Medicine and religion: Should doctors pray with patients or take spirituality into account?
As a member of First Baptist Dallas, he and wife Jessica lead relationship classes on Sundays for dozens of young married couples. Even in his crisp, black-patterned suit, Pool is impossibly youthful — lean and rosy-cheeked, posture straight as a fence post.
And as a cardiothoracic surgeon, another realization has set in: "I have a ministry. I don't need to be standing in a pulpit. I have found a ministry I did not expect. I am able to minister to people in times of need."
Since Texas Health is a faith-based hospital system, he felt at ease taking that step.
"The vast majority of people believe in God," he says, "and yet when people come to the hospital, that's completely ignored by doctors. If anything, they call the chaplain. It's unfortunate that more doctors don't try to engage that part of a patient's life."
That's starting to change. Two decades ago, barely a few med schools offered classes on spirituality. Now, three-fourths of them do.
"Medicine has figured out that we ignore the more human sides of health care at our own peril," says Craig Borchardt, interim chair of humanities and medicine at Texas A&M University.
Studies show 60 to 80 percent of patients want their beliefs noted, he says — not as affirmation but as a sign that the doctor actually cares. But fewer than 20 percent of doctors bring it up.
The push has met with some backlash — from busy doctors reluctant to take time away from other concerns or others who don't like talking about it.
"Some staff are more comfortable with it than others," says Mark Grace, vice president of mission and ministry for Baylor Health Care System.
He doesn't reject the idea of doctors offering to pray, but "if you don't listen to the answer, that's where you get into problems. … The doctor needs to be prepared if the patient says no."
George Washington University's Puchalski says the bottom line is doing what's best for the patient.
"Physicians are generally not trained to lead prayer," she says.
To illustrate the power differential she says exists, she recalls a patient who was also a fellow parishioner. One day, she noticed the woman hadn't been to church for a while, then realized the woman hadn't come into her office either.
When the patient finally resurfaced, Puchalski pressed the matter: "She told me, 'I thought you'd be upset that I switched churches.' That gives you an idea of the power we have over patients. So I would really caution against (taking advantage of) that."
Pool gleans his patients' spiritual beliefs at their initial meeting. Then, on the morning of surgery, he says: "This is a time when a lot of people turn to faith. Would you mind if I prayed with you?"
No one, he says, has ever declined, not even those who believe differently or not at all.
It's 6 a.m., and Pool, shiny black boots poking from beneath blue scrubs, briefs Smith on his surgery. At 83, Smith is fit, mowing the yard occasionally, an active driver.
But coronary artery disease caught up with the retired Farmers Branch pharmacist, slowing his blood flow and causing chest pain. Over time, it could lead to a heart attack.
Madge Smith, his wife of 63 years, and Leah Wilson, his youngest daughter, are near. Scott Smith, his son, would join later.
Pool explains his plan: He'll make an incision down Smith's breastbone, then take arteries from his left and right side, and a vein from his leg, to form new channels for blood to flow through his heart.
"So," he tells Smith, "you told me you're a Sunday school leader. … Would you mind if I said a prayer for you?"
Smith is touched. Pool places his hand on Smith's shoulder and begins:
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