According to background information in the article, many patients use their religious beliefs and values to understand, cope with, and navigate their experience of illness, and at times, these beliefs will conflict with physicians' recommendations. How physicians should act in response to such discrepancies has been a topic of discussion; however, little is know about how these disagreements should actually be negotiated.
Farr A. Curlin, M.D., from the University of Chicago, and colleagues conducted one-to-one, in-depth interviews with 21 physicians in order to explore conflicts between medical recommendations and patients' religious commitments. Of the physicians interviewed, seven identified themselves as non-religious (either no affiliation with or no practice of any religion), six as Protestant, four as Jewish, two as Catholic, one as Hindu, and one as Buddhist.
Nearly all of the physicians interviewed related circumstances in which patients used religious terms to describe their disagreement with medical recommendations. In general, the researchers found that patients most often refuse medical recommendations for religious reasons in scenarios of relative medical uncertainty in which treatment offers moderate possibilities of benefit, or in situations in which treatment is intended to decrease risks of adverse events in the future. The researchers also found that if physicians believed a religious patient would suffer harm by not following their recommendations, "the physician's commitment to preserving the patient's health may lead the physician to attempt to persuade the patient to reconsider his or her decision."
The authors write: "Our findings suggest that physicians always navigate a balance between respect for patient autonomy (remaining open-minded and flexible) and concern for the patient's good (persuading the patient to adhere to recommendations)…Rather than striving for illusory neutrality, physicians should practice an ethic of candid, respectful dialogue in which they negotiate accommodations that allow them to respectfully work together with patients, despite their different ways of understanding the world."
(Arch Intern Med. 2005; 165: 88 – 91. Available post-embargo at www.archinternmed.com.)
Editor's Note: This study was funded by grant support for "The Integration of Religion and Spirituality in Patient Care Among U.S. Physicians: A Three-Part Study" from the Greenwall Foundation, New York, N.Y., and from The Robert Wood Johnson Clinical Scholars Program, Princeton, N.J. [Drs. Curlin, and Lantos and Chin (co-authors)].
To contact Farr A. Curlin, M.D., call John Easton at 773-702-6241.
For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262), or e-mail mediarelations@jama-archives.org.
Journal
Archives of Internal Medicine