A Spiritual Problem? Primary Care Physicians’ and Psychiatrists’ Interpretations of Medically Unexplained Symptoms

Abstract

BACKGROUND:Patients commonly present to their physicians with medically unexplained symptoms (MUS), and there is no consensus about how physicians should interpret or treat such symptoms. OBJECTIVE: To examine how variations in physicians' interpretations of MUS are associated with physicians' religious characteristics and with physician specialty (primary care vs. psychiatry). DESIGN AND PARTICIPANTS: A national survey of a stratified random sample of 1,504 primary care physicians and 512 psychiatrists in 2009-2010. MAIN MEASURES: The extent to which physicians believe MUS reflect a root problem that is spiritual in nature or result from conditions that scientific research will eventually explain, and whether such patients would benefit from attention to their relationships, attention to their spiritual life, taking medications, and/or treatment by physicians. KEY RESULTS: Response rate was 63 % (1,208/ 1,909). More religious/spiritual physicians were more likely to believe that MUS reflect a spiritual problem (55 % for high vs. 24 % for low spirituality; OR=2.8, 1.7-4.5) and that these patients would benefit from paying attention to their spiritual life (79 % for high vs. 55 % for low spirituality; OR=3.1, 1.8-5.3). Psychiatrists were more likely to believe that scientific research will one day explain MUS (66 % vs. 52 %; OR= 1.9, 1.4-2.5) and that these symptoms will improve with treatment by a physician (54 % vs. 35 %; OR=2.4, 1.8-3.3). They were less likely to believe that MUS reflect a spiritual problem (23 % vs. 38 %; OR=0.5, 0.4-0.8). CONCLUSIONS: Physicians' interpretations of MUS vary widely, depending in part on physicians' religious characteristics and specialty. One in three physicians believes that patients with MUS have root problems that are spiritual in nature. Physicians who are more religious or spiritual are more likely to think of MUS as stemming from spiritual concerns. Psychiatrists are more optimistic that these patients will get better with treatment by physicians.

Incorporating Spirituality in Primary Care

“…Taking a spiritual history provides a context for conversations about patients’ experience of their illness and provides the opportunity to discuss and potentially intervene on beliefs that can serve as barriers or promoters to taking certain health actions. Because the physician’s role is not to provide spiritual guidance, experts have suggested that physicians refer patients to appropriate pastoral care in order to address any spiritual needs that arise (Koenig, 2012; Shin et al 2013; Rumbold, 2007; Robinson & Nussbaum, 2004). Chaplains may be able to provide information to patients about health risks and the importance of taking a more active interest in their health.…”

“…Physicians acknowledge the positive role that spirituality plays in patients’ lives (Shin et al, 2013) but express concern about the appropriateness of initiating conversations regarding spiritual matters with their patients. Independent of their religious affiliation, the majority of physicians stated that spiritual issues were appropriate to discuss with patients only if the topic was initiated by patients, with only a small number of physicians praying with or talking about their own experiences with patients (Curlin et al 2007; Shin et al 2013; Saguil, Fitzpatrick & Clark, 2011).…”

“…Independent of their religious affiliation, the majority of physicians stated that spiritual issues were appropriate to discuss with patients only if the topic was initiated by patients, with only a small number of physicians praying with or talking about their own experiences with patients (Curlin et al 2007; Shin et al 2013; Saguil, Fitzpatrick & Clark, 2011). In a survey of medical residents, Saguil, Fitzpatrick & Clark (2011) found that on average, only about 50% received instruction about spirituality in medical school and residency.…”

Directive Counsel and Morally Controversial Medical Decision-Making: Findings from Two National Surveys of Primary Care Physicians

“…The methods of both surveys have been published elsewhere, 31,32 and full methodology reports are available online. 33,34 Case weights were incorporated to account for oversampling and differences in response rates between groups.…”