Praying with Patients: How, When, Where?
June 2000; Volume 3; 61-64
By David Schiedermayer, MD, FACP
Physical presence always has a spiritual component. a pa-tient’s experience with sickness and death is somehow both shameful and endearing, degrading and ennobling. It moves one to prayer, if one is so moved.
Clinical Studies and Practice
Let me say at the outset that I am not writing about how religion makes you live longer (if it does) or whether intercessory prayer increases survival in the ICU (if it does). Others have written on these topics.1-4 (See Alternative Medicine Alert, November 1999, pp. 128-130 and Clinical Trials of Prayer.) Instead, I am going to offer practical ways to look at prayer as it is practiced in the clinical setting, and to emphasize the benefits while minimizing the risks.
Procedure
I have a patient who comes to see me at Family House, where I work in Milwaukee. She has hepatitis C and used to be an IV cocaine user. She has now become a devout believer and is convinced that her faith is a big part of her changed life. The first time I saw her I asked consent to pray with her, and she said, yes, please.
I see and examine her. She has a breast mass. It feels benign, but the right thing to order is a mammogram, so I tell her that I will order it. Then, as we always do, we close the visit in prayer.
Here is today’s prayer: "Dear Lord, I pray for Mrs. Smith, that you would continue to be with her and bless her. Thank you for her life and what you have given her. I do pray for her family and her health. Thank you for her good blood pressure today. We do both pray for this lump in the breast, that you would help us find out what it is, and that if it is your will Lord, it would be alright. Amen."
And she prays: "Gracious heavenly Father, thank you and bless you for your many blessings to me. Be with Dr. Schiedermayer and strengthen him as he sees patients today. We know by your power you have promised us healing, and I thank you for your almighty presence this very day. We bless you and give you the praise, for in your name we pray, Jesus. Amen."
So this is the scene. A white male doctor and an African-American female ex-addict are joined in a non-medical and yet very medical spiritual union, praying in an inner city clinic. I can’t tell you how much I appreciate her prayer for me. And she keeps coming to the clinic and feels the same way.
Clinical Practice Questions
Many physicians feel reluctant to pray with patients. Here are some of the questions that we ask, and some answers I have found. Nine core principles for clinical practice are summarized in Table 1.
| Table 1-Core principles for clinical prayer |
| 1. Ask the patient's consent. |
| 2. Don't ask her faith tradition. |
| 3. Pray for the patient if she is willing. |
| 4. Prayer is not theology; for theology, call a chaplain. |
| 5. Use prayer for support, not for treatment. |
| 6. If you can't pray, offer to listen to the patient's prayer. |
| 7. Keep prayers simple—for the patient, her illness, her well-being. |
| 8. Avoid prayers that can be viewed as coercive or proselytizing. |
| 9. Pray at the time and point of the patient's greatest need. |
What does prayer do for patients? The object of prayer is God; one prays to receive answers, to intercede for others, to plead, and to give thanks.
What about various religious traditions? Some don’t agree with praying for people outside of their faith. That’s why I always ask consent. And that’s why I don’t ask the person’s faith tradition—I am willing to pray for a patient if they are willing.
What if we aren’t praying to the same God? This is not a clinical question. It is a good theological question, but not a clinical one. If we agree that part of the healing setting involves spiritual work for the patient, then it makes sense that prayer is part of it. For theology, I call the chaplain. We may be praying to different Lords but we are united in our prayer, in the sense that we are both seeking a spiritual element.
What if the patient has a faith tradition that doesn’t allow prayer with someone of a different faith? I’ve noticed, for example, that Jehovah’s Witness patients do not pray in the office with me, and that’s just fine. But I make it a practice not to interrogate the patients on the fine points of theology before I offer to pray with them. If we have to agree exactly on the form God takes, we will never get to the helpful aspects of praying. The point is that we are both asking for help. And I, as a physician, am acknowledging that I am not God.
What if one doesn’t believe in God in the first place? Though there are conflicting data, most show that many physicians are less religious than many of their patients. I have many patients who are more faithful to their religious traditions than I am to mine. But prayer may help a patient to verbalize his or her private terrors and fears. The non-believing clinician can still offer to hear the person’s prayer and be with them as they say it—the patient praying with the doctor, or for the doctor.
Clinical Prayer as Adjunct to Informed Consent
I keep prayers simple and targeted toward the patient’s illness, family, and general well-being. I avoid prayers that would be coercive or viewed as proselytizing. I try to pray at the point of the patient’s need. For example, I had a patient with a large transitional cell cancer of the bladder. On ultrasound it was as big as a large plum. She had been informed by the urologist that she might have to have her bladder removed to get all the cancer.
I went to see her right before the operation and prayed with her: "Dear Lord, please help Mrs. Brown to do well during the surgery. Guide the doctor’s hands and help him to do his best. We know that there is risk during the surgery. We know there is risk of anesthesia, even the risk of death. We know that she may lose her bladder as part of the cancer surgery. But we pray that you may be with her through all of this, that you would protect her, and that you would help her to get better."
Here the prayer acknowledges the likely possibility of losing the bladder, the less likely risk of death, but in the end offers more than statistical reassurance. Prayer offers this patient the sense that someone besides her doctor has her best interest at heart. That someone is the someone she believes in far more than she believes in doctors. That someone is her God. And the timing of this prayer—right before surgery—is at her point of greatest need for prayer.
Adverse Effects
Prayer can be coercive. I have a husband and wife who are having marital problems related to the husband’s use of alcohol. He drinks several glasses of wine every night, and gets sleepy. When I pray with them, I say something like this. "Lord, thank you for this marriage, and I pray that you may help this couple toward mutual respect and healing. Lord, I pray about this drinking situation. Give Tom strength and help and be with him as he works on this. We are grateful for your love for them, Amen."
This borders on preachy, but it is not proselytizing or coercive—the coercion here would be if I were trying to insist to Tom through the prayer that he needs treatment. I have told him in person, face-to-face, that he needs treatment, and I’ve suggested resources. It doesn’t seem proper to ask God to make him get treatment. That is up to Tom—not to God. My role is to pray for him, not to dictate to him with my eyes closed.
In addition, more than a few patients endow their health professionals with godlike powers, and more than a few doctors are willing to assume that mantle of power. This is an error, and a misinterpretation and misuse of the power of prayer. As a doctor I have discovered that:
When your patient dies call the family send a card go to the funeral. At the funeral the patient’s wife will secretly become your patient. She will call six months later to say she’s ready to take care of herself now. The patient’s children will do the same. If you don’t go to the funeral chances are you will never see any of them ever again. When you go to the funeral the family will see you sitting in the back and know in that moment they can forgive you for not being God.5
Conclusion
"Prayer is to religion," P.T. Forsythe noted, "what original research is to science."6 Many patients would feel comforted by the offer of both information and spiritual communication with God. Prayer should not be used as a kind of magic life-prolonging potion, and clinical prayer should not seek to be sectarian. Perhaps "In Canterbury Cathedral" by E.W. Oldenburg puts it best:
On a day sweet with April showers the safe tires of our tour bus had sung us south from London Sightseer pilgrims, cameras slung, no need or time on patient plodding horses for long diverting tales We stood at last at Beckett’s shrine, lost in architecture and dates, confused by Norman and Gothic. Our ancient tiny guide seemed shrunk into his suit, dwarfed by his clothes as we all were dwarfed by time His small precise English voice went on: pronounced "Our Lord," and the words fell on us like a benediction.
"Our" incredible assumption of union offered in passing to American strangers, mortar for diverse motley stones. Time and blood and history redeemed from meaningless: two words turned sightseers into pilgrims.
When praying with patients, prayers should be:
a. simple and targeted toward the illness.
b. viewed as coercive or proselytizing.
c. considered a life-prolonging potion.
References
1. Harris WS, et al. A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit. Arch Intern Med 1999;159:2273-2278.
2. Dossey L. Healing Words. New York: Harper Collins; 1993.
3. Koenig HG. Is Religion Good for Your Health? Binghamton NY: Haworth Press; 1997.
4. Matthews DA, Clark C. The Faith Factor: Proof of the Healing Power of Prayer. New York: Penguin; 1998.
5. Schiedermayer D. House Calls, Rounds, and Healings: A Poetry Casebook. Tucson AZ: Galen Press; 1996.
6. Steere DV. Forward. In: Merton T. Contemplative Prayer. New York: Doubleday; 1971:11.
June 2000; Volume 3; 61-64
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