Re: Addressing existential suffering

I enjoyed reading Dr Bates’s excellent article on addressing existential suffering in patients with terminal illnesses (BCMJ 2016;58:268-273). Spiritual/religious issues are important for many of our patients, not just those facing end-of-life issues. A study of 2000 physicians published in 2007[1] indicated that most psychiatrists and nonpsychiatric physicians believe that religion/spirituality helps patients cope with and endure illness and suffering by offering a positive, hopeful state of mind and/or a community that offers emotional or practical support. Over the years I have recommended that medical students, psychiatry residents, and residents in other disciplines routinely ask patients about their spiritual beliefs and how they would like them to be addressed. Dr Bates included a copy of the FICA spiritual history tool in his article. I would highly recommend that the FICA be used routinely with patients, especially those who have chronic illness and suffering. It could be used as a brief screening tool, similar to the CAGE questionnaire, which is commonly used to screen for alcohol/substance abuse. Over the years I have seen no negative effects from asking patients about spiritual issues. Instead, it usually improves rapport and contributes to a positive doctor-patient relationship. Patients can be referred to appropriate spiritual care resources as needed, but physicians should not neglect identifying important spiritual/religious issues that may be affecting a patient’s well-being.
—Stephen D. Anderson, MD, FRCPC
Clinical Associate Professor, UBC Faculty of Medicine, Dept. of Psychiatry


1.    Curlin FA, Lawrence RE, Odell S, et al. Religion, spirituality, and medicine: Psychiatrists’ and other physicians’ differing observations, interpretations, and clinical approaches. Am J Psychiatry 2007;164:1825-1831.

Stephen D. Anderson, MD, FRCPC. Re: Addressing existential suffering. BCMJ, Vol. 58, No. 7, September, 2016, Page(s) 359 - Letters.

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