The empirical literature from epidemiological and clinical studies regarding the relationship between religious factors (eg, frequency of religious attendance, private religious involvement, and relying on one's religious beliefs as a source of strength and coping) and physical and mental health status in the areas of prevention, coping, and recovery was reviewed. Empirical studies from the published literature that contained at least 1 measure of subjects' religious commitment and at least 1 measure of their physical or mental health status were used. In particular, studies that examined the role of religious commitment or religious involvement in the prevention of illness, coping with illnesses that have already arisen, and recovery from illness were highlighted. A large proportion of published empirical data suggest that religious commitment may play a beneficial role in preventing mental and physical illness, improving how people cope with mental and physical illness, and facilitating recovery from illness. However, much still remains to be investigated with improved studies that are specially designed to investigate the connection between religious involvement and health status. Nevertheless, the available data suggest that practitioners who make several small changes in how patients' religious commitments are broached in clinical practice may enhance health care outcomes.
Physicians do not receive from the medical model the same explicit guidance in relating to their patients as in making diagnoses and prescribing pharmacologic and other treatments. To meet this need, we offer a framework for expanding the model. Therapeutic contact takes place within a connexional, or transpersonal, dimension of human experience, within which basic human needs for connection and meaning are met. Although seldom explicitly recognized, connexional experience is basic to medical care. Awareness of this dimension of experience leads clinicians to appreciate that establishing a therapeutic relationship is one of the principal goals of medical practice. It also reframes the doctor's task to make clinical uncertainty more tolerable and situations in which there is no appropriate biomedical response (such as care of the terminally ill) less frustrating and more fulfilling.
Healers must try to understand what the illness means to the patient and create a therapeutic sense of connection in the patient-clinician relationship. A favorable climate for "connexional" experiences can be created through the use of various interviewing techniques. Attending to rapport, silencing internal talk, accessing unconscious processes, and communicating understanding can help clinicians enhance their sensitivity to the subtle clues on which issues of meaning and connection often depend. Several risks are associated with the establishment of closer patient-clinician relationships, including dependence and power issues, sexual attraction, and deeper exposure of the clinician to the patient's pain. Prepared with an awareness of these risks and techniques to address them, clinicians are encouraged to deepen their level of dialogue with patients, to compare their experiences with those of other clinicians, and to thereby develop a more systematic understanding of therapeutic relationships.
The life and works of the pioneer British geriatrician, Marjory Warren, are worthy of closer examination. The transformation of a Public Assistance Institution into her unit at the West Middlesex Hospital in 1935 represented the first organized geriatric medicine service in the United Kingdom. She promoted multidisciplinary rehabilitation and holistic appreciation of elderly patients, and emphasized the economic, social, and moral problems associated with their care. She was particularly concerned with the rehabilitation of hemiplegics and amputees, preventive medicine, patient responsibility, and home nursing. She underscored the need for geriatrics to maintain a close link with general medicine and its training programs. Her innovative methods, influential writings, committee work, and personal force were instrumental in the evolution of modern British geriatrics and rehabilitation medicine.
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