Doctors at religious hospitals may encounter conflicts about care, study finds

When religion and medicine intersect it can create difficulties for physicians. A new study finds that not only do some doctors clash with the religious hospitals at which they work, but those disagreements could affect patient treatment.

Researchers surveyed 446 U.S. doctors (family physicians, general internists and general practitioners), asking them via questionnaire if they had ever worked in a religious hospital; if they had ever had a conflict with religion-based patient care policies; and what should a physician do if a patient needed an intervention the hospital barred due to its religious practices. For the last question the doctors were given four scenarios: provide the intervention openly, even if that risks the doctor's job or hospital privileges; provide the intervention discreetly to avoid getting fired or losing privileges; encourage the patient to get the intervention at another hospital; or recommend another treatment approved by the religious hospital.

Among the participants, 43% had worked in a religiously affiliated hospital, and 19% had some conflict about religion-based policies. Most physicians -- 86% -- said that when conflicts arise about those policies, physicians should encourage patients to get the needed intervention at a hospital where it's not prohibited. Only 10% thought recommending another hospital-approved treatment was a good idea, and 4% supported giving the intervention, either openly or discreetly, against hospital policy.

"Primary care physicians routinely see patients facing reproductive health or end-of-life decisions that may be restricted in religious healthcare institutions, so we were not surprised to learn that nearly 1 in 5 of the physicians who have worked in a religious setting have faced a conflict with their hospital," lead author Dr. Debra Stulberg, instructor of family medicine and of obstetrics and gynecology at the University of Chicago, said in a news release.

The study was published online in the Journal of General Internal Medicine.

A study last year looked at another aspect of religion and medicine -- how doctors handle prayer requests by patients and families in clinical settings.

-- Jeannine Stein

Photo credit: Kathy Willens / Associated Press

Looking for guidance on circumcision? You’re on your own

Circumcision. It’s a delicate procedure and a loaded word, filled with connotations of pain, religious significance and hotly debated health benefits.

Some commentary in the current issue of the Archives of Pediatrics and Adolescent Medicine shows that medical professionals are not quite ready to come down on one side or the other. “Recommendations for routine newborn circumcision will need to wait for well-designed studies that verify its cost-effectiveness for the individual and/or society,” the editorial said.

But another paper in the same issue pointed to three recent studies that found circumcision helped reduce HIV acquisition by up to 60%.

In this L.A. Times story, writer Marnell Jameson highlighted the dilemma for many parents looking to circumcise:

Those who strongly oppose infant circumcision believe the procedure violates a child's human rights. …

The downside of letting the child make the decision later is that adult circumcision is more expensive, painful and extensive. During an infant circumcision, practitioners numb the site with local anesthesia, then attach a bell-shaped clamp to the foreskin and excise the skin over the clamp. The clamp helps prevent bleeding. In adults, the procedure involves two incisions, above and below the glans (tip of the penis), stitches and a longer recovery. The cost is about 10 times that of a newborn procedure.

Bottom line: In the delivery room or afterward, no one’s going to be providing some infallible rules on circumcising your child. Do your homework before you have to decide. Here’s a brief description from the American Urological Assn. and some very helpful information from KidsHealth. Should you choose not to make the cut, the American Academy of Pediatrics has a guide on caring for an uncircumcised penis.

-- Amina Khan

Photo credit: Annie Wells / Los Angeles Times

When asked to pray, what do doctors say?

Families often turn to prayer when a loved one is in the hospital. But what happens when they ask their doctor to take part?

A new study reveals how physicians deal with a request for prayer by patients and their families in clinical settings. The 30 doctors surveyed by researchers from Brandeis University in Waltham, Mass., and Rice University in Houston were pediatricians or pediatric oncologists chosen from 13 highly ranked hospitals.

In nearly all cases, the patients or their families brought up the idea of prayer, and it was most often related to a child who was seriously ill or dying. And while every physicians wanted to be respectful of the families, they handled prayer requests differently. Researchers boiled those variations down into four scenarios.

In the first, doctors actively took part in the prayer. Some, when asked, attended religious ceremonies such as baptisms. Said one, "...I had the parents ask me to be there for the baptism given to the baby because the baby was dying...I stay at the bedside myself because, I felt like, you know they're part of my family, so...I love to share that."

In the second, physicians were present for the prayers but did not take part, instead standing with the families and perhaps showing respect by bowing their heads. Some even spoke at funerals. Said one pediatric oncologist, "I participate [in prayers]. I mean in the sense that I generaly sit quietly and listen to their prayer in what I hope is a respectful manner."

One, when asked to lead a prayer, explained his reaction: "If somebody wishes me to lead a prayer, I say, 'I don't think that's appropriate or I would prefer not to but I'll be happy to be here with you.' " The physician went on to say he feels it is "manifestly unfair of patients to demand something so personal of their physicians."

In the third scenario, doctors tweaked prayer requests to make them more realistic and appropriate. "I try not to bring myself into it," said one physician, "because I don't want this to be about me, and I don't want them [the family] to think that I have more...power to cure their child than I actually have."

In the fourth, physicians referred patients and family members to religious or spiritual leaders or to the hospital chaplain. One doctor explained that while she told families she would keep them in her prayers, she would also suggest they also talk to a chaplain. "If I don't feel comfortable," she said, "if I feel that their religion is something that I have a hard time understanding, I often ask if they would like to have some spiritual guidance."

The study appears in the December issue of Southern Medical Journal.

-Jeannine Stein

Photo credit: Francine Orr / Los Angeles Times

Doctors recognize the healing power of spirituality

When physicians treat their patients, they can write prescriptions, recommend surgery, order physical therapy – or call upon the services of a professional chaplain.

According to a survey reported today in the Archives of Internal Medicine, 89% of physicians who took part in a nationwide poll said they had worked with a chaplain. Of those doctors, 90% said they were “satisfied” or “very satisfied” with the ministers, priests, rabbis and other clergymen.

Researchers from Rush University Medical Center in Chicago found that physicians who had training in religion and spirituality were more likely to put their patients in touch with a chaplain. So were doctors who treated lots of patients who were critically ill or who worked in the fields of psychiatry or obstetrics and gynecology.

Not surprisingly, the doctors’ own views about religion and spirituality played a role. Those who believed that belief in a higher power could be helpful to patients were more likely to reach out to chaplains, as were doctors who felt comfortable discussing religion with patients directly, the survey found.

Support for chaplains was geographically widespread. Among the 1,102 physicians whose responses were tabulated, only those from the Northeast were less likely to appreciate chaplains.

-- Karen Kaplan

Photo: Doctors appreciate the role that chaplains play in their patients’ lives, according to a new survey. Credit: Nicholas Roberts / For The Times

On a mission? Wear a mask

In the no-good-deeds-go-unpunished category, 20 volunteers from mission groups in Pennsylvania and Virginia who helped renovate a church in El Salvador earlier this year fell ill with a fungal disease called histoplasmosis.

The fungus, Histoplasma capsulatum, is found in soil, especially soil that's been contaminated by bird or bat droppings. If inhaled, it can cause acute respiratory illness.

The outbreak was written up in Thursday's Morbidity and Mortality Weekly Report, published by the national Centers for Disease Control and Prevention.

The 20 volunteers were among 34 people from three mission groups who traveled to Nueva San Salvador, El Salvador, last January and February for a week to replace a church roof, tinker with plumbing and generally spruce up the place. Those whose jobs included digging or sweeping were the most likely to fall ill, probably because they disturbed the soil and caused microscopic fungal spores to become airborne.

Symptoms, which began about 12 days after exposure, included fever, fatigue, headaches and chills. Six of the volunteers were hospitalized. All recovered.

The fungus can be found in soil throughout the world, including the United States, especially around chicken coops and bird roosts. Most people who become infected have only mild symptoms and recover without treatment. Construction workers and farmers, who are most at risk, are advised to wear respirators and to spray water to keep dust down.

Good-deed doers can do the same.

-- Mary Engel