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Physician Perspectives on Religiously Related Conflict in the Medical Encounter

Farr A. Curlin, MD; Chad J. Roach, BS; Rita Gorawara-Bhat, PhD; John D. Lantos, MD; Marshall H. Chin, MD, MPH

Arch Intern Med. 2005;165:88-91.

Background  Patients at times disagree with medical recommendations for religious reasons. Despite a lively debate about how physicians should respond to patients’ religious concerns, little is known about how physicians actually respond. We explored the ways in which physicians interpret and respond to conflict between medical recommendations and patients’ religious commitments.

Methods  One-to-one, in-depth, semistructured interviews with 21 physicians from a range of religious affiliations, specialties, and practice settings. Interviews were transcribed, coded, and analyzed for emergent themes through an iterative process of textual analysis informed by the principle of constant comparison.

Results  Conflict introduced by religion is common and occurs in 3 types of settings: (1) those in which religious doctrines directly conflict with medical recommendations, (2) those that involve an area in which there is extensive controversy within the broader society, and (3) settings of relative medical uncertainty in which patients "choose faith over medicine." In response to such conflict, physicians first seek to accommodate patients’ ideas by remaining open-minded and flexible in their approach. However, if they believe patients’ religiously informed decisions will cause them to suffer harm, physicians make efforts to persuade patients to follow medical recommendations.

Conclusions  When religiously related conflict arises, physicians appear to intuitively navigate a tension between respecting patients’ autonomy by remaining open-minded and flexible and seeking patients’ good by persuading them to follow medical recommendations. In such contexts, religion and medicine are intertwined, and moral counsel inheres in physicians’ medical recommendations.

Author Affiliations: Sections of General Internal Medicine (Drs Curlin and Chin) and Geriatrics (Dr Gorawara-Bhat), Department of Medicine, and Section of General Pediatrics, Department of Pediatrics (Dr Lantos), Pritzker School of Medicine (Mr Roach), The Robert Wood Johnson Clinical Scholars Program (Drs Curlin, Gorawara-Bhat, Lantos, and Chin), and MacLean Center for Clinical Medical Ethics (Drs Curlin, Lantos, and Chin), The University of Chicago, Chicago, Ill.

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