As a surgeon specializing in cancer, I often meet people at a time of crisis and fear, when they have just been diagnosed with cancer. For many, their belief system is central to their coping strategy. So I believe it is an appropriate time to talk about faith and religion, though many of my colleagues may disagree.
I met a patient I’ll call Brenda not long ago. A tall, thin woman, she would not look me in the eye, and surprised me by not seeming to be relieved when I told her she had a curable cancer with an excellent prognosis.
“I’m ready to die,” she said. “I don’t see the point of fighting this thing.”
As I asked further questions, I learned that Brenda was a middle-aged widow, alone in life and lonely. With no other family, her part-time job as a cashier was her main source of human interactions, and these weren’t satisfying.
Toward the end of our conversation, I asked gently, “What about religious affiliation? Do you have community there?”
“Protestant,” she said. “And no, I don’t go to services anymore.”
It’s a delicate thing, as a doctor, to prescribe a bit of church. But that is what I suggested to Brenda, “Perhaps you can re-engage with your church or reach out to your pastor,” I suggested.
I meet people like Brenda almost every day, people for whom meaningful social connections don’t exist. But given the importance of these connections in mental and physical health, I believe that physicians cannot ignore the role faith and religion can play in fostering them.
Times of crises are reminders of humans’ need for social connection; they are often a time when people reconnect with their faith. The Covid-19 pandemic has been a collective crisis that brings into stark focus our need for community amid the forced isolation. For many people, faith and religion have been ways to maintain social connection and cope with the stress of the pandemic.
Yet medicine has minimized the importance of faith and religion in patient well-being. They have been largely sidelined, something to be engaged with only when death approaches.
For cancer patients, hearing the “C” word splits time into before and after. They run the gamut of emotion: disbelief, fear, anger, and swirling thoughts about who will help them get through it. During discussions about treatment, patients learn the lexicon of cancer — surgery, chemotherapy, radiation, immunotherapy, and the like. Doctors also discuss the need for support, but too often my empathic colleagues do not ask their patients about religion or faith or spirituality. In doing so, they inadvertently focus on the cancer and lose focus of the patient and their emotional well-being.
Marriage and religion, proxies of social connection, have been linked to earlier cancer diagnoses and better outcomes. Married colon cancer patients have better five-year survival rates than unmarried patients. For many cancers, social support is beneficial in ways that cannot often be measured. In older, chronically ill hospitalized patients, religiousness and spirituality are predictors of increased social support, and those with better social support are less likely to experience depressive symptoms and have improved cognitive function.
Americans increasingly identify as non-religious. And many of my colleagues may believe that religion or faith or spirituality is a private matter outside the purview of medicine. Yet this is not entirely true: Physicians are comfortable relegating faith and religion to palliative or hospice care. This reinforces the notion that faith, religion, and spirituality are only end-of-life issues and not also ways to foster human connections.
Medicine is in the midst of a concerted effort to deliver culturally competent care. But that can’t happen by ignoring something that may be central to some patients’ identities or coping strategies. It can also be difficult to do in a society with a plurality of faiths.
Training is central to helping physicians be more comfortable discussing issues of faith and religion. This is not additional training to burden physicians, but rather reclaiming the holistic view of patient care. Once historically central in medicine, this view has fallen by the wayside as the science of medicine has exploded. I remind trainees that physicians practice the art and science of medicine, not just the science. Medical education needs to make future physicians comfortable discussing matters of faith, religion, and spirituality as part of providing culturally competent care. This can be discussed in medical school, but unless trainees see their role models doing this, it is just another fact-finding exercise to be tested on an exam.
Providing holistic care means that discussions about faith, and religion, and spirituality cannot be parsed out to social workers and chaplains, relegating physicians to the role of technicians.
Despite an increased focus on the impact of social drivers of health, medicine has been slow to recognize that how people are connected to one another and their community — including their community of faith — is a social driver of health.
My goal as a physician is not just to cure my patients of cancer, but also to ensure that they find a new normal post-cancer that ensures optimal physical and emotional well-being.
I had the opportunity to see Brenda for a follow-up visit. Over time, and after multiple phone calls, she had opted for treatment and was doing well. Walking into the room, I was struck by her smile. Somewhere along the way, someone from her church had reached out, and a coffee date had resurrected a lapsed friendship. By the end of the visit, I had a huge smile as well, not only because she had successfully completed treatment but because she had once again found human connection.
T. Salewa Oseni is a surgical oncologist at Massachusetts General Hospital and an assistant professor of surgery at Harvard Medical School.