Waltham, Mass. - Modern medicine, with its profound dependence on technology, often seems nothing short of miraculous. But even the best medicine sometimes falls short of offering a successful treatment or cure. It is in these situations that recent national surveys show many Americans think God can help.

Indeed, three-quarters of Americans believe God can cure people who have been given no chance of survival by medical science. More than half of Americans regularly pray for their own health or the health of their family. Yet many physicians are unwilling, or ill-equipped, to support patients and families on this level.

Many doctors see religion and spirituality as a barrier to medical care or, at most, a useful crutch when medicine has no more answers. But healing involves more than just medical diagnosis and treatment. Often patients and families see spirituality as a source of support when they are ill, or appear to be dying.

A holistic approach to medicine requires physicians to understand the complex role of spirituality and religion in compassionate patient care. The best prescription: Integrate these topics throughout medical education.

What physicians get trained to do
Rice University sociologist Elaine Howard Ecklund and I wanted to find out how physicians respond to patients' spiritual and religious beliefs in their work. Of the 30 academic pediatricians and pediatric oncologists we interviewed, few learned about spiritual or religious issues they might encounter in patient care during their formal medical education.

About a third spoke informally with colleagues about issues of religion during training. Some reported taking steps on their own to get to know hospital chaplains and talk with them about death and dying, family decisionmaking, and how to respond to patients and families who are very religious - especially Jehovah's Witnesses and Orthodox Jews.

Almost none of the physicians we interviewed learned how to respond to religion and spirituality as they often learn other skills - by observing how senior physicians model them.

In another recent national study of physicians, University of Chicago physician Farr Curlin found that only a quarter of the physicians surveyed reported having received any formal training at the intersection of spirituality, religion, and medicine.

This may be changing, however, as a growing number of medical schools - many with the support of the George Washington Institute of Spirituality and Health GWish) - started offering courses about spirituality and religion during the past 20 years. These courses try to prepare students to engage in a broad range of conversations about spirituality and religion. Individual courses vary significantly, however, leading GWish to collaborate with medical schools to develop six core competencies in spiritual and health education and to design a uniform way to measure and evaluate them.

While such top-down efforts are a good beginning, it's clear that most practicing physicians have at least some level of discomfort regarding spirituality in their work, and some consider it a real source of conflict. Our bottom-up research approach - based on talking to physicians in the field - convinces us that a more nuanced, flexible approach to helping doctors and medical students navigate the spiritual shoals is needed.

A holistic approach
First, physician educators must pay attention to the way they and their colleagues act around spirituality and religion in their work. Too many debates about spirituality in medicine are focused on what physicians should do rather than what they are actually doing now.

While some are silent, others have developed ways of responding to or accommodating discussions of spirituality and religion that may be instructive. For example, we asked physicians whether prayer comes up in their work. All reported that it does, at least occasionally, usually when a patient or family member asks them to pray for them.

The physicians described a range of ways they respond to these prayer requests. While a few do pray with patients, many more reframe such requests in ways that feel more comfortable to them. They might stand silently in support of patients while family members or chaplains offer prayers, for example, or speak at funerals rather than lead prayers, as some families have asked.

Second, doctors should pay more attention both to people's religious traditions and to their broader senses of spirituality and meaning.

Given recent survey data showing how often people combine religion and spirituality, and how helpful either one or both can be, being sensitive to questions of spirituality and of religion is especially important.

This means engaging with patients when they want to talk about their religious background or attending religious services and being open to broader conversations about spirituality and meaning.

There are lots of different "spiritual tools" available for physicians. One example is a set of questions healthcare providers can ask patients to gather information from them about their religion or spiritual needs. Having questions on hand that address faith and belief and how medical professionals can address these issues in healthcare can help.

Third, it makes sense to systematically include hospital chaplains and nurses in educational initiatives. Two-thirds of American hospitals have chaplains, and nurses have a much longer tradition of talking with patients about spirituality and religion at the bedside than do physicians. Nurses also often spend more time with patients than do physicians.

Although physicians frequently spoke with us about Jehovah's Witnesses and Orthodox Jews, it is important for them to remember that a broader range of people see spirituality and religion as important to their healthcare.

It seems that physicians often forget that religious and spiritual issues are important to people all the time, not just when chaplains are called in hospitals, which is often in end-of-life situations.

A holistic approach to taking care of people, one that will most help those who seek healing, means that more doctors will have to begin to understand patients' complex relationships to spirituality and religion, rather than ignoring them.

Wendy Cadge is associate professor of sociology at Brandeis University in Waltham, Mass. She is working on her second book, "Paging God: Religion in the Halls of Medicine."

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