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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)

  • 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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