How Spiritual Are Physicians and How Do They View Death?
How Religious Are Physicians?
According to a 2008 Pew Report, 88% of Americans believe in God or a universal spirit. The Medscape survey, instead of asking for specific religious affiliations, wanted to know whether physicians have a spiritual belief, regardless of active participation. When asked if they have any religious or spiritual belief, 83% of physicians reported that they do, with slightly over 40% of them actively practicing their faith. The remaining 17% had no belief system.
Although an association between being religious and lower rates of depression is widely held, a recent study suggests that people who develop depression might simply be more likely to stop going to services. The Medscape survey seems to reflect this. When looking at the happiness scores by religious belief, the happiest were those who actively practiced (4.03) and the least happy were those with a spiritual belief but no active practice (3.89) -- not the nonbelievers (3.92). Also from the survey, family physicians, pediatricians, rheumatologists, ophthalmologists, and rheumatologists were the most actively religious groups and they were also within the top 10 on the happiness score. Those who had the highest percentage of spiritual belief and no active practices (plastic surgeons 44.5%, intensivists 40.6%, cardiologists 40.2%, gastroenterologists 39.8% and general surgeons 39.7%) shared happiness scores toward the bottom of the list: 3.89, 3.90, 3.92, 3.88, and 3.89, respectively. There was no obvious happiness trend among those with the highest nonbelief percentages (pathologists 23.6%, intensivists 23.4%, infectious disease physicians 23.1%, radiologists 21.9%, and psychiatrists 21.8%), whose happiness scores were 3.93, 3.90, 3.97, 3.99, and 3.99, respectively (see Table 2).
Of note, the Pew report found significantly more men than women claiming no religious affiliation (20% and 13%, respectively). The Medscape survey found almost no differences at all between male and female physicians in having or not having a belief and actively or not actively practicing their faith.
Table 2. Physicians and Religion
Belief but No
|Diabetes & Endocrinology||3.90||18.89%||35.19%||39.26%|
|Ob/Gyn & Women's Health||3.96||13.28%||42.71%||38.95%|
|Psychiatry & Mental Health||3.99||21.84%||32.73%||38.26%|
What Would Physicians Do if They Were Told They Had a Terminal Illness?
In a 2011 poll conducted by the National Journal and the Regence Foundation, 71% of the general population felt that quality was more important than length of life, 23% felt that it was important to extend life with every intervention available, and only 6% didn't know or didn't answer the question. Physicians, according to the Medscape poll, were more ambivalent, with slightly over 23% uncertain about how they would respond if they were told they had a terminal illness. Almost 65% of physicians said that they would choose quality over length of life, and only about 12% were certain about wanting to have aggressive treatment. A Medscape physician-only discussion on this topic overwhelmingly supported the decision for palliative care vs aggressive treatment for extending life. In the discussion, a primary care physician whose mother-in-law had died recently said, "She chose no medical or oncologic interventions after her hemi-colectomy 19 months ago. No pain meds, only supportive measures. A true profile in courage to choose to die on her own terms."
The responses varied slightly by age. The percentage of those who would choose more aggressive treatments rose slightly during mid-life, from about 10% in the 31- to 40-year age group to 14.3% in those between 41 and 50 years of age. This dipped back down to around 10% after age 50. When the responses were filtered by religious or spiritual belief, over 70% of those with no belief system reported that they would choose quality of life over extending life. Slightly fewer who reported having a spiritual belief would choose the same path (63% of those actively practicing their religion and 65% of those not actively practicing).