are confident’ … Faith in Gods or in the Saints cures one, faith in little pills another, suggestion a third, faith in a plain common doctor a fourth.”
– Sir William Osler

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