Pediatric physicians see religion, spirituality as barrier, bridge to medical care, Rice sociologist finds

BY FRANZ BROTZEN
Rice News staff

Pediatricians and pediatric oncologists express differing views on religion and spirituality that are largely based on the types of patients they treat, according to a study that appears in the current edition of the journal Social Problems.

	ELAINE HOWARD ECKLUND

Elaine Howard Ecklund, assistant professor of sociology and associate director of the Center on Race, Religion and Urban Life, is a co-author of the study, which is based on in-depth interviews with 30 doctors who practice and teach at elite medical centers around the
United States.

The study focused on two questions: How do pediatric physicians gather information about religion and spirituality in their work with patients and families and when, if at all, is that information relevant to their professional work? Second, as they negotiate professional boundaries around religion and spirituality in everyday interactions with patients and families, do they perceive religion and spirituality to be a barrier or a bridge to medical care?

The research found “pediatric oncologists are more likely than the pediatricians interviewed to see the religion or spirituality of patients as relevant to their professional jurisdictions, what they do in their daily work as pediatricians.” Moreover, the majority of the physicians interviewed saw religion and spirituality as “most relevant in difficult medical decision-making situations, in particular those made about end-of-life care.”

There is significant sociological research on professional boundaries
— “the process through which a profession attempts to establish its unique claim to an issue or body of knowledge,” the authors wrote.

Social service professionals, teachers, coaches and lawyers all are faced with decisions on “whether religion and spirituality, in various forms, is either within their jurisdiction or relevant to it.” Members of the medical profession, the authors said noted, “are no exception.”

Yet physicians receive very little training in religion and spirituality in medical school, which suggests, according to the authors, “that medical educators view the topics as outside the jurisdiction of physicians.” As a result, they said, “it is not surprising that the majority of pediatric physicians rarely ask patients and families directly about their religious/spiritual backgrounds, reflecting an implicit lack of jurisdiction or formal boundary between medicine and religion and spirituality.”

Some pediatricians, the authors said, “illustrate the boundary between their work and patients’ religious/spiritual lives by adopting a public/private sphere dichotomy to describe religion and spirituality, seeing such topics as ‘personal’ and using the language of ‘prying’ when discussing conversations about religion and spirituality.”

According to the study, pediatric physicians said religion and spirituality is present and relevant in their work when serious medical problems arise, such as when families have difficult medical decisions to make or when patients are dying.

The researchers concluded that overall, the physicians in the survey “see religion and spirituality as both a barrier and a bridge to medical care. Physicians think it is a barrier when it impedes their work and/or care for children, especially care for children who are Jehovah’s Witnesses, Orthodox Jews or members of religious traditions that have existed in some tension with biomedicine. It is a bridge when it helps patients and families make sense of illness, adjust to difficult news and answer questions that medicine inherently cannot.”

The survey’s data were gathered through lengthy interviews with 30 randomly selected pediatric physicians (14 pediatricians and 16 pediatric oncologists) at top U.S. teaching hospitals, including
Stanford Hospital and Clinics, Johns Hopkins Children’s Center, UCLA Medical Center, the University of Michigan Medical Center, Duke University Medical Center, University of Washington Medical Center, Mayo Clinic, Cleveland Clinic, New York-Presbyterian Medical Center, Massachusetts General Hospital, Hospital of the University of Pennsylvania, University of California San Francisco Medical Center and Barnes-Jewish Hospital.

The other authors of the study, titled “Religion and Spirituality: A Barrier and a Bridge in the Everyday Professional Work of Pediatric Physicians,” are Wendy Cadge of Brandeis University and Nicholas Short of Baylor College of Medicine. The work was funded by the Robert Wood Johnson Foundation Scholars in Health Policy Research Program and the John Templeton Foundation.

The full text of the study can be found at http://caliber.ucpress.net/toc/sp/56/4.