Introduction

• There IS evidence to suggest that many patients believe religion and spirituality plays an important role in their lives, that there is a positive correlation between a patient's spirituality or religious commitment and health outcomes, and that patients would like physicians to know about it.

• A spiritual assessment can be a practical first step in incorporating consideration of a patient's spirituality into medical practice.

Family medicine up till now has included care about physical mental social, financial and environmental well - being. This includes an understanding of a patient's family and environment, as well as the social, cultural and psychological situation. Over the past several years, it has now been suggested that spirituality is another important, yet often neglected, factor in the health of patients and the same should be included as a part of the definition of health.

The evidence

1. Up to 77% of patients would like spiritual issues considered as a part of their medical Care, yet only 10-20% of physicians discuss these issues with their patients.

2. There is an increased interest in the incorporation of spirituality into the practice of medicine. Nearly 50 medical schools in the USA currently offer course in spirituality and medicine.

Spirituality and medicine: Is there a relation?

1. Evidence suggests a strong relationship (not cause and effect) between spirituality and medicine.

2. Polls of the US population have consistently shown that 95% of Americans believe in God.

3. One study found that 94% of patients admitted to hospitals believe that spiritual health is as important as physical health, 77% believe that physicians should consider their patients' spiritual needs as a part of their medical care, and 37% want their physician to discuss their religious beliefs more. However, 80% reported that physicians never or rarely discuss spiritual or religious issues with them.

4. One study in an OPD setting found that 91 % of patients believe in God. compared with 64% of physician. In this study, 40% of patients felt that physicians should discuss pertinent religious issues; however, only 11 % of physicians frequently or always did.

5. Another study has reported similar findings. A recent national survey of family physicians reports that the percentage of physicians who have spiritual beliefs is closer to that of the general population.

6. That relationship between religious commitment and health outcomes has also been reviewed in detail.

Although some disagree most authors reported that a positive relationship between religious commitment and mental and physical health was found in up to 84% of studies that included a measure of religious commitment as a part of the study. Religious commitment of illness (including depression, substance abuse and physical illness), in coping with illness and in recovery from illness.

7. A recent study of elderly patients undergoing elective cardiac surgery showed that lack of strength and comfort from religion was independently related to the risk of death during the 6-month period following surgery.

8. A prospective cohort study of elderly poor forced to move from their homes showed that those who were more religiously committed were twice as likely to survive the 2-year study period as persons without such religious commitment. The most influential study variable was strength and comfort derived from religion.

9. Some studies have evaluated the effects of the relaxation response and meditation on health outcomes. The relaxation response can be elicited by a simple 2-step procedure: (1) Repeating a word. phrase or muscular activity, and (2) passively disregarding any obtuse thoughts that come to mind and returning to the repetition. When practiced regularly, this technique results in a reproducible set of physiologic effects and is effective therapy for several medical conditions.

10. Benson reports that 80% of patients, when given the choice between a religious or secular phrase, voluntarily choose a religious phrase to elicit the relaxation response. One quarter of the patients described a feeling of increased spirituality as a result of practicing the technique. These same patients were more likely to have better measurable medical outcomes than those who did not experience increased spirituality.

11. One review points out methodological problems with these studies, including ethical issues in studying the effects of religious behavior on health outcomes. The investigators did not address patients' wishes for spiritual discussions with their physicians, studies on relaxation! medication or patient's general spiritual concerns (beyond specific religious practices).

Although still preliminary, other areas of study regarding spirituality and medicine include the effects of prayer and the placebo effect.

Conclusions: Spiritual well being is as important as physical

Spirituality is an important multidimensional aspect of the human experience that is difficult to fully understand or measure using the scientific method, yet convincing evidence in the medical literature supports its beneficial role in the practice of medicine. These may not be cause & effect relation. It will take many more years of study to understand exactly which aspects of spirituality hold the most benefit for health and well -being. The world's great wisdom traditions suggest that some of the most important aspects of spirituality lie in the sense of spirituality lie in the sense of connection and inner strength, comfort, love and peace that individuals derive from their relationship with self, others, nature and the transcendent.

Studies of the links between spirituality and health
 

The Relaxation Response

Technique to elicit relaxation response

1. Repeat a word, sound, phrase, prayer or muscular activity that has meaning for you (e.g., "one," "peace," "Om," "AUM" "Oang" "Sh'ma. Yisroel," "The Lord is my shepherd," "Insha'allah," "Hail Mary, full of grace," jogging, breathing techniques, knitting).

2. Passively disregard intrusive thoughts that come to mind and return to the repetitive focus.

3. Body mind relaxation.

4. Shavasana.

5. Present moment awareness.

Physiologic effects of the relaxation response

Decreased metabolism, decreased rate of breathing, decreased blood pressure, decreased muscle tension, decreased heart rate and increased slow brain waves.

Conditions where relaxation has been found effective:

• Hypertension, cardiac arrhythmias, chronic pain, anxiety, insomnia
• Mild-to-moderate depression, infertility
• Postoperative anxiety
• Premenstrual syndrome
• Migraine and cluster headaches
• Low self-esteem
• Symptoms of cancer
• Acquired immunodeficiency syndrome (AIDS)

Source: Benson H. Timeless Healing: The Power and Biology of Belief Scribner, NY 1966.