Reprimanded by the GMC for sharing faith with a patient – reflections on the Richard Scott case

On 14 June the General Medical Council’s Investigation Committee reprimanded a Christian doctor who shared his faith with a patient at the end of a private consultation. They ruled that his actions ‘did not meet the standards required of a doctor’.

Dr Richard Scott (pictured) has now been issued with a warning which will remain on his record for five years. Further serious or persistent failure to follow GMC guidance will put (his) registration at risk.

Dr Scott, who has been a doctor for over 28 years, was initially investigated by the GMC after it received a complaint from a patient that he had discussed the benefits of Christianity with him.

The full judgement is available on the GMC website and the Huffington Post gives more detail of what Dr Scott said in his defence.

The case arose from a complaint made to the GMC on 14 August 2010 by a patient’s mother about the doctor’s conduct when her son consulted him ten days earlier. It was alleged that Dr Scott ‘abused his position as a medical practitioner to push (his) religion upon a vulnerable patient’.

The patient on 20 October 2010 provided a written statement on which the GMC’s allegations were based. After seeking Dr Scott’s views on the allegations, which he did not accept, they sought to issue him with a warning, which he refused thus exercising his right to an oral hearing before the investigation committee.

When the patient refused to give evidence to the committee last autumn the case was adjourned until June 2012. On this occasion the patient again refused to appear but eventually agreed to give oral evidence over the phone.

During the hearing the committee noted that there was ‘clearly a conflict of recollection of what occurred in the consultation between the participants’ but considered that ‘both witnesses were honest and not trying to deceive’.

Dr Scott insisted that he had acted with the GMC guidance but also accepted that if he ‘had acted in the way in which the alleged this would be a significant departure from (it)’.

There was, in other words, a significant disagreement between Dr Scott and the patient about what was actually said during the consultation.

The committee, however, considered that the patient ‘gave credible evidence, direct answers and made all due allowances’ in Dr Scott’s favour. But they considered that ‘a number’ of Dr Scott’s responses ‘were in conflict with the evidence’ and that at times he ‘appeared to be evasive when answering questions’.

In other words the committee appeared to prefer the patient’s evidence over that of Dr Scott where their recollections were in conflict.

However, whilst a number of the allegations made were found ‘proved’, three significantly were not, raising questions about the accuracy of some of the patient’s evidence.

In summary, the committee concluded that Dr Scott ‘caused the patient distress which (he) should have foreseen’ by the way he expressed his beliefs. He also ‘sought to suggest (his) own faith had more to offer than that of the patient’ and in so doing ‘sought to impose his own beliefs’.

The GMC claimed that Dr Scott’s actions were in direct conflict with paragraph 19 of its supplementary guidance: Personal Beliefs and Medical Practice’:

‘You must not impose your beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views’.

and also with Paragraph 33 of ‘Good Medical Practice’:

‘You must not express to your patients your personal beliefs including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress.’

The GMC defended its issuing of a warning by saying it was obliged ‘to lay down a marker as to expected standards and to maintain public confidence in the profession’. It also said that ‘the discussion of religion within consultations is not prohibited’ and that this case ‘relates to the manner in which religion was approached during the consultation’.

The case raises a number of important questions for Christian doctors:

1.Is the GMC guidance overly restrictive?

The GMC Guidance, ‘Personal Beliefs and Medical Practice’ is currently under review but the 2008 version, under which Dr Scott has been assessed ‘attempts to balance doctors' and patients' rights - including the right to freedom of thought, conscience and religion, and the entitlement to care and treatment to meet clinical needs - and advises on what to do when those rights conflict.’

It does not intend to ‘impose unnecessary restrictions on doctors’ but does point out that doctors have an obligation not to impose their beliefs on patients. So there is no blanket prohibition on expressing personal beliefs, as long as it is done in a way that is sensitive and appropriate.

The guidance also underlines the principle that doctors must ‘make the care of (their) patient (their) first concern’ and must treat them ‘with respect, whatever their life choices and beliefs’.

These are all good principles that I personally have no problem with. No doctor, Christian or otherwise, should impose his views on his patient or seek to exploit his or her position.

However, the guidance goes on to stress that all patients and doctors have personal beliefs implying that these principles apply not just to those who subscribe to a particular faith, but to everyone.

‘Personal beliefs and values, and cultural and religious practices are central to the lives of doctors and patients.’ ‘All doctors have personal beliefs which affect their day-to-day practice.’

It also emphasises that taking account of patients’ beliefs is part of good medical care.

‘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.’ ‘For some patients, acknowledging their beliefs or religious practices may be an important aspect of a holistic approach to their care. Discussing personal beliefs may, when approached sensitively, help you to work in partnership with patients to address their particular treatment needs.’

Provided these guidelines are retained within the new guidance, they are parameters that Christian doctors should be able to work with.

2.Was this investigation fair?

The faith conversation which seems to have got Richard Scott into trouble came at the end of a 20 minute consultation, when he asked the patient whether he could talk about his Christian faith and the patient replied ‘Go for it’. So there was mutual consent and when the conversation became tense they stopped it.

The key problem faced by the GMC was that they were making an assessment based on two varying accounts of what actually happened, one from the patient and one from Dr Scott. However, in so doing they seem to have preferred the patient’s testimony over that of Dr Scott where the two accounts conflicted. Also the initial complaint was made by the patient’s mother who was not a witness to the consultation and transcripts of Dr Scott’s radio interviews were actually gathered by the National Secular Society, who undoubtedly had an ideological vested interest in the case.

Furthermore there were elements of the patient’s written testimony which were not upheld on cross-examination and he repeatedly refused to turn up to give evidence face to face. The Christian Legal Centre, who represented Dr Scott, have understandably raised questions about the legality and transparency of this process and had undertook unsuccessfully to have the case ‘struck out’. They are still considering whether to ask for a judicial review of the way the GMC conducted the enquiry.

Given, as acknowledged by the GMC, that Dr Scott had a previously unblemished record and was able to produce many patients’ testimonials, might they not have given him the benefit of the doubt in these particular circumstances? Wasn’t this a case that would have been better resolved locally with a mutual apology and a handshake? Has the GMC overreacted?

Furthermore, might the judgement encourage other individuals or organisations to bring forward vexatious written complaints against other Christian doctors knowing that it will essentially be the patient’s word against the doctor’s?

And why should suggestions that faith might help a patient be treated any differently from suggestions about other lifestyle choices or beliefs? As one doctor has argued in Pulse this week:

‘Patients already could say that you are ‘exploiting their vulnerability’ and ‘causing them distress’ when you speak to them about lifestyle choices which have led to obesity or addiction, but that is OK, because the evidence shows that dealing with these things would be good for them. Dr Scott has presented similarly robust evidence that shows that ‘doing God is good for your health’. So why would the GMC want to encourage one and discourage the other?'

There are certainly questions here that are worth asking and I am aware that a number of Christian doctors have already written to the GMC about them. Others who wish to express concern about the case, or to ask questions, can do so via the GMC website. The most appropriate addressee would be Niall Dickson, the Chief Executive.

3.What sort of faith discussions are still allowed within a consultation?

Last year I was involved in a Radio four PM debate with Niall Dickson, the Chief Executive of the GMC in which he confirmed the appropriateness of sensitive faith discussions with patients. His exact words were as follows:

‘The first point is that the start of a consultation is not the point at which you start introducing your faith and you should be where the patient is at. But there may be circumstances where a patient is at a point where they do want to discuss faith and it may be appropriate for the doctor to reflect on their own faith during that discussion.’

When asked how the GMC determined whether or not a doctor had expressed ‘religious, political or other beliefs or views’ in an ‘inappropriate or insensitive’ way Dickson explained that the GMC guidance was there to enable doctors to make good judgements themselves:

‘I am not there to judge, the doctor is there to judge and this essence of medicine is making judgements in the face of uncertainty and the importance of the doctor understanding where the patient is at. Taking a vulnerable patient and imposing your religious views on them and exploiting their vulnerability would be on the wrong side of the line as far as we are concerned.’

Jane O'Brien, GMC Assistant Director for Standards and Fitness to Practise, in a letter to the Daily Telegraph in 2009 even suggested 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.’

The same sentiments were expressed in a letter from David Horkin, GMC Investigation Officer, to a CMF member this last week.

‘The GMC has no objections whatsoever to the clinician bringing up faith in the consultation if it is done in an appropriate and sensitive manner. The patient must of course consent and be happy for such discussions to take place. Also, the clinician should take note of the patient's own beliefs and not attempt to belittle / disrespect their own faith or lack thereof. You should not attempt to impose your views on any patient who does not want to discuss such matters.’

These three statements strongly endorse the appropriateness of sensitive faith discussions.

4.Are doctors still free to practise ‘spiritual care’

Taking all this into account, it is clear by the GMC’s own admission that doctors are fully entitled to take part in ‘faith discussions’ within a medical consultation provided that they are carried out in an atmosphere of sensitivity, permission and respect.

In fact, good doctors, we might argue, have a professional duty to practise ‘whole person’ medicine that is not concerned solely with physical needs, but also addresses social, psychological, behavioural and spiritual factors that may be contributing to a person’s illness.

It would be a tragedy if, as a result of this case, Christian doctors shrunk back from providing appropriate spiritual care or from sharing their own Christian beliefs in a sensitive way, when it was appropriate, and when the patient had welcomed it.

The GMC is recognizing the importance of spiritual care but is still struggling to define what it actually is

The General Medical Council is about to review ‘Good Medical Practice’, its general guidance to doctors, and new draft guidance is due to be issued later this month.

Early indications are that the revised guidance will give more latitude to doctors attempting to provide whole-person healthcare (including spiritual care) but will take a harder line than at present on doctors who attempt to share their own faith with patients in the context of a consultation.

But given that there is a substantial body of evidence which suggests that religious faith benefits health, does withholding ‘spiritual care’ constitute a breach of GMC guidelines?

One doctor decided to pose exactly this question to the GMC and has given me permission to post his letter along with the reply he received.

Letter to GMC from Dr David Chaput de Saintonge

Dear Sir,

Thank you for your detailed reply to my letter of 27.5.2011.

In fact, my query was not ‘… whether doctors are permitted to offer or provide spiritual care of their patients’ though I'm pleased to note the GMC’s acceptance of this, always providing it is done sensitively.

The question I asked was when it would be allowable to contravene GMC guidelines by withholding spiritual care which is shown to be beneficial?

Of course I recognise that, as you state, the committee cannot, require doctors to offer faith-based management options. I don’t think that is the point. Your guidance on consent: patients and doctors making decisions together (Part 1; para 5) clearly states:

‘The doctor and the patient make an assessment of the patient's condition, taking into account the patient's medical history, views, experience and knowledge. The doctor uses specialist knowledge and experience in clinical judgement, and the patient's views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit from the patient. The patient weighs up the potential benefits, risks and burdens of the various options as well as any nonclinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which one.’

However the patient will be unable to weigh up the risks of an intervention which has not been discussed with them. They will therefore be denied the freedom of choice which your guidelines indicate they should be given and spiritual care might be wrongfully withheld.

I recognise, of course, that the doctor might consider that spiritual interventions ‘would not be of overall benefit to them’ and would advise against any such intervention.

However, according to your guidelines, this does not absolve the doctor of the responsibility taking the patient's views into account when entering into this discussion.

Clearly the doctor cannot fulfil this requirement with respect to spiritual care without ascertaining the patient's views. It would therefore seem an essential part of the assessment not just to enquire about physical, social and psychological aspects of the patient's condition, but the importance to the patient of spiritual aspect also.

Failure to do so restricts the patient's choice and is would appear to be a denial of their autonomy.

It may be I have misunderstood the GMC’s position on this. If so I'd be very grateful for your clarification.

Yours sincerely

Reply from Jane O’Brien, Assistant Director, Standards and Fitness to Practise Directorate

Dear Dr Chaput de Saintonge,

Thank you for your letter of 30 August 2011.

I think your analysis of our guidance is absolutely right, and where there is medical treatment that is clinically appropriate for the patient and likely to provide overall benefit, doctors should raise this with the patient as part of the consent process.

The more difficult issue is where the boundaries lie between medical treatment and management, which are within the expertise of doctors and properly provided by the NHS or other health funding bodies; and the provision of spiritual support and care, which is generally provided by religious or faith leaders or others with expertise in this area. The GMC does not place a duty on doctors to provide 'spiritual care' - but rather to recognise patients' need for such care and to facilitate patients’ access to it, where the patient would welcome this and is not in a position to do so him or herself.

There are some therapies that might be regarded as 'faith based', including meditation and yoga, but in general it is difficult to identify treatment options which would be available only as part of faith-based management of conditions. Where such treatment options exist, they should be discussed with patients.

I would not claim to be an expert on the research on the impact of faith or spirituality on health, but much of the most accessible evidence relates to the health benefits of practising religion or having a 'spiritual' life more generally. We encourage doctors to help patients to take an interest in their health (see paragraph 6 of Good Medical Practice), for example by talking about the benefits of lifestyle choices, such as taking exercise or losing weight. Of course, doctors can also tell patients about the evidence of the impact on health of being an active member of a faith community or otherwise engaging in a spiritual life.

Finally, the GMC fully supports a holistic view of patient care. You will see in our guidance on consent and treatment and care towards the end of life, in particular, that we encourage doctors to think about the patient’s overall needs, and to take into account their values and beliefs. You may be interested to note that as part of the review of Good Medical Practice we will be consulting shortly on changes to our guidance on good clinical care. This will include the following (additional text in bold type):

If you assess, diagnose or treat patients you must provide a good standard of clinical care: Good care will involve:

a. Adequately assessing the patient’s conditions, taking account of their history (including the symptoms, and psychological, spiritual, religious, social and cultural factors), the patient’s views, and, where necessary, examining the patient.

If you would like to be sent an alert when the consultation is launched later this month, please let me know.

Yours sincerely

Observations

The GMC letter makes a number of statements that Christian doctors will welcome, namely:

1.Where faith-based treatment options exist, they should be discussed with patients (but what does the GMC actually understand by the term 'faith-based'?)
2.The GMC fully supports a holistic view of patient care (but what does it understand by the term 'holistic'?)
3.Good care, which doctors must provide, involves taking a spiritual, cultural and religious history.

But there is still lack of clarity over whether providing information about spiritual care and access to it is a duty or an option.

On the one hand the GMC says that doctors must recognise patients’ need for spiritual care and facilitate their access to it, when they would welcome this and are not in a position to access it themselves.

On the other hand the GMC seems to give doctors an option about whether or not to tell patients about the evidence of the impact on health of being an active member of a faith community or otherwise engaging in a spiritual life.

But if patients are not aware of the benefits of faith to health then how can they be in a position to welcome spiritual care?

The GMC is moving in the right direction but needs to be clearer on its requirements so that doctors understand their duties and patients understand their rights.

Perhaps the key problem here is that while the GMC is recognizing the importance of spiritual care for health, it has not yet managed to define what spiritual care actually is. They will need help from doctors practising spiritual care on the front line to do this effectively.

I would urge Christian doctors to respond to this consultation in order to ensure that a whole person approach - including spiritual care - is universally implemented; that doctors are given freedom to practise it and that patients are given full opportunity to make use of it. A majority of patients actually want their doctors to practise whole person medicine which involves the spiritual dimension. Shouldn't that be the bottom line?

The big interview from Evangelical Times

I gave an interview last month for the October Evangelical Times ‘big interview’ column. It is posted on their website but I have also pasted it below.

The big interview – October 2011

Peter Saunders is Chief Executive of the Christian Medical Fellowship, a UK-based organisation with 4,500 UK doctors and 1,000 medical students as members. His role includes leadership training, teaching evangelism and ethics, medical mission, writing, editing and media work. Peter took some time out to answer questions from Sheila Marshall.

SM Which TV drama series — Holby City, Casualty or ER?

PS Definitely ER. As a general surgeon I loved the challenge of assessing and treating critically ill patients. Holby City and Casualty are just too ‘soapy’ and too slow-moving for me.

SM What drives your work with CMF?

PS Luke the physician tells us that Jesus sent his followers out ‘to preach the kingdom of God and to heal the sick’ (Luke 9:2). This means, to attend to the spiritual and physical needs of a suffering world. Christian doctors motivated by Jesus’ teaching and example have been profoundly influential in shaping healthcare’s history. A significant number of medicine’s pioneers were people of faith — Paré, Pasteur, Lister, Paget, Barnado, Jenner, Simpson, Sydenham, Osler, Skudder, Livingstone and many more. The CMF exists to help doctors continue in the steps of Jesus, the Great Physician. What drives me is a desire to help doctors fully integrate their faith and practice, to be witnesses to the gospel, and instruments of God’s grace and compassion.

SM Why does CMF need to promote Christian values in the church?

PS CMF’s fourth aim (after evangelism, discipleship and healthcare mission) is ‘to promote Christian values, especially in bioethics and healthcare, among doctors and medical students, in the church and in society’. As Christian doctors, rooted in Scripture and dealing daily with a host of physical, psychological and spiritual needs, we are uniquely placed to bring medicine and the Christian faith together. Members are often asked by Christian friends for guidance on end-of-life care, abortion, infertility, contraception and a host of other lifestyle and healthcare issues. Many pastors feel they lack the expertise to apply the Bible to contemporary issues of healthcare and medical ethics. Christian doctors can help fill that gap. We want to help Christians make wise decisions about their own healthcare and want to equip Christians to engage in the wider national debate on issues that have a significant effect on the most vulnerable people in our society.

SM Can Christian values be promoted in a secular society?

PS As Christians we are called to proclaim the gospel and live to honour Christ in every way. This involves bringing a Christian mind to the many issues that plague our society, and being salt and light. As citizens of a democracy, we have a responsibility both to choose our political leaders and to do what we can to ensure that the laws in our statute books are just and fair. We have a special responsibility to stand up for those who have no voice, like those who are poor, marginalised, elderly, unborn, sick and disabled. There is a growing hostility amongst some quarters of our country towards Christian faith and values. This needs to be challenged.

SM Are Christian values too expensive for our welfare system?

PS The current crisis in healthcare has complex causes. Much of the rising burden of disease is a consequence of poor lifestyle choices, such as people literally eating, smoking, drinking and drugging themselves to death. There is little money free to invest in care, because we are spending our financial resources on the wrong things or living way beyond our means. This is compounded by the breakdown of the family. I believe that the root cause is that as a society we are increasingly turning our back on God, so the supports of family, church and community are no longer there. Christian faith has huge benefits for health, because it has a huge impact on lifestyle choices; people are more likely to avoid or delay many of the diseases that are costly to our health service. If more people in Britain lived according to Christian values, there would be less medical need and much more money available to care for the sick and dependent.

SM What issue did you take with Terry Prachett’s recent BBC documentary on assisted suicide?

PS The BBC has become something of a cheer-leader for assisted suicide. This was the fifth BBC documentary in three years that portrayed assisted suicide or euthanasia in a positive light. We are disturbed by the bias of our national broadcaster, which has an obligation to remain impartial. The programme also breached both national and international guidelines on suicide portrayal and posed a great risk to vulnerable people by fuelling the well-documented phenomena of suicide contagion and copycat suicide.

SM How should the media approach this subject?

PS The BBC’s own editorial guidelines on portrayal of suicide are very clear. They call for, ‘great sensitivity’; ‘factual reporting and fictional portrayal of suicide, attempted suicide and self-harm have the potential to make such actions appear possible, and even appropriate, to the vulnerable’. The World Health Organisation’s guidance is equally unambiguous: ‘Don’t publish photographs or suicide notes. Don’t report specific details of the method used. Don’t give simplistic reasons. Don’t glorify or sensationalise suicide’.

SM Can you give examples?

PS Media stories about how people coped positively with suicidal feelings lead to a decrease in levels of suicide in the general population. Researchers have named this protective effect the ‘Papageno effect’, in honour of the character in Mozart’s opera The magic flute. When Papageno fears that he has lost his love, Papagena, he prepares to kill himself. But three boys save him at the last minute by helping him to find purpose in his suffering.

SM Are euthanasia, abortion and bioethics matters of conscience?

PS The Bible teaches us that human beings are made in the image of God and infinitely precious — meaning worthy of respect, protection, empathy and compassion. The sixth commandment ‘You shall not kill’ is based on this idea and forbids taking the lives of innocent human beings, even if they request us. For centuries the laws of our country have been based on these biblical concepts. Moral issues are not simply matters of individual conscience. It takes a huge amount of grace, courage and character to obey God in tough, costly decisions, but that doesn’t mean that it should not be clearly and unambiguously taught. That is why there is so much moral teaching throughout Scripture.

SM How can everyday believers make a difference?

PS God uses weak and ordinary people to do great things. The smallest step of faithful obedience by God’s grace can turn the course of history. God can use day-to-day decisions to advance his kingdom in and through us. Nothing done in his service is ever in vain and our job is to be faithful to him where he has placed us and trust the results to him.

SM What verses inspire you?

PS Too many to mention really, but here are just a few: Luke 4:18-19 — the Nazareth manifesto; 1 Corinthians 15:58 — never give up; 2 Corinthians 8:9 — Jesus our model; 2 Corinthians 12:9 — strength in weakness; Proverbs 31:8 -9 — speaking up for the weak.

General Medical Council considers changes to its guidance that could further restrict faith discussions

Pulse magazine reported last week that the General Medical Council is planning to ‘harden’ its guidance on religion in practice.

The document Good Medical Practice (2006) is the core guidance to doctors and describes what is expected of all doctors registered with the GMC. Although the guidance is addressed to doctors, it is also intended to let the public know what they can expect from their doctors.

The GMC says that it is reviewing Good Medical Practice ‘to make sure it is up to date and fit for its many purposes’.

A formal consultation will be launched later this month and will lead to publication of a new edition of the guidance in 2012.

The new draft guidance has added a duty for GPs to consider ‘patients' religious, spiritual and cultural history' when assessing patients.

The regulator also plans to tighten up anti-discrimination guidance on doctors expressing personal views, including religious beliefs, in consultations.

Its previous guidance had stated: ‘You must not unfairly discriminate by allowing your personal views to affect adversely your professional relationship with patients.' Its new version removes the word ‘adversely', requiring GPs to challenge their colleagues' behaviour if there is any effect to the professional relationship.

Once ‘Good Medical Practice’ has been modified it is expected that the GMC will then move to modify its supplementary guidance ‘Personal Belief and Medical Practice’ which goes into these matters in far greater detail.

The revision of ‘Good Medical Practice’ comes during the course of an ongoing investigation into the case of Dr Richard Scott, a GP in Margate, Kent, who was the subject of a complaint for suggesting to a patient that he might find an examination of the Christian faith helpful.

The GMC had proposed giving Dr Scott a warning for discussing his Christian faith during a consultation, but he refused to accept it and opted instead for an oral hearing before its investigations committee.

Dr Scott told the BMJ in May that he had raised the possibility that Christianity might help his patient only in the last five minutes of a 20 minute consultation, after first asking his permission and being told to ‘go for it.’

His mother then brought a complaint to the GMC, saying that Dr Scott had ‘pushed religion’ on her son.

On 23 September, the second day of the two day hearing in Manchester, the committee adjourned ‘to make a further attempt to secure the attendance of Patient A,’ who has so far refused to appear before the committee. His absence prevented Dr Scott’s lawyer cross examining him to challenge his account of what happened at the consultation in August 2010.

The committee heard that Dr Scott had seen the 24 year old man at his surgery in Margate, Kent, after his mother had said that he was ‘suicidal’.

Paul Ozin, for the GMC, said, ‘A line was crossed because Dr Scott expressed his personal religious belief to a person he knew was a vulnerable patient in a way that was plainly liable to cause the patient distress.' However this is disputed by Dr Scott's lawyer, Paul Diamond of the Christian Legal Centre.

Ozin claimed that Dr Scott 'suggested that Jesus or Christianity - his own religion - offered something exclusive and superior to that offered by the patient’s own religion. It is a matter of record that Patient A subsequently complained about Dr Scott and said he was very upset about the consultation and he was offended by what he saw as the belittling of his own religion.’

The revision of the GMC’s guidance appears to have been influenced by this case. The suggested amendments indicate that the regulator is considering more formally acknowledging that doctors have a duty to consider a patient’s spiritual history whilst at the same time taking a sterner view of any attempt to share their own faith.

Interestingly the GMC guidance ‘Personal Beliefs and Medical Practice’ actually acknowledges 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 also 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)

The GMC’s suggested new approach will not just make things more challenging for Christian doctors but will have implications for any doctor of any faith (or none) who expresses a personal belief that he or she feels might help (about anything) to a patient. This has the potential to lead to many more complaints against doctors and many more cases for the GMC to examine. The regulator could be walking a very delicate path indeed.

I suspect it will not just be Christian doctors who will be awaiting the draft guidance with much interest and examining its wording very carefully.

British Medical Journal publishes my reply to its article on CMF and faith discussions with patients

A couple of weeks ago the British Medical Journal published an article in its Lobby Watch column about Christian Medical Fellowship, focussing on the issue of whether or not Christian doctors should engage in faith discussions with patients.

This week they have published my response which I quote below in full for the benefit of those who do not have direct access to the BMJ website.

BMJ 2011; 343:d5214 doi: 10.1136/bmj.d5214
(Published 16 August 2011)
Cite this as: BMJ 2011; 343:d5214

Christian Medical Fellowship’s chief executive responds to Lobby Watch article
Peter Saunders, chief executive
Christian Medical Fellowship, London SE1 1HL, UK
pjs@cmf.org.uk

The Lobby Watch article on the Christian Medical Fellowship (CMF) is one sided and devotes 412 words to one of our 5000 members, 127 words to one course that we run, and only 111 words to CMF itself(1).

CMF was founded in 1949 following a notice placed in the BMJ and is affiliated, through the ICMDA (International Christian Medical and Dental Association), with about 70 other national bodies of Christian doctors worldwide. We are interdenominational and mainstream and share the same biblical Christian beliefs as other doctors motivated by Jesus Christ’s teaching and example, including Luke the Physician (who wrote Luke and Acts in the New Testament) and such medical pioneers as Paré, Pasteur, Lister, Paget, Barnardo, Jenner, Simpson, Sydenham, Osler, and Livingstone.

CMF’s principal work is to unite and equip Christian doctors, but we also seek to be a voice for Christian values in healthcare. Our commitment to marriage and upholding the sanctity of human life in particular may jar with those pursuing more secular agendas, but the BMA itself referred to abortion as 'the greatest crime' in a 1947 supplement to the BMJ(2).

We welcome the General Medical Council’s recognition that 'all doctors have personal beliefs which affect their day-to-day practice' and that 'discussing personal beliefs may, when approached sensitively, help you to work in partnership with patients to address their particular treatment needs.' We also welcome the recent endorsement by the GMC and Medical Defence Union of “tactful” offers of prayer by general practitioners (3) and the GMC’s confirmation on national radio of the appropriateness of sensitive faith discussions with patients (4). CMF’s new book At a Given Moment by Graham McAll and my recent editorial explore these matters in more depth (5).

Notes
Cite this as: BMJ 2011;343:d5214

Footnotes
Competing interests: PS is chief executive of the Christian Medical Fellowship.

References
1. Cassidy J. Christian Medical Fellowship. BMJ2011;343:d4586. (26 July.)
[FREE Full text]
2. Saunders P. BMA’s 180 degree turn to embrace what it once called 'the greatest crime.' cmfblog.org.uk 25 July 2011.
3.Saunders P. General Medical Council and Medical Defence Union endorse 'tactful' offers of prayer by GPs. cmfblog.org.uk 20 July 2011.
4.Saunders P. General Medical Council confirms the appropriateness of sensitive faith discussions with patients. cmfblog.org.uk 20 June 2011.
5. Saunders P. Faith matters in healthcare encounters. Triple Helix 2011;summer:3.

Medical Defence Union finally publishes full version of new guidance on praying for patients

I recently blogged about new guidance from the Medical Defence Union which endorsed tactful prayer with patients. The full version of this new guidance is now available on the MDU website. It makes it clear that the guidance has been released as a result of the recent case of a GP, Richard Scott, who refused a formal warning from the General Medical Council following a complaint that he had discussed faith with a patient.

The MDU says it has received just seven requests for advice and assistance over the last two years about discussing religion with patients.

It outlines that the ‘issue is a sensitive one’ which ‘arouses strong feelings from those who see religious belief as a potential comfort for patients and those who see such discussions with patients as inappropriate in a clinical consultation’.

The key thing according to the MDU is ‘the context of the consultation and the doctors’ existing relationship with a patient’.

The MDU advises doctors to ‘think very carefully before raising the subject of religion with patients’ and to be aware that patients may already feel ‘vulnerable or distressed’ or ‘inhibited from talking openly or honestly if they believe your religious views may lead you to judge them’.

They also emphasise, from the GMC’s guidance on personal beliefs and medical practice, that doctors should not ‘impose beliefs on patients or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views’. Neither should they ‘put pressure on patients to discuss or justify their beliefs’ but they should not ‘normally discuss personal beliefs with patients unless those beliefs are directly relevant to the patients’ care’.

However the MDU then quotes at length a letter from Jane O’Brien, the Assistant Director of Standards and Fitness to Practice with the GMC whose letter to the Daily Telegraph in February 2009 made the following points:

‘Nothing in the GMC’s guidance precludes doctors from praying with their patients. It says that the focus must be on the patients’ needs and wishes. Any offer to pray should follow on from a discussion which established that the patient might be receptive. It must be tactful so that the patient can decline without embarrassment because whilst some may welcome the suggestion others may regard it as inappropriate’.

The MDU also quotes controversial guidance from the Department of Health issued in January 2009 entitled ’Religion or belief: a practice guide for the NHS’. This guidance was highly criticised at the time for over-interpreting the law and erring on the side of gagging doctors rather than allowing free discussion about a patient’s spiritual needs.

As I have emphasised before, there is much in the GMC guidance which provides latitude for faith discussions and in particular it emphasises that ‘discussing personal beliefs may, when approached sensitively, help doctors to work in partnership with patients to address their particular treatment needs’.

Human beings are not biological or biochemical machines but complex unities of body, soul and spirit. This means that real whole person care should address not just issues of physical health but also psychological, social and spiritual issues which are having an influence on health. There is a huge and growing body of evidence outlining the health benefits of Christian faith.

Overall the MDU guidance seems to strike a good balance and gives a reasonable amount of latitude both to doctors and patients who are open to faith discussions that have a bearing on health.

£200k of lottery money spent on Reiki like therapy in West Midlands Hospital a waste of time and money

Back in February I reported on a BBC story claiming that ‘a third of NHS trusts still offer homeopathy despite there being no scientific evidence for its effectiveness’. I laid out a checklist for Christians for assessing complementary and alternative medicine (CAM) therapies.

Today, Archbishop Cranmer (aka ‘His Grace’), has drawn my attention to a story in the Mail on Sunday, '"Voodoo" row as the Lottery gives £200k to spiritual healers available on NHS', reporting on a research project into a controversial form of ‘alternative medicine’ being carried out in a West Midlands Hospital.

Three healers at Good Hope are apparently recruiting 200 patients suffering from bowel conditions. These healers then pass their hands over the patients' bodies to channel 'healing energy' to affected areas in 20-minute sessions designed to see whether the treatment relieves discomfort.

A Big Lottery Fund grant for the two-year study was awarded to healing charity ‘Fresh Winds’, which is working with Birmingham University and the NHS Good Hope Hospital in Sutton Coldfield.

Advocates say the energy works 'like a gentle set of jump leads' and can alleviate pain. But critics say the healing has no scientific basis and money raised through the Lottery should not be used to promote alternative medicine when the NHS is squeezed for cash.

One patient at Good Hope is reported as refusing to join the trial. 'How a person running their hands over you can make a difference, I really don't know,' she said. 'I think there is a certain amount of pandering to people's desperation. The healing appears to be based on the Buddhist spiritual practice of Reiki, which is ironic when Christian doctors and nurses are warned about praying for their patients.'

She is referring to the case of Caroline Petrie, a Christian nurse who was suspended from her job for offering to pray for an elderly patient's recovery from illness.

Simon Singh, the author of Trick or Treatment? Alternative Medicine on Trial, has said: 'The £200,000 should have been spent on much better causes. There is no worthwhile evidence at all that spiritual healing works in any way, shape or form other than the placebo effect – when the patient feels better just because they are getting some attention. To use Lottery money on this is to introduce voodoo into our health service. It is genuinely tragic to spend money this way when there are so many real medical questions that need answering.'

Simon Singh's co-author Edzard Ernst, professor of complementary medicine at Exeter University, added: 'It makes a mockery of evidence-based medicine to put public money into this.'

Reiki is an increasingly popular ‘therapy’ recommended for a variety of acute and chronic conditions. Developed in the late 19th century, it is characterised by the laying on of hands, and based on an ancient Buddhist healing technique. Like other alternative therapies with New Age associations, it involves belief in an invisible life force that generates self-healing.

Reiki has no credible scientific basis and there is no evidence for its efficacy in controlled trials. Although posing little medical danger, apart from causing delay in orthodox diagnosis and treatment, its spiritual roots and lack of evidence-base should ring loud alarm bells.

Two major reviews have recently been published looking at Reiki’s effectiveness.

The first, ‘Effects of reiki in clinical practice: a systematic review of randomised clinical trials’, was published in 2008 and concluded that ‘the evidence is insufficient to suggest that Reiki is an effective treatment for any condition’.

The second, 'A systematic review of the therapeutic effects of Reiki', in 2009, drew the conclusion that ‘the serious methodological and reporting limitations of limited existing Reiki studies preclude a definitive conclusion on its effectiveness’.

But as well as having no proven benefit, Reiki’s spiritual roots should also ring alarm bells for Christians. A review in the CMF Journal Triple Helix concluded:

‘Reiki claims to be a spiritual path leading to physical, mental, emotional and spiritual attunement, harmony, good health and happiness. As a holistic therapy with Buddhist roots, it clearly has serious spiritual implications but does not and cannot supply answers for the basic spiritual sicknesses of mankind such as sin, guilt, fear and the need for forgiveness and salvation.’

In other words there is not only no evidence that it actually works. It is also spiritually unsound. Two good reasons to stay away from it!

For both reasons Reiki is what medics call a ‘WOTAM’ therapy – a ‘waste of time and money’.

Hospitalised patients more satisfied when given chance to discuss faith and religion, new study shows

Hospitalised patients who are able to talk about their religious and spiritual concerns are more satisfied with their care, but one-fifth are not given the chance to have these discussions, researchers in Chicago have found.

The authors of the new study, published online on 1 July in the Journal of General Internal Medicine, compiled information on the spiritual concerns of more than 3,000 patients hospitalized over a three-year period, and had the patients rate their sense of satisfaction with their overall hospital care.

The study found that 41 percent of patients had religious or spiritual concerns they wanted to talk about while in the hospital. These discussions took place among 32 percent of all patients.

The study also pointed out that the patients did not care who spoke with them about their religious concerns. What mattered most was just having the discussion. Most of the patients, 61 percent, spoke with a chaplain, 12 percent with a member of their own religious community, 8 percent with a doctor and 12 percent spoke with other people.

Half of the patients who wanted a discussion, however, did not get to have one (20 percent of patients, overall), the researchers pointed out. Meanwhile, one in four who said they did not want a conversation about spiritual issues had one anyway.

Regardless of whether they wanted the religious discussion or not, those that did reported being more satisfied with their overall level of care while in the hospital, the researchers noted.

The study’s authors concluded, ‘These data suggest that many more inpatients desire conversations about R/S than have them. Health care professionals might improve patients' overall experience with being hospitalized and patient satisfaction by addressing this unmet patient need.’

This new research follows several recent endorsements of various aspects of spiritual care by doctors’ leaders in the UK.

The General Medical Council and Medical Defence Union have recently endorsed 'tactful' offers of prayer by GPs and the GMC has also confirmed the appropriateness of sensitive faith discussions with patients.

Professor Mike Richards, national clinical director for cancer and end-of-life care, said at the recent 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.

And RCGP clinical champion for end-of-life care Professor Keri Thomas said that spiritual care was 'essential' for end-of-life care.

These developments suggest that those who are not providing spiritual care are practising sub-optimal medicine and also that doctors who have no faith are not exempt from this responsibility.

General Medical Council and Medical Defence Union endorse 'tactful' offers of prayer by GPs

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.

General Medical Council confirms the appropriateness of sensitive faith discussions with patients

Last Thursday I took part in a discussion on the Radio 4 PM programme about whether or not faith discussions were ever appropriate in the context of a doctor-patient consultation.

The journalist introducing the programme made reference to the case of Richard Scott, the subject of a complaint to the GMC for discussing his faith with a patient.

Also mentioned was CMF’s own Saline Solution course which is aimed at helping doctors integrate faith and practice.

The key question was framed as follows: ‘Do General Medical Council guidelines leave room for a course which teaches doctors to initiate discussions with patients based on the belief that having a faith is good for you?’

Niall Dickson, Chief Executive of the General Medical Council, explained that the GMC’s role was not to vet courses but to guide doctors. ‘The first point is that the start of a consultation is not the point at which you start introducing your faith and you should be where the patient is at. But there may be circumstances where a patient is at a point where they do want to discuss faith and it may be appropriate for the doctor to reflect on their own faith during that discussion.’

When asked how the GMC determined whether or not a doctor had expressed ‘religious, political or other beliefs or views’ in an ‘inappropriate or insensitive’ way Dickson explained that the GMC guidance was there to enable doctors to make good judgements themselves:

‘I am not there to judge, the doctor is there to judge and this essence of medicine is making judgements in the face of uncertainty and the importance of the doctor understanding where the patient is at. Taking a vulnerable patient and imposing your religious views on them and exploiting their vulnerability would be on the wrong side of the line as far as we are concerned.’

When asked how frequently this occurred in practice he said that it was very uncommon: ‘It has happened on a couple of occasions. It is not a common thing. The vast majority of doctors with faith or without faith know how to talk to patients and know where the patient is at and even if you haven’t got faith you should, if a patient wants to talk about faith, be able to respond positively as well.’

I was asked about the content of the course and was able to talk about the large amount of evidence there is for the positive effects of faith on physical and mental health: ‘What we do at these courses is to teach people firstly about the very strong link that there is between faith and health. There is actually a huge evidence base. We are talking about in the vicinity of 1,200 research studies and 400 reviews in peer-reviewed medical journals. 81% show a positive correlation between faith and health; 4% a negative correlation and 15% sit on the fence.’

I emphasised, as the GMC guidance states, that faith discussions ‘should not normally be part of the consultation, and would not normally be. But there are occasions when it would be appropriate to move into these sorts of areas. The World Health Organisation’s definition of health is that health is not just to do with the physical things but also to do with mental, social and spiritual things as well. Human beings are not just biological machines. We have social, psychological and spiritual needs as well and there are times when it is appropriate to address those if they are having a bearing on a person’s health.’

When asked if I thought there was a danger of doctors taking advantage of patients I emphasised that, ‘Doctors must never impose their beliefs on patients nor exploit their vulnerability. But if they feel it is appropriate (and the key words we use are sensitivity, permission and respect) and a deeper exploration is being invited or would be helpful in a patient-centred consultation then it wouldn’t be inappropriate to do that. In fact many patients will actually welcome that sort of discussion. We know that many medical conditions do have social, psychological and spiritual elements to them and if you are not addressing those then you are not really practising whole person medicine.’

I was asked finally if we had developed our course because ‘Christian doctors felt put upon’. I said ‘no’ and explained that we had developed it ‘because we think Christian doctors really want to practise medicine that addresses the needs of the whole person’.

I closed by adding that I welcomed very much the GMC guidance stating that ‘all doctors have personal beliefs which affect their day to day practice’ and that it applied not just to doctors with a faith ‘but to all doctors equally. No doctor should impose his or her beliefs whether they are political, religious, moral or otherwise.’

New End of Life Patient Charter is a good start but does not go far enough

More than 8,000 GP surgeries in England will be asked to display a new patient charter on end of life care launched today.

The document contains seven ‘pledges’ to make the last few weeks and days of a person's life as comfortable as possible.

It also includes calls for healthcare teams to do all they can to preserve patients' ‘independence, dignity and sense of personal control’ along with ‘doing their utmost’ to ensure patients’ remaining days are comfortable, and that they get ‘all the specialist care and emotional and spiritual support (they) need’.

It has been created by the Royal College of General Practitioners (RCGP) and Royal College of Nursing (RCN) as an example of the ‘best practice’ all patients deserve from nurses and GPs in primary care.

Two of the seven points in the charter mention that patients’ intentions should be written down. The charter pledges that doctors and their practice teams will ‘assist you to record your decisions and do our best to ensure that your wishes are fulfilled, wherever possible, by all those who offer you care and support’ and advises that doctors and nurses should ‘ensure clear written communication of your needs and wishes to those who offer you care’.

We have heard an awful lot about dying in the last few weeks.

Two weeks ago we had national 'Dying Matters' awareness week, and this month is the International Society for Advance Care Planning and End of Life Care conference, being held in London. The NHS is also rolling out its National End of Life Care Programme, which works with health and social care providers across England to improve adult end of life care.

Of course charters, plans and awareness weeks are one thing and may well signify genuine good intentions. But the real proof of the pudding will be implementation at a time when health budgets are being cut and when elder abuse and poor care seems to be on the rise.

The charter comes hot on the heels of a report by the health services watchdog, the Care Quality Commission (CQC) which rated one in seven privately-operated care homes in Britain ‘poor’ or ‘adequate’.

Their inspections looked at nutrition and found cases of patients not being helped to eat, poor monitoring of patients' weight and people not being given enough to drink, with water being out of reach for long periods of time. In one case, a member of staff at Worcestershire Acute Hospitals NHS Trust said they had to prescribe water on medical charts to ensure patients got enough to drink.

So what should we make of this charter? In the main it seems a good attempt to improve patient care at the end of life.

Could it have been better? Most certainly! Here are three suggested improvements.

There seems to be a lot of emphasis on choice, independence, dignity and control. But I would have liked to have seen more recognition of the vulnerability of many people who are dying and a commitment to protect them from financial, emotional or physical abuse.

The charter makes passing reference to ‘spiritual support’ but there is nothing specifically about understanding the patient’s world view or religious faith and how it might help them cope with death. In particular there is no mention at all about understanding what beliefs the patient might have about life after death or how this might affect their dying process.

There is lot of emphasis about writing down patients’ wishes. One hopes this will not result in a push to make patients fill out ‘advance refusals’* that might conceivably be used against them later by someone with an interest in their death. I would recommend that establishing a lasting power of attorney (allowed for under the Mental Capacity Act 2005) is a better option: appointing someone you trust to honour your decisions. Better to rely on a trustworthy person than a piece of paper!

Is there anything sinister in this charter? I don’t think so. One does wonder how the emphasis on choice and control might work were assisted suicide or euthanasia ever to become legal. And no doubt the pro-euthanasia lobby will use this as another opportunity to advance their agenda. But given the huge opposition to legalizing assisted suicide or euthanasia from the medical profession I don’t think we need to have too much concern about that, at least in the immediate future.

In the meantime let’s see if this charter can be used to make a genuine positive difference in the way dying patients are cared for.

* There is lots of helpful background material on advance refusals in a previous statement on the CMF website.

‘Doing God’ is good for your health

Practising Christian faith is good for your health. That’s the verdict of a new report which shows that the faithful live longer and remain healthier. At a time when the health service is facing financial cuts and government is seeking ways to enhance happiness, the report shows that politicians who say ‘We don’t do God’ should think again!

The report, published by the Christian Medical Fellowship (CMF), issues a challenge to those who want to stop Christian medics and health professionals from talking to patients about faith. ‘Patients do not simply present biological problems to be solved. Rather, effective medical interventions should address all the dimensions of our humanity. It is clear that most patients value and seek this form of holistic care,’ the report says.

Drawing on evidence from over 1,200 studies and 400 reviews, the report titled ‘Health Benefits of Christian Faith’ by Dr Alex Bunn and Dr David Randall, points out that the overwhelming majority of scientific studies highlight the positive health benefits of faith, including protection from illness, coping with illness, and faster recovery from it.

Christian faith is shown to increase life expectancy: in one study of 21,204 adults, those who attended church regularly had a life expectancy up to 14 years longer than those who did not.

Other benefits of faith include:

·increased well-being, happiness and life satisfaction;
·hope and optimism;
·purpose and meaning in life;
·higher self-esteem;
·better adaptation to bereavement;
·less loneliness;
·lower rates of depression;
·lower rates of suicide;
·less anxiety;
·lower rates of alcohol and drug abuse;
·less delinquency and criminal activity;
·greater marital stability and satisfaction.

Quoting Andrew Sims, a former President of the Royal College of Psychiatrists, Bunn and Randall lament the lack of attention given to the strong evidence: ‘for anything other than religion and spirituality, governments and health providers would be doing their utmost to promote it’.

So should doctors prescribe faith?

CMF emphasises that Christians want to follow the example of Jesus, who was strikingly gentle and caring in his interactions with suffering human beings. The report stresses, ‘The founders of the church advised that Christians should respond to spiritual enquiries “with gentleness and respect”. The General Medical Council came to the same conclusion 2,000 years later.’

But doctors do also need to consider their patients’ spiritual care in diagnosis and treatment, the report says.

‘The people we most need to listen to are patients, who typically are more religious than their carers. In one survey, patients and families stated that faith was the second most important factor in their decisions about cancer treatment, whereas the oncologists treating them imagined it would be last on the list. Even if we consider those patients who are not involved in organised religion, 76% admit to spiritual experiences and beliefs.

‘Modern doctors need to become more patient centred by supporting spiritual care, as secular training has tended to exclude some of patients’ deepest concerns. At a time of illness spiritual issues often rise to the surface – questions of worth, mortality, and place in the world. The sensitive doctor will explore these by taking a spiritual history and considering how a patient’s existing spiritual views may impact on their current illness and hopes for recovery.’

Bunn and Randall conclude: ‘In contrast to the popular myth that Christian faith is bad for health, on balance, and despite its limitations, the published research suggests that faith is associated with longer life and a wide range of health benefits. In particular faith is associated with improved mental health. At the very least, the burden of proof is on those who claim that faith is bad for health and that all forms of spiritual care should be excluded from modern medicine.’

News outlets covering the story

Faith 'good for your health'
(Telegraph, 28 April 2011)

Religion 'can add 14 years to lifespan'
(The Scotsman, 24 April 2011)

How to live long and die happier
(Baptist Times, 28 April 2011)

God is good for your health, says new report
(Woman Alive, 28 April 2011)

Religion helps you live 14 years longer
(The Times of India, 25 April 2011)

Being Religious Can Extend Your Lifespan By 14 Years!
(Med India, 27 April 2011)

Do Christians Really Live Healthier & For Longer???
(Mex Magazine, 27 April 2011)

Report: Christians Live Healthier, Longer
(The Christian Post, 25 April 2011)

Get saved, It's good for you!
(Keith's Journal, 26 April 2011)

Believing in God is good for your health
(Christianity Today, 27 April 2011)

Religion ‘can add 14 years to lifespan’
(Online Investing, 24 April 2011)

Nottingham hospital officials shoot themselves in the foot by proposing Gideon Bible ban

I gather that hospital officials at the Nottingham University Hospitals NHS Trust want to ban Gideon Bibles from patients’ bedside lockers.

The ban, at the Nottingham University Hospitals NHS Trust, is intended to help cut levels of infectious superbugs such as MRSA. Apparently they want all bedside areas in Queen’s Medical Centre and City Hospital kept tidy and ‘clutter-free’ to stop disease spreading.

A similar proposed ban in Leicester in 2005 was called off after being criticised as ‘political correctness gone mad’ and after an outcry from local Christians Nottingham hospital officials are now consulting staff, patients and chaplains before bringing in the ban.

A ban on Gideon Bibles makes little sense as an infection control measure. The MRSA risk is low and to be consistent hospitals would have to ban newspapers, library books and all paper from patients’ bedsides. One wonders about the real motivation here.

The move also betrays a profound ignorance of the link between spirituality and health. A major review of 1,200 studies in the British Medical Journal showed a 60-80% relation between better health and spirituality and summarised a growing body of medical research showing that religious faith has a positive impact on disease prevention, coping with illness, recovering from surgery and improving treatment outcomes. The majority of these studies specifically evaluated the Christian faith and the majority of them have now been gathered in Koenig’s magnum Handbook of Religion and Health,which is regarded by many as the key authoritative text on the subject.

This and other scientific evidence has convincingly demonstrated that a natural by-product of religious faith is longer life, less illness, better physical and mental health, more marital stability, less divorce, less suicide and less abuse of alcohol and other substances, all outcomes that we would expect a health authority might be keen to promote.

The Gideons is a respected organisation operating in 181 countries that for over 100 years has been distributing Bibles free of charge. It is deeply ironic that this latest ban is being considered on highly tenuous grounds in a country where 70% still claim to be Christian and where members of other faiths have not been offended.

It is also sad that by doing so hospital managers risk depriving vulnerable people of spiritual comfort and may well be shooting themselves in the foot with respect to promoting health.

Christianity provides medicine with a whole person perspective

When I was medical student I was required to write an essay on the nature of man.

The secular world has developed many different models for human beings. There are psychoanalytical models like that of Sigmund Freud who saw man as the product of a complex reaction between superego, ego and id. Then there are the behaviourists like B F Skinner who see human beings as complex stimulus-response machines. Then there are the physical anthropologists who see man as simply a clever monkey, and finally the biochemists who see man as nothing other than a complex chemical reaction, the product of matter, chance and time in a universe without meaning or purpose.

All these views are 'reductionist' in that they reduce man to simply the sum of his individual parts.

As doctors we know that the biochemical, anthropological, behaviourist and psychoanalytical models are all useful in understanding how human beings function. We learn our biochemistry, physiology and anatomy because we know that human beings are physical entities. We learn our psychology, social anthropology and sociology because we know that human beings are more than just physical entities - they need to be understood also as thinking entities existing in relationship. We learn our philosophy and religion because we know that human beings ask deep questions about morality, purpose and destiny. Human beings are also spiritual.

Biblical Christianity teaches that human beings are a complex unity of spirit, soul and body; and that these elements together form an inseparable whole. We can be understood in physical terms because we are made from physical elements, but we are more than just physical beings. We have souls and spirits too, and these three parts of our natures – body, soul and spirit - interact in a complex fashion.

We know that our physical health has profound effects on the way that we think, and that illness causes us to ask questions about meaning and purpose. We know that the mind can also affect physical health in the case of psychosomatic illness. We know that major life events like bereavement or divorce can have profound effects on our health.

If we treat our patients simply as physical bodies we will be doing them a gross disservice. It is true that they have physical bodies and that they may need their biochemistry corrected, their physiology normalised and their anatomy realigned.

However they are also souls enmeshed in a complex set of relationships and spirits asking serious questions about hope, meaning and destiny. These factors have profound implications for health and need to be addressed too.

Jesus Christ healed physical illness but he also restored broken relationships, forgave sin and reintroduced people to their creator.