Harold Koenig, MD, remembers the first time he didn’t just talk about spirituality with a patient but let it shape his care.

A thirty-something sanitation worker survived a fall but not the agony that followed. “He had back surgery, but it left him with chronic severe pain,” professor of psychiatry at Duke University School of Medicine, Durham, North Carolina, remembers. Narcotics only relieved so much, and as he struggled to continue working, depression and thoughts of suicide soon followed.

“However, he had a strong religious faith,” Koenig said. “We had many discussions about his beliefs and why God would allow him to suffer like this.” The patient wondered whether his behavior in his youth had anything to do with the pain he was enduring and whether God was punishing him.

Koenig found himself doing something unusual. “I prayed for him every day and told him I was praying for him,” he said. “This meant a lot to him.” Although he had prayed for patients in the past, Koenig never admitted as much openly in a hospital setting. Twenty years later, the patient is still alive and making slow improvements. Koenig doesn’t suggest that the praying made a difference, but “it does make a difference in terms of my compassion for a patient,” he said.

Doctors are starting to talk openly about that spiritual dimension of their work. Surveys taken before and after the pandemic show a steady rise in physicians who say they hold spiritual beliefs or practices, even when they don’t identify as religious. In one recent national sample of general internists, published by the University of Michigan, Ann Arbor, Michigan, earlier this year, nearly 7 in 10 reported belief in God or a higher power; about half said they pray privately at least weekly, and about half believe in life after death.

An earlier large-center study from the Mayo Clinic found a similar pattern, with 44.7% of physicians admitting to frequent prayer and the vast majority describing themselves as either religious or spiritual.

Whatever label they use, many doctors are not operating as strictly secular technicians.

Daniel Sulmasy, MD, PhD, is a physician-ethicist at Georgetown University, Washington, DC, and a former Franciscan friar (he left the church in 2012 to marry). The way he sees it, “spirituality is the way we live our lives in relationship to transcendent questions. In medicine, the most important are questions about meaning, value, and relationship.”

Illness summons those questions relentlessly. Questions like, Why is this happening to me? Why is this happening to my child? Is there any meaning in my suffering? Those aren’t answerable by a lab or a scan, but they hover in almost every hospital room.

Clinics run on science and time management. People run on hope, love, and fear — things with no Current Procedural Terminology code. Physicians work at that intersection, which raises practical questions: What happens to a clinician’s own beliefs once the pager starts going off? How do you make room for a patient’s spiritual life without crossing lines? And if meaning-making really buffers burnout, why isn’t it taught with the same intention as pharmacology?

Holding Meaning in a System That Drains It

Koenig believes many doctors avoid the topic because most were never taught how to integrate it. “Physicians are often not trained to take a spiritual history,” he said. And if they aren’t religious themselves, they may feel awkward doing it. Time pressure does the rest.

He also sketches a familiar arc. Many people enter medicine with a sense of calling. The training — fast, punishing, and relentless — can sand that down until the work feels like a job. But as a 2017 Mayo Clinic study found, the stronger a physician’s sense of calling, the lower the burnout rate. And as burnout climbed, calling fell away. The clinicians who manage to keep that call tend to burn out less and enjoy the practice more. In fields where endings are unavoidable, like palliative care, the spiritual dimension is woven into the day, not tacked on at the end.

Exposure to suffering doesn’t move everyone the same way. For some clinicians whose faith animates their choice of work, the pressure deepens it. For others who were on the fence, the weight of grief and the grind of the system can squeeze out whatever belief was left. The through line is not piety; it’s whether people have a framework, religious or not, for making meaning of what they see.

In cancer and palliative settings, brief, structured conversations about meaning and faith are associated with higher patient satisfaction and better quality-of-life scores, while spiritual distress — when present and unaddressed — predicts worse symptoms and more intensive, unwanted care at the end of life.

None of this makes belief a pill. It does make meaning of a clinical variable worth noticing.

If medical culture wants clinicians to engage patients’ spiritual needs, Koenig argues, it has to start upstream: “First of all, expose future doctors to the immense amount of research that has accumulated showing that religious faith is overwhelmingly positively related to all aspects of mental, social, behavioral, and physical health,” he said. “Next, students must be taught on how to take a spiritual history in a patient-centered manner. They must also be trained not to let their own beliefs influence the way they identify and address the spiritual needs of patients, which always must be patient-centered.”

The “immense amount of research” line isn’t a rhetorical flourish. “There have been quite literally thousands of published research studies, which have investigated associations between measures of religious identity or practice or spirituality and physical or mental health indicators,” said Jeff Levin, PhD, epidemiologist and religious scholar. Although the research has investigated everything from depression to addiction to overall health, Levin says he’d sum up the general findings like this: “Religion or faith or spirituality, in the broadest sense of these words, is a protective or preventive factor when it comes to our health and well-being, especially our mental health.” For example, a 2024 study of frontline healthcare workers in Poland during the pandemic found that higher levels of spirituality were tied to greater posttraumatic growth — the positive psychological change that can follow intense adversity.

That doesn’t turn spirituality into a treatment order. “Among us epidemiologists, we tend to speak in the subjunctive tense,” Levin said. “I’ve always been a bit wary of speaking of determinants.” Still, he argues it “deserves a place at the table. No more, no less.”

Sacred Moments, Real Effects

There’s a name for the flashes of depth many doctors quietly report: sacred moments.

They’re brief, unscripted, and not necessarily religious. It might be a sense that something more than technique just happened between two people. In the University of Michigan’s recent national survey of internal medicine physicians, more than two thirds said they’ve had those moments. Those who noticed them more often and talked about them with colleagues were less likely to report extreme burnout.

The takeaway isn’t to chase epiphanies; it’s to admit they’re already part of the work and to make room for them in the same way we debrief a code or a near miss. Naming what happened helps metabolize it.

Seen that way, these moments can become a return to first principles. For Sulmasy, he’s often reminded of a famous quote by Abraham Joshua Heschel, the rabbi, philosopher, and theologian. In 1964, long before burnout had a name, Heschel stood before the American Medical Association and urged a profession enamored of progress not to forget its oldest truth. “To heal a person, you must first be a person,” he told them.

The pandemic made that argument newly legible. When fear, fatigue, and grief stripped the work to essentials, it became harder to pretend that professionalism meant impersonality. Programs began to formalize space for reflection, chaplaincy pulled closer to the team, and residents were told aloud what used to be whispered: compassion is not a luxury; it’s a competency.

Sacred moments are one way the culture is relearning this. Patients bring histories, hopes, and beliefs that shape how they suffer and heal. Physicians bring consciences, limits, and the need to make meaning of what they witness. Naming both inner worlds is a practical safeguard, and it helps people do the work without losing themselves in it.

Lines and Guardrails

Sulmasy’s playbook starts with a clear rule: never proselytize. Patients are vulnerable, and trying to sway their beliefs is unethical. Instead, he says, follow the patient’s lead. Pay attention to what is already in the room — a Bible or a Quran on the tray table, a rosary in a hand, a photo surrounded by candles.

Ask open-ended questions that let the patient decide where to go next: Is that meaningful to you? or Would you like to talk about it?

If the conversation reaches beyond your training, invite help. Chaplains are the specialists for this work. Offer a simple handoff that respects both the patient and the team: Would it help if I asked our chaplain to stop by? Keeping the exchange patient-centered and team-based protects boundaries and makes it more likely that the patient receives the kind of support they want.

Clinically, there’s a simple way to open this door. The FICA Spiritual History Tool, a framework first developed in the late 1990s, takes about a minute and helps surface both spiritual distress and sources of strength, especially in serious illness. It moves through four prompts: ask about faith or beliefs (“Are there spiritual or personal beliefs that matter to you?”), the importance or influence of those beliefs (“Do they affect how you’re coping or making decisions?”), community (“Who supports you — family, friends, a congregation, a meditation group?”), and how to address this in care (“Would you like us to involve them, or our chaplaincy, while you’re here?”). It works because it sounds like medicine, not a sermon. You ask, you listen, and you note what matters.

What does it give you? A quick map of supports (a pastor who visits, a practice that eases pain) and stressors (a belief that conflicts with transfusion and guilt that fuels anxiety). It identifies people to loop in so the patient isn’t carrying this alone. It suggests concrete next steps — chaplain consult, time for prayer before a procedure, access to sacred texts or objects, attention to diet or rituals, and a heads-up about end-of-life preferences. And it leaves a brief note you can revisit, the way you would any other part of the history, so the plan stays aligned with what gives the patient meaning.

Outside the hospital walls, programs like IU Health’s Congregational Care Network match recently discharged, socially isolated patients with trained “connectors” from local congregations for several weeks. The companionship is more than catechism and is open to people of any faith or none. The aim is simple: fewer lonely recoveries and more eyes and ears on what helps at home.

Brains on Prayer, Hearts at Work

Neuroscientist Andrew Newberg, MD, has spent years imaging prayer, meditation, and mystical states. “The brain seems to be structured and function in a way that enables us to have various types of spiritual experiences,” he said. His scans show that multiple parts of the brain work together during these states. When the feeling is intense, the brain’s emotion centers fire more strongly.

Newberg cautions against overreach. “Just because we can do a brain scan to find out what parts of our brain are active when we feel love or listen to music does not diminish the power and importance of love and music in our lives,” he said. Neuroscience helps us deepen understanding, but it doesn’t settle metaphysical questions. “If someday we can devise a study to firmly establish the ‘realness’ of these experiences, then at that point we might experience a paradigm shift in how we understand ourselves and the universe,” Newberg said.

The practical takeaway is straightforward. Spiritual practices and experiences can change how people cope, adhere, and heal, even when medicine cannot answer ultimate questions. “Some circumstances such as a simple infection might just require an antibiotic to treat,” Newberg said. “But for many challenging and chronic conditions including cancer, diabetes, chronic pain, depression, or anxiety, a spiritual component can help people cope more effectively.”

And if people are able to deal with their health issues more effectively, he says, “they will be more compliant, manage symptoms and side effects better, and improve their outcomes and quality of life.”

The Hard Consolation

Not every encounter reconciles suffering with belief. For some, faith is strengthened by what they witness. For others, it thins.

Sulmasy doesn’t pretend there’s a neat answer. “In the end, the questions ‘Why must patients suffer?’ or ‘Why must I suffer?’ are essentially just another way of asking, ‘Why am I a human being and not God?’ Well, because I’m finite. So it’s really about coming to grips with our own finitude, our true humanity. That’s really what medicine is about, right? People’s bodies are finite, and there’s only so much we can do.”

He carries a story from early in his career, when confidence ran ahead of experience. Sulmasy was performing a thoracentesis on a woman dying of breast cancer. “I hadn’t really done many,” he recalled. Yet he told the fellow, Oh, I can do this.

As he pulled the catheter back over the needle, he felt it catch. “I wound up shearing a piece of the plastic off the end of the catheter,” he said. “And a piece of plastic was floating in this woman’s pleural space.” Panic surged. The monitors kept their indifferent rhythm. A dying patient now had a foreign body in her chest because a young doctor had hurried.

With the fellow beside him, he chose the hardest next step. “I told her what I’d done,” he said. He explained the mistake as plainly as he could. She listened and answered in a voice he still hears: “That’s all right, doctor. You know, I’m dying anyway. Doesn’t matter to me. Thank you for telling me.”

Her cancer did not retreat, but something else changed. The confession acknowledged harm, and her response offered a kind of absolution.

“The phenomenal thing you can learn about forgiveness,” Sulmasy said, “is that it can do work when medicine can’t.” In a room where nothing can be fixed, something can still be healed.