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We need to bring God into general practice

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Increasingly, it appears that the medical profession is becoming a no-go area for God. It is possibly the clearest area where practice differs from policy. The RCGP curriculum emphasises the need to ‘promote equality and value diversity’ and we all have to undergo regular equality and diversity training as part of our mandatory training programmes. University curricula include the importance of faith and different worldviews in healthcare. NICE and similar organisations are increasingly including the provision of ‘spiritual care’ in their guidelines, notably in cancer and palliative care. In short, we should be able to provide spiritual care to our patients, as well as respect our colleagues who have a personal faith.

So why is it that so many doctors find it so hard to be open about their faith in the workplace? And how confident are we at providing spiritual care, or at least signposting spiritual care, to our patients?

The patient in front of us may well be looking for spiritual answers

I think part of the issue is that our profession may underestimate the importance of spiritual care as Government data still largely relies on measuring organised religion. In the 2011 census only 25% of the population reported that they had no religion. On the other hand, a staggering 73% of adults in London pray. One in five adults attend church at least once a month with one in three adults believing that God is watching over them and will answer their prayers.

Too often my friends who are atheists or agnostics point to declining Anglican congregation numbers as evidence of increasing secularisation of Britain. However, it is clear that for the post-modern generations and millennials, faith is much more personal than attending a building on a specific day of the week. And it appears that when the going gets tough even more people would turn to prayer: a Church of England survey found only one in seven people would ‘never resort to prayer’ if they ran into difficulty in their lives. It appears that people born in the 50s and 60s are least likely to pray, with younger people more likely to pray than their parents.

And this leads us to a new problem facing us in primary care. In the past, if someone who believed in God was faced with a terminal diagnosis, they would more often than not already be established in a community who shared their religious beliefs, who could support them as they navigate the inevitable doubts and stress that such a diagnosis brings. With the latest millennial generation, they are more likely than their parents to have a spiritual worldview, yet are less likely to be part of a community who can support them through such a period. Where will they turn? Who can they ask? What would I say? What can I say?

Hospitals traditionally have been very good at having chaplains of many different faiths, and able to signpost other faith based organisations. Primary care has been slow off the mark. There are a few primary care chaplaincies across the country, and NHS England notes ‘a small but growing body of evidence links the use of chaplaincy to reduced stress, anxiety, depression, isolation and spiritual disease. These benefits have the potential to enhance patients’ resilience in the face of illness.’

At the end of the day, a GP may feel secure in their atheism or paralysed in their theism, but the patient in front of them may well be looking for spiritual answers. Which leaves me asking that classic opener for consultations: ‘How can I help?’

Dr Phil Williams is a First5 GP in Lincoln, and former RCGP National Lead for the First5 initiative 

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Readers' comments (41)

  • Shame about your headline here. If my GP started trying to bring their own belief in God into my consultation I think this would be absolutely inappropriate and would be outraged and never see them again.

    However, gently asking patients about their beliefs, without telling them my own, (unless they specifically ask me) has long been my practice, and is a very good thing, particularly near the end of life.

    Leave your own beliefs out of it, and concentrate on your patients beliefs.

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  • Great idea. I always thought Eric Clapton would make a fantastic GP...

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  • This is about as wrong headed as can be. We have quite enough to deal with without having to confront weird "spiritual" beliefs that are largely a hangover from the dark ages.

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  • Befire I die can you sort out the stinging nettles in my garden

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  • How can I help?
    Within the bounds of my surgery I am a doctor first, any belief in sky faries or established deities is my business. I can help you as a physician; look to your own faith group for spiritual healing and if your looking for love then you are in the wrong place! Marvin Gaye might help.

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  • He's from the RCGP.
    Of course.
    Fruitcake anyone?

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  • Some of the comments here are incredibly offensive and demeaning. The ignorance and judgemental attitudes of colleagues is obviously also a reason why people find sharing their beliefs of any denomination at work difficult.

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  • I agree with Michael Caley and just hope that more empathy, maturity, tolerance and respect is shown to patients than is displayed in some of the comments.

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  • Well said 8:03.

    There is a huge benefit in encouraging patients to explore how their suffering relates to any spiritual beliefs of their own.

    There is no value in volunteering an unasked opinion on how it relates to our own spiritual beliefs.

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  • Unfortunately for the atheists among us who have faith that there is no god, they have no one to pray to. I think 5:05 pm is in danger of bringing the profession into dispute if that is how he treats patients. I pray he becomes more tolerant of others

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  • Jamie Green

    Nice blog... I think there is something about valuing patients beliefs and accommodating patients expectations no matter how whacky or far out they are, after all this is the undercurrent of the mental capacity act.

    I do think we should not be scared about bringing this up, and sometimes it is hard to do, but if done right then I believe this is useful for some patients.

    You know my feelings on religion and mythology, as we have discussed them at BMA events before.

    The counter narrative here is what we often see the danger that "dodgy-theology/mythology" can get in the way of good-medicine. Indeed many faith based groups try and promote compassion, while actually using religion to control their 'followers'.

    We should be mindful that in more extreme communities spiritual leaders might be offering advice which is poorly evidenced, or not in the patients best interests.

    And I guess all the more reason to be aware of what the patients thinks / feels / believes.

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  • Like any placebo effect- if it works, great. Placebos are known to work even if people know they are placebos. I'm a complete atheist but I find myself praying when in trouble an it works.

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  • Agree completely with the first post - those advocating either foisting their own beliefs on vulnerable patients or those not respecting the beliefs of the patient are in my view equally bad.

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  • You might as well bring in homoeopathy. Keep superstition out of evidence-based medicine.

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  • Good consultation skills demand a fusion of art and science, sure, but as doctors in the 21st century we are surely scientists first? That means discussion about whichever brand of sky fairy or bearded prophet you chose to believe in outside the consultation room should stay outside the consultation. That goes for patients too; whether they are at Mosque every Friday is simply not my affair. I just don't care. I don't know what I am supposed to say to such people after I have finished telling them they have brain Mets and won't make Easter. Jesus loves you? And, fusing religion and medicine with some spurious evidence-free guff about spiritual health makes me positively queasy. Practices who style themselves "Christian Medical Practice" and who start practice meetings with a prayer - I have worked as a locum in some - scare the pants off me. Neither do I think the NHS should be funding Chaplains, anymore than they should be funding leeches in Haematology or a Ducking Stool in the Psychiatric unit. What my patient eats has a bearing on their health, but I don't tell them where to shop, give them recipe cards from a 2000 year old cookbook, or recommend ond local supermarket over the others. We have quite enough to pack into our 10 minutes without coming over all Harry Seacombe and bursting into Abide With Me over a gangrenous foot. Can we stick to what we are trained to do, Phil?

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  • First5 eh? The first 5 minutes of the day you commune with God. That's good. As long as it stops there.

    No proselytizing. No hell and damnation. No smug I've got an imaginary friend who loves you too.

    I come for a consult not a conversion. Leave it Phil.

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  • As part of palliative care, I am sure some patients find spiritual care important. Maybe families though would be in the best position to ensure their "healer" is sourced appropriately.

    For the other 95% + of general practice it certainly isn't.

    The thought of pre-practice meeting prayers sound scary to me too Gp 8.02pm.

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  • We have discussed this before Phil and you know my opinions on religion in practice.
    Yes, if it is important to a patient, that should be dealt with, by a priest, minister etc. Many people rely on caffeine, I don't plan on becoming a barista.
    If a doctor has religious faith, then I suppose it could be discussed if the patient initiates however on the same level as I share my thoughts on helpful books etc.
    What must NEVER happen is religion used instead of good medicine, religion influencing the choice of treatment or the doctor forcing their religious views on the patient.
    And it is those events that I have been party to in places I have worked with religious individuals and that is unacceptable. The GMC agreed when a patient complained.
    The more evangelical the GP, the more I worry.

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  • May I also add that no practice should be allowed to define itself by the religious beliefs of the partners. No "we are a Christian practice, we are a Muslim practice, we are a spaghetti monster practice". That is where the rot really sets in and it has no place in medicine.

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  • The last time I brought Cthulhu worship up in a consultation, I got a complaint.

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  • If I were a Jedi though I could use mind tricks like 'these aren't the antibiotics you're looking for.' 'you want to go away and re-think your life.' I go into training tomorrow. Although definately turning cash into wine before I get home.

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  • I am very confused by this blog and have had to read it several times.

    The author associates the promotion of equality and value of diversity with providing spiritual guidance. How are these two areas connected?

    As an atheist working in a multi-cultural area, I aspire to respecting people's cultural and religious beliefs when discussing health beliefs and treatment decisions. I have no idea why I need to be responsible for providing "spiritual guidance" whatever that may mean. I am more than happy to discuss the support a depressed or grieving patient may be getting from the church as it is part of their recovery plan. But I in no way equipped with providing this type of guidance,and neither should I.

    This reads as another one of the long list of "GP is best placed to ........" (insert anything from check your boiler to screen for gambling)

    As an aside, I do feel that there is absolutely no place for religion in schools, the NHS or anything public. Perhaps we need an Meriden style constitution

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  • *American style constitution

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  • "there is absolutely no place for religion in schools, the NHS or anything public"!!!

    You seem to be suggesting that atheism is the only belief that should be allowed in public.

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  • I agree with you Phil.
    As GPs we are hugely privileged to be trusted by our patients with some of the most intimate areas of their lives. If during the course of our getting to know them we become aware that they have a faith, or that they are wrestling with the big questions of life, then it is entirely reasonable to include that in our duty of care towards them.
    We may not be qualified to provide the answers (and in many cases there may not be answers) but we should at least be comfortable in signposting them to someone who can help them. We signpost people all the time for help with other things for which we lack answers - relationship issues, addictive behaviours, stress, anxiety and depression - why should spiritual needs be treated differently from any of these?
    What you are suggesting is a world apart from ramming our own views down patients' throats. I find it sad and rather concerning that some of those commenting don't seem to recognise that difference.
    I have never yet had a patient take offence when I have inquired about spiritual needs; rather I have lost count of the patients who have been enormously grateful to me for legitimising those needs and helping them to address them.

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  • Patients come in hope, not trust. They hope that they can trust you to get them better or at least do your best for them. My beliefs if any are irrelevant, but if I had a choice I be a Jedi or Yoda. "Pills wanting are you? Getting are you if clinically indicated are they. The Force is strong in this one.."

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  • If I'm not mistaken religiosity or having faith is probably more prevalent than atheism in most societies, so I fail to see why some commentators seem to by openly phobic to those who have faith, either patient or practitioner.
    Its rather insulting in fact to pronounce other peoples beliefs as 'fairies in the sky' or 'mumbo-jumbo' just because you do not believe in God. Are those who hold such intolerant views on religion and happy to espouse them on line, the same bunch to go epileptic when similar viewpoints are expressed and directed to those of different sexuality or race to them?
    This article only commented on the place of religion in the lives a lot of our patients, and how it might be addressed particular by those who share the same belief. It is not attempting encourage atheists to renounce their non-belief in respect of their religious patients, just a clarion call to practitioners of a religious nature not to feel marginalised by the wholesale secularisation of the medical profession and feel forced to hide away their faith from those who might benefit because of ridicule or venom of those atheist who feel superior in their divine knowledge of certitude.

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  • I agree - there is a lot of comfort for a religious patient if they know a doctor also has a faith.

    But to say that we should provide "spiritual guidance" is confusing and comes across a little paternalistic.

    As an atheist, I will openly discuss a patient's feelings about God and the afterlife if it is appropriate to the situation. It is called being professional.

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  • 'Compassion with science' is the RCGP motto- where do atheists get their compassion from ?

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  • I agree Shaba, clinician should be free to practice in a manner that is appropriate to each particular situation and conscientiously. But, I find it difficult to believe that those who can belittle other peoples faith so openly and disdainfully, as has be witnessed on here, can truly be considered as having a 'professional' attitude.

    I am sure you are very aware of the concept of unconscious bias and how adversely that can effect behaviour and outcomes (see CSA debacle for details). As was said previously a lot of patients are religious, and just like I would not expect a religious doctor to think less of those patients who they think are faithless nor try to convert them, I would also like to think atheist doctors do not hold disparaging views of patients with faith even they don't express it overtly- i.e. ACT professional. Its the unconscious bias effect that could adversely effect the patient outcome of any clinical encounter by either group, no matter how professional the clinician (religious or atheist) thinks they are being.

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  • "Regardless of race, creed, ideology, political bloc or economic region, the most important and basic aspect of all people is their shared humanity, the fact that each person - young, old, rich, poor, educated, uneducated, male or female - is human. This shared humanness and thus the shared aspiration of gaining happiness and avoiding suffering, as well as the basic right to bring these about, are of prime importance" HH Dalai Lama

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  • How a highly educated human being can be religious is beyond me. It must take a lot of denial and turning a blind eye to science during medical school.

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  • On the contrary. There is no conflict between science and belief in God.

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  • We all express our world view to some extent and the most aggressive proselytisers in my experience are those with an atheist world view. Surely in an advanced society we should live peaceably with a freedom of belief as long as that belief does not lead to aggression or violence. Heaping abuse and controlling by ridicule are not markers of a higher evolutionary process. It is totally inappropriate to force our own belief structure on patients, using our position to gain credence whether atheistic or faith based, however neither should we suppress who we are, it is a matter of mutual respect both with colleagues and patients.

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  • Science catecorically proves there is no god. It is very difficult indeed to ignore the evidence, yet many do. Pure denial.

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  • Samuel Lewis

    One opener of mine was "why are you here"

    "Why are any of us here" came the riposte.

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  • God can't save you from a Conservative Government, but at least these holy docs have something to fall back on when the NHS goes tits up in August.

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  • "Science catecorically proves there is no god. It is very difficult indeed to ignore the evidence, yet many do. Pure denial."

    No it doesn't

    If believing in God is equivalent to "sky fairies" the what is the belief in "millions of non-organic particles randomly came together in a Big Bang to form organic matter and sustainable life forms"?

    The calculated scientific probability for the above via the standard scientific method would clearly reject this outright.

    Believe in what you want, that's your business.
    But don't claim theories to be facts.

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  • 0:12 you were up too late last night.
    The big bang didn't directly create organic matter or life-forms. It took many aeons of repeated star formation and destruction through supernova explosions to create the heavier elements necessary for complex life to develop.

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  • @4.11

    Your explanation, if true (debatable - links to evidence please) would the explain how heavier elements formed.

    This does not equate organic matter.

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  • Thanks Phil for the encouragement to talk about God in General Practice.

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