Year : 2002 | Volume
: 18 | Issue : 2 | Page : 207--212
The relevance of spirituality in medical profession
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
Department of Urology, JIPMER, Pondicherry - 605 006
Patients expect holistic care from the medical profession. In holistic care, the whole person comprising bodv, mind and spirit is given attention and six dimensions of health (physical, mental, emotional, spiritual, social and environmental) are recognised as being equally important. Patients«SQ» needs and expectations have forced the medical profession to recognise spiritual and religious factors in medical care. This article describes in detail the relevance of spirituality and religion in medical pr ofession and suggests guidelines, for doctors for handling the spiritual and religious beliefs of patients.
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Kumar S. The relevance of spirituality in medical profession.Indian J Urol 2002;18:207-212
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Kumar S. The relevance of spirituality in medical profession. Indian J Urol [serial online] 2002 [cited 2020 Oct 22 ];18:207-212
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Doctors are the service providers and patients are the service users. Patients expect holistic care from the medical profession.  In holistic care, the whole person comprising body, mind and spirit is given attention and six dimensions of health (physical, mental, emotional, spiritual, social and environmental) are recognised as being equally important.  Patients' needs and expectations have compelled the medical profession to recognise spiritual and religious factors in medical care.
This article describes the evolution of the relationship between medicine and religion, the recognition of spirituality as distinct from religion, spirituality as a component of holistic medical care, the reasons for the popularity of Complementary and Alternative Medicine (CAM), the meanings of the word "spirit" and spirituality, the difference between spirituality and spiritualism, the effect of spiritual and religious beliefs on human behaviour, the effects of spiritual and religious beliefs on health and sickness, the expectations of patients in relation to their spiritual and religious beliefs and, finally, guidelines for doctors for handling the spiritual and religious beliefs of patients.
I. Evolution of the Relationship Between Medicine and Religion
Following three eras can be identified in the historical evolution of the relationship between medicine and religion [Figure 1]
1. The Era of Close Association
Since the beginning of the human race (40,000 BC), medicine in some form and religion have existed and have had a close relationship.  This relationship continued till the beginning of scientific medicine in the middle of the 19th century. Sickness was thought to be due to the anger of gods and healing was sought through the appeasement of gods by worship.
2. The Era of Separation
For more than a century, after the beginning of scientific medicine in the nineteenth century, there was a separation of medicine and religion.  This separation occurred because medicine adopted the biophysical model of disease [Table 1] and it regarded religion as unscientific.
3. The Era of Co-operation
During the last quarter of 20 th century, the limitations of the biophysical model of disease have been recognised and the biopsychosocial model of disease has been adopted [Table 1]. This has led to an increasing recognition of the role of religious factors in health and disease and the era of cooperation between scientific medicine and religion has begun. 
II. The Recognition of Spirituality as Distinct from Religion in the Last Quarter of the Twentieth Century
With the decline in the popularity of religions, religious leadership and religious institutions, secularism has become popular in the twentieth century and spirituality has come to be recognised as distinct from religion in the last quarter of twentieth century.
Religion refers to "the adherence to the beliefs and practices of an organised church or religious institution." 
Earlier, the term "spirituality" was used to denote "the quality of being interested in religion or religious matters". 
Now, the term "spirituality" is employed to describe "the transcendent relationship between the person and a Higher Being, a quality that goes beyond a specific religious affiliation".  The main feature of spirituality is a belief in a power greater than oneself.
III. Spirituality as a Component of Holistic Medical Care
Holistic medicine recognises that the whole person comprises body, mind and spirit.  There are six dimensions of health:' physical, mental, emotional, spiritual, social and environmental [Figure 2]. These six dimensions of health are thought to be equally important.
IV. Why is Complementary and Alternative Medicine (CAM) Popular?
Complementary and Alternative Medicine (CAM) refers to diagnostic and therapeutic disciplines which exist largely outside the medical schools where conventional medicine in taught and provided.  Complementary and Alternative Medicine includes disciplines like Acupuncture, Homoeopathy, Yoga, Meditation, Herbal Medicine, Osteopathy, Relaxation and Visualisation, Chiropractic, Hypnosis, Aromatherapy, Massage. Nutritional Therapy and Reflexology.  These disciplines have been covered in a British Medical Journal series recently.
Studies have shown that Complementary and Alternative Medicine is popular throughout the industrialised world. In the USA, for the year 1997, out-of-pocket expenditures for Complementary and Alternative Medicine were estimated to be $27 billion which was comparable to the projected out-of-pocket expenditures for all US physician services. 
The main reason for the popularity of Complementary and Alternative Medicine is the fact that most of the Complementary and Alternative Medicine provides holistic care. 
In the USA, health insurance coverage for Complementary and Alternative Medicine is increasing and the NIH Office of Alternative Medicine (OAM) has been created. 
V. Meanings of the Word 'Spirit' and Spirituality
The word "spirit" is derived from the Latin word "spiritus" which means breath. Meanings of the word "spirit"  are given in [Table 2]. Most of the meanings are positive. As the word "spiritual" means "connected with your spirit rather than with your body or mind",  spirituality is also associated with positive thoughts, feelings and beliefs.
VI. Spirituality is Distinct from Spiritualism
It is essential to understand that spirituality is distinct and different from spiritualism.
1. Spirit and Spirituality
The word "spirit" means soul which is the part of someone that is believed to continue to live after one is no more.  The term "spirituality" is related to this meaning of the word "spirit".
2. Spirit and Spiritualism
The word "spirit" also means a person who has passed away and who is believed to have returned to this world and has strange or magical powers' (evil spirits, ghosts). The term "spiritualism" refers to the belief that people who have passed away may send messages to living people usually through someone with special powers. 
VII. Spiritual and Religious Beliefs Affect Behaviour
Beliefs are strongly held thoughts and they affect behaviour by changing attitudes [Figure 3]. Because spiritual and religious beliefs are perhaps the most fundamental beliefs, they strongly affect the meaning and purpose of life, attitudes and human behaviour.
Although some of the spiritual and religious beliefs may have conflict with science, most of them have no conflict with medical science and they promote health and help in overcoming sickness.
VIII. Spiritual and Religious Beliefs Promote Health
Studies have shown that spiritual and religious beliefs and practices help in stress reduction  and in the prevention of high blood pressure and heart diseases. 
IX. Spiritual and Religious Beliefs Help in Overcoming Sickness
Research work has revealed that spiritual and religious beliefs and practices help in mitigation of pain,  recovery from illness  and overcoming disability. 
X. Many Patients Expect Doctors to ask About Their Spiritual or Religious Beliefs
Studies have revealed that many patients expect their doctors to enquire about their spiritual or religious beliefs when they are suffering. , This is understandable because spiritual and religious beliefs are among fundamental beliefs and they affect a person's attitudes to suffering and other problems.
XI. What Can Doctors Do?
The doctor must respect the spiritual and religious beliefs of patients even if these beliefs are contrary to their own [Figure 4].
The doctor can respectfully ask the patients who are suffering whether they would like to tell him about their spiritual or religious beliefs. If patients do not want to tell the doctor about their beliefs it should be respectfully acknowledged [Figure 4].
If patients tell the doctor about their beliefs and these beliefs do not conflict with medical science, as is the case with most of the beliefs, the doctor should patiently and respectfully (1) listen to the patient and accept it as it is, (2) allow in hospital any spiritual or religious practice if requested, and (3) arrange for any support service if requested [Figure 4].
If patients tell the doctor about their beliefs and these beliefs conflict with medical science, as is the case with only some of the beliefs, the doctor should respectfully explain the adverse effects and leave it to the patient to decide [Figure 4].
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