The GP magazine Pulse reports in an exclusive this week on new guidance from the Medical Defence Union saying that GPs can pray with their patients as long as they ensure patients are ‘receptive' to the offer.
The guidance quotes a letter from Jane O'Brien, GMC Assistant Director for Standards and Fitness to Practise, published in the Daily Telegraph in 2009 suggesting that a ‘tactful' offer to pray could be appropriate. O’Brien’s letter in full read as follows:
‘Nothing in the GMC's guidance Personal Beliefs and Medical Practice (2008) precludes doctors from praying with their patients. It says that the focus must be on a patient's needs and wishes. Any offer to pray should follow on from a discussion which establishes that the patient might be receptive. It must be tactful, so that the patient can decline without embarrassment – because, while some may welcome the suggestion, others may regard it as inappropriate.’
Although Pulse does not mention it this guidance from the MDU is not actually breaking new ground. Their last guidance in 2009 made the same points and quoted the same letter.
The development is highly significant in that it follows a statement by the GMC’s Chief Executive Niall Dickson who in a recent Radio Four interview confirmed the appropriateness of sensitive faith discussions with patients.
Dickson amplified his comments further this week. ‘Conversations about faith should not be a starting point. Doctors can however sensitively explore whether a patient may wish to discuss their own faith when it is appropriate to their care and then provide spiritual support if this is what the patient wants.’
Clare Gerada, Chair of the Royal College of General Practitioners, largest Royal College in UK, with 44000 members, tweeted on the new guidance that it was ‘good that sense is prevailing at last’. Other high profile doctors have also recently endorsed the importance of spiritual care.
Professor Mike Richards, national clinical director for cancer and end-of-life care, said at the launch of the new RCGP end of life charter that it was important that patients at the end of their lives should be offered spiritual support from GPs if they wanted it. He added that studies in other countries, such as Canada, had shown that spiritual assistance – such as that provided by hospital chaplains – was very valuable.
And RCGP clinical champion for end-of-life care Professor Keri Thomas said that spiritual care was 'essential' for end-of-life care.
The latest advice follows the case of Dr Richard Scott, who made national headlines in May when he said he would formally reject an official warning from the GMC for discussing his faith with a patient. Dr Scott told Pulse he received, and rejected, the official warning this week, and now ‘fully expects' to face a public hearing. I have previously argued that the GMC had overreacted in this case by jumping to conclusions without a proper investigation on the basis of a complaint from the patient’s relative.
Pressure is now intensifying on the GMC to offer more definitive guidance on the issue. Dr Andrew Freeman, a GP in Mossley, Greater Manchester, is reported by Pulse as calling for greater clarity: ‘The guidance isn't clear enough. We are told to judge the patient's receptiveness to religion, but in the Dr Scott case it was not the patient, but their family, that took exception. If GPs are given better guidance and more help where to draw the line, it will improve care for patients, their relatives and doctors.'
The current GMC guidance gives considerable latitude for faith discussions. It recognises that ‘all doctors have personal beliefs which affect their day-to-day practice’ and that these principles apply to all doctors whatever their political, religious or moral beliefs. It emphasises that ‘personal beliefs and values, and cultural and religious practices are central to the lives of doctors and patients’ (p4); that ‘patients’ personal beliefs may be fundamental to their sense of well-being and could help them to cope with pain or other negative aspects of illness or treatment.’ (p5) and that ‘discussing personal beliefs may, when approached sensitively, help you to work in partnership with patients to address their particular treatment needs.’ (p9)
Faith discussions are not normally part of the consultation, but there are occasions when they were appropriate. The World Health Organisation’s definition of health includes physical, mental, social and spiritual dimensions and part of practising whole-person medicine means addressing all issues that have a bearing on a person’s health.
Let’s pray that the GMC handles Dr Scott’s case wisely and let’s continue to encourage Christian doctors to practise medicine that addresses the needs of the whole person, to take opportunities to address spiritual issues impacting on health, and to share their faith sensitively when it is appropriate to do so.