Rockville, MD: National Institute for Healthcare Research; 1995. $20.00. Order phone 301-984-7162.

Spirituality is critically important to clinical medicine, and yet it is addressed only rarely and obliquely in much of modern medicine, including medical teaching. Matthews strives to put religion back into the thought and bedside repertoire of physicians. He has used various teaching techniques, including a lecture presented at numerous medical schools around the United States. A videotape of that lecture constitutes the bulk of the longer and more scholarly of these publications, which are manifestly designed to widen the audience for Matthews's important ideas.

Matthews cites numerous studies showing that clinical outcomes are superior for religiously observant persons, considered as a group, than for nonbelievers and those who only "go through the motions" of religion. His extensive literature review provides a vital underpinning of scientific validity to an impassioned plea that physicians acknowledge patients' spirituality, inquire about it, and feel free to pray with and for them.

Many physicians, including myself, share deeply the basic conviction that bioscientific medicine alone is often inadequate for the care of sick human beings or those susceptible to illness. All physicians are likely to admire the effort, bravery, and vigor of Matthews's effort to promote this approach. Yet one notes shortcomings in these videotapes. They are too polemical. They give short shrift to studies showing that religious observance results in harm. The biopsychosocial model is cited but is dismissed as incomplete because it lacks a spiritual aspect; no mention is made of the interpersonal and social web that is indispensable to patient (and all human) well-being. This is particularly troublesome because much of the benefit of religious observance lies in the concept of being "connected" not only to a supreme being but to persons of like mind and spiritual values.

An assertion that alcohol and spirituality drive each other out of a life is naive, even disingenuous, when applied without qualification. The word "religiosity" is used in place of "religiousness," although the dictionary gives this word an antithetical meaning. Mention of the sponsor's belief that his faith underlay his material success introduces a false and crass note foreign to Matthews's values. The suggestion that one take a "faith history" from patients ignores the discomfiture that may arise if the patient's religion is perceived by society as inimical or foreign to the mainstream or to the physician's own religion.

For busy physicians, the longer videotape is preferable; the shorter one presents little data and is intended for a lay audience. The need for more effort in this domain is great. Matthews is realistic and appealing in listing what needs to be done now; his list includes far more work with non-Christian religions.

Unfortunately, those most in need of greater spirituality are least likely to drink at this well. Surely, this is why Matthews expends so much effort on educating medical students before clinical toughening renders so many of them too cynical to hear the soundness of the message through the details with which they might disagree.