Medical Matters Tom O'DowdSome years ago a colleague asked to see a senior Government minister on a medical ethics matter. He was met in the hall of Leinster House by an anxious minister who said, "Are you on your own - I was sure you would have a bishop with you". You couldn't blame the minister for seeing medicine as an extension of religion at the time.
Medicine has borrowed heavily from religion. Its code of ethics emphasises caring for the poor since Hippocrates' time and medicine is still seen as a calling or vocation where the work is inseparable from life.
The less well off suffer more illness, have worse access to hospitals and general practice. Doctors who work in deprived areas are less well paid, have to fight the patient's corner and face more bureaucracy - which are all factors leading to burnout. In research we did on GP stress and morale those doctors who were in entirely private practice were the happiest.
The religious have a long history in healthcare in Ireland and internationally among the deprived. Generations of doctors have been trained in hospitals owned by the nuns.
Now that they are less visible in medicine they must wonder how the less well off will be looked after.
A recent study from Chicago will give the nuns and patients food for thought. The authors asked if religious doctors were more likely to work in deprived areas. The research team has a track record of exploring religion and spirituality in medicine and patient care.
They sent a specialised 12-page questionnaire to 2,000 doctors across the United States and got a fairly good response rate. Most major religions were represented and 35 per cent said they had no affiliation.
Over a quarter of the doctors worked in deprived areas. Over half said their religious beliefs affected their practice of medicine and 56 per cent said that they considered the practice of medicine to be a calling. However, nearly 80 per cent said they were spiritual to a greater or lesser degree.
The authors let them define spirituality for themselves although they give their own definition in the research paper as an "aspiration toward connection with the sacred and to others".
Doctors were more likely to practise in deprived areas if they had high degrees of spirituality, if they said their religion affected their practice of medicine than if they had no religion. Doctors who came from families who emphasised service to the poor were also more likely to work with them.
People are sniffy about self-defined spirituality and what it means. In this study, however, those who graded themselves as highly spiritual were four times more likely to work as family doctors in deprived areas than those who said they had low spirituality.
Those doctors with run-of-the-mill, average religiosity and those in subspecialities were not likely to work in deprived areas.
The authors speculate that modern spirituality has its roots in what they call "golden rule Christianity" where concrete personal actions attempt to right social justices. This would certainly fit with the commitment needed to work in healthcare in deprived areas.
America is different of course. The same research group found that religious doctors are likely to pray with their patients and to discuss religion with them. In Ireland this seems to be left to the clergy and pastoral care teams.
We don't know what the situation is in Ireland but it would make a fascinating study. It would be the ultimate irony if doctors working in deprived areas were religious because we know that religious practice in deprived areas is very low - six per cent in my own deprived area a few years ago.
My own experience of working in deprived areas for over 20 years is that many doctors are willing to give them a try and find the work fulfilling and in line with their aspirations. I think female doctors have a tougher time as they are expected to be better listeners and to be more patient than us males.
However, more patients in deprived areas do not have the emotional or material resources to make changes in their lives in line with medical advice.
They can become overly dependent on the doctor in a way that the better-off need not as they can find broader sources of support.
It requires doctors to resist such dependence and to encourage some degree of patient self reliance.
Prof Tom O'Dowd is professor of primary care and public health at Trinity College Dublin.