Spirituality in surgical practice.

The role of spirituality in surgical practice has long been recognized as important, but it is only now receiving detailed analysis. In 1910 the British Medical Journal invited Sir William Osler, the premier physician of his day, to editorialize about people who depended on faith and prayer rather than medical professionals for treatment and healing. Osler concluded this editorial with the comment, “. . . the whole subject is of intense interest to me. I feel that our attitude as a profession should not be hostile . . . A group of active, earnest, capable young men are at work on the problem, which is of their generation and for them to solve.” Four generations later the question remains unresolved. Unfortunately, until the last decade or so the academic medical community has expressed little interest in or support of physicians, and especially surgeons, who attempt to shed light on spiritual issues as related to medical outcomes. Arguably the most imaginative and productive surgeon scientist of the early 20th century was Alexis Carrel of France. In 1903 he witnessed and recounted a scientifically unexplainable (miraculous?) healing of a pilgrim in Lourdes. Subsequent to the resultant publicity, surgical superiors at the University of Lyon warned that he would likely fail his final examination; this threat possibly contributed to his leaving France for the United States, where he later received the 1912 Nobel Prize in physiology. His account of the Lourdes experience and a small volume on prayer were both published posthumously. Another surgeon who applied academic scrutiny to the study of spirituality as understood in psychologic terms was Barney Brooks, chairman of surgery at Vanderbilt University Hospital from 1925 to 1951. In the early 1940s Brooks secured funds from the Rockefeller Foundation to assess the psychologic makeup and needs of surgical patients. Brooks reported the findings in his 1943 presidential address, “Psychosomatic Medicine” at the Southern Surgical Association. His colleagues responded negatively when he asserted that mental preparation and the patient’s mindset were on par with surgical skill, so the surgeon was responsible in assisting with this mental preparation. Brooks also addressed the psychologic nature of the surgeon as vital to the patient-physician relationship, deeming some technically skilled but socially deficient people unworthy of the surgical profession. Although Brooks’s study design would never be approved by any institutional review board today, his conclusions asserting the importance of a surgeon’s social interactions with patients were far ahead of his time. Matthew Walker, chairman of surgery at Meharry Medical College from 1944 until 1973, insisted that medical students and physicians needed to be in touch with their own mortality if they were to assist patients and their families in dealing with end-of-life issues. Addressing the role for spirituality in surgical practice involves the historical perspective, definition clarification, public opinion, current practices, funding, communication skills, and even accreditation requirements. Spiritual issues daily influence academic medical centers. Chaplaincy services, while often underused, exist in most medical centers. Hospital food services accommodate Muslim, Jewish, vegetarian, and other dietary restrictions. Scheduling of clinics, procedures, and even staff vacations frequently takes into account religious holy days. Challenges to hospital regulations concerning clothing, hairstyles, and head coverings arise from cultural and faith traditions. Some surgeons have developed special techniques in caring for Jehovah’s Witnesses because of their aversion to blood products. Beliefs about after-death physical wholeness lead some patients and No competing interests declared.