Faith at the Medical School

Press releases, event announcements, weekly updates–almost daily, students at Harvard Medical School (HMS) receive mass e-mails from a variety of administrative departments. We gloss over many of them. But I try to read the e-mails on medical education reform. Many of the medical school’s most thoughtful and experienced teachers are leading this initiative, and broad agreement exists among students that the need for reform is pressing.

One recent e-mail was a bit more striking than the rest. The e-mail, from HMS’s Office of Public Affairs, contained a “vignette” emphasizing that the medical school would insist on “evidence-based” approaches to medical education. Doctors call medical therapies “evidence-based” only if clinical trials–as opposed to mere anecdotal experience–have suggested that the therapies are effective. The medical school wants to establish a new Center for Evaluation to apply the academic gold standard to medical education techniques. “To ensure that curriculum reform is not a faith-based initiative,” the vignette continues, “the center will take its measuring tape [to assess how well the curriculum meets students’ needs].”

The phrase confused me, and I read it over and over again. A faith-based initiative? The author could have written “to ensure that curriculum reform is not based on unproven methods,” or any number of different formulations. He seems to use the term “faith-based” to contrast with “evidence-based.” And in doing that, he stumbled upon a contemporary idiom, “faith-based initiatives.” He didn’t have to employ an idiom that, for so many Americans, contains an entirely different meaning.

I don’t mean to imply that the choice was intentional. This muddled double-entendre, however, evokes a disturbing failure of medical education at Harvard—a consistent failure to engage the important role of religion in medical care.

The culture of the medical school is secular, with relatively little discussion of faith in social medicine and patient-doctor courses. From my experience, acknowledging a patient’s or a caregiver’s faith in actual hospital care almost never happens.

This all comes in the context of an otherwise thoughtful medical curriculum that includes social phenomena that affect patient care, like socio-economic, linguistic, and racial issues. The underlying principle is that we need to learn about issues that are important to our patients–issues that affect patient care. But with religion, the medical school misses its own principle.

America is a devout nation, and our patients are generally religious. If the medical school continues to give short-shrift to religion in medical education, then graduates of the medical school will be less prepared to deliver effective care.

Furthermore, faith animates and sustains the work of many medical students, doctors, and nurses. For many of us, the medical duty to serve others and the faith-based call to treat others as we would treat ourselves are mutually reinforcing missions. That doesn’t mean, of course, that we agree with right-wing calls to avoid secular institutions and erase the boundary between church and state.

Schools rightly want to preserve their secular orientation. But too often, that attempt becomes an avoidance of even discussing religion, which is absolutely central to death and disease for so many of us, caregivers and patients alike. I’ll never forget when one of my attendings told me that when sick patients ask her to pray with her, she just holds their hands, “because that’s what they really mean anyhow.” A more honest answer would be for the doctor to admit that she doesn’t believe in God and doesn’t feel at ease praying with the patient. That attending is an exceptionally capable and compassionate physician. But she’s probably uncomfortable with dealing with the role of faith in death and disease. And that discomfort is all too common at HMS.

Many of us are absolutely committed both to our faith and to our work and education at secular institutions. And our patients, in huge numbers, turn to their God in moments of crisis. The medical school needs to acknowledge all this more openly and more consistently.

Jason H. Wasfy is a fourth-year medical student at Harvard. In June, he will begin medical residency at a Harvard-affiliated teaching hospital.