Science and religion have always had a complicated relationship, so it’s not surprising that, as interest in holistic care grows, physicians are trying to come to grips with whether they should play a role in patients’ spiritual care.

“We’ve always talked about the limitations of the biomedical model that would reduce people to our physiology,” says Carol Taylor, PhD, director of the Center for Clinical Bioethics at Georgetown University. “When we talk about holistic health, we talk about biological, psychological, and social needs and now we’re talking about spiritual needs as well. They’re all interrelated.”

More than half of physicians believe that religion and spirituality affect patient health in some way, according to research conducted by the University of Chicago. In a survey of 2000 physicians, 56% believed that religion and spirituality have much or very much influence on health, but only 6% believed they often changed “hard” medical outcomes.Rather, respondents suggested that religion and spirituality help patients cope, give them a positive state of mind, or provide emotional and practical support via the religious community.

While doctors might believe religion and spirituality influence health, acknowledging a connection raises some fundamental and tricky questions. The American College of Physicians’ ethics manual encourages physicians to explore a patient’s religion and spirituality as part of an overall physical. But how are they to do that? What does it mean, and what are they to do with the information?

Stethoscope and Spiritual Care?

Spirituality, broadly defined, is what gives a person’s life meaning. Religion may or may not factor into the picture. In asking about spirituality, clinicians are seeking to identify a patient’s source of hope, strength, and values, not their dogma or doctrine.

Research indicates that roughly 80% of medical schools now offer spiritual care courses or integrate spirituality into their curricula, according to Christina Puchalski, MD, an internist at George Washington University and director of the George Washington Institute for Spirituality and Health. But what’s included and how it’s taught differs tremendously from one institution to the next. In an effort to bring consistency to the spiritual history and assessment process, various proponents have development of myriad tools represented by apropos acronyms such as FAITH, SPIRIT, and HOPE as well as the slightly less catchy FICA and FACT.

Assessing a patient’s spiritual health is important, because spiritual issues can not only impact a patient’s health, but they can impact a patient’s medical compliance and treatment choices as well, says Puchalski.

“What if they don’t want to take medicines because they believe God will heal them? What if they’re very nature-centric and don’t want to put medications in their body? What if they don’t believe in blood transfusions?” she asks. “Physicians need to know these concerns if they’re going to treat a patient.”

However, not everybody believes spiritual care belongs in the examination room. Indeed, those who oppose the idea present a litany of arguments: Spirituality is a private matter. Over-zealous physicians might abuse their position and proselytize to their patients. Pragmatically, many note that in the real world of 15-minute office visits, taking the time to ask questions about spirituality would come at the expense of addressing clinical issues.

Most worrisome says Richard Sloan, professor of behavioral medicine at Columbia University Medical Center and author of Blind Faith: The Unholy Alliance of Religion and Medicine, taking a spiritual history sets a doctor up to be a spiritual guide, “which they are completely untrained and unequipped to do.”

“Nobody should deny that spirituality is important to a great many people, but I don’t think it’s grist for the physician’s mill,” he says. Doctors need to know about all facets of their patients’ lives, he says, but shouldn’t ask more than “Is spirituality important to you?” A simple “yes” or “no” answer suffices, he says.

As for the possibility that patients’ spirituality might impact their care, Sloan notes that spiritual, financial, transportation, and other potential barriers to care are more likely to surface if a doctor asks, “Is there anything that would keep you from taking this medication?”

Patient Receptivity to Spiritual Subjects

How do patients feel about the subject? Not surprisingly, it depends. World War II Army Chaplain William T. Cummings famously declared, “there are no atheists in fox holes.” Patients seem to have the same sentiment when it comes to talking to physicians about their spirituality.

In a survey published in 2003 in the Journal of General Internal Medicine, researchers asked 456 outpatients in North Carolina, Florida, and Vermont whether they wanted their doctor to ask them about their spirituality. Only one third of respondents interviewed in a clinic setting liked the idea, but the number climbed to 40% in a hospital setting and 70% in hospice.

“Should we do this in every primary care practice and patient interaction?” asks Drew Rosielle, MD, director of the University of Minnesota’s Hospice and Palliative Medicine Fellowship. “Realistically, of course not.”

But when a doctor has a little more time, such as during an annual physical, or when a patient is faced with a major diagnosis, working a question or two about spirituality into the conversation can help a physician better understand and support a patient, he says. Rosielle routinely asks a couple of questions about spirituality as part of his initial palliative care consultation with patients so he can refer them to the chaplain on his care team if necessary.

“For patients who are not interested, it’s a non-issue,” he says. “You just move on. I’ve never had a patient get offended about being asked.”

But for patients with spiritual concerns, the conversation helps him connect them with the support they need. “When you get sick — especially when you’re facing a terminal illness or a life-changing situation, it affects your entire being emotionally, spiritually, existentially,” he says. “Patients are hungry for any support they can get.”

Puchalski sites an example from her own experience. Several years ago her father, a devout Catholic, underwent surgery for colon cancer. Prior to the procedure, the nurse asked him whether he was spiritual and what that meant to him. A retired opera singer, he responded that he couldn’t live without music. Intrigued, she asked him to sing and he responded with a heart-felt aria. Afterward he felt more relaxed and uplifted. The nurse noted his love of singing on his chart. After the operation, other clinicians read her notation and encouraged her father to sing as a way of exercising his lungs.

For her father, Puchalski says, bringing music into the hospital was a profoundly positive experience, “but how would the doctors and nurses have known that if the nurse hadn’t asked the question?” she asks.

Assessing Spiritual Outlook

Still, fitting spiritual assessments into practice is a hodgepodge. “From what we’ve seen in our research almost nobody is using those acronyms,” says Farr Curlin, MD, co-director of the Program on Medicine and Religion at the University of Chicago. “It’s the rare physician who uses these pneumonic tools. Rather they try to pay attention to signs from the patient and then they try to query them to bring those issues out and connect the patient with spiritual resources in the community or their organization’s pastoral care department.”

Taylor, says clinicians are caught in a theory-practice gap.

“The problem is we say, ‘spiritual care matters,’ but we haven’t gotten to the point where clinicians can identify spiritual need,” she says.

Read more articles at Medscape.com.

Now that 2011 is behind us, I think we can look back and say that it was a rocky, up and down, transition type of year for many of us. For me, I went through several transitions in my practice — first changing to no insurance and then next, changing from a traditional type practice to a new mobile practice model.

I can tell you this — 2012 already feels different. There is positive energy in the air. As an integrative medicine doctor, I widely accept and believe in energy healing and I can tell you that the energy has shifted with this change in year. 2012 is about positivity, fresh starts, and rejuvenation.

The question truly becomes: What will you choose to focus on in your practice? Certainly there will be those among us who choose to pay attention to the negative and view their practice through the lens of half-empty. But, I believe that 2012 is about changing your perspective.

Here are my top 10 items I think you should choose to focus on in the new year:

1. Connections with Your Patients: Above all else, this is the heart of medicine — for far too long we have been focused on the pill or the surgery or the protocol. Put those things aside this year and instead focus on developing strong and meaningful connections with all of your patients.

2. Social Media Integration: 2012 represents a fantastic opportunity to truly become a social media wizard. Start your blog, get your Facebook fan page fired up, and start making some YouTube videos. The more you spread your personal message, the better.

3. Show Your Vulnerability More: Patients want us to be human, to make mistakes but then apologize for them. The more we become vulnerable in front of our patients, the more human we are and that only leads to more trust.

4. Innovate One Thing: At least one area of your practice needs a make-over or even a do-over. Now is the perfect time to innovate and try something brand new

5. Slow Down: In this crazy health insurance environment the squeeze is to either super-size or downsize — join a large group/ hospital/ corporate structure or go completely solo. No matter which direction you go, try slowing down instead of speeding up.

6. Embrace the Digital Landscape: Do you e-mail with your patients, use Skype, or even text message? Have you purchased an iPad but don’t know how to make it work for you. Now is the time to get going and make the automated software out there work for you.

7. Start a Blog: While Facebook and YouTube are great tools, far and away, blogging helps you more than anything else. By writing about health and your personal views on health and well-being you will not only help your patients learn more about you, you will learn more about yourself from the writing process

8. Work Flow Efficiency: Far too many doctors do not spend enough time tweaking how efficient they can be with their work flow. So much time is wasted in the hallways and exam rooms when it could be used more efficiently. Don’t you want to get home at the end of the day?

9. Say Yes: Practice saying only yes — the more you do so, you will find that yes is always a choice for you. 2011 was about saying no; 2012 is about saying yes.

10. Leave The Room Brighter: I always liked the saying about leaving the room a little bit brighter than when you entered. Make 2012 your year to exit all of your rooms a little bit brighter.

By Craig Koniver, MD

Read more articles at PhysiciansPractice.com.

Despite what the public might think, just because you’re a doctor, you’re not immune to higher prices, flat or lower incomes, and the general sense of uncertainty that comes with a struggling economy.

It’s no wonder, then, that primary care doctors and even specialists are trying to shake some trees for extra cash. Thankfully, physicians do have some fairly financially savvy options that can help them maintain their income, and perhaps even increase it.

None of the activities we’ve identified require a tremendous amount of time, but the income they generate can improve your finances — and thus your sleep, if bills tend to keep you up at night. Here are 7 popular ones that you might consider:

Offer New Services Based on a Fresh Strategy

In these tough economic times, it makes sense to do everything you can to welcome patients into your practice, providing not only basic care, but things they might go elsewhere for. For a family physician or internist, this may mean performing services typically handled by a specialist: nutritional counseling, minor dermatologic procedures, or Holter monitor testing, to name a few.

Many specialties are concerned about turf wars, in which physicians have begun to offer services that have traditionally been the domain of others. This is now a fact of life, and a look at your competitors may reveal that many have already begun to do this.

Determining new services to offer may require an innovative way of thinking about your view of your practice. A strategy session could be helpful. Enlist your staff for brainstorming; find out what patients have been asking about; look at patient records to see which service you’ve been doing the most referrals for; think about services that may have a steady flow of patients.

“Take a hard look at the numbers and feasibility,” says Bruce A. Johnson, JD, a Denver-based attorney and medical practice expert with the law firm Polsinelli Shughart, and a consultant to the Medical Group Management Association (MGMA). “Figure out which services complement your practice and what makes sense from a patient care standpoint.”

Pros. Depending on the services you choose to offer, and how often you provide them, you can increase your income by 10 percent, 15 percent, or even more, say the people interviewed for this article. At the same time, you’ll enhance your status in the medical community as someone who can be relied upon for more than simply basic, or specialty-specific, care.

Cons. If you rush to add a service based on dollars alone, without getting the requisite training and (if necessary) certification, you’re setting yourself up for a possible lawsuit if your inexperience results in a patient being harmed. So before you decide to offer Botox® treatments or laser hair removal, say, make sure you know what you’re doing—and that you’ve informed your malpractice insurer about your new sideline and that it agrees in writing to cover you for claims related to it. Some companies may balk at defending you if you’re sued for something outside the scope of your usual practice.

How to find out more. A practice management consultant who knows the local medical climate can give you a sense of what types of services the community may be in need of and what the level of competition might be for providing them.

Join Forces With Pharmaceutical Companies

Drug and device companies rely heavily on doctors to help discover and promote new medicines and treatments. Billions of dollars flow through these research pipelines each year, including monies paid to doctors for serving as a speaker or consultant, or for participating in clinical studies within their medical practice. It’s not uncommon for physicians to earn a minimum of 5 figures a year from these activities. Some doctors make in excess of $100,000 annually — on top of their income from seeing patients.

Although some extra money is nice, too much can turn heads — and not in a good way. Last year, The Boston Globe reported on an allergy and asthma specialist who was issued an ultimatum by his hospital, the prestigious Brigham and Women’s Hospital (Boston, Massachusetts): Stop moonlighting on behalf of pharmaceutical companies or resign from your staff position. The doctor chose to give up his post.

Pros. With typical payments running about $1500-$2500 for a single talk, there’s substantial opportunity to supplement your regular income.

With regard to clinical trials, the size of compensation for participating in clinical trials, on the other hand, depends on your specialty and how your medical group divides income. Some clinical trials will pay more to physicians who are active in negotiating contracts with pharmaceutical companies, in addition to earning a cut for their role in the actual research.

“I’ve interacted with the pharmaceutical industry for more than a decade in various capacities, and some of the most positive interactions have been in conducting clinical trials,” says Adrian M. Di Bisceglie, MD, Chairman of Internal Medicine and Chief of Hepatology at Saint Louis University School of Medicine, in St. Louis, Missouri. “It’s been very rewarding to be involved from the ground up in the development of a new drug or therapeutic modality,” he added.

Furthermore, “Besides the revenues my institution earns from this work, I’ve been an occasional author or co-author of articles in high-profile publications, and my patients gain earlier access to new medications.”

Cons. These arrangements are coming under increasing scrutiny from hospitals, legislators, regulators, and the media. In fact, some of the doctors whom we contacted for this article declined to talk about their involvement with drug companies.

Chief among the charges is that generous payments to MDs and DOs are further inflating the costs of healthcare. Moreover, doctors have been accused of not informing their patients of their ties to the very products that they may be prescribing or using in surgical procedures.

How to find out more. Talk to your colleagues who are already working with pharmaceutical companies. Ask them how they got into it, and what they find satisfying (and frustrating) about their assignments. Most companies are always looking for talented, well-credentialed researchers and speakers. Another resource is the Website of the Pharmaceutical Research and Manufacturers of America (www.phrma.org). Contact information for member companies is listed on the homepage, under “About PhRMA.”

Round at Nursing Homes

While seeing nursing home patients used to be more lucrative in years past, the threat of reduced reimbursements and increased liability risks have made it less appealing to many doctors. However, most MDs and DOs who still see patients regularly in long-term care facilities believe that it’s worth the effort. Some physicians report that they earn in the range of $15,000-$30,000 a year for this extra, part-time work.

Pros. The pros include very low overhead, flexible hours, and the gratitude of patients who are often forgotten or neglected by their families and caregivers.

“Most of my nursing home patients only want reassurance that I won’t forget them and let them suffer in pain,” says Gregory P. Zydiak, MD, who practices internal medicine and geriatric medicine in Webster Groves, Missouri. “Their trust in me is quite gratifying.”

Cons. The cons include malpractice risks (including potential charges of elder abuse) and unreasonable demands from family members who may visit sporadically and not communicate with each other. The watchful eyes of insurance companies as well as state and federal regulators can be draining, too.

Malpractice insurance is generally not an issue because you’d be covered under your regular policy. However, some companies may make a distinction and charge you more for seeing nursing home patients.

How to find out more. Talk to your colleagues who work in nursing homes, or call the medical directors at facilities in your area. A good resource for basic information is Dr. Zydiak’s aptly named Website, www.geriatric-medicine-made-practical-and-profitable.com

Get Hired as a Medical Director

This is a good opportunity for a board-certified family physician or internist who has an interest in geriatric medicine, with compensation averaging about $1000-$2500 a month for about 5-10 hours of work. Your duties will include overseeing the quality of care, presiding over monthly staff meetings, and helping to craft policies and procedures.

Pros. Overall, there are fewer messy reimbursement issues with long-term care work because you’d be paid directly by the facility on a contract basis. However, not all of the perks are monetary: “Medical directorship offers a welcome change of pace from regular practice,” Zydiak says. “It’s also taught me administrative problem-solving skills that were totally foreign to me.”

Cons. Despite how much patients may love them, medical directors are often undervalued and underutilized, in terms of establishing policies and procedures to help assure patients’ rights and head off ethical issues before they happen

Of note, it’s important to make sure that the facility has business liability coverage, which covers the administrative functions of a medical director. Some places have dropped this coverage and gone bare, so be sure to ask about it.

How to find out more. The Website of the American Medical Directors Association (www.amda.com) has a link to career opportunities on its homepage (see “LTC Jobs”). The site also details the steps required to become a “Certified Medical Director in Long Term Care,” and is an excellent source of education and management tools for directors.

Team Up With Attorneys

The success or failure of a medical malpractice case often hinges on the testimony of the experts hired by each side to support their client’s claims. Lawyers rely on doctors for everything from examining the relevant medical records in a case and rendering an opinion, to testifying in court on behalf of a plaintiff or a physician-defendant.

To do this job, you need to have strong people skills. If you wind up on the witness stand, it’s especially important that you be able to communicate complex subjects clearly and simply to laypeople.

Pros. Reviewing records might pay $200-$300 per hour or more, depending on the complexity of the case, where you practice, and a number of other factors. Depending on your medical specialty, credentials, and experience, you can command between $2000 and $5000 per day, plus expenses, to testify at a deposition or trial.

Cons. Expert witnesses, especially those who testify against doctors, run the risk of being labeled “hired guns” who don’t always endear themselves to their colleagues.

How to find out more. National Medical Consultants, based in Bayside, New York, is a doctor-owned company that has about 1800 medical experts available to law firms throughout the country (www.nationalmedicalconsultants.com). A more direct approach to finding this sort of work would be to offer your services to local law firms that specialize in medical malpractice cases.

Consult for Wall Street

While it may seem true when the stock market’s sinking, mutual fund managers and other financial professionals don’t pick names out of a hat when choosing healthcare companies to invest in. Besides poring over balance sheets and working their contacts at the companies themselves, they talk to physicians like you before buying or selling. Your opinion on how well a drug or a device works, as well as a description of some of the common problems that you’re currently experiencing, can go a long way toward helping them decide whether to increase or decrease their stake in a company.

Pros. The pay is pretty sweet: about $250 per hour to do everything from filling out surveys to participating in phone calls and panel discussions.

Cons. You’ll have to be very careful about the type of information that you reveal, lest you violate any of your nondisclosure or confidentiality agreements. For instance, if you participate in ongoing drug trials, you can’t leak critical details that might be used by a brokerage firm in deciding whether to buy or sell a stock. (Does the term “insider trading” ring a bell?) Sometimes even a hint of impropriety or a conflict of interest might be enough to land you in hot water.

How to find out more. Contact a “matchmaker” firm that connects physicians and professionals in other fields with folks on Wall Street. One of the industry leaders is Gerson Lehrman Group (www.glgresearch.com), which has established relationships with mutual fund companies, global banks, and private equity firms.

Become a Media Darling

Do you have a knack for explaining technical subjects in terms that are easy to understand? If so, media outlets want you! As an expert, you can help journalists do their job better by providing a local angle on a national medical topic — in the form of a quote, a column or opinion piece, or an on-air appearance.

Pros. You’ll get exposure for your practice and attract new patients. If, say, 50 or more come to you over the course of a year, that could mean thousands of dollars in additional income. Also, here’s a bonus: You could become the next Sanjay Gupta, the ubiquitous medical correspondent on CNN.

Cons. You probably won’t become the next Sanjay Gupta. Those gigs, as you’ve probably already guessed, are few and far between. Nor will you likely make much money working with media outlets in rural areas of the country. Some newspapers may pay you as little as $50-$100 for a column, whereas TV or radio stations are not apt to compensate you at all. Again, the larger financial benefits are likely to be indirect, in the form of new patients who saw you on TV or read your quote or column in the newspaper.

How to find out more. Start by offering your services locally, as a resource for reporters working on stories. If you find that you enjoy the interaction and you’re getting good feedback, you might want to call a public relations firm that has extensive healthcare contacts. Not all firms do, and some doctors have been burned by companies making promises that they later couldn’t keep. To narrow your search, start with the respected Public Relations Society of America (www.prsa.org). Click on the “Find a Firm” link on the homepage. A recent search of the United States yielded 11 matches using “health care/medical” and “media relations” in the drop-down menus.

Read more articles at Medscape.com.