Physician and philosopher Daniel Sulmasy, who completed his residency training and fellowship at Johns Hopkins, lived for nearly 27 years as a Franciscan friar. Now director of the Kennedy Institute of Ethics at Georgetown University, he lectures and writes frequently about the connections between spirituality and medicine. Some key takeaways from his recent essay in The New England Journal of Medicine, also shared at a Johns Hopkins Center for Innovative Medicine (CIM) seminar:

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Clinicians have a duty to make sure a patient’s spiritual needs are addressed.  By inquiring about patients’ spiritual needs, doctors demonstrate respect for them as whole persons and strengthen the patient–physician relationship. Doctors may be the only team members who uncover spiritual struggles or negative forms of coping that can interfere with a patient’s well-being, notes Sulmasy. He suggests following a “FICA” framework: inquiring about the patient’s faith and spiritual beliefs; the importance of religion and spirituality in their lives; whether they belong to a spiritual community that could serve as a resource for them; and how patients would like to see spirituality addressed in relation to their medical care.

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Engagement should be tailored to the specifics of the patient’s case: the seriousness of the medical condition, the patient’s level of distress, and their openness to spiritual conversation.  For patients with serious illness, physicians can start by asking about affiliations and beliefs and then turn to more specific spiritual questions: “What are your deepest hopes? What sense, if any, can you make of this?” Following the patient’s lead, the questions can become more specific: “Are you at peace? Do you realize you are still valued and cherished, no matter how sick you are?” If the conversation becomes too complex, Sulmasy says doctors can step back and ask if a chaplain could stop by to continue the conversation.

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Physicians may believe that if they don’t share the patient’s faith, they shouldn’t ask about spirituality or religion lest they make a mistake or seem disingenuous. But the deepest spiritual questions are applicable not only across all faiths but also to people who practice no religion, Sulmasy says. “Buddhists and Christians, for instance, respond differently to human suffering,” he writes, “but the suffering that accompanies illness or injury is a universal aspect of the human predicament.”