Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Don't despair
- James A Cave (4 February 2006)
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Keep all religions out of it. Lesson for the doctors is to improve their communication skills
- Mariwan Husni (9 February 2006)
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Congratulations on a provocative article
- Clare M. Hamon (11 February 2006)
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Re: Don't despair
- Naomi D. Lear (28 February 2006)
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James A Cave, GP West Berkshire RG20 8UY
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Dear Naomi, I think you are missing a point, perhaps. Of course you are fed up having to learn the nitty gritty, but learning the nitty gritty is what being a doctor is all about. Anybody can be spiritual and caring, but only a doctor can be a good doctor if he or she has the knowledge. Taxi drivers in London have a reputation of being the best in the world because they still have to spend literally years driving around London on little motorbikes learning the "knowledge". It would not matter how charming they were or friendly if they could not get you from A to B. You must learn yours. The problem it seems to me is that some doctors imagine that knowledge is all you need to be a good doctor. Not you! The art and spirit of medicine will come; Dr Ipp will make sure of it. Competing interests: None declared |
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Mariwan Husni, Consultant Psychiatrist Northwick Park hospital, Harrow HA1 3UJ
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It is imprecise to suggest that a religious philosophy will always provide lessons for personal growth of doctors and spirituality alone will enable doctors to take interest in patients as people. Religious beliefs will not always enable a doctor to relate what he knows and how he can help others relate to what he knows. For example because of the inherited problems that is mostly complicated by individual interpretations of religion in the Middle East a particular religious faith does not enable a doctor to relate any better to a patient from a different religion. The religious philosophy is open for personal interpretation hence leading to misunderstanding and divisiveness. Individuals interpret religious doctrine in ways that reflect their own personality and past experiences as it is obvious in the first year medical student, Naomi Lear’s situation (4th February BMJ 2006;332:311). Naomi is proposing that doctors should take lessons from her religion to be “whole people” if they are to help their patients as whole people, I think this a simplistic view that is based on lack of experience of the wider world and perhaps it suggests how hard medical students have to work in there first year at McGill university with out appropriate mentoring. The view of religious or cultural enrichment reminds me of what you can read in the Yiddish translation of Shakespeare which carries on it “Translated and improved”. A religious idealist may claim that lessons should be taken only from Islam in treating mentally unwell individuals because historically they have held the whole society responsible for the “kindly care” of the insane, their hospitals had psychiatric divisions in Baghdad (750) and Cairo (873); they also built special insane asylums in Damascus (800), Aleppo (1270), and the Muslim-ruled Spanish city of Grenada. There is undoubtedly a degree of subjectivity in the interpretation of this historical narration and if you look at the state of psychiatric services in Moslem countries, they are far from being ideal. In prehistoric times, disease was believed to be caused by evil spirits or forces. The concept of disease as a result of divine intervention to test or punish the guilty or ungodly is well entrenched in Judeo-Christian religion as reflected in the Book of Job and the exorcisms practiced by Jesus in the New Testament. What are now understood to be mental disorders were believed to result from possession by evil spirits or demons that could be cast out by exorcistic rites or destroyed by killing the possessed persons. Alternatively, one could be cured or cleaned of illness by supplication, sacrifice, prayer, or ritualistic appeasement of the gods. Belief in the power of prayer and other religious and spiritual rituals to invoke divine intervention to alter the forces of disease remains a component of most religious belief systems. Differences in gender, education, language, race, ethnicity, nationality, value system, religion and other significant cultural differences between a patient and a doctor can impair communication and may lead to misunderstandings unless the doctor is well trained in all aspects of communication skills. Through out history religious individuals have assumed the role of healers with opposing overall outcomes. For example, the existence of many traditional healers/ shamans in the native Canadian communities has not particularly resulted in improving the health of the young or the older members of these communities. Conversion to Christianity under the influence of the settlers has not been much more helpful. We continue to read about and see the health problems in these communities. Many people, not excluding medical students, when they are under stress, feel desperate or regretful, may return to religion as a source of comfort and as a social resource. I agree with Stephen J Goldie, medical student, University of Glasgow (studentBMJ 2004;12:1-44 February ISSN 0966-6494), that his intention to practice equal and non-judgmental medicine without religious beliefs should not be disparaged. In order to be able to practice equal and judgmental medicine requires ongoing training in communication skills. Good communicators usually understand their patients very well by attempting to understand their culture, belief and way of life. It is extremely important that good communicating doctors are also aware of their own religious beliefs, culture and moral modes operands, which at times can have negative influence on the doctor patient relationship and their communication. Erich Fromm (1900–1980), a Psychoanalyst, who emphasized that culture and social setting influence an individual's dynamics as much as instincts do. Through years of studying, he identified the constructive and destructive roles that religion may play in individual lives. Therefore there is less value in taking lessons from any particular religious philosophy but rather understand the dynamics of your patients’ and your own set of values and other relevant cultural differences. Competing interests: None |
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Clare M. Hamon, part-time GP Plymouth
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Dear Naomi Congratulations on your article in the BMJ. I hope it inspires a large and thoughtful response. I have just had my 50th birthday and practise as a general medical practitioner. I share your commitment to the spiritual side of living. I am delighted that the local primary care trust has set up a one-day study course on spiritual awareness, which I am attending next month. I work in a very deprived area and I feel it is essential to acknowledge my patients' spiritual strengths and spiritual distress in order to help them to health and wholeness. It is also important to cherish every member of staff and facilitate their personal growth. There is more to life than being a doctor. Because I take a holistic approach to the health of my city and the world, I work part-time and devote some of my time and energy to other things. I am the chairman of a local "global justice" group which produces a guide to fair trade in and around Plymouth. Next month, as part of Fairtrade Fortnight, we are organising a Fairtrade Fashion Show. I am a member of many other groups, including Amnesty International, and take part in their campaigns. I know the huge amount of factual knowledge you have to accumulate is tiresome, but you need both scientific knowledge/skill and compassion to be a good doctor. You can't do the job really well unless you have both. You can't instill spiritual values into people; there is a limit to what the education system can achieve. We can only hope that medical students are chosen with an eye to their potential as truly holistic practitioners. As it says in Ecclesiastes, there is a time for everything and perhaps for many students it is right to focus on the light-hearted joy of life rather than the more serious issues which will need to be dealt with at some stage but can wait. I hope you find the spiritual sustenance and challenges which you need in order to grow and to be fulfilled. Yours sincerely Clare Hamon Competing interests: None declared |
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Naomi D. Lear, Medical Student Faculty of Medicine, McGill University
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Dear Dr. Cave, Thank you for responding to my article. In my view, the question is not whether knowledge is important for doctors. The question is whether basic science is all the knowledge that doctors need in order to adequately treat their patients. I am now in my third year of medical training. Although I am often able to look up my patients' medical conditions and formulate treatment plans, I frequently find myself ill prepared for the significant emotional and ethical challenges I face, such as decisions about artificial nutrition and hydration, assessing competency, and with-holding life sustaining treatment. Medicine means more than caring people practicing basic science. As such, students require a broad base of knowledge, including not only basic science, but, also, knowledge of ethical decision making, the social determinants of health and the cultural aspects of illness. It is the responsibility of medical education to promote the acquisition of these diverse forms of knowledge. Naomi Lear Competing interests: None declared |
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