So should your annual physical include a few questions about your spiritual side? Questions like: “Do you have peace of mind?” and “Are you able to reach down deep into yourself for comfort?”

While acknowledging that some doctors might be uncomfortable delving into their patients' spiritual or religious life, a San Antonio researcher says such questions are surprisingly effective in predicting repeat visitors to outpatient and mental health clinics, as well as a patient's overall satisfaction with life.

His findings from a study of 353 patients at two University Health System clinics were published today in the Annals of Family Medicine — one of three papers focusing on spirituality and health that appear in the journal.

“A small percentage of our patients — 10 (percent) to 20 percent — are very heavy utilizers of health care services,” said Dr. David Katerndahl, professor of family and community medicine at the University of Texas Health Science Center at San Antonio.

“You see them weekly. They talk about chest pain this week; next week they have a stomachache. You never really make an impact on this. So one of the things we may think about is maybe there's something going on with them at a spiritual level that we need to at least address with them.”

Katerndahl said spirituality is a natural extension of a movement in recent years to see patients as more than just the sum of their parts, like a machine. Some tout a biopsychosocial model of health care, which also looks at the patient's psychological and social health to understand their overall well- being.

Katerndahl developed a survey that combined questions about physical symptoms, emotional and social (are you isolated from other people?) symptoms, along with seven spiritual symptoms.

Spiritual symptoms include the degree to which patients feel peaceful, have a reason for living, feel their lives are productive, have peace of mind, have a sense of purpose, are able to reach deep within themselves for comfort and feel a sense of harmony. None of the questions referred to a specific religion.

Katerndahl then measured how each of the symptoms predicted 10 health outcomes that included frequent use of services, overall health status, quality of life and an absence of meaning in life. Spiritual symptoms — either alone or in combination with emotional or social symptoms — predicted seven of the 10 outcome measures.

In fact, the spiritual symptoms were far more effective than psychological symptoms in predicting whether someone had recently sought mental health services.

In an accompanying editorial in the journal, Richard Davidson with the Waisman Laboratory for Brain Imaging and Behavior at the University of Wisconsin-Madison suggested that a spiritual-medical connection isn't so far-fetched.

“Science has begun to dissect the complex mechanisms by which the brain can influence peripheral biology, thereby providing the beginnings of a mechanistic understanding of how the mind may influence bodily systems,” Davidson wrote.

Katerndahl acknowledged that doctors are divided on whether spirituality is an off-limits topic in the exam room.

“There are certain doctors who think the spiritual side (is something) we don't want to touch,” he said. “No matter what kind of questions you ask, it's not real science to talk about this stuff. We don't think patients want us to ask them about it. “On the other hand, if you ask the patients, they overwhelmingly want their doctor to talk about these things — especially in certain situations. When they're having a baby. If there's some sort of life stress, some crisis in their life. Some patients even want their doctor to pray with them.”

Don Finley

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