By Autumn Dawn Galbreath, MD, MBA | May 16, 2018

It was with surprise that I read the subject line in my inbox last month: “Should Physicians Pray with Patients?” I was surprised because this email was not, as I would normally expect, from CMDA. It was from the Medscape Business of Medicine list serve. Many articles on prayer cross my computer screen, and some of them are even related to prayer in the exam room, but rarely are they from a secular source. I eagerly opened the article, fascinated to see what secular physicians had to say about this topic that is important to me in my own practice. Not surprisingly, there was a wide range of opinions.

Michael Balboni, PhD, ThM, MDiv, instructor of psychiatry at Harvard Medical School, argues that prayer is desired by patients and his research shows that “the majority of patients, physicians, and nurses view patient/practitioner prayer as appropriate and spiritually supportive.” He doesn’t think there are concerns with potential harmful effects of doctor/patient prayer outside of a psychiatric setting.

In contrast, Rob Poole, MB, FRCPsych, professor of social psychiatry at Bangor University, North Wales, is opposed to doctors praying with their patients in any setting, according to his quotes in this article. In fact, he goes so far as to say that even doctors and patients who share the same faith should not pray together. He “advocates a firm policy [against doctor/patient prayer] that applies in all situations” and argues that praying “with a patient in the course of clinical treatment is a serious breach of the boundaries of appropriate professional conduct and can become a slippery slope to other even more serious boundary violations."

If you have been around CMDA very long, you know prayer with patients is an important topic to its members. In fact, Grace Prescriptions (formerly Saline Solution) is a two-day course specifically focusing on deepening the spiritual aspects of the care we provide as Christian healthcare professionals. Walt Larimore, MD, has also contributed several articles and lectures on this topic over the years, and his well-reasoned approach to the subject always encourages me to further incorporate it into my practice. In a 2016 article in Today’s Christian Doctor entitled “Praying With Our Patients,” he argued, “For Christian healthcare professionals in particular, prayer is one of the most potent spiritual interventions we can utilize with our patients, not only because it has been shown by research to provide comfort for patients, but because we understand it is ultimately God who heals (Exodus 15:26).” Personally, this is the most important reason to pray with patients—it reminds both them and me that while I provide the best care I can, God is the Healer.

The question of prayer in the exam room has two key components—namely, the patient and the doctor. Clearly, the patient must be comfortable with prayer in the context of his relationship with his doctor. Prayer should never be forced upon a patient and some researchers, like Harold Koenig, MD, director of the Center for the Study of Religion/Spirituality and Health at Duke University, argue that prayer should never even be offered to a patient. Dr. Koenig feels that prayer “should always be within the control of the patient—it should be patient-initiated, patient-centered, and patient-directed.” If the patient doesn’t request prayer from his physician, it doesn’t happen.

Dr. Balboni feels differently. He says, “We ask patients whether they would find it supportive for us to pray with them, and the vast majority of patients, at least in a serious illness context, have indicated that they would find it supportive and wouldn't be offended by it if the doctor or nurse offered to pray." He also stresses that patients should never be obligated to participate in prayer, but he advocates offering it as a part of the doctor/patient relationship when appropriate.

CMDA is also supportive of physicians offering prayer as a part of their interactions with patients, but they do recommend considering the following prerequisites:

You should have taken a spiritual history.
The patient must either request or consent to prayer.
The situation calls for prayer.
What about the other half of the exam room prayer—the healthcare professional? As Christians in healthcare, many of us may support the idea of prayer with patients, but being comfortable actually doing it is a whole different level. CMDA does offer Grace Prescriptions as a training tool to become more comfortable with spiritual issues in the doctor/patient relationship. And I have found that every time I have prayed with a patient I have become more comfortable with the idea of doing it the next time. Like much of what we do in healthcare, it seems to be a skill that becomes more natural with practice.

But are there times when we might not want to pray with a patient? Personally, I have not encountered a situation in which a patient requested prayer and I felt it was inappropriate, but I can imagine some. What about a patient for whom “prayer” means something completely different than it does to me? A patient whose religious perspective is not a Christian one and who might not even be praying to the God of the Bible. One option in this situation would certainly be to decline prayer and direct the patient to a chaplain or his local religious leader. Another option would be to explain that I do not share his religious beliefs, but could share a silent time of prayer. I think that, when these situations present themselves, we each have to weigh them individually and discern the best approach to that specific patient.

Another situation in which prayer might be inappropriate is a complex doctor/patient relationship in which prayer could obscure boundaries. Psychiatric patient interactions come to mind. If a patient’s own view of spirituality is clouded by delusion or confusion, or if his view of his physician is complicated by inappropriate expectations or over-dependence, prayer together could make a complex situation toxic.

While there are certainly situations in which prayer might be inappropriate, or even detrimental, I tend to agree with Dr. Balboni. In general, as a physician to whom prayer is critical for life and wellness, I want to utilize it in my practice when “appropriate and spiritually supportive.” And I think it’s a tool I could be using a lot more often than I do.