The spiritual assessment in family medicine: unnecessary or essential?

- Kenny Lin, MD

Since it became possible to post online comments on AFP content earlier this year, no single article has prompted as many comments as "The Spiritual Assessment," published in the September 15th issue. The range of comments thus far reflects family physicians' diversity of views on this topic. For example, while one reader opined that spiritual concerns have "little to do with improving the health of our patients," another countered, "I do not think this article goes far enough in promoting this type of spiritual health assessment." Another reader argued that the spiritual assessment should "not be elevated to the status of another vital sign we must always take." Some readers expressed concerns that physicians might seek to impose their religious beliefs on vulnerable patients, while another suggested that "many physicians seem to have more fear of [discussing] spiritual issues than the patients do."

In the article, Drs. Aaron Saguil and Karen Phelps suggest assessing older patients, hospitalized patients, and patients with worsening or terminal illness, who are more likely to be interested in sharing their spiritual or religious beliefs. Other patients may bring up their faith or spiritual practices without prompting in the course of a normal conversation. Since 80 percent of patients and family physicians perceive religion to be important, according to the authors, acknowledging and supporting spiritual beliefs is a key component of holistic, patient-centered care:

The spiritual assessment allows physicians to support patients by stressing empathetic listening, documenting spiritual preferences for future visits, incorporating the precepts of patients' faith traditions into treatment plans, and encouraging patients to use the resources of their spiritual traditions and communities for overall wellness. Conducting the spiritual assessment also may help strengthen the physician-patient relationship and offer physicians opportunities for personal renewal, resiliency, and growth.

We invite other readers to share their perspectives on the role of the spiritual assessment in family medicine by posting a comment on the article, posting a comment to this blog, or sending an e-mail to afpcomment@aafp.org.

What works for patients with irritable bowel syndrome?

- Kenny Lin, MD

A lot of treatments do, according to a review article by Thad Wilkins, MD and colleagues in the Sept. 1 issue of American Family Physician. Most effective appear to be regular exercise, antibiotics, antispasmodics, peppermint oil, and probiotics. Less effective (increase stool frequency but not pain) are over-the-counter antidiarrheals and laxatives. Fiber is no more effective than placebo. Other treatments that can provide some benefit include antidepressants, psychological therapies, and lubiprostone. With this many options to choose from, the challenge for physicians is selecting treatments that are most likely to benefit individual patients. The authors suggest classifying irritable bowel syndrome as diarrhea-predominant, constipation-predominant, or mixed presentation to guide initial and subsequent choices. Forming a therapeutic alliance with patients is critical, since IBS symptoms often recur despite treatment, and "a positive patient-physician interaction is associated with fewer return visits for IBS and is a key component in the treatment of these patients." A freely accessible handout for patients summarizes the most common treatments and provides additional informational resources.