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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Re: An Indictment of Doctors of Faith
"Religious affiliation" might mask some important differences
Response to prior comments
More Investment Required
Accounting for misisionaries?
An Indictment of Doctors of Faith
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Robert A. Yourell, San Diego, USA Psychotherapy
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What sleight-of-hand on the part of A. Weir, in commenting on this article. The writer says that athiest doctors help the poor because religion caused our culture to support this. That can't be, since religious doctors are no less influenced by culture than atheists. This and other comments attribute financial pressures to the religious doctor's behavior. Why would athiests have less financial pressure? But the worst of it was implying that athiests, without the religious influence on our culture, would create a "survival of the fittest" world. How was this justified? Simply because evolution includes the concept of natural selection. This is sheer bigotry. The word "Darwinism" is converted into a vulgarity with this sleight-of-hand. Competing interests: None declared |
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Jerry Stromberg, Chicago, USA Former Executive Director, Christian Community Health Fellowship
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This is a very interesting piece. For those of us that have been following the articles on this general topic by Curlin, et. al., the overall findings are not particularly surprising. It is the subtleties that are fascinating. Physicians work in settings that serve the poor for a variety of reasons. I’m reminded of the comment by a recent CCHF conference speaker. When joining a large metropolitan public hospital staff, she was asked: “What kind of an “M” are you: Marxist, Messianic or Mad?” My experience and perspective draws me to the relationship between faith (especially Christian faith) and care for the underserved. The authors state that “Physicians who are more religious do not appear to disproportionately care for the underserved.” I’m not really surprised by this finding, however disturbing it may be for those of us that understand that our faith clearly calls us to service and care for the poor and underserved. My sense is that there are important differences that are not adequately captured by the nature of the variables used. For example, “Religious affiliation” is represented by the nominal categories: “None; Catholic; Jewish; Other religion; and Protestant.” Given the nature of this inquiry, I would speculate that within the “Protestant” category, for example, there are important differences between those physicians affiliated with religious bodies that have strong social justice traditions (e.g., Mennonite) and those with conservative, more individualistic and pietistic emphases (e.g., many conservative Evangelicals). Some of the potential (intra-Protestant) differences are hinted at by the distribution of responses for variables such as “Family emphasized service to poor” and “Practice of medicine is a calling.” There is a strong association between these variables and the “Spirituality” and “Intrinsic religiosity” variables, (Table 4). It would be interesting to see if physicians scoring high on most or all of these variables (“Family emphasized service to the poor;” “Practice of medicine is a calling;” “Religious belief influences medicine;” and “Spirituality”) are more highly represented among those caring for the underserved. Competing interests: None declared |
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Farr A Curlin, Chicago, IL Assistant Professor of Medicine, The University of Chicago
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As lead author of this manuscript, I appreciate the comments of my colleagues. I embrace efforts like the "4% solution" of CMDA, as a way of helping doctors think through how they might practice medicine faithfully with respect to the poor. Victor Kolade is undoubtedly correct that educational debt constrains doctors intentions to practice among the underserved, but it is not clear to me why that burden would fall disproportionately on religious physicians. Jonathan Biggar correctly notes that we did not account for physicians' practice overseas or even for their part time volunteering locally. We do not know whether religious physicians disproportionately engage in those forms of care. However, more than 1 in 20 religious physicians would have to practice overseas for religious physicians to have a significantly higher rate of caring for the underserved based on that unmeasured factor. It is unlikely such a high proportion do in fact practice overseas. In the end, we don't find much difference in practice among the underserved based on physicians' religious characteristics. It remains for religious physicians, and the communities that form them, to make the connection between their religious commitments and the care of the underserved. Competing interests: None declared |
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Victor O Kolade, Cheektowaga, NY Internist
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I found the article on physician spirituality and care of the underserved intriguing (1). While acknowledging the limitations listed by the authors, I noted an absence of testing for possible effects of years of practice and/or profession of faith. Fewer than 5% of respondents had received loan repayment assistance; without such a boost, it can easily take 30 years to repay medical school debt (2). Perhaps a number of religious physicians are waiting to pay off their debt or retire to commit significant chunks of their practice to underserved populations. Indeed, religious literature includes teaching that adherents should minister to the sick with resources they have freely received (3). If our society will invest more in physician training and reimbursement, more physicians will feel empowered to attend to the underserved. References 1. Curlin FA, Dugdale LS, Lantos JD, Chin MH. Do religious physicians disproportionately care for the underserved? Ann Fam Med. 2007;5(4):353- 360. 2. Bishop M. Life Math. JAMA. 2007;298(3):266-268. 3. Matt. 10:8. The Holy Bible. Competing interests: None declared |
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Jonathan P Biggar, Mountain View, CA Software Engineer
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Many Christian denominations have a tradition of recruiting doctors for foreign missionary service. Might not that affect the outcome of this study by redirecting doctors that would otherwise be more disposed to serve the disadvantaged in the U.S. to instead serve the even more disadvantaged in other countries? Competing interests: None declared |
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alva b weir, bristol, TN USA Christian Medical and Dental Associations
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Curlin, et al’s report comes to us suggesting a bidirectional influence of secular and sacred. First, the article is an indictment of physicians who follow the great faith traditions, each of which mandates a responsibility for the poor. Though the most spiritual doctors do serve the poor more, the majority of doctors practicing their faith do not seem to take the mandate seriously. There seems to be a disconnect between the teachings of their faith and this selected practice of their faith. This suggests a contagion of a secular culture’s philosophy, “Each man for himself.” On the other hand, the care documented for the undeserved by physicians of little faith suggests an influence of the faith traditions they deny. A culture completely dominated by a Darwinian “survival of the fittest” mentality would find it difficult to embrace care for the underserved except through very twisted social Darwinian theory. It is the great faith traditions of the world that have taken a religious mandate to care for the poor and imbedded it into our social conscience. Can we change the reality that doctors of faith are doing less for the poor than their faith encourages? Someday our government may mandate that we each care for the poor regardless of our religious beliefs if physicians do not step up and volunteer beforehand. The Christian Medical & Dental Associations is calling on physicians to step up. Through an initiative, The Four Percent Solution, we are suggesting that all doctors come at least to the starting point of donating four percent of their time to the care of the underserved. This translates into: • two weeks a year in medical or dental work overseas for the underserved in developing countries, • or eight hours a month serving in North American health care clinic for the poor, • or a deliberate effort to care for at least one out of every twenty five patients in their practice without reimbursement, • or a deliberate effort to see more Medicaid patients than their colleagues, • or some combination of these suggestions to equal a four percent commitment. Physicians of faith embarrassed by the implications of Dr. Curlin’s study should ask themselves if they should be doing more. They should care that society sees them practice differently than what their faith calls them to do, and even more embarrassed before the God who speaks to them his heart for the poor. Competing interests: None declared |
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