The sacramental requests most often made by patients are for "Sacrament of the Sick" what some Catholics may think of as "Last Rites" , Confession, and Holy Communion Eucharist --the latter, however, does not have to offered by a priest but may be offered by an authorized lay Catholic Eucharistic Minister. If a patient is near death , there may be an urgent request for a Catholic priest to offer "Sacrament of the Sick" which some Catholics may call "Last Rites".

Medicine, Religion, and Magic in Early Stuart England

Even if the sacrament has already been offered, there may still be a request for a priest to offer prayers and bless the patient. All requests for the sacrament of baptism should be relayed to a Catholic priest, but in the case of an infant who is likely to die before a priest can arrive, such an infant may be baptized by any person with proper intent --the person would say, "[ name of infant ], I baptize you in the name of the Father, and of the Son, and of the Holy Spirit," pouring a small amount of water over the infant's head three times. A report of such an emergency baptism should be made to the local Catholic parish priest.

Patients may request Holy Communion Eucharist prior to surgery. While a Catholic priest or Eucharistic Minister would typically offer such a patient only a tiny portion of a wafer, patents who are NPO to have nothing by mouth should have this request approved by the care team as medically safe.

Spirituality and Medicine

Some patients may keep with them religious objects , such as a rosary a loop of beads with a crucifix, used for prayer , a scapula a small cloth devotional pendant , or a religious medal. If patients request that such an object remain with them during medical procedures, discuss the option of placing the object in a sealed bag that can be kept on or near the patient. If an object is metal and the patient is having a radiological procedure or test like an MRI scan , ask the patient or family if they can bring in a non-metal substitute.

Interruption of religious practices , such as regular attendance at Mass or special observance of special holy days, may be highly stressful to Catholic patients.

Medicine, Religion, and Magic in Early Stuart England

Catholic teaching does not generally require any treatment considered "extraordinary means," but a priest may offer authoritative guidance in specific situations. Within families, there may be diverse opinions about Catholic moral teaching, and differences sometimes fall along age cohort lines because of the Second Vatican Council's many changes, occurring in the s.


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Patients may request non-meat diets , especially during the late-winter time of Lent the 40 days before the festival of Easter. Eight Practical Points for non-Hindu Providers Hindu patients may express strong, culturally-based concerns about modesty , especially regarding treatment by someone of the opposite sex. Genital and urinary issues are often not discussed with a spouse present.

Hindus are often strictly vegetarian in refusing to consume any meat or animal by-products. Some Hindus may also refrain from eating certain vegetables, like onions or garlic. The act of washing is generally conceived as requiring running water, either from a tap or poured from a pitcher. For many Hindu patients, there is a cultural norm to use the right hand for "clean" tasks like eating often without utensils and their left hand for "unclean" tasks like toileting.

Medical and nursing staff should consider this right-left significance before hindering a patient's hand or arm movement in any way. Discuss options with the patient. Patients may wear jewelry or adornments that have strong cultural and religious meaning, and staff should not remove these without discussing the matter with the patient or family. Hinduism teaches that death is a crucial "transition," with karmic implications. There may be a strong desire that death occur in the home rather then in the hospital. Family may request that there be constant attendance of the deceased's body , and a family member or representative may wish to accompany the body constantly, even to the morgue where the person may sit outside any restricted area yet relatively near the body.

Seven Practical Points for non-Jehovah's Witness Providers The most defining tenant for Jehovah's Witnesses in health care is the strict prohibition a scriptural injunction against receiving blood that is: Some blood fractions such as albumin, immunoglobulin, and hemophiliac preparations are allowed, but patients are guided by their own conscience.

Account Options

Organ donation and transplantation is allowed, but patients are guided by their own conscience. Jehovah's Witnesses are usually well prepared to work with health care providers to seek all possible options for treatment that do not conflict with religious concerns. It is very common for adults to carry at all times a card stating religiously-based directives for treatment without blood. Contrary to some popular misconceptions, faith-healing is not a part of Jehovah's Witness tradition.

Prayers are often said for comfort and endurance. Jehovah's Witness tradition does not teach that those who die experience an immediate afterlife. It would be in appropriate to say to the family of a deceased patient anything like, "He's in a better place now. Eleven Practical Points for non-Jewish Providers Some Jewish patients may strictly observe a rule not to "work" on the Sabbath from sundown on Friday until sundown on Saturday or on religious holidays.

If so, this religious injunction against "work" -- which includes prohibitions against using certain tools or engaging in tasks such as those that initiate the flow of electricity -- would be problematic to tasks like writing, flipping a light switch, or pushing buttons to call a nurse, adjust a motorized bed, or operate a patient-controlled analgesia PCA pump. Also, the tearing of paper may be considered "work," so roll toilet paper should be replaced with an opened box of individual sheets. Medical procedures should not be scheduled during the Sabbath or religious holidays unless they are life-saving , nor should hospital discharges be planned during such times without the consent of the patient.

While these restrictions on "work" are generally associated with Orthodox Judaism, it is possible that they may be important for any Jewish patient. Jewish holidays are usually highly significant for patients, especially Passover in the spring and Rosh Hashannah and Yom Kippur in the fall. These holidays may affect the scheduling of medical procedures and may involve dietary changes related to a need for special food or to a desire to fast. All Jewish holidays run sundown-to-sundown. Jewish patients often request a special "Kosher" diet , in accordance with religious laws that govern the methods of preparation of certain foods for example, beef and prohibit certain foods for example, pork or gelatin and combinations for example, beef served with dairy products.

During the holiday of Passover, an important distinction is made between food that is merely "Kosher" and that which is specifically "Kosher for Passover. Some Jewish patients may have culturally-based concerns about modesty , especially regarding treatment by someone of the opposite sex.

However, Jewish tradition holds the expertise of medical practitioners in high regard, and this fact may assuage concerns about treatment by the opposite sex. Questions about the withholding or withdrawing of life-sustaining therapy are deeply debated within Judaism, and some patients or families are strongly opposed to the idea.

Family members often wish to consult with a rabbi about the specific circumstances and decisions regarding end-of-life care. After a patient has died, Jewish tradition directs that burial happen quickly and that there be no autopsy though there is acceptance when autopsy is deemed necessary, such as by a mandate from the Medical Examiner.

Also, the family may request that a family member or representative constantly accompany the body in the hospital, even to the morgue where the person may sit outside any restricted area yet relatively near the body , to say prayers and read psalms. There may be a request that amputated limbs be made available for burial. Jewish religious laws pose a complex set of restrictions that can affect medical decisions, and patients or family members may request to speak with a rabbi to determine the moral propriety of any particular decision.

Exceptions are often made to the normal application of the religious laws when an action is understood in terms of " saving a life ," such as with emergency surgery during the Sabbath or potentially in the case of organ donation. The value of "saving a life" is held in extremely high regard in Jewish tradition. It is common for Jewish patients to a yarmulke or kippah skull cap , especially for prayer, , but some people may wish to keep them on at all times. Patients or family members may also wear prayer shawls and use phylacteries two small boxes containing scriptural verses and having leather straps, worn on the forehead and forearm during prayer.

A Jewish person need not be religious to be "Jewish," and such non-religious patients may observe Jewish religious traditions for cultural reasons. A brief pilot workshop on spirituality and medicine had a modest effect in improving attitudes and perceived competence of both medical students and residents. North Americans are a spiritual people: To address these concerns, governing bodies for medical education, such as the Association of American Medical Colleges, have recommended that spirituality and religion be incorporated into medical training.

Faced with limited curricular time for new courses, we developed and piloted a brief workshop on spirituality and medicine. We sought to determine whether the content was relevant to learners at different levels, whether preliminary evaluation was promising, and to generate hypotheses for future research. One of us A. For expediency, we involved these learners in the pilot project.


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In , we performed a needs assessment 16 by reviewing the medical school's preclinical curriculum and the residency program's didactic curriculum to determine existing spirituality and medicine content. We informally interviewed residents and found that they had little or no contact with hospital chaplains. We searched the literature for expert suggestions and reported curricula 12 — 14 , 17 and, based on this information, developed specific learner objectives listed in Table 1 column 2 and educational strategies to address these objectives Table 1 , columns 1 and 4 The medical student workshop was 2 hours long and was presented as part of a required Doctor-Patient Encounter course, while the separate resident workshop was one-and-one-half hours long and was given during a required ambulatory block rotation.

Each workshop accommodated approximately 20 learners and was repeated to train all second-year students and all 60 primary care residents in the to academic year. One of 3 physician instructors presented each student workshop; 1 physician instructor presented all the resident workshops.

To help standardize delivery, instructors attended a training session and used the same PowerPoint presentation and speaker's notes for all workshops Appendix A. Learners received a handout covering key concepts Appendix B and a spiritual assessment pocket card Appendix C. There were no advance readings. We used several instructional strategies in specific sequence to meet the educational objectives Table 1. The workshops began with a brief review of the medical interview to provide context for including a spiritual assessment as part of the social history 18 and care of the whole person.

This was in order for learners to understand the prevalence and breadth of spirituality among Americans and possible reasons why Medicine has not addressed this topic until recently. The instructor then facilitated discussions among learners about the potential harm of patients' religious or spiritual beliefs to their health and health care e.

Spirituality and Medicine

Reported physician barriers were also presented. Next, the instructor introduced a mnemonic to guide spiritual assessment. Learners used the mnemonic to take a spiritual assessment of one another in pairs and then regrouped to debrief the experience. Those uncomfortable discussing their own spirituality were invited to make up answers for this exercise. In the student workshop, a hospital chaplain then introduced and discussed the role of pastoral services and pastoral consultation in the inpatient and outpatient setting.

For logistical reasons, there was no chaplain present in the resident workshop; instead, the physician instructor briefly discussed chaplains' roles and handed out an information sheet on obtaining pastoral consultation at the hospitals where the residents rotate. For this pilot, we chose to assess a subset of the curricular objectives. Learners completed voluntary, anonymous surveys, approved by the human investigations committee, both immediately before and after the workshop.

The surveys contained 6 statements on attitudes toward spirituality and medicine, perceived competence in taking a spiritual history, perceived knowledge of pastoral care resources, and comfort working with hospital chaplains Table 2 , column 1. Demographic information was not collected. Standard frequencies and means were calculated for individual variables.

Because the data were not normally distributed, we used nonparametric tests for comparisons. Changes in survey responses before and after the workshops were analyzed with the Wilcoxon rank-sum test for paired data. Differences between students' and residents' responses were analyzed using the Mann-Whitney U test. Table 2 shows learners' Likert survey scores and changes after the workshop. Medical students, but not residents, increased their perceived comfort in working with others on the health care team who emphasize patients' spirituality, such as chaplains.

The most useful workshop components cited by learners were as follows: The most common questions remaining for learners after the workshop concerned appropriateness e. Overall, the results from this pilot study of a brief workshop in spirituality and medicine indicate a modest effect on medical students' and primary care residents' attitudes regarding the appropriateness of taking a spiritual history, perceived knowledge about accessing pastoral care resources, and perceived competence in asking patients about their spiritual or religious beliefs.

These pilot results are encouraging as already crowded curricula can make more extensive courses difficult to implement. Identifying appropriate content for curricula in spirituality and medicine may aid future curriculum developers. Our learners already arrived at the workshop tending to agree that spiritual assessment was appropriate and that patients' beliefs could impact health; workshop time could perhaps have been spent on other content.

Conversely, the most frequent question remaining for learners after the workshop related to issues of appropriateness. This needs further research. Learners most valued receiving information the demographics of spirituality in the Unites States, local pastoral referral resources , learning and practicing the spiritual history mnemonic and being able to discuss the topic in a safe environment. One of the workshop objectives was for learners to recognize how physicians' spiritual or religious beliefs can affect their provision of health care. In fact, students remained nearly neutral in their agreement with this statement compared with residents, despite discussing examples of physicians proselytizing patients or being judgmental on religious grounds.

We hypothesize that a more positive attitude toward the topic of spirituality and medicine after the workshop may have led them to feel that they could exhibit appropriate professionalism. Preclinical students lack the clinical context and experience of residents, so the discussion may have been more theoretical for them. Medical students, but not residents, significantly increased their perceived comfort in working with hospital chaplains; this may represent an unintended training effect because of the involvement of a hospital chaplain in only the students' workshops 42 or a ceiling effect among the residents, although students' and residents' perceived comfort did not differ significantly before the workshop.

The workshop content appears to have been relevant to both medical students and residents, suggesting that such curricula may be appropriate to introduce in both medical school and residency.


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While residents may have a more immediate need, if students are not exposed to this information before they start clinical rotations, they may miss opportunities to assess spirituality in their new patients. Students also have more time than others on the team to elicit a social history and thus may be better able to uncover a patient's spiritual or religious crisis or concern.

Our workshop had several limitations. This rate did not differ significantly from attendance at other sessions in the doctor-patient encounter course but, as we did not collect demographic data on participants versus nonparticipants, we cannot comment on how their absence impacted our results. There was no comparison group, although the immediate posttest makes it unlikely that any other intervention could have accounted for the observed changes. The workshop was offered only once to learners; lasting change in knowledge, skills, and attitudes may be more likely if a topic is integrated into the larger curriculum and introduced repeatedly.

Clinical medical students or residents from other specialties may have responded differently. The workshops were not identical within and between groups of learners, so differences in survey responses may be attributable to differences in the intervention rather than differences between the groups.

For example, a chaplain participated only in the students' workshops. The students' workshops were led by 3 different instructors, while the residents' workshops had the same instructor. The instructors received identical training and used the same curricular material, but individual presentation styles or delivery may have affected survey responses. We did not use dated surveys so we could not assess for such an effect.

Our evaluation method also had weaknesses. Instructors and students were not blinded. It is possible that social desirability bias or a wish to please the investigators affected learners' survey responses. This is mitigated somewhat by the anonymity of the surveys. We evaluated only a subset of our educational objectives. Finally, our outcome measures relied on self-reports rather than actual behavior change. Further research is needed to determine whether improvements in attitudes, perceived knowledge, and perceived skills persist over time; whether medical students and residents who complete such a workshop are more likely to perform spiritual assessments with their patients and request pastoral care consultations; and how best to integrate this topic into the larger medical school and residency curriculum.

As more medical schools offer training in this area, needs of future residents will likely change. Learners' questions about the appropriateness of spiritual assessment may be best answered by introducing the ethic of discourse about ultimate human concerns. We also thank the Yale University School of Medicine class of and the Yale Primary Care residents for their adventuresome spirits and honest feedback. The funding organization had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

The following supplementary material is available for this article online at www. National Center for Biotechnology Information , U. J Gen Intern Med. Author information Copyright and License information Disclaimer. Address correspondence and requests for reprints to Dr. This article has been cited by other articles in PMC.