2010 Houston Area Physicians Survey
A survey of physicians in the Harris County Medical Society was undertaken in 2010 to identify physicians' opinions towards religion and spirituality in medicine (RSM) as well as their own religious and spiritual characteristics.
Patients in the US healthcare system have consistently express religious and spiritual aspects of their life as important to their care and treatment. Despite this, a majority of physicians still rarely, if ever, address their patients’ religious and spiritual (R/S) concerns. We found that higher measures of intrinsic religiosity significantly correlate with a higher likelihood of finding R/S interactions appropriate, being comfortable with them, and actually inquiring about R/S issues. Furthermore, training in this area did significantly correlate with a higher likelihood of inquiring about patients’ R/S issues. Survey results demonstrate that training may improve how frequently physicians inquire about R/S in their patient care.
Scholars have identified barriers that physicians feel stand in the way of R/S discussions with their patients, and these include lack of training, improper environment, lack of time, and concerns about the ability for physicians to communicate effectively in the spiritual area.
While perceived barriers are preventing physicians from addressing the R/S needs of their patients, attention to matters of religion, spirituality, and medicine (RSM) has been associated with practical outcomes in clinical settings including patient satisfaction and less aggressive care at the end of life.
Our methods were inspired by, and in some cases replicate, previous studies on similar themes. The sample for this study consisted of 283 members of the Harris County Medical Society (HCMS). The subject pool included medical students, residents, and active and retired physicians who are members of the HCMS. Subjects were mailed a one-page cover letter explaining the study, an eight-page survey, and a pre-addressed, pre-paid envelope to use to send the completed survey back.
Results
Of the sample set, a majority (64%) of physicians believed that it is always or usually appropriate to discuss R/S issues when a patient brings up their issues. Physicians who agreed or strongly agreed to the statement “I try hard to carry my religious beliefs over into all my other dealings in life” were more likely to believe it is generally appropriate to discuss R/S issues when first brought up by the patient (69.5% vs. 56.1%, P<0.05).
A physician’s religious preference also correlated with varied responses to patient-initiated R/S clinical discussions. A majority of self-identified Protestants had the most favorable view (76.2%, P<0.001) while only a minority of Agnostics, Muslims, Buddhists, and Hindus had a favorable view (<50%, P<0.001). There were no significant correlations between formal training in RSM and appropriateness of patient-initiated discussions (P > 0.05).
An overwhelming majority (87%) of physicians would agree or strongly agree with the statement “I would feel comfortable discussing a patient’s religious/spiritual concerns if the patient brought them up.” Again, almost all physicians with high intrinsic religiosity agree with the aforementioned statement (92.8% vs. 79.6%, P<0.001).
Though a majority of physicians respond that engaging a patient’s religious/spiritual concerns is generally appropriate if the patient initiates the discussion, less than half of doctors in the Harris County Medical Society (49.1%) ever actually inquire about their patients’ R/S issues. One of the best indicators for whether a physician will ask about their patients’ issues is high intrinsic religiosity (58.5% vs. 35.6%, P<0.001). Similar to other questions of RSM, self-identified Protestants had the greatest percentage of inquirers (61.2%, P<0.05) while less than half of surveyed physicians who were Atheist, Agnostic, Jewish, or of Eastern religions did inquire into their patients’ R/S issues. Another distinguishing factor of a physician’s likelihood to include active inquiry in their practice is formal training. Physicians were much more likely to say they inquired if they had attended formal training regarding RSM (66.7% vs. 42.1, P<0.001).
For the multivariate analysis, gender, medical rank, current religious preference, intrinsic religiosity, and formal training were included in the model as covariates. In response to whether discussing a patient’s R/S concerns after the patient initiated the topic is appropriate, self-identified Agnostics were 7x less likely than Protestants to agree or strongly agree with the statement even after accounting for gender, medical rank, intrinsic religiosity, and formal training (95% CI:[2.39,21.74], P<0.001). Jewish physicians were also 4x less likely to agree than Protestants (95% CI:[1.43,8.85], P<0.01)
A similar trend was uncovered for the survey responses to how comfortable physicians would feel when discussing a patient’s R/S concerns when patient-initiated. Self-identified Atheists were 7x less likely to agree or strongly agree even after accounting for medical rank, formal training, intrinsic religiosity, and gender (95% CI=1.5;29.4, P<0.05). Agnostics were 4x less likely to agree (95% CI=1.03;14.08, P<0.05).
In regards to concrete inquiry about a patient’s R/S issues, physicians who had formal training in RSM were 3x more likely to inquire (95% CI: [1.64,6.20], P<0.01). Again, similar to previous responses regarding RSM, Atheist and Jewish physicians were less likely to inquire about their patient’s R/S concerns compared to Protestants.