What I learned from a dying patient

Since I teach medical students and residents in physical-diagnosis class about the importance of taking a spiritual history, you’d think that I wouldn’t fall prey to this oversight, but I had. The literature shows that most patients want to be asked about their spiritual beliefs or nonbeliefs, and that many think it rude if health-care professionals don’t consider this important aspect of their well-being.

The question should be asked out of respect and in a nonjudgmental manner (as one might take a sexual history: “Do you have sex with men, women, both, or neither?”). Thus, I said to her, “Do you have any spiritual values that you want me to know about that might influence your medical decisions?” We’ll get to her answer in a minute . . .

Within 24 hours of our meeting, the patient had been checked with an array of blood tests and imaging studies. The list of diagnostic possibilities was led by infections, cancers and rheumatologic diseases like lupus. I pushed for a bronchoscopy (looking into the lung with a light and lens), but others said it wouldn’t change the care we were already giving her and argued that we move ahead with anything treatable.