Crossing the Line (Part 2)

Last week I wrote about the need for doctors to adopt a holistic approach to caring for patients, reflected on the General Medical Council (GMC) guidance on religion, and finished with the historic connection between priests and doctors.

Last month a Kent GP was accused of ‘crossing the line’ when he asked a patient whether he had ‘considered Christianity’ as a means of psychological support. The patient was apparently willing to listen (BBC News, 22 Sept), but later told his mother that the GP had said that he ‘just needed Jesus’. The mother reported the GP to the GMC. Following a disciplinary hearing the GP was given a formal warning, which he has appealed against and the case will now go to a public hearing. The appeal is yet to be heard. However, it does raise many important issues; not least the manner in which patients interpret what is said within consultations. We all know of patients with incurable problems who, after the GP has gone through the long-term management plans of (say) pain relief, physiotherapy, occupational therapy, home adaptations, diet and exercise, tells his family that ‘nothing can be done’; which is not quite the message the GP had in mind.

However, there is also the issue of whether a GP is wrong to raise the subject of religion. The GMC stated that the Kent GP ‘crossed the line’, meaning the GP moved from acceptable to unacceptable practise. So what happened to the holistic approach to caring for a patient? This is where I believe that the medical profession is confused and acting illogically. On one hand, the GMC has announced that it is ‘tightening up’ the guidance on religion in practice (Pulse Today, 5 Oct), by making it a duty for GPs to consider patients’ ‘religious, spiritual and cultural history’, whilst simultaneously castigating a GP for having that very discussion. Unless a GP can openly explore a patient’s views, how are the requirements of the new GMC duty to be met? The conundrum is added to by a recent Health Foundation study, which states that doctors should adopt the role once taken by a ‘local priest’. I cannot see the GMC warming to that report.

So what of other views? The Department of Health issued guidance earlier this year warning against ‘proselytising’, stating that it is the role of the NHS Chaplaincy Service to meet patients’ spiritual needs. Fine, but when did you last see an NHS Chaplain in your surgery? Many doctors have told the British Medical Association that they want the right to pray with their patients without fear of being suspended; whilst the co-director of Patient Concern has stated that patients often welcome the offer of a prayer as a ‘warm and kind thought’. Understandably, the National Secular Society has the counter view that health and religion should not mix.

Holistic care means precisely what it says. The key point amidst all of this is for a doctor to be sensitive to a patient’s views, regardless of what they may be. Patients need doctors to be human beings and to consider them likewise; for some this occasionally means the need to include spiritual matters within a consultation. However, until the GMC, RCGP and BMA agree how doctors can approach such matters, doctors will find themselves between Scylla and Charybdis; damned if they do and damned if they don’t consider patients’ religion. One thing is certain: extracting the spiritual component from medical care produces a large hole in ‘holistic’.

(First published in the Scunthorpe Telegraph, Thursday 27th October 2011)