The Religion of Medicine

Spirituality is a nebulous term and I’m not sure I think of it the same way everybody else does. If it’s the same as faith, how does it differ from religion? If it’s just a set of values or a belief system, how does it differ from culture? Like religion, I think of medicine as a faith system instead of a factbook. Every time we prescribe a medication or send a slide to pathology we are secretly hoping and praying that we are in the 95% confidence interval. We use p-values and percentages to reassure ourselves that we know what we’re doing despite the inherent uncertainty of the scientific method. And if all else fails we can always seek comfort in describing a presentation as atypical.

But our patients often expect us to have the answers. We live in a world that highly values the tenets of science and technology; we live in a world that places empiric data and experimental reproducibility on a pedestal. Patients want the definitive diagnosis. We search for the pathognomonic feature believing that if we find it, we cannot be wrong. It didn’t surprise me to find a mother throwing stimulant drugs at her 4-year-old misbehaving son for a criteria-based diagnosis of ADHD, but it was quite a shock to find a patient who accepted the response, “We just don’t know.” But we practice medicine with the faith that we are doing our best, and there are times when our beliefs butts heads with other religions.

I come from a Christian household and a Chinese heritage. I think it is Asian culture that has convinced my mom that herbs are good and synthetic medications are bad. She views the body as a tumultuous entity constantly fighting to balance positive and negative chi. Disease occurs when one side wins out. She believes that, instead of restoring that balance, most drugs disrupt it further and cause side effects. But I think it is religion that has convinced her that, if she were diagnosed with a terminal disease, she would refuse life-prolonging non-curative therapy. She feels she has led a full and complete life, and she will be ready to die if and when God makes it clear that it is her time to go. Unfortunately, hypothetical situations can only reveal how we think, not how we act. I tried to take it out of the theoretical realm to find out what she would really do. Would she really refuse chemotherapy to prolong a prognosis from 1 year to 10 years so that she could see her son graduate medical school, get married, and have children? She didn’t answer, but her silence was a far more illuminating response. She didn’t know.

As far as religion goes, I have yet to encounter one of the “classic” confrontations between religion and medicine on my rotations. I haven’t seen any Jehovah’s Witnesses hemorrhage out and refuse blood. I haven’t seen any devout Christian family refuse to take a permanently unconscious family member off life support. What I have seen is a great many people confused about the role of medicine, searching for its place in their lives. I am always humbled when our patients realize that medicine is as much a faith as their religion is, but even more so when they believe in its power to help as strongly as I do.