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Letters to the Editor  |   August 2008
Spirituality is Fundamental to Osteopathic Medicine
Author Affiliations
  • Anthony R. Beazley, MDiv
    G.V. (Sonny) Montgomery Veterans Affairs Medical Center, University of Mississippi School of Medicine Jackson
    G.V. (Sonny) Montgomery Veterans Affairs Medical Center Jackson, Miss
    Staff Chaplain
Article Information
Addiction Medicine / Cardiovascular Disorders / Endocrinology / Medical Education / Hypertension/Kidney Disease / Neuromusculoskeletal Disorders / Obstetrics and Gynecology / Pediatrics / Professional Issues / Psychiatry / Pulmonary Disorders / Sleep Medicine / Urological Disorders / Diabetes / Arthritis
Letters to the Editor   |   August 2008
Spirituality is Fundamental to Osteopathic Medicine
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 468-469. doi:10.7556/jaoa.2008.108.8.468
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 468-469. doi:10.7556/jaoa.2008.108.8.468
To the Editor:  
In the April issue of JAOA—The Journal of the American Osteopathic Association, Elizabeth K. McClain, EdS, and colleagues1 reported that osteopathic medical students generally receive 2 to 20 hours of instruction on spirituality and religion, and that approximately 55% of all colleges of osteopathic medicine (COMs) have some form of spirituality-in-medicine program in place. The authors concluded that it is important that more information regarding methods of medical schools' spirituality curriculum development and program evaluation become available.1 We strongly agree with their conclusion. In addition, we believe it could be argued that spiritual aspects of patient care are a fundamental part of osteopathic medical care. 
A number of studies have demonstrated the value of religion and spirituality to the physical and mental health of patients,2-4 making it clear that a high proportion of patients rely on religious beliefs to help them cope with their health problems. In fact, more than 60 studies have examined the role that religion plays in helping people deal with such diverse conditions as diseases of the heart, lungs, and kidneys, as well as AIDS, amyotrophic lateral sclerosis, arthritis, cancer, chronic pain, diabetes mellitus, and other illnesses.2 
According to Harold G. Koenig, MD, MHSc,3 codirector of the Center for Spirituality, Theology, and Health at Duke University Medical Center, among 445 patients who were consecutively admitted to general medicine cardiology and neurology services at Duke, nearly 90% reported using religion to some degree to cope with their conditions. Similarly, more than 40% indicated that religion was the most important factor that kept them going.3 
Koenig and McCullough4 note that more than 700 studies have examined the relationship between patients' religious beliefs, well-being, and mental health—with nearly 500 of these studies demonstrating a beneficial association between religion and better mental health, greater well-being, and lower levels of substance abuse. Koenig and McCullough4 also summarize research from numerous investigations that found beneficial effects of religion/spirituality on patients' physical health outcomes. 
Among the findings of these investigations, religious beliefs and activities were associated with improved immune functioning in 5 of 5 studies; reduced death rates from cancer in 5 of 7 studies; less heart disease and better cardiac outcomes in 7 of 11 studies; reduced blood pressure in 14 of 23 studies; lower cholesterol levels in 3 of 3 studies; reduced cigarette smoking in 23 of 25 studies; increased exercise in 3 of 5 studies; and improved sleep in 2 of 2 studies.4 
In addition to being a growing area of research, religion/spirituality is becoming a crucial part of modern medical practice. Increasing evidence suggests that religious beliefs influence patients' medical decisions and that religion/spirituality becomes even more important to patients as they face the specter of serious illness.5 
Many patients desire their physicians to consider their spiritual needs on an equal basis with their physical health,6 and many want clinicians to ask about their religious beliefs in times of serious illness.7 The Joint Commission on Accreditation of Healthcare Organizations now requires that certain patients in inpatient behavioral healthcare programs be given an assessment that “includes the client's religion and spiritual orientation.”8 
The proposed tenets of osteopathic medicine offered by Rogers and colleagues9 indicate that spirituality should be an important part of the osteopathic approach to treatment. The first tenet states the following: 

A person is the product of dynamic interaction between body, mind, and spirit. The human body functions as a unit, integrated such that no part truly operates independently. Alterations in the structure or function of any one area of the body influence the integrated function of the network as a whole. A comprehensive approach recognizes the integral roles of body, mind, and spirit in health and disease. [emphasis added]

 
In view of this tenet, it would seem that there is little question that addressing spiritual issues related to a patient's illness should be an essential part of the osteopathic approach to treatment. 
In describing why physicians should consider spirituality to be an integral part of the practice of medicine, Dr Koenig5 stated, “...because doing so is part of whole person health care. Simply treating a medical diagnosis or a disease, without considering the person with the disease, is no longer acceptable.” 
The need for additional education regarding religion/spirituality for trainees in osteopathic medicine is evident. We believe that the 2 to 20 hours of didactics currently provided at COMs may not be sufficient to address this topic. However, we acknowledge that it may be problematic to fit additional training into the extensive curriculum already in place at COMs. Thus, we encourage further dialogue on religion and spirituality among members of the osteopathic medical profession. 
McClain EK, McClain RL, Desai GJ, Pyle SA. Spirituality and medicine: prevalence of spirituality-in-medicine instruction at osteopathic medical schools. J Am Osteopath Assoc. 2008;108:197-202. Available at: http://www.jaoa.org/cgi/content/full/108/4/197. Accessed July 31, 2008.
Koenig HG. An 83-year-old woman with chronic illness and strong religious beliefs. JAMA. 2002;288:487-493.
Koenig HG. Religious attitudes and practices of hospitalized medically ill older adults. Int J Geriatr Psychiatry. 1998;13:213-224.
Koenig HG, McCullough ME, Larson DB. Handbook of Religion and Health. New York, NY: Oxford University Press;2001 .
Koenig HG. Religion, spirituality, and medicine: research findings and implications for clinical practice. South Med J. 2004;97:1194-1200.
King DE, Bushwick B. Beliefs and attitudes of hospital patients about faith healing and prayer. J Fam Pract. 1994;39:349-352.
Ehman JW, Ott BB, Short TH, Ciampa RC, Hansen-Flaschen J. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med. 1999;159:1803-1806. Available at: http://archinte.ama-assn.org/cgi/reprint/159/15/1803. Accessed July 31, 2008.
Joint Commission on Accreditation of Healthcare Organizations. 2008 Standards for Behavioral Health Care. Oakbrook Terrace, Ill: Department of Publications, Joint Commission Resources;2008 : 215.
Rogers FJ, D'Alonzo GE Jr, Glover JC, Korr IM, Osborn GG, Patterson MM, et al. Proposed tenets of osteopathic medicine and principles for patient care. J Am Osteopath Assoc. 2002;102:63-65. Available at: http://www.jaoa.org/cgi/reprint/102/2/63. Accessed July 31, 2008.