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Praying With Our Patients

by Walt Larimore, MD
Today's Christian Doctor - Fall 2016

"Not to employ prayer with my patients was the equivalent of deliberately withholding a potent drug or surgical procedure."
—Larry Dossey, MD

We had completed a full workup for chronic pain for Susan, a patient of mine, and I could not find a physical or emotional etiology.
Though she initially resisted discussing her social and spiritual health, she eventually became willing to talk after I questioned her again. She admitted her marriage was on the rocks. And while she was active in her church, she did not know the peace her pastor often spoke about. I asked Susan if she ever prayed about these things. She had not, but she said she was willing to. When I asked if I could pray for her, tears filled her eyes. As I prayed, an emotional floodgate opened in Susan’s heart.

More than two years later, Susan’s chronic pain is now much improved. She points back to our time in prayer as the beginning of her healing. What do you think? Do you think it is appropriate for healthcare professionals to pray for or with their patients? Do you pray for or with your patients?

Spirituality in Practice

As we discuss in Grace Prescriptions and two previous articles published in Today’s Christian Doctor on this topic, researchers increasingly report evidence linking positive spirituality with health, calling it the forgotten factor in health and insisting the spiritual care of our patients should not be the exclusive domain of pastoral professionals. 1,2,3,4

In fact, significant evidence indicates all healthcare professionals should incorporate positive spirituality into their practices.5 A spiritual history or assessment is now considered a core clinical competency for quality care for all of our patients, not just for palliative care or end-of-life care.6,7,8,9 In fact, “the ability to identify and address patient spiritual needs has become an important clinical competency.”10

For Christian healthcare professionals in particular, prayer is one of the most potent spiritual interventions we can utilize with our patients, not only because it has been shown by research to provide comfort for patients, but because we understand it is ultimately God who heals (Exodus 15:26).

The Biblical Case for Prayer

As we see in Genesis 20:7, the first time God calls on a man to pray it is for physical healing. Scripture also provides these biblical reasons for our praying with and for our patients:

  • God prescribes prayer for Christians (1 Thessalonians 5:16-18).
  • God prescribes prayer for the sick (James 5:14-15).
  • God prescribes prayer for our time of need (Hebrews 4:16).
  • God cares about the physical world and human bodies (Matthew 14:14; 3 John 1:2; 1 Thessalonians 5:23).
  • God hears and answers prayer (1 John 5:14-15).
  • Ultimate healing comes from a relationship with Christ (Isaiah 53:4-5; Revelation 21:3-5; John 6:44).

The Clinical Case for Prayer

Randomized controlled trials are no help

Along with these biblical admonitions, the research literature encourages us to pray with our patients. Several randomized controlled trials (RCTs) reported statistically significant effects with intercessory prayer, including a retrospective study completed 10 years after diagnosis.11 However, several RCTs have been negative, including the largest and most rigorous trial.12 (For a full list of these trials, please visit www.cmda.org/graceprescriptions.)

Why the mixed results? Simply put, the scientific study of prayer’s efficacy in healing using RCTs is problematic. One group of researchers explained, “God may indeed exist and prayer may indeed heal; however, it appears that, for important theological and scientific reasons, randomized controlled studies cannot be applied to the study of the efficacy of prayer in healing.” They added, “In fact, no form of scientific enquiry presently available can suitably address the subject.”13

Why is this? According to a 2006 article published in Perspectives in Biology and Medicine, all of the published studies fail to meet RCT standards in several critical respects. Most importantly, each one of them fails “to measure and control exposure to prayer from others.”14

It would be like doing a RCT in Mexico in which we were trying to determine if an antibiotic worked for a particular common bacterial infection. We randomly and in double-blinded fashion give half the patients the active drug and half the patients a placebo. So far, so good. But the problem arises when we realize that antibiotics in Mexico are over the counter. Almost everybody has a supply in their home medicine cabinet. And with no way of knowing which of the patients are taking or being given an over-the-counter antibiotic, our study would be useless.

Just like our antibiotic RCT would fail to measure and control for exposure from an over-the-counter antibiotic, the prayer RCTs “fail to measure and control exposure to prayer from others.”15

In their study published in the Indian Journal of Psychiatry, authors Andrade and Radhakrishnan said two important questions remain unanswered. First, if a RCT “on intercessory prayer is positive, does it suggest to us ways and means by which we can manipulate God or make His behavior statistically predictable?” Secondly, “Why would any divine entity be willing to submit to experiments that attempt to validate His existence and constrain His responses?”16

Non-RCT Data Are Very Helpful

Even though the RCT data are not able to guide us as Christian healthcare professionals when it comes to whether we should or should not pray with patients, we can hang our hats on other significant data. Specifically, studies show that most of our patients draw on prayer and other religious resources to navigate and overcome the challenges that arise in their illnesses.17

Furthermore, religious beliefs and prayer are commonly used to endure the distress caused by health problems, giving meaning to illness, promoting hope for recovery and providing rituals and behaviors that bring individuals together and settle anxiety.18 In some areas of the country, 90 percent of hospitalized patients use religion, especially prayer, to enable them to cope with their illnesses, and more than 40 percent indicate it is their primary coping behavior.19

Patient agreement with a healthcare professional praying for them increases strongly with the severity of the illness setting: 19 percent agree with prayer during routine office visits, 29 percent in hospitalized settings and 50 percent in life-threatening scenarios.
20

In addition, research indicates about 75 percent of physicians report that patients sometimes or often mention spiritual issues such as prayer. While two-thirds of U.S. physicians believe the experience of illness often or always increases patients’ awareness of and focus on religious and spiritual issues, about 75 percent of these physicians believe prayer is positive in healthcare by helping patients cope and giving them a positive state of mind. In addition, 55 percent believe prayer provides emotional and practical support via the religious community.21

However, primary care physicians are divided about when and if it is appropriate. At least one-third of surveyed doctors sometimes engage in prayer with their patients; however, this number increased to more than 77 percent if the patient requested physician prayer.22

Cautions for Praying with Patients

When it comes to praying with patients, Duke University psychiatrist Harold Koenig, MD, suggests:

  1. Contemplating a spiritual intervention (praying with patients) should always be patient centered and patient desired.
  2. The healthcare professional should never do anything related to religion or spirituality that involves coercion.
  3. The patient must feel in control and free to reveal or not reveal information about their spiritual lives or to engage or not engage in spiritual practices (i.e., prayer, etc.).
  4. The healthcare professional, however, may inform religious or spiritual patients (based on the spiritual history) that they are open to praying with patients if that is what the patient wants.
  5. The patient is then free to initiate the request for prayer at a later time or future visit, should they desire prayer with the healthcare professional.
  6. In most cases, healthcare professionals should not ask patients if they would like to pray with them, but rather leave the initiative to the patient to request prayer.23

However, CMDA has found that most members are comfortable praying with their patients in at least some clinical situations. Furthermore, after going through CMDA’s Saline Solution or Grace Prescriptions courses, Christian healthcare professionals
seem even more willing and able to pray with patients. If you choose to offer to pray with patients, CMDA recommends considering the following prerequisites:

  1. You should have taken a spiritual history.
  2. The patient must either request or consent to prayer.
  3. The situation calls for prayer.

Discuss with the patient any specific prayer requests and specific people you can share the prayer request with (i.e., colleagues, prayer ministers at your church, etc.). Finally, it is critical you record the patient’s request or consent for prayer in the medical record and, of course, at all times, remember confidentiality.

Opportunities for Prayer WITH Patients

  • Critical care, critical counseling or giving a critical diagnosis
  • After the return of test results
  • During hospice or specialty referrals
  • Preventive care visits
  • Prenatal visits or after the birth of a baby
  • Preoperative visits and hospital visits
  • Consider asking a patient pray with or for you (i.e., before a surgery or a procedure you’ll be performing on the patient)

Opportunities for Prayer FOR Patients

  • During your daily quiet time
  • While driving to and from work
  • With other believers at work or at worship
  • Via an electronic prayer memo

The Obligation

“…pray for each other so that you may be healed. The prayer of a righteous person is powerful and effective.”
—James 5:16, NIV 2011
“To be a Christian without prayer is no more possible than to be alive without breathing.”
—Martin Luther King, Jr.
“Prayer can never be in excess.”
—Charles H. Spurgeon
“Men may spurn our appeals, reject our message, oppose our arguments, despise our persons, but they are helpless against our prayers.”
— J. Sidlow Baxter


For Christian healthcare professionals, not praying for and with their patients is as much spiritual malpractice as for pastors failing to pray for their flock. Larry Dossey, MD, wrote, “Not to employ prayer with my patients was the equivalent of deliberately withholding a potent drug or surgical procedure.”24 And for a patient who desires prayer, a Christian healthcare professional’s prayer may be as or more therapeutic than any other intervention we can offer.

In a weekly devotion to CMDA members, Al Weir, MD, writes about the power of prayer:

Adam sat across from me, two years out from a very severe illness. “You know, I contribute my healing to four things: the grace of God, the miracle of modern medicine, the support of family and friends and the power of prayer.”

He then added after a pause, as if to avoid hurting my feelings, “And I sure thank you for what you’ve done.”

I answered him, “I just work for the Boss; He’s the One who healed you.”

Not a bad quatrain for the wonder of healing. Those who follow the Christ should remember:

  • The grace of God
  • The miracle of modern medicine
  • The support of family and friends
  • The power of prayer

Summary

Eighteenth century pastor and theologian Samuel Chadwick wrote, “Satan dreads nothing but prayer. His one concern is to keep the saints from praying. He fears nothing from prayerless studies, prayerless work, prayerless religion. He laughs at our toil, he mocks our wisdom, but he trembles when we pray.”

As Christian healthcare professionals, we have a powerful healing resource not all healthcare professionals know how to use—prayer. Use it! Intentionally, wisely and prayerfully.


Bibliography

1 Crowther MR, Parker MW, Achenbaum WA, Larimore WL, Koenig HG. Positive spirituality: The forgotten factor. Gerontologist. 2002;42(5):613-20. tinyurl.com/jentnwn
2 Koenig, HG. Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry. 2012. Article ID 278730.
tinyurl.com/pr4xo7z
3 Larimore WL, Parker M, Crowther M. Should Clinicians Incorporate Positive Spirituality Into Their Practices? What Does
the Evidence Say? Ann Behav Med 2002;24(1):69-73. tinyurl.com/ptocd55
4 Larimore WL. Providing Basic Spiritual Care for Patients: Should It Be the Exclusive Domain of Pastoral Professionals? (Medicine and Society) American Family Physician. 2000;63(1):36-40. tinyurl.com/hzcvbnj
5 Larimore WL, Parker M, Crowther M. Should Clinicians Incorporate Positive Spirituality Into Their Practices? What Does the Evidence Say? Ann Behav Med 2002;24(1):69-73. tinyurl.com/ptocd55
6 Graham J. IOM Report Calls for Transformation of End-of-Life Care. JAMA. 2014;312(18):1845-1847. tinyurl.com/zhmaag6
7 National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 2nd ed. National
Consensus Project for Quality Palliative Care. Pittsburgh, PA. 2009. tinyurl.com/nuv9e92
8 Larimore W. Spiritual Assessment in Clinical Care. Part 1—The Basics. Today’s Christian Doctor 2015(Spring):46(1):22-26. tinyurl.com/hkfnsn5
9 Larimore W. Spiritual Assessment in Clinical Care. Part 2—The LORD’s LAP. Today’s Christian Doctor. 2015(Fall);46(3):26-29.
tinyurl.com/hkfnsn5
10 Katz PS. Patients and prayer amid medical practice. ACP Internist. 2012(Oct). tinyurl.com/92o5hws
11 Leibovici,L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised
controlled trial. BMJ. 2001;323:1450-1451. tinyurl.com/k96dey7
12 Benson, H, Dusek, JA, Sherwood, JB, et al. Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. American Heart Journal. 2006;151(4):934-942. tinyurl.com/cczxad
13 Andrade, C, Radhakrishnan, R. Prayer and healing: A medical and scientific perspective on randomized controlled trials. Indian Journal of Psychiatry. 2009(Oct-Dec);51(4):247-253. tinyurl.com/pbunadp
14 Sloan, RP, Ramakrishnan, R. Science, Medicine, and Intercessory Prayer. Perspectives in Biology and Medicine. 2006(Autumn);49(4):504-514. tinyurl.com/q8yqwln
15 Sloan, RP, Ramakrishnan, R. Science, Medicine, and Intercessory Prayer. Perspectives in Biology and Medicine. 2006(Autumn);49(4):504-514. tinyurl.com/q8yqwln
16 Andrade, C, Radhakrishnan, R. Prayer and healing: A medical and scientific perspective on randomized controlled trials. Indian Journal of Psychiatry. 2009(Oct-Dec);51(4):247-253. tinyurl.com/pbunadp
17 Curlin, FA, Sellergren, SA, Lantos, JD, et al. Physicians’ Observations and Interpretations of the Influence of Religion and Spirituality on Health. Archives of Internal Medicine. 2007(Apr);167(7):649-654. tinyurl.com/phln4vg
18 Koenig, HG. Religious beliefs and practices of hospitalized medically ill older adults. International Journal of Geriatric Psychiatry.
1998(13):213–224. tinyurl.com/gn35yy4
19 Koenig, HG. Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry. 2012, Article ID 278730. tinyurl.com/o7ad6mn
20 MacLean, CD, Susi, B, Phifer, N, et al. Patient Preference for Physician Discussion and Practice of Spirituality. Journal of General Internal Medicine. 2003(Jan);18(1):38-43. tinyurl.com/on9v7pz
21 Curlin, FA, Sellergren, SA, Lantos, JD, et al. Physicians’ Observations and Interpretations of the Influence of Religion and Spirituality on Health. Archives of Internal Medicine. 2007(Apr);167(7):649-654. tinyurl.com/phln4vg
22 Monroe, MH, Bynum, D, Susi, B, et al. Primary care physician preferences regarding spiritual behavior in medical practice. Archives of Internal Medicine. 2003(Dec);163(22):2751-2756. tinyurl.com/qj9vhdm
23 Koenig, HG. Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry. 2012, Article ID 278730. tinyurl.com/o7ad6mn
24 Dossey, L. Healing Words: The Power of Prayer and the Practice of Medicine. HarperOne, 1995. tinyurl.com/p4yl9dw
25 Denison, J. I am the bread of life. Denison Forum on Truth and Culture. September 14, 2015. tinyurl.com/j2ew2pn
26 Denison, J. I am the bread of life. Denison Forum on Truth and Culture. September 14, 2015. tinyurl.com/j2ew2pn
27 Adapted from: Hinckley, KC. Living Proof: A Small Group Discussion Guide. CBMC/NavPress, 1990. tinyurl.com/pekfwzd


About the Author

Walt Larimore, MD