"Spirituality may be less and less associated in people's minds with religion per se," said John Ehman, chief chaplain at Presby, "and yet more and more people consider themselves spiritual without an institutional religious association."
It's an acknowledged but often ignored element of health care that has gained a more solid footing in American life during the 1990s, noted Hufford; reflected on TV ("Touched By an Angel") popular films (What Dreams May Come), and in magazines (a Time magazine cover story reported that 69 percent of Americans believe in angels). The role of spirituality is also being discussed in areas not traditionally considered applicable: A symposium at Penn in November, Keeping the Faith, explored religion's role in solving urban ills.
At the same time, alternative forms of medicine, stressing the mind-body connection (meditation, acupuncture, tai chi) are being welcomed into the fold of mainstream medicine.
During the conference, Radiology's Andrew Newberg, PhD, cited more than 50 studies that support the health benefits of spirituality and religion, showing fewer physical, mental, and social problems among those who consider themselves believers.
"Meditation-based interventions have been shown to be very beneficial at times for reducing levels of alcohol and drug abuse," said Newberg. "They are also very useful for other psychological disorders, as well as reducing anxiety and depression."
Newberg's two-year study with the late Eugene d'Aquili, MD, of Psychiatry showed that Tibetan Buddhist meditation -- which promotes sensations of calm and unity -- alters a person's brain function and cerebral blood flow (UPdate, March 1998).
With increasing numbers of published studies on the subject, the connection between spirituality and medicine appears less tenuous. But in routine patient care, it's still the patient who dictates the nature of that connection.
Said Ehman: "The only person who can really interpret for their doctor the connection between a particular spiritual belief and its medical application is the person who holds that belief."
That doesn't mean the physician's role is necessarily passive."We're not saying that it would be appropriate to train physicians to be religious or spiritual," said Elizabeth Mackenzie, PhD, of the Institute on Aging. "But you can train physicians to be respectful of other people's beliefs and to inquire about them appropriately."
"If a patient wants that discussion, then physicians really need to be aware of their religious, spiritual, and existential needs," adds Hematology-Oncology's Janet Abrahm, MD, who frequently cares for terminally and chronically ill patients. "Spirituality is a dimension of people's lives that needs to be addressed. It's a piece of them."
Abrahm believes that physicians should explore the topic as far as they're comfortable, then consult with Pastoral Care at HUP and Presby. Combined, the department's staff includes 10 chaplain residents and six full-time chaplains representing various faiths: one rabbi, two Roman Catholic priests, and a few Protestant and Pentecostal ministers.
"We are diverse by design, not by accident," noted Ciampa. "It's ideal for a pluralistic secular health-care setting."
There aren't enough chaplains to visit every patient, so they operate by referral: from doctors, nurses, social workers, patients, and families. A chaplain is on call 24 hours a day and serves to supplement (but not replace) patients' own clergy. Chaplains are often called in to discuss living wills, advance directives, and organ donation.
A significant portion of Pastoral Care's mission is education: of residents, medical students, and senior physicians. Since religious discourse was a taboo subject in most medical schools a few generations ago, veteran doctors often dismiss its significance, said Ciampa.
But a raised awareness about spiritual beliefs can only help physicians, especially when those beliefs crash with a course of treatment. In certain faiths, medical interventions and life-saving procedures are prohibited. Jehovah's Witnesses, for example, may not accept blood transfusions; Christian Scientists often decline synthetic drug therapies.
"If a patient refuses a particular medical intervention, the health-care team might [initially] get suspicious and suspect an underlying mental health problem," noted John Hansen-Flaschen, MD, chief of Pulmonary and Critical Care Medicine. "Finally, it comes out that they're deeply religious and these decisions are entirely in sync with their religious teachings. This probably happens all the time in psychiatry departments, but it even happens in intensive care units and in acute medical services."
To avoid misunderstanding, doctors might learn to approach patients with targeted questions about spiritual beliefs beforehand. Ehman recently completed a three-year study involving 177 pulmonary patients at Presby. He asked their opinion on a physician inquiry regarding spiritual or religious beliefs; two-thirds said they would "welcome" it, according to Ehman. (The study, accepted for publication in the Archives of Internal Medicine, recently won the Research of the Year Award from the American Association for Clinical Pastoral Education.)
Said co-author Hansen-Flaschen: "It gives patients the opportunity to say 'no' without saying that they're not religious or don't attend church. But a 'yes' answer could lead to more direct questions and some kind of an agreement on how they're going to introduce spirituality into their relationship from there on."