The example that Dr. Graner uses, of a physician who tells a patient that her daughter "will tell us whether she wants to go to heaven," can be appropriate or inappropriate depending on the circumstances. If the physician says this to a patient with whom she has had no discussion about spiritual belief, then we would agree that this is inappropriate. If, on the other hand, the physician knows the family believes in heaven, then such a comment as was quoted in the article would be appropriate.

This clinical example highlights the need for courses on spirituality in medical schools. Spiritual issues are often operative in patients' lives, particularly in the context of their coping with chronic and serious illness (1). In addition, issues of meaning and suffering in patients' lives come up in the context of the physician–patient relationship. Therefore, it is critical that physicians be better educated in addressing spiritual issues appropriately with patients and their families. The medical school courses emphasize respect for patients' belief systems when patients use them to cope with their health and illness (2). Proselytizing or prescribing religious activities for patients is not recommended or encouraged. Physicians need to honor the trust patients give them by respecting their patients' autonomy. Caregivers should be responsive to their patients' spiritual needs but also be aware of appropriate ethical boundaries (3). Thus, the physician in the preceding example would know not to use religious concepts in a discussion with a patient unless that physician had asked about the patient's belief system and used references congruent with the patient's beliefs.

A spiritual history is an inquiry into what gives meaning to a person's life. It is one way to get to understand a patient more fully (4). It is not a substitute for chaplains. In fact, integral to the spiritual history is referral to chaplains and other spiritual care providers. The key element of the spiritual history is listening to what is important to the patient and being truly present to the patient. This is at the root of compassionate caregiving.

The Association of American Medical Colleges emphasizes the need to educate medical students to be compassionate. In their Medical School Objectives Project, they note that "Physicians must be compassionate  ... they must seek to understand the meaning of the patients' stories in the context of the patients' beliefs, and family and cultural values" (5). We would agree and thus support current courses in spirituality and health in medical schools and residencies.