A patient’s request for prayer can leave a physician feeling flummoxed, worried that he could say the wrong thing. But such a request might simply reflect a patient’s anxiety about her clinical circumstances or a desire to better connect with her caregiver. Three physician experts suggest how to prepare emotionally for such a request and offer strategies for responding in ways that strengthen the relationship.

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Following are highlights from an article published in the AMA Journal of Ethics® (@JournalofEthics) by April R. Christensen, MD, and Tara E. Cook, MD, palliative care fellows and clinical instructors of medicine in the Section of Palliative Care and Medical Ethics, and Robert M. Arnold, MD, distinguished service professor of medicine, in the Division of General Internal Medicine in the Department of Medicine at the University of Pittsburgh Medical Center.

Using a hypothetical case of a patient who is a devout Catholic and a surgeon who identifies as a secular Jew and an atheist, the authors explore a nuanced way for physicians to deal with patient requests for prayer, beginning with understanding one’s own thoughts and emotions.

“A physician’s capacity for understanding requires introspection,” the authors wrote. “By practicing introspection, a physician is better prepared to pause and explore the many potential motivations behind the request.”

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They suggest doing five things before responding:

Understand your discomfort. Would accommodating the request force you to reveal more about your personal life than you are comfortable with? Could you be worried about upsetting the patient if you have different beliefs? Are you not religious? Does a request for prayer make you feel your authority and training are being challenged?

Think about your response(s) ahead of time. Anticipatory self-reflection can help you have more considered responses, the authors noted. “In addition, self-reflection has several demonstrated benefits for physicians, including increasing insight into personal feelings, increasing capacity for empathy and enhancing the ability to differentiate between a patient’s and a physician’s needs,” they wrote.

Pause to acknowledge your feelings. Following a request for prayer, an intentional pause can help you process your initial reaction and prevent emotions from clouding your understanding of the request. Slow the conversation down so you can better understand where the patient is coming from and remain true to your core beliefs.

Inquire about the questions and emotions underlying the request. The patient could simply be scared or feel alone or out of control about her situation. On the other hand, a patient might want to know more about your own spirituality. To better understand this, the authors suggested saying, “I see that it’s important for me to be here with you; tell me more.”

Reflect the patient’s concerns. As you learn more about the reasons for the patient's request, acknowledge her feelings. Doing so does not require you to have the same religious beliefs. Repeating or summarizing what the patient says simply tells her that you are listening and helps her feel understood.

The authors also highlight two principles to guide your responses: Never lie about your religious beliefs and promote trust in the relationship.

“Trust forms the cornerstone of the patient-physician relationship and is particularly important for views that are central to one’s belief system, like religion,” they wrote, adding that building trust “means reaffirming one’s dedication to the patient’s well-being and staying present.”

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