Spirituality and clinical care

Editor—I agree with Culliford that knowing your patients better makes for a better therapeutic relationship.1 Often—for example, in terminal care or when physical measures do not have an impact on any disease—being able to relate in “wider” terms can increase the potential for healing. But I disagree with Culliford on the question of methodology. Most religions and other arenas of spirituality use ritualised gestures, incantations, prayers, symbolism, and rites. Unless you believe that these processes have effects through a perceived extracorporeal being, power, or energy, the effect is presumed to come from within patients themselves. But the placebo effect is inherently based on its own camouflage. Once you know you're taking placebo then the magic is lost. The entire effect is dependent on your “faith” in the procedure. Although I might deliberately use the placebo effect in my pharmacological treatment of patients, is it not an unethical deceit for me to portray a facade of spirituality for their benefit when I don't believe it myself? If that is true then what is Culliford suggesting? Might it be that my deficiencies as a non-believer translate into deficiencies as a doctor? Perhaps I don't really want an answer to that.