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Body and soul: When faith guides a doctor's vocation

Some physicians embrace dual careers in medicine and religion.

By Myrle Croasdale — Posted Dec. 24, 2007

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Anecdotal reports suggest that there are several hundred physicians who are both religious leaders and medical doctors. They see a connection between the physical world of medicine and the spiritual world of faith, a perspective that can cross into the exam room.

This may be a positive quality for patients, said Farr A. Curlin, MD, an internal medicine assistant professor at the University of Chicago whose research focuses on spirituality and medicine.

"The training in pastoral care and theology gives a physician a unique set of communication skills and sensitivity to spiritual issues," Dr. Curlin said. It allows these physicians to make better connections with patients.

Here is a glimpse of how an Episcopal priest, a rabbi and a Muslim cleric navigate their faith and their medical practices.

Episcopal priest, general surgeon

Daniel Hall, MD, MDiv, MHSc, finished residency this year and is an assistant surgery professor at the University of Pittsburgh Medical Center.

He is also ordained in the Episcopal faith and is a priest in residence at First Lutheran Church in Pittsburgh. The Episcopal and Lutheran churches recognize each other's ordained clergy. He preaches every fifth Sunday, and on other Sundays he reads Scriptures or leads prayers. He also is involved in adult education there.

Dr. Hall sees his pastoral and theological training as assets and wants to integrate them into his medical practice. He is conscious of the ethical issues raised by offering to pray with patients or to discuss their spiritual beliefs. But his goal is to help patients come to terms with serious illness, not to convert them.

"There are appropriate concerns," Dr. Hall said. "With the unequal power in a patient-physician relationship, it could be a coercive situation."

He works within the Dept. of Veterans Affairs system and finds that the majority of his patients are religious. "Some ask me to pray without me having to open the door," Dr. Hall said.

Other times he may bring it up. "There's a dance that happens there," Dr. Hall said. "I don't know exactly how to describe the moves, but there is choreography that happens as you feel out the person on what they would find supportive."

Delivering bad news to a patient is often when the dance begins. For example, he may tell a patient he or she has lung cancer, and the patient wants to know why.

"They aren't looking for the reason why tobacco mutated their genes and they got cancer," Dr. Hall said. "It's more existential. 'Why did this happen to me?' You pick up on that and engage."

That "Why me?" question can leave patients feeling isolated or cut off spiritually, he said, as they look for meaning in their illness.

"The crisis that is engendered by chronic and terminal illness is huge," he said. Patients might say, 'If I'm not getting well, maybe my prayer isn't strong enough or my relationship with God isn't right.' "This is a great opportunity for appropriate counseling," he said.

End-of-life decisions are another chance for doctors to provide guidance.

He recalled an incident during his residency when a patient with a liver transplant had experienced a number of serious setbacks. An existing hepatitis C infection took over the new liver, sending it into failure. Then a flesh-eating bacterium invaded the patient's leg, and Dr. Hall was called in to remove the dead tissue, a painful procedure that involved flaying off the skin. The limb continued to deteriorate and was amputated.

Dr. Hall, seeing the patient's family struggle, sat down with them to discuss the ramifications of the rapidly changing events.

"Just a couple of weeks before, they felt relief and hope," Dr. Hall recalled. "They felt trapped seeing the disfigurement and obvious suffering of their loved one."

Over a few days he helped them confront the patient's impending death. They decided not to prolong his life.

"There was no doubt in my mind that I was there for a reason," Dr. Hall said. "I had done something for which there is no billing code but is at the absolute center of what it means to be a doctor. Is that something you have to be religious to do? No."

The best doctors seem to know intuitively how to do this, Dr. Hall said, but for him, it has been his training as a priest that helps him to see these needs and address them.

Rabbi, medical student

Eleanor Smith finished five years of rabbinical training and was a rabbi for seven years before becoming a student at the University of Chicago Pritzker School of Medicine. On schedule to graduate this spring, she is going through the matching process for an internal medicine position and then hopes to specialize in oncology. Ideally, she would like to split her time between the synagogue and academic medicine.

"My experience in the rabbinate prompted me to go to medical school," Smith said. "I see it as an enhancement of my rabbinate."

While working as a rabbi, Smith said she had "crazy thoughts about going back to school. I had an increasing conviction that what clergy do and what doctors do are intimately related, though their body of knowledge is so disparate."

One of the experiences that nudged her toward medicine was an end-of-life discussion with a family in her congregation. The family coordinated a meeting in their father's hospital room that included Smith, their rabbi, and their father's physician, along with the family members.

She and the physician answered questions about the family members' obligation to intervene for their father, the value of further medical intervention, their father's physical comfort, and the morality and medical details of a do-not-resuscitate order.

"The experience made me all the more aware of the rarity of these kinds of collaborations," Smith said.

She would like to help others in such situations and, in general, demystify medicine for patients by translating the pathophysiological process into English.

"I don't see medicine as a platform to be a rabbi but an enhancement of the core thing of who I am," Smith said. "Rabbi means teacher. They are not spiritual intermediaries. Their responsibility is to help people become learners of their faith."

Pediatrician, mosque president

Hafizur Rehman, MD, studied medicine in Pakistan, did a residency back home in Kenya, then did a pediatric residency in the United States before opening a practice in Bay Shore, N.Y. He also is a senior pediatric attending physician at Good Samaritan Hospital Medical Center and Southside Hospital in Bay Shore, and an active leader in the Muslim community. Dr. Rehman is president-elect of the Islamic Medical Assn. of North America, president of the Council of Mosques and Islamic Organizations of Nassau and Suffolk counties and president of the Masjid Darul Quran in Bay Shore, the largest Muslim congregation on Long Island with 1,000 members.

As a pediatrician he appreciates the Koran's references to a child's birth and conception.

"The Koran goes into quite a bit of embryology," Dr. Rehman said. "It talks of that in spiritual depth -- God's way of continuing life and the existence of humanity. How a single sperm and egg grows into a fertile piece of flesh. How the bones are covered with muscle. As a pediatrician, that is fulfilling to me."

He considers his mosque his home away from home. He periodically leads prayers, which are held five times a day throughout the week. In addition, he advises mosque members and performs weddings and funerals. Most recently, he has been heavily involved with funerals because the mosque opened the only facility on Long Island for the ceremonial washing, shrouding and burial of the dead, Dr. Rehman said.

His immigration to the United States sparked his deep involvement in congregational leadership.

"Once I came here, I found a big vacuum of what to do, religion-wise," Dr. Rehman said. "Somebody died or got married, and we didn't know what to do. We didn't have a formal mosque or people to perform those services. We needed somebody, so I started to study and learn from others."

His informal training included religious reading and spending time with others more knowledgeable about Islamic traditions. In the late 1990s, the area's Muslim community grew large enough to hire a full-time imam, with a PhD in theology, and build the mosque.

Masjid Darul Quran members seek his religious and medical expertise on questions about abortion, blood transfusions, organ donations and drug problems at the local schools. The parents of his pediatric patients also are aware of his spirituality. "When I walk in [the exam room], in my own heart I always say a prayer. Most of my patients know that," he said.

His patients are primarily Christian or Jewish, and he often finds himself in friendly discussions regarding the merits of his faith compared with theirs.

"I invite them to the mosque to come and see," Dr. Rehman said. "And they do come."

One mother sent her daughter and grandchild to see Dr. Rehman, though her daughter lived 30 miles away. She told her daughter, "You have to go to Dr. Rehman," he laughed. "He's not only a good pediatrician, he's a praying person also."

Such connections tie him to his patients during difficult times. He was invited to the bedside of one cystic fibrosis patient as she felt death approaching. At 18, she had lived the longest of her siblings.

"I had taken care of her for years," Dr. Rehman said. "It meant a lot to me that I was there."

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External links

Stole and Stethoscope, a Web site for ordained physicians (link)

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