In an examination room at the University of Maryland Medical Center, Dr. Iris Keys listened closely as one of her patients, a 54-year-old nurse who recently suffered a heart attack, complained of persistent shortness of breath.
After an examination, however, it became clear to Keys, an internist, that the patient didn't need medicine. Instead, Keys suggested a therapy proven to have healing power in numerous scientific studies.
"Shall we have a word of prayer?" Keys asked. With that, doctor and patient joined hands and bowed their heads as Keys prayed.
It was an encounter that is evidence of a slow, quiet change in the practice of medicine.
No one knows how many doctors, like Keys, are praying with their patients.
But a growing number of doctors across the country are abandoning the traditional separation of religion and science and are exploring the healing benefits of prayer.
A poll conducted in October at the annual meeting of the American Academy of Family Practice Physicians showed that 99 percent of more than 250 family physicians surveyed believe that a patient's spiritual beliefs contribute to healing.
At Harvard University in December, more than 1,000 health care professionals attended a seminar called Spirituality and Healing in Medicine.
And at least five medical schools, including the Johns Hopkins University, now offer courses in the subject.
"The ethos has generally been that science is incompatible with religion," said Dr. Thomas Corson, an internist and pediatrician who last year taught the first course on religion and medicine at Hopkins.
"But I think more and more doctors are beginning to see that even with all our affluence and our medical prowess, it still isn't enough. There can still be a void in terms of total care for our patients.
"So much of what we, as doctors, deal with in our patients has some spiritual dimension," he said. "How can we truly care for people when we subtract a dimension that defines their lives?"
Dr. David Larson, director of the National Institute for Healthcare Research, a Rockville agency that disseminates information about the links between religion and health, said: "We feel like it goes against our ethics to bring up religion with our patients, but our patients want us to talk about it, they want us to bring it up."
The medical community's interest in religion is driven by patients who want physicians to consider spiritual approaches to healing. A Time/CNN poll of 1,004 Americans published last summer showed that 64 percent of those surveyed think doctors should pray with patients who request it.
The nurse who has been a patient of Keys' for two years shares that view.
"It makes me feel good to know that the doctor who takes care of me feels a connection to a higher power," she said. "My faith in God is what has gotten me this far, and I'm glad to have a doctor who can relate to my faith."
An expanding body of scientific evidence suggests that prayer can help relieve many illnesses and even symptoms associated with cancer and AIDS.
Studies -- more than 200 in all -- show that people who are observant of religious faith have lower blood pressure, healthier hearts and lower levels of chemicals, such as adrenalin and cortisol, that can be harmful in excess. So they recover faster from illnesses.
Mental health is also improved among patients who pray, according to studies. They are less depressed, less likely to become addicted to drugs and less likely to commit suicide.
Some of the most often-cited studies include:
* A 1996 study at a Veterans Affairs Hospital in Massachusetts examined the health of 600 heart surgery patients. Patients in one group spent at least an hour each day with a chaplain, while patients in a second group had routine chaplain visits, which average about three minutes each day.
The study showed that patients who had the longer visits were released from the hospital an average of three days earlier than those who had routine visits.
* A study at Dartmouth Medical School in 1995, which examined the survival rate of 232 patients, found that one of the best predictors of survival was reliance on religious faith.
Six months after their surgery, patients with no religious beliefs had a death rate three times higher than those who did. And of the 37 patients who said they were "deeply religious," none died.
* A study of 4,000 elderly people conducted last year by Duke University Medical Center showed that those who regularly attended church were half as likely to suffer depression as those who did not.
Dr. Harold Koenig, chief of the study, said he found that church provides an important social outlet for people, giving them a sense of belonging.
Church is also an important source of hope, he said, and hopeful patients respond better to medication and other procedures, take less pain medicine, heal faster from injury and are more motivated about pursuing health care.
However, even those who advocate mixing religion and medicine see dangers. One is that devout patients may forgo treatment and wait for divine intervention.
Keys faced such a crisis seven years ago. Then, something she could describe only as "a miracle" saved her patient, Rosalie Jones.
Jones, 76, was hospitalized with severe inflammation of her gall bladder; doctors predicted she would die without surgery. Jones, a minister's widow, refused to have it. Instead, she asked people at the hospital to pray for her.
Three weeks later, Jones went home from the hospital.
"I don't know how it happened, but it happened," Keys said of Jones' recovery. "That's when I realized there is more to medicine than giving out pills and pulling out your scalpel."
Keys was thrilled with Jones' recovery, but not with her refusal of treatment. Speaking in various area churches, the physician -- who last year was ordained as an African Methodist Episcopal minister -- says God is in the healing business, but his plan includes doctors, medicine and surgery.
"I tell people they can pray about their illness," said Keys, "but they must also follow their physicians' instructions."
It is advice that Jones, of West Baltimore, has begun to follow. Since being ill seven years ago, she agreed to have gall bladder surgery and takes medication for high blood pressure.
"I love my doctors. They take good care of me," said Jones, whose steady walk, erect posture and quick wit make her seem much younger than her years.
Corson, at Johns Hopkins, said that while studies on prayer are promising, important questions remain unanswered. No one has been able, he said, to determine what specific forces are at work in prayer to achieve healing, except that it is a catalyst for relaxation.
"I'm not saying that the studies shouldn't continue, but there should be more rigor in them," he said. "I'm a little concerned about disillusioning people and asking them to believe in something almost like magic."
Most doctors remain uncomfortable with bringing up matters of faith with their patients, feeling unqualified and worried that such questions might be offensive.
Asking the right questions
But Corson said doctors routinely ask patients sensitive questions, including those about sex and marriage.
A few questions about a patient's faith should also be standard, he said, such as: How would you identify your own religious or spiritual heritage? Do you belong to a church or a synagogue? Is Scripture or other sacred writing important to you?
His course, he said, teaches doctors to broach the subject delicately by using case studies and role playing.
"The prudent way is to be respectful of people, give them the opportunity to express where they are coming from and let them know that their faith is something being considered in their health care," said Corson.
Dr. Patrick Walsh, a world-famous urologist at Johns Hopkins Hospital and a Roman Catholic, said he regularly asks patients questions about their faith.
"I ask them, 'Do you believe in God?' If they say no, I'll say, 'Did you ever?' " he said.
"And if they say yes, I'll tell them that if they want my professional advice, the best thing they can do for their health is to become reacquainted with God."
Corson, on staff at the student health clinic at Johns Hopkins University, pointed out that doctors often find themselves in positions where they must act as ministers. Patients sometimes want a doctor not only to talk to them about therapies and procedures, but to inspire hope as they face life-and-death situations.
"For better or worse, sometimes doctors are priests," he said. "If you are standing over a dead patient, looking into the face of their spouse or children, you can't just sign the death certificate and walk out the door."
Keys agreed. "I have prayed with a lot of my patients. Sometimes I don't even ask, I just see that it is needed," she said.
"If a patient is sitting in front of me, their eyes filled with tears, I just wrap my arms around them and pray."
"I have never had a single one of them stop me and say, 'Don't do that,' " she said.
"I have never been rebuffed."
Pub Date: 2/13/97