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AAs a cancer surgeon, I often meet people in times of crisis and fear, when they have just been diagnosed with cancer. For many, their belief system is central to their coping strategy. So I think the time has come to talk about faith and religion, although many of my colleagues may not agree.
I met a patient I’ll call Brenda not long ago. A tall, slender woman, she didn’t look me in the eye and surprised me that I didn’t look relieved when I told her that she had curable cancer with an excellent prognosis.
“I’m ready to die,” she said. “I don’t see the point of fighting this thing.”
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As I asked more questions, I learned that Brenda was a middle-aged widow, alone in life and lonely. With no other family, her part-time job as a cashier was her primary source of human interaction, and it wasn’t satisfying.
Towards the end of our conversation, I gently asked, “What about religious affiliation? Do you have a community there?
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“Protestant,” she says. “And no, I don’t go to services anymore.”
It’s a delicate thing, as a doctor, to prescribe a little church. But that’s what I suggested to Brenda, “Maybe you can re-engage with your church or reach out to your pastor,” I suggested.
I meet people like Brenda almost every day, people for whom there are no meaningful social connections. But given the importance of these connections in mental and physical health, I believe physicians cannot ignore the role that faith and religion can play in fostering them.
Times of crisis are a reminder of the human need for social connection; it is often a time when people reconnect with their faith. The Covid-19 pandemic has been a collective crisis that highlights our need for community amid enforced isolation. For many people, faith and religion have been ways of maintaining social connection and coping with the stress of the pandemic.
Yet medicine has downplayed the importance of faith and religion in the well-being of patients. They have been largely shunned, something to engage with only when death draws near.
For cancer patients, hearing the word “C” splits time into before and after. They run the gamut of emotions: disbelief, fear, anger, and swirling thoughts about who will get them through this ordeal. During treatment discussions, patients learn cancer lexicon – surgery, chemotherapy, radiation therapy, immunotherapy, etc. Doctors also discuss the need for support, but too often my empathic colleagues don’t ask their patients about religion, faith, or spirituality. In doing so, they inadvertently focus on the cancer and lose focus on the patient and their emotional well-being.
Marriage and religion, indicators of social connection, have been associated with earlier cancer diagnoses and better outcomes. Married colon cancer patients have better five-year survival rates than unmarried patients. For many Cancers, social support is beneficial in ways that often cannot be measured. In older hospitalized patients with chronic illnesses, religiosity and spirituality are predictors of increased social support, and those with better social support are less likely to have depressive symptoms and have functional function. improved cognition.
Americans increasingly identify as non-religious. And many of my colleagues may believe that religion, faith or spirituality is a private matter that does not belong to medicine. Yet that’s not entirely true: Physicians are comfortable relegating faith and religion to hospice or palliative care. This reinforces the idea that faith, religion and spirituality are only end-of-life issues and not means to foster human relationships.
Medicine is in the midst of a concerted effort to provide culturally appropriate care. But this cannot happen by ignoring something that may be central to some patient’s identity or coping strategies. It can also be difficult to do in a society with a plurality of religions.
Training is essential to help physicians become more comfortable discussing issues of faith and religion. This is not about additional training to overwhelm physicians, but rather about reclaiming the holistic view of patient care. Once historically central to medicine, this view has been abandoned as medical science has exploded. I remind interns that physicians practice the art and science of medicine, not just science. Medical training should make future physicians comfortable discussing issues of faith, religion, and spirituality as part of providing culturally appropriate care. This can be discussed in medical school, but unless trainees see their role models doing this, it’s just another fact-finding exercise to be tested on an exam.
Providing holistic care means that discussions of faith, religion and spirituality cannot be analyzed by social workers and chaplains, relegating doctors to the role of technicians.
Despite the increased focus on the impact of social drivers of health, medicine has been slow to recognize that how people are connected to each other and to their community – including their community of faith – is a social driver of health.
My goal as a physician is not only to cure my cancer patients, but also to ensure that they find a new post-cancer normal that provides them with optimal physical and emotional well-being.
I had the opportunity to see Brenda for a follow-up visit. Over time, and after multiple phone calls, she had opted for treatment and was doing well. As I entered the room, I was struck by her smile. Somewhere along the way, someone from her church had reached out and a coffee date had rekindled a long-lost friendship. At the end of the visit, I also had a huge smile, not only because she had successfully completed the treatment, but because she had found a human connection again.
T. Salewa Oseni is a surgical oncologist at Massachusetts General Hospital and assistant professor of surgery at Harvard Medical School.
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