Charity care not tied to faith beliefs

Physicians who consider themselves religious are not more likely to care for the poor than doctors with no religious affiliation, according to a new study.

Researchers are shocked by the discovery, because religious doctors were more likely to view medical practice as a calling and their faith calls on them to serve the poor. Of the 1,144 physicians surveyed nationwide, 31% of doctors who are more religious said they practiced medicine among the underserved. That's four percentage points lower than the 35% of doctors who said they had no religious affiliation.

"The most religious are no more likely to care for the underserved than are the least religious. That to me was both a surprise and a disappointment," said lead author Farr A. Curlin, MD, assistant professor of medicine at the University of Chicago.

The study in the July/August Annals of Family Medicine is the latest to provide a picture of the impact of a doctor's religious beliefs on medical care.

Studies have shown that some physicians said their religious beliefs influence their medical practice and that many doctors said such beliefs help patients cope.

Research also found that many doctors do not feel obligated to inform patients about medical procedures to which they personally object morally.

The Christian Medical & Dental Assns. surveyed some of its members on serving the poor. It found a high level of spiritual commitment is a positive influence for physicians to care for the underserved, and some members serve one week or more each year treating the poor in developing countries.

"We need to encourage all doctors to live up to the ideal of their faith community. We call our members to do that regularly," said Gene Rudd, MD, senior vice president of the CMDA.

Harold G. Koenig, MD, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center, said the Annals study "might get doctors, particularly who are religious, to rethink serving the underserved. That would be a great outcome of this study."

Dr. Koenig said doctors need to be aware of how their faith affects their medical practice and whether patients want religion to play a part in the care they receive.

"There's no question there is more research on religion and health in the last 10 years. People are interested in studying and learning more about it. It certainly influences medical decisions and other factors related to health care," he said.

Many recent findings have come from Dr. Curlin's data. For example, Dr. Curlin's survey of 1,144 physicians found that 76% of physicians believe in God and 59% believe in the afterlife. Doctors were more likely to attend religious services than the rest of the U.S. population, according to a study in the July 2005 issue of the Journal of General Internal Medicine.

That same study found that 55% of doctors said their religious beliefs influence how they practice medicine. But it also showed that doctors are twice as likely as the general population to cope with major problems without relying on God. And more physicians consider themselves spiritual but not religious compared with the population.

A Dr. Curlin-led study in the April 9 issue of the Archives of Internal Medicine found that more than half of physicians said religion and spirituality influence patients' health, and three in four doctors believe that religious beliefs help patients cope and provide a positive outlook.

But that study showed that only 6% said spirituality helps to prevent "hard" medical outcomes such as heart attacks, infections or death. Rather, 76% of doctors said faith helps patients to cope, 74% said it gives patients a positive state of mind and 55% said it provides emotional and practical support.

The same physician survey by Dr. Curlin also yielded a study in the Feb. 8 New England Journal of Medicine that said many doctors do not feel obligated to disclose information about or refer patients for legal but morally controversial medical procedures.

Some experts are concerned what the findings in such studies say about how physicians provide care.

They said there are ethical issues to consider, because a doctor could force his or her beliefs on patients. And a physician's religion could impact medical decisions on matters such as birth control.

"Patients are vulnerable because they're fearful and in pain. When physicians depart from a medical agenda to a religious one, they really capitalize on that vulnerability, and that is manipulative at best, maybe even coercive," said Richard Sloan, PhD, professor of behavioral medicine at Columbia University Medical Center and author of Blind Faith: The Unholy Alliance of Religion and Medicine. "It puts their own faith over the patients' well-being."