GMC Guidance on Personal Belief

I was on BBC Radio 4 this weekend, on the Sunday Programme, talking about the place of the doctor's and the patient's personal beliefs. You can listen to the extract here:

This was in the context of two news stories:

A GP who had been investigated by the GMC for inviting a patient to take part in an 'exorcism' [read the full article in the Telegraph]
The General Medical Council publishes new guidelines on the role of personal belifs [read the new guidelines].

So, on a saturday afternoon, I cycled into the BBC studios in Edinburgh to talk to presenter Ed Sturton in Salford and to Professor Michael King in London - who held different beliefs to me. Time meant the interview you can listen to above was trimmed a bit, so here are some more details.

Both Professor King and I though the new guidance was actually quite good. They explicity require the consideration of all factors relevant to patient care - including spiritual ones. Read a detailed critique of the development of the guidelins by CMF Chief Executive, Peter Saunders. However, in this article, I wanted to focus on two aspects most relevant to psychiatrists.

Is faith beneficial?

You will never be able to prove the existance of God using a randomised controlled trial. Firstly, physical health does not correlate with spiritual health: look at Jesus who died on a cross. Secondly, God may chose to break the randomisation... However, you can look at the general picture of what the research says. In the radio interview, I mistakenly refer to 'thousands of randomised controlled trials' which are not there, but there are several hundred randomised controlled trials and also thousands of other positive scientific studies on the role of faith in health. Why is this? In psychiatry and mental health settings I think there are three levels of explaination.

Behaviourally, getting out of your house once a week is good for you. This could be to church, but of course could equally well be to the mosque of golf club. You get exercise and human contact.
Cognitively, religion can go both ways - some people have negative beliefs [eg excessive guilt], but more have positive beliefs [eg God loves me and similar truths].
Existentially, I know I a part of a bigger something, which helps me deal in a better perspective with the day to day mess I encounter. Life events weigh less in this world view - though of course they can still be heavy...

These three areas should, I believe, be asked about by any good psychiatrist - and this is the view of the Royal College of Psychiatrists Special Interest Group in Spirituality which has over 1600 members - almost 20% of UK psychiatrists. I'm glad that the new GMC guidance encourages this.

And what about the psychiatrists faith? Professor King thinks this should be off limits - and the new guidance from the GMC would certainly suggest that the GP mentioned in the Telegraoh article had gone too far and crossed too many boundaries. However, some specific research from Canada, and a growing groundswell of opinion in therapy research in general, suggests that patients do not want their psychiatrist to be a 'blank slate' or behave like a computer. They want to talk to a human, and this involves seeing something of the humanity they have. Read a recent editorial discussing this issue from the Royal College journal [includes a link to the Canadian research].

Is exorcism bad for you?

If this word conjours up images of crossed goats legs and blood on doorframes - you are in Hollywood. A far better term is 'Ministry of Deliverance'. Pressured exorcism of the kind the Telegraph article seems to mention is clearly bad for you. But if good practice is followed, then I do not think it should be harmful at all. I go into this good pratice in more detail in this article, but the most important things are to maintain respect and if you are unsure just pray a prayer of blessing and back off.

For what it is worth, I believe it is possible to do this kind of ministry in a way that is sympathetic to the new GMC guidance. However, I do not think this should be done by the doctor / psychiatrist. It could be done by a hospital chaplain, but even better done when a person is part of a supportive and loving local faith community who can deal with all the issues round the side. It is not the primary role of the psychiatrist to intervene here - it is a relevant topic for discussion, but I beleve ministry like this should be done elsewhere. The likelyhood of boundaries being crossed is too high and there are probably others who will do a better job.

Rob Waller, 22/04/2013