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Ontario Medical Review
Jan. 4, 2023
Stuart Foxman

What role does spirituality play in the practice of medicine?

Physician Health Program town hall explores its importance for patients, doctors

Dr. Michael Kaufmann doesn’t consider himself to be particularly religious. At a December virtual town hall on spirituality hosted by the OMA’s Physician Health Program, he called himself “the designated atheist in this group.” Yet, he’s grateful for what his own form of spirituality has meant to him.

He shared how the priest who was his sponsor and the recovery groups he attended in church basements shaped his battle with addiction. During one meeting of a support group comprising health-care professionals, a fellow member told him that when she feels life getting out of control, she gets on her knees and asks for help. After driving home, that’s just what he did: “I spoke aloud. To whom I was speaking, I didn’t know.

“I learned that I would have to get a handle on a higher power of some kind in my life. The good news is I could do it any way I wanted. A good orderly direction made sense to me,” said Dr. Kaufmann, who after practicing family and addiction medicine in rural Ontario, became the founding director of the PHP in 1995.

The PHP offers help for physicians, residents and medical students who are struggling with substance use and mental health concerns. The five physicians on the town hall’s panel talked about the ways spirituality informs their practice of medicine and their lives.

Time to talk about spirituality is now

Spirituality defined broadly as an experience of transcendence, or more specifically in reference to religion has long played a role in recovery from substance use disorders.

“Isn’t it about time we get to speak about spirituality?” asked Dr. Jon Novick, the PHP’s current medical director, as he introduced the panel. “Isn’t it about time we create an opportunity to talk about something so significant, yet so often absent from medicine, as it’s taught and practiced?”

Dr. Novick said doctors are taught to understand their patients and themselves from multiple perspectives. But he thinks that should include the role of spirituality for some patients and physicians, at least in understanding suffering, facilitating recovery, making sense of one’s experience and being resilient.

Patients often search for meaning, said Dr. Kenneth Fung, staff psychiatrist and clinical director of the Asian Initiative in Mental Health Program at Toronto Western Hospital, University Health Network. With a Catholic father and Protestant mother, he grew up in a religious family and said he later gained an openness to other practices like Buddhism and Indigenous spirituality.

Dr. Fung “sneaks in” the topic of spirituality during resident training. Do emerging physicians feel it belongs in the practice of medicine? Should they talk about the afterlife with patients? Should they pray with or for their patients? “I ask questions like this and it provokes a lot of dialogue,” he said.

When teaching residents, Dr. Fung also introduces the use of the “FICA” tool for spiritual assessment in patient interactions.

What is FICA?

  • F is for the presence of faith
  • I is for the importance of spirituality on an individual's life and the influence that belief system has on their decision-making
  • C is for the individual’s spiritual community
  • A is for the interventions to address spiritual needs

“Having the comfort to talk about spirituality can be quite helpful,” Dr. Fung said.

Doctors often wonder if there’s space for this type of discussion on the agenda, said Dr. Chase McMurren, the Indigenous medical education theme lead at the University of Toronto’s MD program, and Indigenous practitioner liaison in the Office of Indigenous Health at the Temerty Faculty of Medicine. You never know how that conversation might go. He said it’s important to remember that rituals of all sorts can have “a power in supporting the healing process,” and that every major religious practice includes ritual and some reasoning behind it.

Dr. McMurren also offered this line from the Muslim poet Rumi, whom he says he leans on in rough moments: “There are hundreds of ways to kneel and kiss the ground.”

Faith can help patients and health-care providers alike, said Dr. Yusra Ahmad, a community and academic psychiatrist in Toronto. To her, the word Muslim isn’t just a noun, it’s also a verb, “still and moving at the same time.

“It means one who attains inner peace by actively trusting in and surrendering one’s whole self to the creator of all the worlds,” she said.

Dr. Ahmad, who is also a poet, recited three of her poems that serve as a window into her faith. One offered a series of contradictions:

I am an artist in a world that values me as a scientist,

I am a healer in a world that reduces me to a set of letters: BA, MD, FRCPC,

I am a woman in a world that wants me to be a man,

I am religious in a world that tells me to be secular,

I am spiritual in a world that tells me to be religious,

I am a human being in a world that desires me to be invisible,

I am a speaker in a world that commands me to be silent,

And I am a Muslim in a world that tells me to be anything,

But I am free in a world that wants me to be in chains.

“I believe I’m a spiritual being on a sacred journey,” Dr. Ahmad said. “It’s an antidote to burnout when I can connect with that message. Even the trials and struggles are powerful and meaningful.”

That resonated too with Dr. Rose Zacharias, a family physician with a hospital-based practice, and president of the OMA. She called her Christian faith, and the belief that her life has meaning and purpose, a “remedy for burnout.”

“When I pray and open up scripture, it’s extremely strengthening and grounding and guiding for me,” Dr. Zacharias said.

She added that her personal faith beliefs mesh well with her professional calling. “It helps to know that there is a remedy and a plan, and I believe in a God that is a social justice seeker and intends to use me in that mission.”

Addiction led to feelings of ‘despair’

Dr. Kaufmann’s personal mission led him to work for the PHP. That would have been hard to imagine in the years of his escalating opioid dependency.

During that period, he said he felt “a sense of despair, no way out.” One day a colleague who knew Dr. Kaufmann needed help confronted him in the hospital parking lot. Dr. Kaufmann was given a piece of paper with a phone number and was told if he didn’t call that day, he’d be reported to the College of Physicians and Surgeons of Ontario. “There’s a higher power I wanted nothing to do with,” Dr. Kaufmann said.

Dr. Kaufmann called the number, which was the number for the OMA. This was long before the PHP, but the OMA referred him to a doctor “who knew what to do with people like me.” Dr. Kaufmann entered residential treatment, but a few years later still found himself in “darkness and chaos.

“It spilled out into every part of my life, including my work,” he said.

Eventually, Dr. Kaufmann started attending recovery meetings, going from maybe one a month to four and five a week. His spiritual journey included powerful messages received from his recovery community. The one he kept hearing loud and clear was, “We’re going to love you until you love yourself and forgive you until you forgive yourself.”

“That’s exactly what happened,” he said.

Today, Dr. Kaufmann calls himself “SBNR” spiritual but not religious. Still, he said, “I pray and meditate and try to figure it out to put myself on a good spiritual path every day.”

Watch the PHP town hall on spirituality.


Stuart Foxman is a Toronto-based writer.