Paging God: Q&A with Wendy Cadge

Wendy Cadge, associate professor of sociology at Brandeis University, will release her second book Paging God: Religion in the Halls of Medicine in November 2012. In the book, she examines the role of religion and spirituality in academic hospitals. She shares some of her findings and methods in this interview.

John Shorb: Could you situate your approach to religious and spiritual aspects in medical environments? Where do you see your work in this field?

Wendy Cadge: There is growing interest in the field of religion and health care. But much of the debate asks: “Should religion or spirituality be there?” “How should it be there?” “What should people do?” There is a lot of survey data about how medical professionals and patients should act. However, I’m not sure that we know so much what doctors and nurses actually do in particular situations. In my research, I tried to address this. I’ve interviewed a range of physicians, nurses, chaplains and other medical staff.

You’ve addressed this in journal articles and in the book you’re writing, Paging God: Religion in the Halls of Medicine. Could you talk about the book and what it addresses?

In the book, I focused on 17 big academic medical centers across the country. I was interested in asking descriptively and simply, “How are religion and spirituality present in these big academic hospitals?” I began by talking to the director of chaplaincy and a staff chaplain at each of these hospitals, figuring they were the experts around spirituality and religion. I learned about who they are, what their work is, what they do in the day to day—how chaplains work in their medical center. The chaplaincy system is the most formal and obvious way that spirituality and religion are present in hospitals. But as I was doing this it was pretty clear to me that there are lots of times in hospitals when religion and spirituality come up, and chaplains aren’t around simply because there are so few chaplains.

In addition to interviewing chaplains, I also spent about a year interviewing all of the medical staff that worked in two different intensive care units at one of the 17 hospitals. Some of these staff worked in a neo-natal intensive care unit with babies, and some of them worked in a medical intensive care unit with adults. I was interested in talking to the staff about how they see religion coming up, how they respond, what they do both in their work with patients and families and also in their own lives.

What were some of the biggest findings for you in this project?

One of the main findings was that much of the time when medical staff and hospitals are thinking about spirituality or religion, they’re thinking about death and end-of-life issues. I have a chapter about death and all the ways that chaplains, especially, negotiate death for institutions. I sometimes tell people when I started this project that I didn’t know I was going to be writing a book about death, and that’s certainly one of the major things that I’ve found through the process.

Another one of the big findings is that all of these medical staff speak about religion and spirituality in really different ways which lead to a lot of translation problems. Chaplains, nurses and the physicians might all see themselves talking about spirituality and religion, but they’re not always understanding each other. So part of what I’m hoping to do with this book is to encourage people to think about the different ways they talk about spirituality in medicine and the ways that they can be better translators to try to help patients and families get the kind of care that they need.

Could you give an example of the ways that they are speaking differently? And how do you see them beginning to act as better translators?

Chaplains often frame their work broadly in terms of spirituality which they understand to mean all of the ways people find and create meaning in their lives – from traditional religious organizations, to nature, to friendships. Nurses and physicians speak more in terms of specific religious traditions asking what they teach and how they may inform the decisions patients and families make about care. It isn’t that either of these ways of thinking is better, but that they are different. Staff chaplains are better translators when they listen both to what their physician and nursing colleagues are saying as well as to what patients and families are saying. Asking questions so that they can understand what patients hold closest to them can help give support to patients during their time in the hospital.

You’ve advocated for chaplains to have a greater voice in health care. What do you think about the role of chaplains in hospitals and health care?

Chaplains are important in hospitals because they help to humanize patients beyond whatever their particular medical condition is. They can also advocate for patients and help in situations where patients and families have to make difficult decisions.

Some research I did showed that about two-thirds of American hospitals have chaplains, but we don’t have any idea how many chaplains different hospitals have or how they’re integrated into healthcare. There’s a real lack of good empirical research about where chaplains are and what they’re doing. Farr Curlin at the University of Chicago conducted a big survey in which he asked physicians if they were satisfied with their interactions with their chaplains. Something like 90 percent said that they were, but we just don’t have a good sense of what those relationships look like.

In one of your articles you wrote about medical education. How could medical schools prepare their students to handle both their patients’ and their own religious views?

It seems like since the 1990s there’s been an effort to include training about medicine and spirituality in medical curriculum. My sense is that at the institutions where it is included, it is mostly in the form of elective courses that are pretty short. So while you can say “x” percent of all medical schools have courses about religion and spirituality, I’m not sure that the news is getting out as quickly as it might. We need to at least sensitize physicians to these issues both so that they might think about whether it would be relevant to talk about this to patients in particular situations and perhaps more importantly so that they can, if they’re not sure, make a referral to a chaplain or someone who has this sort of expertise. This is important because we know that large numbers of Americans are religious or spiritual and consider these things important in relation to their health. And significant fractions of people in recent studies say they have spiritual needs that were not met by hospital staff or by their local religious organizations.

John Shorb is Manager of Resource Production at Church Health Center. Visit www.wendycadge.com for more information about Professor Cadge and her work.

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