Week 3 Questions

In your last VoiceThread, you talked about what happens to patient care when the healthcare provider and patient do not see eye-to-eye on matters of faith. In this ScholarBlog, let’s use Courtni’s question in class today as our guide:

(1) If religion is important for a patient’s identity and plays a significant role in their healthcare decision-making, how *should* healthcare providers – who are strapped for time when it comes to meeting with patients – seriously incorporate this into their care plan (if they should at all)?

(2) If a patient asks for a treatment plan (that he/she says is motivated/instructed/compelled by his/her faith tradition) that completely contradicts what the healthcare provider has in mind (based on his/her medical reasoning), how should all of this proceed?

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14 Responses to Week 3 Questions

  1. Matthew Brandon Fine says:

    Religion can often contradict what a healthcare provider suggests as a course of treatment/end of life care. This brings me back to our discussion of last week, and the role of communication in medicine. In a scenario where a person has a substantial relationship with their healthcare provider religious trepidations should pose no real threat to the course of action as the motives from both sides are understood. In emergency care or new doctor-patient relationship situations the lines begin to get blurred. For instance as Dr. Labrecque brought up the Jehovahs’ Witness who had previously rejected transfusions until the emergency scenario reared its ugly head. While it is important to be mindful of the patients beliefs, some situation are unfortunately going to require a physician to treat the physical infirmity with little regards to the spiritual/religious trepidations to such treatment. In non emergency situations the patient and doctor must realize that they are not playing for two different teams and be able to have a conversation that in the end will lead them to a treatment plan that will be able to serve both’s needs or goals.

    While religious beliefs can be serious motivators for every day actions, in a healthcare setting it is important to be mindful of eclecticism and blind faith. As in our discussion on futility of treatment, health care providers must be able to speak to their patients in a more humane way that the treatment will ultimately cause more harm than good and if necessary frame it in the particular religion’s light. It must be made aware to patients and their families, that if the possibility of recovery is not high that solely caring for the life rather than preserving its quality can be just as if not more detrimental than some courses of treatment. Doctors should not solely rely on their hospitals ethics board or chaplains to address these sort of situation to approach resolution of these sorts of conflicts because they are inherently multidisciplinary. It is important to educate doctors on ways to be able to react in these situations rather than just relying on ethics consults

  2. Olha Seredyuk says:

    Religious identity is important to how a patient will carry out healthcare decision-making. If the healthcare provider has limited time with the patient, I think in order to incorporate religion seriously, it is important to address religious beliefs openly and without delay. From my personal archive of “lessons learned” in life, it is always better to ask straightforwardly rather than wonder and hope for mutual understanding.

    My proposed approach would do four important things:

    1. It will set the tone for honesty and respect in communication between the healthcare provider and the patient, which may lead to a start in the credit of trust.
    2. It will let the patient know that the healthcare provider cares enough about the patient’s beliefs and values to ask about them and learn more about the patient as a whole person.
    3. It will relieve anxiety and provide clarity for both the patient and the healthcare provider, which, in the long run, may serve to prevent assumptions, ethical, as well as medical mistakes.
    4. The open conversation concept has the potential to invoke vulnerability in both the patient and the healthcare provider (i.e. doctor) – which can be a powerful tool for storytelling, finding areas of agreement and further developing trust in the patient-provider relationship.

    Often, the conversation around faith and beliefs is awkward because neither side knows how to start on the topic, or whether to address it at all. One of the pitfalls healthcare providers will want to avoid is relying on religious and cultural stereotypes, which essentially heavily contribute to religious illiteracy. A great example of this we read in chapter nine of the Health Humanities Reader (Jones, Wear, Friedman; 2014), where a certain Dr. Mahdavi was accused of unethical and derisory behavior concerning an elderly patient and Islamic cultural/religious beliefs about end-of-life care and respect. The interesting thing is that the text mentions that Dr. Mahdavi [the physician] “had sensed the family’s change in demeanor during his visits but attributed this to distress that Ali was dying” (110). Dr. Mahdavi attributed, assuming he knew why they began acting in a certain way, without clarifying the reason behind it. Assuming something about the patient is dangerous and can create more problems that could otherwise be solved via a direct discussion. I feel like most people have a sense of intuition when it comes to bringing up certain parts of their personal convictions. It is important to acknowledge religious beliefs, because they can (and often do) have a big influence on medical care. The healthcare provider might be concerned with health outcomes, but for the patient, religious considerations concerning living in/with their state of health may be just as important. In some cases, the healthcare provider must be prepared to ask about them before being asked, or before a patient brings religion up. Healthcare providers should include having the conversation about religion/religious implications as an item on their patient care checklist. By making it an item on their checklist, healthcare providers will acknowledge their patient’s beliefs and values. In our class discussion, Dr. Labrecque said that the patient has considerable responsibility to express his/her beliefs and concerns to the provider. While I absolutely agree with this, I think it is ultimately the provider (i.e. doctor) who is the leader in the healthcare setting, because he/she is responsible for setting the healthcare plan and setting the pace for the patient. Therefore, having enough emotional intelligence and foresight to sense what is unspoken or implied is an important part of the compassionate communication that should happen between the patient and the healthcare provider. I think Matt makes an excellent argument by pointing out that the doctor and patient “must realize that they are not on different teams.” While the provider and his patient may seem like they prioritize different parts of the healthcare plan, at the end of the day they should understand that they are essentially interested in one thing only, and that is to secure mutual agreement around how treatment can be most comfortable, safe, and ultimately most effective for the patient.

    I believe that healthcare providers are not intentionally trying to avoid the religious aspect of healthcare, and certainly I do not think a majority of them would say that an individual’s values are irrelevant to decision-making in a healthcare setting. I am personally familiar with a doctor who prays for his patients and cares about their faith. What concerns me is the fact that perhaps some healthcare providers do not feel confident enough to speak on matters of faith, because they feel they are unprepared to handle the conversation.

    I think providing religious-literacy and/or compassionate communication training to healthcare providers would provide them with the necessary confidence to include religion into their healthcare plan. The ability to ask and reflect on hard questions is a respectable skillset and should not be undervalued. Having a mix of specific and broad “tried-and-true” questions healthcare providers can prompt patients with in an appointment-session will save time and help them feel much calmer about handling this type of conversation on their own, without the need to page the hospital chaplain. If the chaplain can do it, so can they. As a related aside, perhaps healthcare providers should devote some time in their professional development to actually collaborating more closely with chaplains in order to analyze common patient concerns and religious identities, and ultimately seek to develop the very questions/prompts for patients I propose. I think in a more general sense, as people, we build our own barriers in relationships. We think we are unable to understand something or someone, but that is a lie we tell ourselves. Because of our humanity, we are enough for everyone we come into contact with, because we, too, experience joy, sorrow, anxiety, worry, love, anger, fear, frustration…Let us think for a moment. There is no experience, no emotion we cannot share with another human being, a “stranger” that we have not experienced ourselves.

    In the situation that a patient asks for a treatment plan incongruent with the healthcare provider’s plan, I think that it is the duty of the healthcare provider to explain the implications and his/her reasoning. I think stressing and helping the patient visualize the effect of their plan may help in discussing what is best for the patient. I think everything possible should be done to provide the patient with some clarity as to their situation, or future complications. In the case that the patient is stubborn and motivated by his/her faith tradition, I think the healthcare provider should advise that the patient to go see an elder or authority in his/her religious community and discuss the situation with that person. As a rule, I think it is best to always act out of respect for the patient, even if that means honoring their choices, even when those could result in lower quality of life, health, and ultimately unfortunate death. That said, a healthcare provider should be vigilant enough to step in where unnecessary suffering is concerned, especially when a condition is preventable (different cases = different ethical dilemmas, of course). Also, the healthcare provider should always try to communicate from a place of opportunity at any point of the patient’s healthcare progress. What I noticed in the story Dr. Labrecque told about the doctor who warned the expectant mother needing an emergency blood transfusion is the fact that the doctor stayed with his patient in the operating room, reminded her of the conversations they had, and ultimately still reached out to her and in her moment of distress, still offered her the opportunity to accept the blood (despite her being a Jehovah’s Witness) that would save herself and her child.

    I enjoyed reflecting on these prompts. Thank you! 🙂

  3. Lucky Khambouneheuang says:

    (1) From one of the articles, Astrow advocates all physicians to pay close attention to their patients, including their religion. While doctors may be time pressed to fulfill other medical obligations outside patient interactions, this does not exempt them from communicating and addressing their patient’s concerns regarding religious faith in the context of medicine. When it comes to choosing the best care plan for the patient, religion becomes exceedingly important here because of the boundaries it sets on the treatment of the body. In another perspective, I want to challenge question 1. Perhaps, it is not as important that the doctor spends more time with the patient listening to the holistic story but more about the idea that the physician cared enough to account the patient’s religious concern in the decision-making process. In my opinion, both acts are demonstrations of compassion.

    (2)As discussed in class, physician-patient negotiation can become necessary when a particular religious belief is misinterpreted, perhaps due to eclecticism. One of the core guiding principles in medicine is that a physician should never do harm to the patient. Even though physicians are required to respect their patient’s autonomy, this does not mean they are obligated to cooperate. A contemporary concrete example that comes to mind is Death with Dignity/ physician-assisted suicide. A case scenario where paternalism seems to carry a heavy weight, the physician should communicate his concern regarding the patient’s treatment. In this case scenario, both sides exercise the power of choosing one’s limits.

  4. Kayleigh Jo Moss says:

    I feel like our first instinct would be to say, “Look at their chart. What religion did they identify themselves by?” This approach, however, would be vastly inadequate and lead to many false assumptions. As Dr. Labrecque noted in class, many who identify with one religion are not governed by those religious principles, while others may choose not to identify on paper, yet have firm religious foundations that guide their decisions. I feel that first visits in which a patient and doctor are interacting for the first time should be allotted more time for the two to build a relationship and trust. I think both would benefit greatly and it would establish good communication between the two which will make for more effective use of time in future visits. If time constraints don’t allow for this longer visit then I would suggest doctors pursue intentional conversations with patients in order to understand any cultural, religious, or other experiential concerns that will influence the conduct of the patient’s healthcare.
    There are many factors to consider in deciding how a healthcare provider and patient should move forward when there are disagreements. A couple of things to take into account are whether the patient proposed method of treatment would hurt the patient or hinder the effectiveness of the doctor proposed treatment. It is possible that the treatments can be used simultaneously even if the healthcare provider does not personally see value in the patient’s method. If the patient refuses the healthcare provider’s recommendation for care or if the patient proposed treatment would hurt their health in the provider’s view, then the answer becomes more complicated. While the doctor should give the best advice he knows how and encourage or discourage certain treatments as appropriate, the patient is ultimately responsible for the decision. A patient has a right to seek the treatment they feel necessary and refuse the treatment they feel violates their faith or yields insignificant results. The doctor also reserves the right not to enact a treatment they feel is harmful to the patient.

  5. Kristine Rosenberger says:

    If religion is important for a patient’s identity then physicians should do their best to incorporate this into their care plan. If the physician refuses to acknowledge how important religious concepts are to the patient in terms of health care decision making, the patient physician relationship can be greatly severed. However any implementation of religious aspects into a medical plan must be done with extreme care and ensure that the patient does not come across undue physical harm. As we discussed in class religion and spirituality are directly related to physical and mental health. That being said it is unfortunate that the majority of health care workers are so poorly trained in the study of religion and spirituality. Religion is important to a patient’s health as it can often add to a person’s explanatory model for a particular ailment. A person who believes in an immanent higher power is more likely to feel supported during the treatment process compared to a patient who does not consider religion or spirituality to be an important part of his life.
    The role of religion in medicine speaks to the importance of doctors seeing patients as people and not cases. If a doctor views his patient as a person he is more likely to be concerned with the person’s holistic health as opposed to just the ailment that brought him in for treatment. Holistic health encompasses all five pillars of health, including spirituality and is hence crucial not only to the patient’s recovery but also to his overall wellbeing. Health is more than just the absence of injury or illness, so a patient with a doctor who incorporates religion into his practice is more likely to be healthy than a patient with a doctor who does not.
    Upon the initial assessment a physician should ask their patient if they identify as religious and what, if any, restrictions this identification places on medical processes. It is important that health care workers acknowledge the religious views of patient and do their best to work these views into treatment even if this means finding alternative forms of treatment when appropriate. However once the medical issue at hand transforms into the choice between following the patient’s religious mandates and causing avoidable harm, the physician must neglect the patient’s religious principles in an effort to preserve his life. A physician is primarily a medical figure and hence his first line of response in a life or death situation must be to save the patient’s life.

    A patient asking for a treatment plan based on personal faith tradition that contradicts that of the physician is a difficult issue in contemporary medicine. This given case touches upon potential consequences of both religious illiteracy and eclecticism. I think this potential for error is especially pertinent in the given example and what stands out to me in the posing of this question is the use of the word “says” (“…a treatment plan he SAYS is motivated by his faith tradition”). Many people who consider themselves devoutly religious either have very little knowledge of the actual aspects of their religion, or chose to focus only certain mandates that support what they want, either knowingly or unknowingly. The patient could use bias while interpreting religious text. This is a difficult dilemma as it in essence pits the authority of the patient against that of the physician. They could potentially be guilty of interpreting the text out of context in order to find support for the treatment they desire. This makes it extremely difficult for a physician to proceed not sure if it is truly a religious mandate or simply the patient relying on extreme means to obtain the desired form of treatment.
    This scenario is increasingly difficult to solve if the patient’s religion causes him to refuse a life saving form of treatment. Obtaining consent is a difficult procedure and even if the patient affirms his desire to stand by his religious driven decision under a normal circumstance, if the hypothetical emergency arises there remains the chance that the patient will change his mind in favor of what will save his life. In class we were given the example of the Jehovah’s Witness who would need emergency surgery should she become pregnant. Even though she initially declined the operation, when it became a matter of life and death she made the choice to forgo her religious teachings. This situation shows that some type of conflict in these types of situations is often unavoidable, even for the patient who makes the initial decision. Therefore I think the best course of action in a dire situation when forced to choose between a patient’s religious convictions and a patient’s life is always to save his life. A doctor’s first and most important duty is to save the life of his patient, and religious convocations should not provide an exception to this standard.

  6. Emily Monika Pieper says:

    As we discussed in class this past week, healthcare providers are constantly under a time crunch to see as many patients as possible. Due to this fast paced care environment in which physicians provide the minimal level of care, there is little time to consider and accommodate for a patient’s religious beliefs. As Lucky mentioned in his comments, it would be better for healthcare providers to at least ask a patient about his or her religious beliefs instead of never expressing any concern for a patient’s religion. By simply taking a minute to inquire about a patient’s religion, the healthcare provider can practice more compassionate care. Understanding the role religion plays in the lives of their patients will allow for a better quality of healthcare by enhancing communication. Healthcare providers will be able to take religion into account when they discuss treatments with their patients, and patients can feel more compassionately cared for knowing that their doctor is at the very least aware of their religious beliefs. Ideally healthcare providers would take the time to sit down and discuss patient religious beliefs more in depth to gain a better understanding. However, since doctors are often strapped for time, this basic surface level understanding would be a good starting point for incorporating religion into healthcare decision-making.

    Sometimes a patient asks for treatment that completely contradicts what the healthcare provider suggests based on medical reasoning. In this case, the patient and his or her healthcare provider should have a serious discussion about care options. As previously mentioned by my colleagues, patients who cite their religious faith as a reason to circumvent the medical advice given by their doctor may not always be fully informed about their religious traditions. Sometimes patients will cite select passages or traditions to support their choice against their doctor’s advice, and disregard those that would align with the doctor’s proposed medical treatment. This is not to say that all patients who are religious are unjustified in their requests to not follow the proposed medical advice. Healthcare providers should however be knowledgeable about religious beliefs and be able to reason with patients who are opposed to necessary medical treatments. If a patient is truly justified in their religious beliefs to forgo their doctor’s medical advice, then their wishes must be respected. In the end, patients should have the final say in their treatments because their bodies belong to them. If however a patient has not discussed his or her religious beliefs with their medical provider, then the doctor should perform any procedure necessary to save the patient’s life.

  7. Kyle Arbuckle says:

    Astrow et al has a great suggestion for how to address a patient’s religion, and that is to simply ask them (Religion, Spirituality, and Health Care 285). This does not have to be a lengthy discussion, especially if the doctor is on a strict timeline. But either including it in patient questionnaires or just basically asking a patient what religion they are, if it is important to them, and how much consideration to it should be used in treating them. A key thing Astrow et al discusses is that doctors should feel comfortable praying with patients. I would agree with this notion because it demonstrates that you are truly invested in the entire livelihood of the patient, not just the medical outcome, and this will help the outcome overall. Lastly Astrow et al recommends that doctors refer patients to spiritual/religious persons, and I would also agree with this. Obviously a doctor trained in medicine cannot answer all the spiritual/religious questions a patient will have, but having a group meeting with a spiritual/religious leader and a patient will show the patient you truly do care about them as a holistic being.

    The second question is obviously a difficult one to answer and Curlin et al provides some direction in the journal “When Patients Choose Faith Over Medicine”. Curlin et al provides various examples of doctors discussing when there is a tension between the patient and doctor, and honestly I am somewhat appalled at some of the answers. Many of the doctors seemed to be in opposition to their patients belief from the outset as some discussed how they inherently disagreed with Catholicism and certain sects of Judaism. Yet, if they simply look to Astrow’s advice and seek a relationship with the patient, the patient will seem more apt to take care from a provider. As Professor Labrecque mentioned in class, many providers run when a patient starts discussing religion, and this is probably very off putting for patients, and they therefore feel distrusting of doctors. As we also discussed in class, doctors are the experts and there is no denying that, so patients should go into a relationship with a doctor recognizing this. In essence the relationship should be mutual between the two.

  8. Akanksha Samal says:

    I definitely think healthcare providers should incorporate their patients’ religious or spiritual beliefs into their care plan, if the number of people who have stated that their belief affects their healthcare decisions is anything to go by. While I do not think providers have to be experts in the field of religion (though that would be helpful), I do feel that religion should be addressed as part of a medical student’s curriculum not only to right any wrong impressions one may have picked up along the way, but also just to help increase one’s awareness of religious and cultural differences. By incorporating a patient’s religious identity into their care plan, a care provider shows that he or she acknowledges that their patient is more than their physical body. This consideration is an act of personal interest and compassion. I agree with the example several of my peers identified from the Astrow reading. I thought the way the question was framed was very simple, and straightforward in line with what Olha stated about not beating around the bush.

    While time is an issue in modern day medicine, I firmly believe that if one cares enough, one can take the time to ask a question that may not take more than a handful of minutes. Doctors of osteopathic medicine do, on average, spend more time with their patients. I feel allopathic practitioners can also do the same. While initial consultations naturally run longer than regular visits (which often leads to the time being cut out of another patient’s appointment or a provider’s personal time), if they are actively scheduled to be longer so that the doctor has time to learn more about their patient beyond their physical illness, the doctor has that scheduled time to inquire about their patient. Perhaps the longer appointments can be repeated every few months to facilitate a deeper doctor/patient relationship. By inquiring about a patient’s religious or spiritual beliefs, if they have any or not, a healthcare provider can earn their patient’s trust.

    Although a healthcare provider indeed has the knowledge and expertise to support their reasoning, a patient has all rights to refuse treatment due to their religious or spiritual beliefs. There are several examples of challenging cases, such as when a patient is underage and his or her views conflict with not only their provider’s views, but also their guardians’ views. This is where proper communication is crucial. A healthcare provider’s goals are, ultimately, to help his or her patient overcome their illness or injury, and, ideally, preserve or improve their quality of life. While I do not agree with the doctor who stated that in order to help his patient he “just planted ideas into her head” (Curlin 95), I do think a physician can offer alternative suggestions instead of manipulating his or her patient when they are not in their best state of mind (such as the Jehovah’s Witness patient we talked about in class). At the end of the day, a provider can provide suggestions that compromise their own concerns for their patient’s well-being and their patient’s autonomy, but as Emily said, a patient’s body is their own, and it is up to the patient to make the final call.

  9. Lauren Maryse McNaughton says:

    As many of my colleagues mentioned above, I believe the patient’s faith should be strongly considered and incorporated in the treatment plan when requested and when feasible. I understand this is a difficult thing to do for every patient because physicians are very tight on time. However, I believe neglecting important parts of an individual’s life when they are so vulnerable is what helps the stance of disease over the individual continue to exist. We mentioned the importance of treating the individual who is sick versus treating just the disease. If important factors that contribute to a person’s life are constantly being neglected, such as faith, it becomes much easier to just look at the disease and the medicine versus treating the person as a whole. Ideally, I believe physicians should take the time to discuss these major contributors to a person’s life with the patient or their family. For example, a family member of mine was diagnosed with cancer (now cancer free!). The entire team made a strong effort to learn what she wanted and a discussion transpired to make sure all the important aspects of her as a person were met (with that being said, none of these requests conflicted with her main goal of survival). I’m aware this isn’t realistic for all field of medicine, such as ER medicine where everything happens very rapidly. In such cases I do believe the best way to handle it is to focus on saving that person’s life first; then address any personal conflicts after.

    For the second question, I believe it depends on what the end result will be. For example, a patient may want to be treated in a certain way that may not be the easiest route, but it also isn’t completely detrimental to their well being. I believe, in this case, the wants of the patient should be considered and followed. It may not be the best or most efficient mode of treatment, but they may still be able to regain their health. However, the requests of the patient may result in detrimental side effects or death. In this case, I believe a series of discussions with the patient, and maybe even their immediate family or religious leader, need to occur. This is a conversation every party involved must be open to- both physician and patient. It was mentioned in the Neglect of Spiritual Needs section of Chapter 36 of the Health Humanities Reader that a possible reason healthcare providers tend to back away from such conversations is the “lack of confidence and competence” in caring for patients spiritually (Jones, Wear, Friedman 378). As I mentioned last week, there must be a sense of understanding and openness when having such a conversation; even if the physician doesn’t necessarily agree. The patient must also be open to hearing the physicians point of view, and understand what the end result will more than likely be if they do not follow the suggestions from the physician. This may also be a bit difficult to do when someone is not looking death directly in the face. This is a great point brought up in the lecture last week with the patient who was a Jehovah’s Witness. She did not realize what she was willing to do to save her life and the life of her child until it was clear they were both very close to death. However, I believe the physician handled this situation well, by giving the patient the facts, and waiting for her go ahead to treat as necessary. Therefore, in the case where the well being of the patient is seriously at risk, there must be an open discussion between the patient and the physician, where the concerns of the physician and the patient are both seriously addressed. However, as mentioned by my colleagues above, the final decision is one the patient must come to on their own…whenever that may be.

  10. MacKenzie Jill Brosnahan says:

    I believe that healthcare providers need to take into serious consideration the religious beliefs of their patients. The first thing that needs to happen in order for a healthcare provider to handle a patient’s wishes regarding their health is clear communication. If religion is an important factor when deciding what to do in a medical situation, the healthcare provider needs to be aware of this importance. As one of my classmates pointed out, this initial conversation can be difficult, especially when healthcare providers are strapped for time. It’s rarely the case that a patient’s first words out of their mouths include something about their religion. So, while it may seem a bit strange, I think it’d be a good idea to include a spot on the questionnaire patients fill out before they are seen by a healthcare professional where the patient can list their religious beliefs. I’ve already seen this done at my hospital back home, but I’m unsure if this is a widespread practice. While this idea is not ideal for medical settings dealing with emergency situations, it can give the healthcare provider an cue that this may be a topic that needs to be discussed with the patient when they have time to talk face to face. Then, the patient’s religious beliefs can be discussed and worked with when deciding the path of treatment.

    Even if a patient’s idea of treatment completely contradicts what the healthcare provider has in mind, I believe that the healthcare provider is obligated to hear out the patient’s wish for their treatment. There needs to be an open discussion where the healthcare provider and the patient are able to sit down and discuss what each person thinks and why they believe their treatment is the best option. This allows the patient to understand where the healthcare provider is coming from and maybe even learn about the treatment that the healthcare provider proposed. On the doctor’s side, listening to what the patient has to say might open up areas for discussion when the doctor can help alleviate worries or misconceptions about the treatment the doctor wants to proceed with. Now I know that this alone will not solve all of the provider/patient issues, but it will hopefully allow each side to have a better understanding of where the other is coming from. At the end of the day the healthcare provider must listen to the patient’s wishes. For example, if a patient signed a DNR, the healthcare provider cannot, by law, resuscitate the patient if it is needed.

  11. Amelia Elizabeth Van Pelt says:

    Unfortunately, the time spent between the physician and the patient in the exam room is decreasing. As a result, the physician must collect as much crucial information as he or she can in a small amount of time. For many, they may focus on gathering family history or information about current symptoms due to their training in medicine. However, the physicians may miss an influential factor in the patients’ treatment plan: their religion. As discussed in the readings and in class, religion plays an important role in the medical decision-making process of a religious person. Furthermore, treating patients as wholes, including their spirit, yielded better health outcomes. Unfortunately, however, certain beliefs, such as the prohibition of blood transfusion for Jehovah’s Witnesses, can thwart a physician’s treatment plan. Therefore, a physician must address the religion of a patient. However, I disagree with some of my colleagues, for the physician should not just outwardly ask about a patient’s religion. Although the physician has a limited amount of time with the patient, he or she should take nonverbal cues instead. For instance, if the physician sees a bible on the table or a yarmulke, then he or she can bring up the topic of religion. If nonverbal cues do not exist, then the physician can open the conversation in a different approach. For example, he or she can begin the appointment by providing the patient the opportunity to express concerns. If the patient worries about a religious belief’s influence on his or her treatment plan, then he or she will more than likely express it. After all, we have discussed the idea that religion becomes a part of a patient’s identity. Moreover, by avoiding the direct question of religion, the physician can prevent certain situations from occurring. For instance, if the patient does not follow a religion, then he or she may be put off by the question about religion. As a result, a sense of distrust in the physician’s medical abilities may arise. On the other hand, however, not addressing a patient’s religious beliefs could lead the patient to distrust the physician as well. Thus, the conversation about religion in the medical field presents many challenges, especially in a setting pressed for time. Nonetheless, however, a physician should treat the patient as a whole, which includes his or her mental concerns stemming from religion.

    Although the physician has agreed to address the religious concerns of a patient, those beliefs may contradict the physician’s treatment plan. As a result, a complicated situation occurs that requires careful consideration of bioethics. For example, the physician must not take away the autonomy of the patient over his or her body. However, a physician may feel that he or she took an oath to “do no harm” and to provide the “best” medical care possible. Therefore, the physician should consider the status of the patient, such as a minor, and the influences of the patient’s religious beliefs, such as parents. In the end, however, the patient should have the right to decide his or her own medical decisions. Thus, a physician in disagreement with a patient’s refusal to pursue treatment can proceed in a couple of ways. To begin with, the physician can provide evidence for the suggested treatment, for the patient may not have the knowledge on the science. Furthermore, as the article articulates, the physician can attempt to say that “God provided this technology for the treatment” etc. In addition, he or she can try to remain open-minded to examine the potential benefits of the patient’s proposed treatment plan. After conducting research on a particular practice, perhaps the physician could incorporate it into his or her original treatment plan. Moreover, if the patient is not proposing an alternative form of treatment but rather just refusing the physician’s plan, then the physician can simply remove himself or herself from the case. After all, a physician’s oath to “do no harm” includes not compromising the care of the patient. Thus, if a different physician can address the religious or spiritual beliefs of the patient, then the original physician should find that alternate.

  12. Courtni Alexis Andrews says:

    I think that healthcare professionals, specifically physicians, should adopt a model that facilitates conversations about the “whole” being, rather than what the patient history and report reads. It’s easy when you’re strapped for time to “speed date” patients and only facilitate discussion and dialogue when times are dire, but just like how speed dating works to create relationships between two strangers who really hit it off, I think physicians should really aim to get to know their patients, even if they only see them once every so often or once at all. I don’t think prying or being so invasive is the right way to approach this, but being compassionate and communicating with someone about who they are while keeping knowledge of their mental and physical well-being, history and life facts is the best way to approach this problem of time. I also think it’s important to emphasize a team model approach – one of the most important messages I have been told by medical staff that I work with is that, while doctors are considered the “brains” of the operation, nurses, social workers, psychologists and other professionals are the arms, legs, soul, body and help mold the identity of people, patients and the world around them. Doctors should work with their teammates to get the entire picture of who someone is to provide the best care. As others have mentioned, osteopathic physicians and nursing professionals already incorporate models of care that allow their patients to really get to know them, but the system of medicine for allopathic physicians seems to circumvent this ideal. Therefore, by being active in communication, listening and inquiring and working with other professionals, religion can be incorporated into the conversation of who someone is.

    As for contradictory views, I also agree with the comments above; although physicians should make sure to provide the best care for patients by giving them options, facts and possibilities, patients still have the right to choose what method or treatment option they wish to consider for themselves. Whether they are a young adult or an elderly individual, it is not right or fair for a physician to disallow a patient to make a decision that they have thoroughly thought about it or contemplated on their own, once the physician has evaluated and explained in entirety what each option would mean. I would recommend that physicians encourage their patients to really think about their decisions with close confidantes, friends and family if they choose to, but it would be best for physicians to stand their patients’ choice if they have understood what their options means.

  13. Farida says:

    Patients should have the right to incorporate all worries and aspects into their meetings with their doctors if it affects the treatment and the relationship between the patient and the doctor. Religion should be one of these things, especially if it motivates treatment or action plans. While it would be extremely difficult due to time constraints, the idea of taking religion into consideration should be the same as taking a patient’s medical or narrative history into account. Even if concerns are expressed briefly, at least they have been expressed. This allows for trust between the patient and the physician, just like MacKenzie stated above.

    Patient autonomy is a huge issue especially in treatment plans that are affected by someone’s faith. Cory’s story about being lucid during decision making is something that really struck me. While being challenged with death, the patient let go of his or her religious needs in order to survive. I think for both the patient and the provider, it is important to communicate recommendations along with reasonings to ensure that they both have an idea of what he/she wants and why. A patient should have a say in the decision-making process, but not without considering the recommendations and reasonings of the provider. The same goes for the physician. This is exactly what Courtni and my other colleagues mentioned in their responses. “Do no harm,” like Amelia states, is the Hippocratic Oath, and there is a gray line in helping someone survive, especially when it causes pain to do so.

  14. Jennifer Becerra says:

    Just as my classmates have said, patients have the right to incorporate religion into their their worries especially if it is a defiant of their identity. If the health care provider does not take the time to discuss the patient’s worries then they could lose connection with the patient which could ultimately lead the patient to disregard the doctor’s orders. There is also the case in which the patient can’t do a certain procedure due to their religious beliefs such as it is the case with Jehovah’s witnesses not being able to get blood transfusions. If this is not discussed prior to a procedure, the transfusion could happen and the patient could be left feeling like they betrayed their faith.

    I feel that this is a scenario that is seem often with health care providers and patients. Many health care providers get frustrated and ask themselves “Why can’t they just listen to me?”, since the primary reason for the patient being there to get consulted by the physician. In these cases, however it is important to also take the patient into consideration. They are being asked to do something that goes against what they believe. Therefore what should be done is that the health care provider should inform the patient and let them know all the risks associated with the alternative treatment plan that they want. Once they are well informed then the patient should be able to chose what method they want and the health care provider must respect this decision even if it is not the option they recommended.

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