October 2005 Articles of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.
Curlin, F. A., Roach, C. J., Gorawara-Bhat, R., Lantos, J. D. and Chin, M. H. "How are religion and spirituality related to health? A study of physicians' perspectives." Southern Medical Journal 98, no. 8 (August 2005): 761-766.
Curlin, F. A., Lantos, J. D., Roach, C. J., Sellergren, S. A. and Chin, M. H. "Religious characteristics of US physicians: a national survey." Journal of General Internal Medicine 20, no. 7 (July 2005): 629-634.
COMMENTS and SUMMARIES: The lead author of both of this month's articles is Farr A. Curlin, MD, Assistant Professor of Medicine, University of Chicago Division of Biological Sciences. Dr. Curlin has recently noted that his "career aim is to study the ways physicians' religious commitments shape clinical decisions" [--see his abstract for "Religious Commitments and Clinical Engagements," a project funded through the National Center for Complementary & Alternative Medicine, listed on the Computer Retrieval of Information on Scientific Projects (CRISP) database], and these articles shed much light upon the beliefs and attitudes regarding religion/spirituality that physicians bring to their patient encounters. Health care chaplains should find these studies illuminating and, I shall suggest in regard to the first of these studies, a model for research into the attitudes of chaplains themselves.
In "How are religion and spirituality related to health? A study of physicians' perspectives," Curlin and his colleagues interviewed a purposive sample of 21 physicians from diverse religious backgrounds, practice settings and clinical specialties. "The average age of participants was 42 years, and 7 were women" [p. 762]. The one-hour interviews were guided by the following general question and subsequent probes:
The authors offer a good description of their method of qualitative analysis on pp. 762-763.
- What do you think is the relationship, if any, between a patient's faith, religion or spirituality, and his or her health?
- Do you think religion or spirituality has a negative effect? Explain. --Can you recall examples that would illustrate what you have just described?
- Do you think that religion or spirituality has a positive effect? Explain. --Can you recall examples that would illustrate what you have just described?
- You may have noticed over the past few years that much has been written about the effect of religion on health. Have you followed any of this discussion? What are your thoughts about it? --Do you think the effects of faith or spirituality on health can be explained in scientific terms? Explain.
[See the box on p. 762.]
Physicians emphasized three basic ways that religion influences health. First, they noted that religion forms the paradigm from which many patients understand, cope with, and respond to illness. Second, they noted that many patients are members of, and therefore shaped by, religious communities. Finally, they described ways that religious paradigms and religious communities at times lead patients to make decisions that conflict with medical recommendations. ...Physicians did not talk about the instrumental or biomedical effects of religion on health, and only indirectly discussed influences on specific health outcomes. [p. 763]
Those who were familiar with the medical literature [on religion & health] described it as suggestive of, but not able to prove, a link between religion and positive health outcomes. They generally believed that science could explain at least some of the effects--mentioning brain chemistry, stress reduction, and other mechanisms--and they expected new scientific explanations to be forthcoming. At the same time, most expressed doubts that scientific explanations would ever fully account for the relationship between religion and health, and several were critical of focusing on biomedical outcomes.
Throughout the article, the findings are well illustrated by the use of quotes from the interviews. However, readers should be mindful of a printing error: what appear to be endnote numbers following each of the illustrative quotes in the Results section (pp. 763-765) are actually interview numbers which should have been printed in parentheses in the manner noted after the very first quote in the section.
The Discussion section offers this practical insight: "Through the lens of the clinical encounter, physicians appear most often to observe religion as an influence on the ways in which patients cope with and make decisions related to their illnesses" [p. 765]. Therefore, the debate in the medical literature on the effect of religion/spirituality on health outcomes may be less important to physicians in general than are issues of how they might "seek accommodations when patients disagree with medical recommendations for religious reasons..." or how they might "be attuned to and empathic toward the ways that religion often allows patients to cope with suffering and illness" [p. 765].
The authors address several limits of this study, including the small sample size (though it is a size appropriate for the qualitative methodology employed). However, this reader would like to raise one additional thought about the generalizability of the findings: The study participants' average age was 42, and while that is relatively young, so is the field of research into the effects of religion/spirituality on health outcomes. It seems unlikely that the participants would have experienced as part of their formative medical education the kind of outcome research on religion/spirituality & health that has been a focus of the literature in the last decade. It might just be that such research on outcomes in this area may lead successive age cohorts to give greater emphasis to outcomes evidence.
For chaplains, this study may also serve as a template for research on the attitudes of chaplains themselves. The interview question and subsequent probes could be asked, without changing the wording, of CPE students and staff chaplains, and could establish valuable comparison data. It could be especially interesting to see what clinical examples chaplains offered to support their basic responses. If this reader had to venture a guess, it may be that chaplains today--like the physicians in the current study--place little weight on outcomes research and think largely about how patients' religion/spirituality plays into decision-making and coping.
Turning to "Religious characteristics of US physicians: a national survey, " Curlin, et al. sent to a national probability sample of practicing US physicians a 12-page questionnaire covering religious affiliation, intrinsic religiosity, frequency of religious service attendance, beliefs, spirituality vs. religiosity, religious coping, and basic demographics. Their response rate was 63% (of the 1,820 physicians contacted), yielding 1,144 questionnaires for quantitative analysis. The article provides a great deal of data, conveniently organized in tables, comparing physicians' responses to those of the general US population as indicated by the 1998 General Social Survey.
Among the findings: 55% of physicians who responded "agreed with the statement, 'My religious beliefs influence my practice of medicine'" [p. 631]. Also,
Physicians and [US] population members are equally likely to have some religious affiliation, but physicians are much more likely to belong to religious traditions that are underrepresented in the United States. Physicians are more likely than population members to attend religious services regularly, but less likely to consciously make efforts to apply their religious beliefs to other areas of life. Physicians are more likely to describe themselves as "spiritual" as distinct from religious, whereas for the general population, spirituality and religion appear to be more tightly connected. Finally, our data suggest that patients and physicians are likely to differ in their reliance upon God as a means of coping and making decisions in the context of major illness. While most patients will "look to God for strength, support, and guidance," most physicians will instead try to "make sense of the situation and decide what to do without relying on God." [p. 632]
Data are also presented comparing characteristics of medical specialties [--see especially Table 4 on p. 632], confirming--among other things--the findings of previous studies that have suggested that family practice physicians and pediatricians tend to be more religious than their colleagues in other specialties. The authors also address potentially complex findings about the role of religious beliefs in the professional practice of Jewish, Hindu, and Muslim physicians [--see p. 632].
This study details "the diversity of religious commitments that enter clinical encounters from the perspectives of physicians as well as those of patients" [p. 633], and that point--by itself--is worth serious consideration in light of other research that suggests that religious variables may affect physicians' practice in many areas [--see p. 632]. This study essentially sets out an array of topics for further research into how particular characteristics might shape the physician-patient encounter.
Chaplains who are not aware of the General Social Survey may want to investigate that data source beyond the scope of the present article. The 1998 GSS data, from a random sample of 1,445 adults in the US is available on line (along with data from earlier GSS surveys) through the National Opinion Research Center at the University of Chicago: go to http://www.norc.org/GSS+Website, and under Browse Variables look for the Subject Index for Religion. There is a wealth of data on a broad range of issues.
Suggestions for the Use of the Articles for Discussion in CPE:
The article on "...Physicians’ perspectives" seems well suited to CPE discussion and would be a good choice for students new to the research literature, as it is relatively brief and very readable, offers illustration of points through quotes from the interviews, and provides a clear explanation of the qualitative methodology employed. One approach to discussion could be to ask students--before they read the study--to guess what physicians might say about the relation of religion/spirituality to health and the importance of scientific evidence about the effect of religion/spirituality to health outcomes. Discussion could then include some consideration of how scientific inquiry seeks to provide insights that run much deeper than casual observations and opinions. Students might also be invited to talk about their own responses to the basic interview questions which the physicians were asked [--see the box on p. 762], and how their own perspectives compare or contrast to those revealed in the study.
The survey of "Religious characteristics of US physicians..." will likely be intriguing to students in general, but its special value for discussion in the CPE context may be its premise that encounters with patients are not only influenced by patients’ beliefs and attitudes but by those of the health care professionals involved. Discussion could dovetail into the issue of how chaplains’ own beliefs and attitudes affect patient encounters, and that rather typical conversation in CPE could be enriched here by inviting one or more physicians to participate.
Related Items of Interest:
I. Studies of physician spirituality/religiosity:
[ADDED 12/27/05]: Cheever, K. H., Jubilan, B., Dailey, T., Ehehardt, K., Blumenstein, R., Morin, C. J. and Lewis, C. "Surgeons and the spirit: a study on the relationship of religiosity to clinical practice." Journal of Religion & Health 44, no. 1 (April 2005): 67-80. [This survey of 35 surgeons, using items from the Duke University Religion Index, the Salesian Center Intrinsic Religiosity Scale for Clinicians, and Rotter's Locus of Control Scale, found that 68% of the sample indicated that their religious beliefs play a role in their medical practice, 47% attended worship at least weekly, and 44% prayed every day. No correlation was found between religiosity and locus of control.]
Chibnall, J. T. and Brooks, C. A. "Religion in the clinic: the role of physician beliefs." Southern Medical Journal 94, no. 4 (April 2001): 374-379. [Among the findings of this study of 78 physicians: "Most physicians do not initiate religious discussion with patients, though a majority accept a link between religion and health. Physician personal discomfort with addressing religious topics was the sole multivariate predictor of clinical religious behavior." (--from the abstract, p. 374)]
[ADDED 4/24/06]: Curlin, F. A., Chin, M. H., Sellergren, S. A., Roach, C. J. and Lantos, J. D. "Association of physicians' religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter." Medical Care 44, no. 5 (May 2006): 446-453. [This analysis of 1144 surveys (63% response rate from a sample of 2000 physicians of all specialties in the US who were mailed questionnaires), found: "Almost all physicians (91%) say it is appropriate to discuss R/S issues if the patient brings them up, and 73% say that when R/S issues comes up they often or always encourage patients' own R/S beliefs and practices. Doctors are more divided about when it is appropriate for physicians to inquire regarding R/S (45% believe it is usually or always inappropriate), talk about their own religious beliefs or experiences (14% say never, 43% say only when the patient asks), and pray with patients (17% say never, 53% say only when the patient asks). Physicians who identify themselves as more religious and more spiritual, particularly those who are Protestants, are significantly more likely to endorse and report each of the different ways of addressing R/S in the clinical encounter." (--from the abstract, p. 446)]
[ADDED 12/19/07:] Curlin, F. A., Lawrence, R. E., Odell, S., Chin, M. H., Lantos, J. D., Koenig, H. G. and Meador, K. G. "Religion, spirituality, and medicine: psychiatrists' and other physicians' differing observations, interpretations, and clinical approaches." American Journal of Psychiatry 164, no. 12 (December 2007): 1825-1831. [(Abstract:) OBJECTIVE: This study compared the ways in which psychiatrists and nonpsychiatrists interpret the relationship between religion/spirituality and health and address religion/spirituality issues in the clinical encounter. METHOD: The authors mailed a survey to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. The authors asked the physicians about their beliefs and observations regarding the relationship between religion/spirituality and patient health and about the ways in which they address religion/spirituality in the clinical setting. RESULTS: A total of 1,144 physicians completed the survey. Psychiatrists generally endorse positive influences of religion/spirituality on health, but they are more likely than other physicians to note that religion/spirituality sometimes causes negative emotions that lead to increased patient suffering (82% versus 44%). Compared to other physicians, psychiatrists are more likely to encounter religion/spirituality issues in clinical settings (92% versus 74% report their patients sometimes or often mention religion/spirituality issues), and they are more open to addressing religion/spirituality issues with patients (93% versus 53% say that it is usually or always appropriate to inquire about religion/spirituality). CONCLUSIONS: This study suggests that the vast majority of psychiatrists appreciate the importance of religion and/or spirituality at least at a functional level. Compared to other physicians, psychiatrists also appear to be more comfortable, and have more experience, addressing religion/spirituality concerns in the clinical setting.]
[Added 5/15/08:] Curlin, F. A., Nwodim, C., Vance, J. L., Chin, M. H. and Lantos, J. D. "To die, to sleep: US physicians' religious and other objections to physician-assisted suicide, terminal sedation, and withdrawal of life support." American Journal of Hospice & Palliative Care 25, no. 2 April-May 2008): 112-120. [This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians' religious characteristics, ethnicity, and experience caring for dying patients.]
[ADDED 9/14/07:] Curlin, F. A., Odell, S. V., Lawrence, R. E., Chin, M. H., Lantos, J. D., Meador, K. G. and Koenig, H. G. "The relationship between psychiatry and religion among U.S. Physicians." Psychiatric Services 58, no. 9 (September 2007): 1193-1198. Comment, with authors' reply, in vol. 58, no. 11 (November 2007): 1499-1451. [(Abstract:) OBJECTIVE: This study compared the religious characteristics of psychiatrists with those of other physicians and explored whether nonpsychiatrist physicians who are religious are less willing than their colleagues to refer patients to psychiatrists and psychologists. METHODS: Surveys were mailed to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. Physicians were queried about their religious characteristics. They also read a brief vignette about a patient with ambiguous psychiatric symptoms and were asked whether they would refer the patient to a clergy member or religious counselor, or to a psychiatrist or a psychologist. RESULTS: A total of 1,144 physicians completed the survey, including 100 psychiatrists. Compared with other physicians, psychiatrists were more likely to be Jewish (29% versus 13%) or without a religious affiliation (17% versus 10%), less likely to be Protestant (27% versus 39%) or Catholic (10% versus 22%), less likely to be religious in general, and more likely to consider themselves spiritual but not religious (33% versus 19%). Nonpsychiatrist physicians who were religious were more willing to refer patients to clergy members or religious counselors (multivariate odds ratios from 2.9 to 5.7) and less willing to refer patients to psychiatrists or psychologists (multivariate odds ratios from .4 to .6). CONCLUSIONS: Psychiatrists are less religious than other physicians, and religious physicians are less willing than nonreligious physicians to refer patients to psychiatrists. These findings suggest that historic tensions between religion and psychiatry continue to shape the care that patients receive for mental health concerns.]
[Added 4/11/07:] Curlin, F. A., Sellergren, S. A., Lantos, J. D. and Chin, M. H. "Physicians' Observations and Interpretations of the Influence of Religion and Spirituality on Health." Archives of Internal Medicine 167, no. 7 (April 9, 2007): 649-654. [(Abstract:) Background: In spite of a substantial body of empirical data, professional disagreement persists regarding whether and how religion and spirituality (hereinafter "R/S" and treated as a single concept) influences health. This study examines the association between physicians' religious characteristics and their observations and interpretations of the influence of R/S on health. Methods: A cross-sectional survey was mailed to a stratified, random sample of 2000 practicing US physicians from all specialties. Physicians were asked to estimate how often patients mention R/S issues, how much R/S influences health, and in what ways the influence is manifested. Results: The response rate was 63%. Most physicians (56%) believed that R/S had much or very much influence on health, but few (6%) believed that R/S often changed "hard" medical outcomes. Rather, most physicians believed that R/S (1) often helps patients to cope (76%), (2) gives patients a positive state of mind (75%), and (3) provides emotional and practical support via the religious community (55%). Compared with those with low religiosity, physicians with high religiosity are substantially more likely to (1) report that patients often mention R/S issues (36% vs 11%)(P<.001); (2) believe that R/S strongly influences health (82% vs 16%) (P<.001); and (3) interpret the influence of R/S in positive rather than negative ways. Conclusion: Patients are likely to encounter quite different opinions about the relationship between their R/S and their health, depending on the religious characteristics of their physicians.]
Daaleman, T. P. and Frey, B. "Spiritual and religious beliefs and practices of family physicians: a national survey." Journal of Family Practice 48, no. 2 (February 1999): 98-104. [Among the findings: "Seventy-four percent of the surveyed physicians reported at least weekly or monthly service attendance, and 79% reported a strong religious or spiritual orientation. A small percentage (4.5%) of physicians stated they do not believe in God." (--from the abstract, p. 98)]
[ADDED 12/26/07]: Delaney, H. D., Miller, W. R. and Bisono, A. M. "Religiosity and spirituality among psychologists: a survey of clinician members of the American Psychological Association." Professional Psychology: Research & Practice 38, no. 5 (October 2007): 538-546. [(From the abstract:) Clinician members of the American Psychological Association (APA) were surveyed regarding their religion and spirituality. The survey was sent to 489 randomly selected members of APA, of whom 258 (53%) replied. Items were drawn from prior surveys to allow this APA sample to be compared with the general U.S. population and with an earlier survey of psychotherapists by A. E. Bergin and J. P. Jensen (1990). Although no less religious than A. E. Bergin and J. P. Jensen's (1990) sample, psychologists remained far less religious than the clients they serve. The vast majority, however, regarded religion as beneficial (82%) rather than harmful (7%) to mental health. Implications for clinical practice and training are considered.]
[ADDED 11/5/07]: Ecklund, E. H., Cadge, W., Gage, E. A. and Catlin, E. "The religious and spiritual beliefs and practices of academic pediatric oncologists in the United States." Journal of Pediatric Hematology/Oncology 29, no. 11 (November 2007): 736-742. [This study compares data from surveys of 77 pediatric oncology faculty (from a total sample of 122) working in 13 "honor role" hospitals, as designated by US News and World Report, with data from the General Social Survey. Results (--see the Abstract, p. 736): "Eighty-five percent of pediatric oncology faculty described themselves as spiritual. In all, 24.3% reported attending religious services 2 to 3 times a month or more in the past year. Twenty-seven percent of pediatric oncologists believed in God with no doubts. In all, 52.7% believed their spiritual or religious beliefs influence interactions with patients and colleagues. Among the general public 40.1% reported attending religious services 2 to 3 times a month or more in the past year (P<0.01) and 60.4% believed in God with no doubts (P<0.001). Conclusions: Although many have no traditional religious identity, large fractions of pediatric oncology faculty described themselves as spiritual. This may have implications for the education of pediatric oncologists and the spiritual care of seriously ill children and their families." (The article is preceded by a commentary: Walco, G. A., "Religion, spirituality, and the practice of pediatric oncology," on pp. 733-735.)]
Frank, E., Dell, M. L. and Chopp, R. "Religious characteristics of US women physicians." Social Science and Medicine 49, no. 12 (December 1999): 1717-1722. [This survey (with 4501 respondents, for a 59% response rate from random national sample) offers basic information about religious affiliation and found that physicians who claimed strong religious beliefs were more likely to perform volunteer work, though the number of hours given to pro-bono medical work did not differ according to strength of religious identity. It was also found that "for Whilte/non-Hispanic physicians and for physicians of any ethnicity, being Muslim or being a member of a non-mainstream Christian religion was highly associated with having a history of ethnically-based harassment in the medical setting," as was also the case for Jewish respondents (p. 1720).]
[ADDED 2/11/07]: Grossoehme, D. H., Ragsdale, J. R., McHenry, C. L., Thurston, C., DeWitt, T. and VandeCreek, L. "Pediatrician characteristics associated with attention to spirituality and religion in clinical practice." Pediatrics 119, no. 1 (January 2007): E117-123. [(Abstract:) OBJECTIVE. The literature suggests that a majority of pediatricians believe that spirituality and religion are relevant in clinical practice, but only a minority gives them attention. This project explored this disparity by relating personal/professional characteristics of pediatricians to the frequency with which they give attention to spirituality and religion. METHODS. Pediatricians (N = 737) associated with 3 academic Midwestern pediatric hospitals responded to a survey that requested information concerning the frequency with which they (1) talked with patients/families about their spiritual and religious concerns and (2) participated with them in spiritual or religious practices (eg, prayer). The associations between these data and 10 personal and professional characteristics were examined. RESULTS. The results demonstrated the disparity, and the analysis identified 9 pediatrician characteristics that were significantly associated with more frequently talking with patients/families about their spiritual and religious concerns. The characteristics included increased age; a Christian religious heritage; self-description as religious; self-description as spiritual; the importance of one's own spirituality and religion in clinical practice; the belief that the spirituality and religion of patients/families are relevant in clinical practice; formal instruction concerning the role of spirituality and religion in health care; relative comfort asking about beliefs; and relative comfort asking about practices. All of these characteristics except pediatrician age were also significantly associated with the increased frequency of participation in spiritual and religious practices with patients/families. CONCLUSIONS. Attention to spiritual and religious concerns and practices are associated with a web of personal and professional pediatrician characteristics. Some characteristics pertain to the physician's personal investment in spirituality and religion in their own lives, and others include being uncomfortable with spiritual and religious concerns and practices. These associations shed light on the disparity between acknowledged spirituality and religion relevancy and inattention to it in clinical practice.]
[Added 10/18/05:] Klitzman, R. L. and Daya, S. "Challenges and changes in spirituality among doctors who become patients." Social Science & Medicine 61, no. 11 (December 2005): 2396-2406. [Fifty physicians from major urban areas in the US were interviewed regarding their experiences and views of religion/spirituality in light of their own hospitalizations for serious illnesses.]
Messikomer, C. M. and De Craemer, W. "The spirituality of academic physicians: an ethnography of a Scripture-based group in an academic medical center." Academic Medicine 77, no. 6 (June 2002): 562-573. [This is an engaging sociological analysis of a group of 20 academic physicians who allowed the investigator to attend their weekly meetings whose purpose was to foster spiritual growth and connectedness.]
O'connor, S. and Vandenberg, B. "Psychosis or faith? Clinicians' assessment of religious beliefs." Journal of Consulting and Clinical Psychology 73, no. 4 (August 2005): 610-616. [Mental health professionals (n=110) were asked to assess the pathological seriousness of patient case scenarios. Among the findings: cases were assessed to indicate greater pathology if they involved patients' beliefs that were associated with less mainstream religions, if patients’ beliefs were not explicitly identified as belonging to established religions, and if patients’ beliefs were connected to high levels of harm. There were also differences in assessments in terms of the identified religious traditions of the patients in the scenarios (i.e., Catholic, Mormon, and Nation of Islam).]
Olive, K. E. "Physician religious beliefs and the physician-patient relationship: a study of devout physicians." Southern Medical Journal 88, no. 12 (December 1995): 1249-1255. [This older study of 40 physicians who indicated that their religious beliefs were an important part of their lives found: "Thirty-two percent reported having shared their beliefs with patients. Praying aloud with patients occurred with only 13% of patients, but 67% of respondents reported having done this on at least one occasion." (--from the abstract, p. 1249)]
Oyama, O. and Koenig, H. G. "Religious beliefs and practices in family medicine." Archives of Family Medicine 7, no. 5 (September-October 1998): 431-435. [This survey of 31 family medicine faculty/residents and 380 family medicine clinic outpatients found, among other things, that these physicians were more likely than the patients to have no religious affiliation and less likely to pray privately, to hold intrinsic religious attitudes, or to be interested in their own physicians’ religious beliefs.]
II. Articles about physicians who have experienced pastoral care training:
[Added 4/19/06:] Allbrook, D. B. "A metamorphosis: doctor to chaplain." Medical Journal of Australia 172, no. 8 (April 17, 2000): 390-391. [This is a personal reflection by an Australian retired palliative care physician and academic after a year in a hospital pastoral care (chaplaincy training) program. The author treats implications for his understanding of the practice of medicine and offers a description of the role of the chaplain.]
[Added 4/19/06:] Faris, I. B. "Perspectives from a surgeon turned hospital chaplain." Medical Journal of Australia 172, no. 8 (April 17, 2000): 389-90. [An Australian retired surgeon reflects upon his experience in a hospital chaplaincy program and the perspective he has gained, in the process, on the practice of medicine.]
[Added 4/19/06:] Tarumi, Y., Taube, A. and Watanabe, S. "Clinical Pastoral Education: a physician's experience and reflection on the meaning of spiritual care in palliative care." Journal of Pastoral Care & Counseling 57, no. 1 (Spring 2003): 27-31. [A Canadian physician "reflects on her experience as a chaplain intern and how this Clinical Pastoral Education experience led to a deeper understanding of spiritual care in the palliative setting" (--from the abstract).]
[Added 4/19/06:] Todres, I. D., Catlin, E. A. and Thiel, M. M. "The intensivist in a
spiritual care training program adapted for clinicians." Critical Care Medicine 33, no. 12 (December 2005): 2733-2736. [This is a report of how a special Clinical Pastoral Education program for physicians at Massachusetts General Hospital affected those physicians. Integration papers revealed that "clinical practice became infused with new awareness, sensitivity, and language; graduates learned to relate more meaningfully to patients/families of patients and discover a richer relationship with them; spiritual distress was (newly) recognizable in patients, caregivers, and self" (--from the abstract, but see also, p. 2735).]
III. The physician-patient encounter was also explored in the September 2004 Article-of-the-Month.