https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/33 Tue, 02 Aug 2016 09:11:38 +0000 In recent years there has been growing awareness regarding the role of religion and spirituality   (R/S) in the practice of clinical medicine. Despite hundreds of articles in professional journals on the subject, little is known about physician beliefs regarding the influence of religion on health. We aim to assess the beliefs and observations of physicians regarding the role of R/S and patient’s health and whether they address such issues in their clinical practice. Concomitantly, we aim to assess the beliefs of our patients and whether they like to address such issues. Questionnaire was based on a cross sectional survey among hospitalized patients and their treating physicians. Nearly all patients and physicians reported a high prevalence of religiosity. Patients also acknowledged that their R/S was respected by the staff, and that physicians inquired R/S about half of the time. R/S was described as beneficial as it enabled patients to cope better with their illness and gave them a positive state of mind. Religion is important to many patients and physicians, but half of the physicians ignore it in their clinical practice. Physicians need to be attentive to patients R/S issues and address them in specific clinical situations. Introduction   This was a questionnaire based cross sectional study among 280 hospitalized patients from Hospital Tengku Ampuan Afzan (HTAA) and their treating doctors (92) to inquire about their religious affiliation, beliefs and experiences regarding the role of R/S in specific clinical situations. Malaysia is a multi-racial, multi-religious, fast developing country where a western oriented information delivery policy is adopted in the medical curriculum. HTAA is an 800-bed, tertiary level state hospital in Pahang- the biggest state in Peninsular Malaysia with a population of about 1.6 million people. It is also the main teaching hospital for the medical faculty of the International Islamic University Malaysia (IIUM). A similar self-reported questionnaire based study of physicians from the same hospital was conducted and questions were framed on similar issues. They were approached individually, provided with a brief description and aim of the study and requested to fill up the questionnaire form at their leisure. The forms were collected again after contacting the respondents. Ninety two physicians responded by filling the questionnaire out of 110 approached.   Of the 92 participant physicians (men 61, women 31), the majority were Muslim (53), followed by Hindu (17) and Buddhist (12). Table 1 summarises the beliefs of the physicians towards R/S. Table 2 depicts the physicians clinical practices/observations. Most physicians reported a high prevalence of religiosity and were inquisitive but respectful of patients’ R/S issues. About two thirds (65%) did encourage R/S practices and 54% would do so irrespective of R/S beliefs of their patients. Of the 280 participating patients (men 176, women 104), 75% were Muslims and 11% were Buddhists, and the rest were from Christian and Hindu religion. Regarding education, 80% were from primary and secondary and 5.7% were from tertiary level and 13.3% were illiterate. Patients reported high religiosity, acknowledged that their R/S was respected by the staff, and that physicians inquired about half of the time about R/S (Table 3). About half of the patients could not recall any inquiry by physicians about religious issues. About 79% patients noticed increase in faith due to illness and wanted religious counselor to help them rather than a psychiatrist. Table 4 compares the religiosity of HIV/AIDS patients relative to rest of the patients. It was found that patients in HIV/AIDS category, 22.1% had never performed meditation or Salat as against 24.7% who had daily performance of meditation or Salat. Table-1: Belief of physicians     Table-3: Belief of patients       In general, research has shown R/S positively affects physical and mental health and the findings apply across boundaries and religions.1,4,16-18 Physicians in our sample were in agreement that religion has a positive impact on health. 85% of our patients who used prayer for their health concerns reported high levels of perceived helpfulness as has been reported by earlier studies.19 R/S beliefs and practices are associated with not only lower anxiety, lesser degree and frequency of depression, lower suicide rates, less substance abuse, but also help patients to cope better with greater wellbeing, hope and optimism, more purpose and meaning in life, greater marital satisfaction and higher social support.1,20 R/S practices are also statistically significant in coping with a terminal illness.21 Many prospective studies have also shown that R/S involvement lead to reduced death rates from cancer, lower rates of heart disease, emphysema and cirrhosis; lower blood pressure and lower levels of cholesterol, reduced rates of myocardial infarction and increased longevity.11,22-24 Religion serves an important preventive role, as most religions discourage or as in the case of Islam altogether ban alcohol and drug abuse. Many studies have found inverse relationship between religiosity and substance abuse.21,25,26 According to a report by the Center for Harm Reduction in Australia’s Burnet Institute based on illicit drug and injection safety study of 20 Asian countries, drug use has become one of the major causes of the HIV epidemic in Asia. Most (81.5%) of the HIV infected persons were young males (age 20-40 years) - people in their prime of life.27 Among our patients 27.5 % had HIV/AIDS, 88.3% of whom were young IVDUs with mean age of 34 ±7 years. They were least religious as depicted by their religious activities (p<0 .001). When asked whether they were told their diagnosis and how they felt about it, many of them responded by saying “Don’t bother.” Drug abuse renders a person a diseased member of society and may result in the destruction of the family, and commit various types of crime, homicide and suicide.   Physician is not just a dispenser of medicine but a value maker, having ethicist, social force and political influence in the life of his patients. Religion and spirituality deserve attention in professional practice, as it appears to have a positive influence on patients’ health. It may also go a long way in making the practice of medicine more holistic, ethical and compassionate. It will also strengthen medical students in their commitment as caring doctors. Acknowledgment   1.   Curlin FA, Sellergren SA, Lantos JD, Chin MH. Physicians’ Observations and Interpretations of the Influence of Religion and Spirituality on Health. Arch Intern Med. 2007; 167(7):649-54. 3.   Chatters LM. Religion and health: Public health research and practice. Annu Rev Public Health 2000; 21: 335-67. 5.   Hill PC, Pargament KI. Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research. American Psychologist 2003; 58(1), 64–74. 7.   Cohen Z, Headley J, Sherwood GW. Spirituality and bone marrow transplantation: When faith is stronger than fear. Int J Human Caring Summer 2000; 40-6. 9.   Harold G. Koenig Religion, Spirituality, and Medicine: Application to Clinical Practice. JAMA 2000; 284(13):1708 (doi:10.1001/jama.284.13.1708) http://jama.ama-assn.org/ cgi/ content/ full/ 284/ 13/ 1708. 11.Sloan RP, Bagiella E, VandeCreek L, et al. Should physicians prescribe religious activities? N Engl J Med 2000; 342:1913-1916. 13.Sulmasy DP. Spiritual issues in the care of dying parents: “…It’s okay between me and God”. JAMA 2006; 296: 1385-92. 15.  Koenig HG, Idler E, Kasl S, et al. Religion, spirituality and medicine: a rebuttal to skeptics. Int J Psychiatry Med 1999; 29: 123-31. 17.  Baetz M, Bowen R, Jones G, et al. How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population. Can J Psychiatry 2006; 51: 654–661. 19.  McCaffrey AM, Eisenberg DM, Legedza ATR, Davis RB, Phillips RS. Prayer for health concerns: results of a national survey on prevalence and patterns of use. Arch Intern Med 2004; 164: 858–62. 21.  McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet 2003; 361: 1603-7. 23.  Matthews DA, McCullough ME, Larson DB, Koenig HG, Swyers JP, Lilano MG. Religious commitment and health status: A review of the research and implications for family medicine. Arch Fam Med 1998; 7: 118-24. 25.  Shields J. J, Broome K. M, Delany P. J, et al.Religion and Substance Abuse Treatment: Individual and Program Effects. JSSR 2007; 46(3): 355-71. 27.  Cassel CK, Foley KM. Principles for Care of Patients at the End of Life: An Emerging Consensus among the Specialties of Medicine. 1999; NY: Milbank Memorial Fund. 29.  Puchalski CM, Larson DB. Developing curricula in spirituality and medicine. Acad Med 1998; 73: 970-4. 31.  Brunt PW, Short DS. Body, mind and spirit. What doctors need to know about the Scottish health department’s spirituality initiative? Scott Med J 2005; 50: 3–4. 2026 Ibrahim Medical College. All rights reserved.