CHICAGO — As a medical student, Dr. Julie Oyler was told to remove the cross she wore on the lapel of her white coat. As a resident, Dr. Aasim Padela was told he wouldn't have time to recite Islam's five daily prayers. But ignoring God was not an option for Oyler, an evangelical Christian, and Padela, a Muslim. Nor should it be, according to researchers at the University of Chicago, where both doctors now freely practice their medical specialties and religious traditions.
After discovering that silence on matters of spirituality left some patients unsatisfied with the care they received at the University of Chicago, two doctors there and four faculty scholars have chosen to examine how some medical schools either encourage or discourage physicians to integrate their faith both in conversations with patients and their own professional lives. Doctors who set their faith aside, they say, can become disillusioned and less effective.
"When doctors are dispirited, the care they give to patients is worse," said Dr. Farr Curlin, co-director of the Program on Medicine and Religion. "Patients should be very hopeful that their doctor sees their work as a remarkable privilege, even a holy privilege, that will make the doctor respond to that patient out of joy."
Both Curlin and Dr. Daniel Sulmasy, an internist who also serves on the Presidential Commission for the Study of Bioethical Issues, said they believe that as the gap between health care and religion has widened, the quality of care for patients has diminished.
For Curlin, an evangelical Christian who also serves as a hospice and palliative care physician, the pursuit is a labor of love and a calling. For Sulmasy, it is an application of lessons learned as a medical ethicist who found that doctors were coming to him for help with existential dilemmas in addition to ethical ones.
Racked with guilt when they make a mistake, grief when they can't heal a patient, and emptiness when they feel overworked and uninspired, doctors more often than not wrestle with whether it's right to turn to their faith for comfort or clarification, Sulmasy said.
"We can talk to people about their sexual practices, but not about their own spirituality, and certainly not talk to another clinician about his or her own spirituality," he said. "In prehistoric times, the role of the healer and the priest were one and the same. We don't want to go back to that. But we've encountered a situation in that they are so radically separated that physicians think religion has no role."
Those who do publicly embrace religion feel alienated and alone, Curlin said.
Both men say policymakers and insurers have perpetuated that sense of alienation by treating health care as nothing more than a business. That has led some doctors to feel unfulfilled. Many seem to have forgotten the calling that led them to medicine, having been urged to abandon that way of thinking and focus on science, Sulmasy said.
"The kinds of questions and the kinds of places where medicine intersects the lives of patients and the clinicians are the same places religion does: birth, suffering, death, sex," he said. "These huge human questions are part and parcel to what the clinician lives day in and day out. These are eternal questions."
For many, that repression of faith begins in basic training when medical students are typically pressured to set their lifelong beliefs aside and focus on objective science. Oyler, a primary care physician at the University of Chicago, said she felt uncomfortable sharing her faith for years after she was reprimanded as a medical student for wearing a cross on the collar of her white coat.
While she still doesn't advertise her evangelical Christian faith to patients, she does establish during the initial appointment what role religion plays in her patients' lives, in case that becomes the basis for decisions they make over time. If the person shares her Christian faith, she lets them know they have something in common.
"I have patients I have prayed with and made faith part of their medical therapy because we've found common ground from the beginning," Oyler said.
One of those patients, Christella Wynn, 75, recalls introducing faith into the conversation when she first met Oyler. Though Oyler's disclosure didn't make her seem more competent than other doctors, Wynn said her doctor's openness did put her at ease.
"You've got to carry something in there with you," Wynn said. "You don't just go in there alone. You have to have faith in something and that God will work through you."
At one point when Wynn felt particularly overwhelmed by a chronic low blood count and breathing problems, she asked Oyler to pray with her. Oyler gladly grabbed her hand in the exam room and did.
Though the American Medical Association has no policy encouraging or discouraging a separation of church and medicine, the Joint Commission, the accrediting agency for health care institutions, requires medical professionals to receive some training in spiritual care.
Still, there are some who believe God talk should be taboo in medicine and religion should play no role in a doctor's bedside manner.
Richard Sloan, professor of behavioral medicine at Columbia University and author of "Blind Faith: The Unholy Alliance of Religion and Medicine," argues that only a chaplain should bring up religion. Doctors should avoid the risk of patients making decisions about their health based on their caregiver's beliefs instead of sound medical advice, he says.
"No matter how smart patients are, they're still subordinate in a relationship with a physician," Sloan said. "Even as well-intentioned as Sulmasy and Curlin are, there's too much at risk."
Curlin said it is indeed important to let the patient take the lead in such scenarios to avoid the appearance of proselytizing.
But the introduction of a doctor's faith in the clinical setting can be unwelcome for other reasons, especially when a doctor comes from a minority faith tradition. To delve deeper, Curlin and Sulmasy secured a $2 million grant to fund four faculty scholars including Padela. An assistant professor of general internal and emergency medicine at the University of Chicago, Padela will explore the challenges facing American Muslim doctors like himself.
His course was charted on Sept. 11, 2001, when as a second-month medical student Padela helped treat victims in an emergency room a mile from the twin towers. At the end of the day, bus drivers wouldn't let Padela board their buses to go home, he said. Later, patients refused his care because they didn't want "a terrorist" treating them, Padela said.
"Being Muslim externally is problematic and opens you up to discrimination," he said.
But incorporating his Muslim faith also gives him a peace of mind when it comes to providing emergency care and comfort for patients he usually sees only once, Padela said.
"There are higher levels of understanding that we might never get to," he said. "An Islamic worldview sometimes allows me to connect with patients (Muslim and non-Muslim) in a positive way."
In some cases, practicing medicine can deepen a doctor's faith. Life-and-death situations, and the ethical dilemmas those often present, led Dr. Roy Weiss, the University of Chicago's chief of adult and pediatric endocrinology, to seek a clear ethic of his own and become a more observant Orthodox Jew.
"I appreciated the role of G-d in the fragility of life and how things can turn good and bad rather quickly," he wrote in an email. Many observant Orthodox Jews don't write the name of God.
"This (fragility) forced me to better appreciate and learn more about what the Torah teaches about these things," he added.
Weiss acknowledges that patients often have a hard time seeing him as a doctor. Despite his white coat and stethoscope, they address him as "Rabbi" and focus on his yarmulke, beard, and the ritual fringes dangling near his waistband called tzitzit.
"Although I never had a patient refuse to see me or my treatment, we invariably get into a discussion of religion, family, ethics," he said. "Perhaps it brings out a more frank discussion of those things."
Dr. Alex Lickerman's spiritual journey and career path also have run parallel. A practicing Buddhist and physician at the University of Chicago, Lickerman said he entered the profession for the same reasons many of his colleagues did: He liked biology and wanted to help people. But as his Buddhist practice has evolved, his medical career also has become more fulfilling.
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"Most of the time you can figure out what's going on pretty easily. What's not straightforward is how you help people maintain happiness when they're hit with a devastating illness," Lickerman said. "It's more real and more satisfying as I've continued in my Buddhist practice. My interest in really helping people not just with their physical symptoms has really expanded. My desire has redefined itself."
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