The American Journal of Surgery (2011) 201, 275–278

Midwest Surgical Association

Presidential Address: Can prayer help surgery?

Donn M. Schroder, M.D.*

Department of Surgery, St. John Hospital, Detroit, MI, USA

KEYWORDS:
Prayer;
Surgery;
Surgeon;
Professionalism

Surgeons use chemotherapy and radiation as adjuvant ther- medicine were woven together. The pendulum swung the
apies to surgery, working synergistically to cure cancers. We other way as religion and medicine took divergent paths
believe that neoadjuvant therapy can help our surgical out- during the Renaissance. In the past 15 years, the pendulum
comes. Despite the good results we have achieved, our patients may be swinging back, evidenced by the press publishing
want better. There has been a plethora of Internet searches by numerous articles on prayer and health—not so much on
our patients looking for ways to improve their surgical results. faith healing but on prayer working together with modern
Like other alternative therapies to aid surgery, prayer has medicine to promote well-being. Articles in Time and News-
become increasingly popular among patients in the United week reflect the explosion of manuscripts published in the
States.1,2 Can prayer really help our patients, either by affect- medical and surgical literature. A MEDLINE search from
ing their surgical outcomes or at least by creating a perioper- 1950 to 1995 revealed only 212 articles published about
ative relaxation response to alleviate their anxiety? Should prayer aiding healing, compared with 855 in just the past 15
surgeons pray for the health of their patients? Does prayer with years. There are 46 prospective randomized series on prayer
patients detract from or enhance the relationship between sur- aiding medicine and surgery in the Cochrane database.
geons and their patients? Is engaging in prayer with patients Studies that show benefit to prayer and healing do not favor
outside the realm of professional ethics? These are questions one religion over another.3,4 Equal healing benefit has been
that I would like to address today. demonstrated whether the prayer is Hindu or Buddhist,
The historical foundation for prayer to aid in healing is Catholic or Protestant, Jewish or Muslim.
replete in the Torah, the Bible, and the Qur’an. Health is There are different types of prayer that may work to-
directly related to prayer and spiritualism in the Hebrew gether with surgery to promote healing. The forms of prayer
Torah. In the Bible, there are 42 accounts of healing by range from meditation to traditional ritualistic prayer (such
Jesus in the Gospels alone. Luke, who is credited for the
as the Lord’s prayer) to colloquial petitionary prayer. Prayer
third Gospel, was a physician. Prayer for healing is integral
can be directed, asking for something very specific such as
to the teachings of Mohammed in the Qur’an. For well over
a quick surgical recovery, or nondirected, requesting that
1,000 years, the only physicians in Western civilization
God’s will be done. Also, prayer can be offered for oneself
were Christian monks or Muslim physicians who invoked
or on someone else’s behalf, so-called intercessory prayer.
prayer to aid medicine and surgery. The fabric of prayer and
Numerous surgical studies have focused on intercessory or
distant healing prayer.3–5 Some have surveyed surgeons to
* Corresponding author: Tel.: 313-881-1429; fax: 313-647-3995.
E-mail address: [email protected]
see if they pray for their patients.1 Others have analyzed the
Manuscript received July 18, 2010; revised manuscript August 10, effects of patient prayer alone or surgeons engaging in
2010 prayer together with their patients.6 –12

0002-9610/$ - see front matter © 2011 Elsevier Inc. All rights reserved.
doi:10.1016/j.amjsurg.2010.08.029
276 The American Journal of Surgery, Vol 201, No 3, March 2011

ness of the cause? What happens when the outcome being

prayed for is not in accord with the will of God? If it’s the
time for a person to die, does prayer defer destiny? Reli-
gious scholars are still wrestling with these questions. So
where does this leave us? The scientific foundation for
prayer is not solid. There is no indisputable proof that prayer
can aid in healing. Those who believe do so by faith alone.
I’ve seen the power of prayer work together with surgery
many times firsthand. An example of this was witnessing
my father-in-law miraculously survive an aortic arch dis-
section, outliving his surgeon by 20 years.
Like me, many surgeons do believe that prayer can affect
surgical outcome. In a recent survey, 38% of neurosurgeons
in the state of Washington pray for the health of their
patients, and 42% believe that prayer affects surgical re-
sults.1 I’m sure that many of you have prayed for your
patients’ health. Our patients certainly believe in the power
of prayer to aid surgery. A 1996 Time magazine poll found
that 82% of Americans believe that prayer could bring
healing. In a 2008 study by the American Cancer Society,
prayer was the most common method (61.4%) used by
patients to supplement efforts by medical science.2 Specif-
ically for open-heart surgery, a study from the University of
Alabama at Birmingham revealed prayer to be a coping
Donn M. Schroder mechanism among 96% of patients as a way to relieve their
stress.6 Similar results were found from a 2009 study on
cardiac surgery patients at the University of Michigan
Can medical science prove the benefit of prayer to im- where prayer was used to relieve their anxiety as evidenced
prove the result of an operation? I refer you to the latest by quality-of-life analysis.7
Cochrane review on this topic.5 This 69-page manuscript is There are physiologic effects of prayer that are measur-
a meta-analysis of 10 prospective randomized studies on able. For instance, single photon-emission computed tomo-
intercessory prayer to help the efforts of modern medicine graphic brain scans demonstrate changes in blood flow
involving over 7,000 patients. Some studies in this meta- during prayer, effectively deactivating a part of the parietal
analysis showed benefit, while others did not. The conclu- lobe where spatial relation brain cells dominate, creating a
sion of the authors was that there is no indisputable proof sense of transcendence.8 Prayer is known to accelerate brain
that intercessory prayer lowers surgical complications or waves on electroencephalography in a like fashion to tran-
improves mortality rates. Why is it that not all studies scendental meditation.9 Pressure regulators in blood vessels
demonstrate prayer benefit? Unfortunately, most of these are also altered during prayer into a relaxation response.10
studies have flaws in their methods. The investigators as- The measurable relaxation response induced by prayer can
sume that while the “prayed-for patients” receive distant benefit our surgical patients.
intercessory prayer from assigned prayers, their “control In the United States, team prayer is common at sporting
groups” are not prayed for by anyone. Wait a minute. Do events when the results of a mere game are at stake. Shouldn’t
patients not pray for themselves? How can researchers re- prayer among members of a surgical team be commonplace
ally think that a patient undergoing open-heart surgery is not when patients’ lives are at stake? At the center of this team are
going to pray for his or her health before and after the surgical patients. Shouldn’t they be given the option of partic-
operation? Do the investigators think that the patients’
ipating in prayer with their surgeon? Do patients want their
mothers and fathers, sisters and brothers, and their children
doctors to pray with them? A survey from a group of family
or friends are all struck spiritually mute during this time of
physicians revealed that the more serious the medical condi-
need? The point is that there is no control group. Somebody
tion, the more likely an offer to pray with a physician would be
prayed for all of these patients. Thus, there can be no valid
welcomed.11 Patients view even what we consider to be minor
scientific comparison of so-called prayed-for and not-
surgery to be major for them. The poet Emily Dickinson says
prayed-for surgical patients. Furthermore, are there factors
this well with her verse:
that, as humans, we may never understand about prayer that
affected the results of these prayer studies? For instance, Surgeons must be very careful
does the religious devotion of the prayer intercessor or the When They Take the Knife!
holiness of the patient have any bearing on how God re- Underneath Their Fine Incisions
sponds to prayer? Does God take into account the worthi- Stirs the Culprit—Life!
D.M. Schroder Presidential Address 277

Perceived life and death situations make surgery ripe for did not remember being offered. The lost memory of a
our patients to want to pray with their surgeons. Of 300 prayer offer in those 29 patients could be because the offer
survey respondents in Oklahoma, 99% accepted prayer ini- was made just before preoperative sedatives were given,
tiated by eye surgeons just before their operations.12 Only with their known amnesic effect, or because the survey was
1% of patients stated that they would rather not have been retrospective up to 1 year later. Most of these patients wrote
offered prayer. Of patients accepting prayer, 90% felt that that they would have accepted prayer with the surgeon if the
the prayer enhanced the relationship with their surgeons. offer were made. Of the 10 patients rejecting the offer, 2
It is my practice to say a silent preoperative prayer for were Christian, 2 were agnostic, and 6 were atheistic. All 10
my patient at the scrub sink. I do extend an offer to pray felt free to reject the offer, but 2 felt offended by the offer
with my patients in the preoperative area as well. After (both male atheists who had hernia operations). One of the
discussing the operation and answering any questions the 2 commented, “I don’t pray and it made me think it was
patient may have, I say, “I know that some patients like to really bad going into surgery.” Comments from some of the
pray before surgery. If you would like me to pray with you, patients rejecting the offer to pray who were not offended
just ask.” If they ask to pray, then I respond, “Would you were also noted: “I think prayer would be very helpful for
like to lead?” I hope not to be coercive and realize that some patients, but not for me”; “As long as the surgeon is
prayer in this instance must benefit the patient more than the respectful, and not assuming that everyone is religious, I
surgeon. We then pray together in whatever manner the think that prayer is a very nice thing to offer”; and “I prefer
patient chooses. Sometimes patients ask me to lead in focusing on the surgeon’s medical experience and insights
prayer. Since I do not volunteer my religious background over prayer.” As a surgeon, I could not agree more that
and do not ask them theirs, I offer a prayer that is nonde- surgical expertise is more important than the offer to share
nominational. If asked, usually I pray, “God, please be with a prayer with a patient, but why cannot a patient who desires
(patient’s name) as he/she has surgery today. Guide the prayer have both?
hearts, minds, and hands of all the members of the operating Of the 147 patients who responded as accepting the
team. Please comfort (patient’s name) as he/she recovers prayer offer, 91% identified themselves as Christians.
from surgery and let us do everything according to your Eighty-six percent of patients accepting the offer agreed that
will. Amen.” the prayer decreased their anxiety (57% strongly agreed).
In my experience, roughly 2 of 3 men and 4 of 5 women Three percent disagreed. Seventy-nine percent felt that the
were willing to share a preoperative prayer. I sought to more prayer affected their surgical outcomes in a positive way
scientifically quantify the effects of prayer. After institu- (52% strongly agreed). Two percent disagreed. Ninety-three
tional review board approval, an anonymous survey was percent agreed that the prayer affected their relationship
sent to 393 of my adult patients (208 men and 185 women) with their surgeons in a positive way (67% strongly agreed).
who underwent elective hernia repair (n ! 212) colon Two percent disagreed. Comments from patients who were
cancer surgery (n ! 11), breast cancer surgery (n ! 21), atheists or agnostics who accepted the offer to pray with the
laparoscopic cholecystectomy (n ! 124), or emergent ap- surgeon included the following: “The offer to pray prior to
pendectomy (n ! 25) over a 1-year period (June 2009 to surgery made me feel closer to my surgeon” and “I’m not a
May 2010). These constitute the mainstream of my opera- religious person, but was happy to accept the prayer offer. I
tions as a general surgeon. The focus of the survey was on thought it was great!” A patient who classified herself as a
prayer acceptance, anxiety reduction, and effects on the Wiccan/pagan wrote, “Because he was open-minded
surgeon-patient relationship. The survey asked if the offer enough to a prayer within our different concepts of Divinity,
of prayer with the surgeon was accepted or rejected and if I think it was helpful to me.”
the patient felt free to reject the offer and/or felt offended. Christian patients accepting the prayer were very respon-
If the patient prayed with the surgeon, he or she was asked sive with comments: “Any type of surgery is serious when
to grade on a 5-point, Likert-type scale from “strongly you are going through it, even if it is minor, so prayer takes
disagree” to “strongly agree” whether he or she had preop- away a lot of worry and stress”; “The prayer invoked tran-
erative anxiety and whether prayer alleviated that anxiety. quility instantly”; “I felt so much more prepared to engage
Patients were also asked to agree or disagree on the same in the surgical portion of my treatment with this thoughtful
5-point, Likert-type scale on whether they felt that prayer prayer”; “The prayer with the surgeon was one of the most
with the surgeon improved their operative outcomes and moving moments of my life. Sometimes, when all else fails,
whether prayer enhanced their patient-surgeon relation- we need to touch our spiritual side”; “I was pleased that my
ships. Patients were asked to indicate their gender and type surgeon had the courage to offer me prayer”; “I believe
of operation and to include any comments they wished to prayer builds a stronger bond between patient and doctor”;
share. “I felt unified with my surgeon and it brought me a sense of
One hundred eighty-six patients responded (a 47% re- peace in those moments just before my surgery”; and
sponse rate). None felt coerced, as 100% felt free to reject “Prayer lifted the surgical event to an act of transformation
the offer for prayer. Seventy-nine percent of them accepted where body, mind, and soul were healed through the con-
the offer for prayer, 5% did not accept the offer, and 16% vergence of science and religion.” Comments from Chris-
278 The American Journal of Surgery, Vol 201, No 3, March 2011

tians were not all supportive. One Catholic patient wrote, relax an anxious preoperative patient and may help enhance
“Prayer slightly increased my anxiety as it felt like Last the relationship between patient and surgeon. A surgeon
Rites. That being said, it didn’t bother me enough where I must be comfortable with prayer to offer it. Professionalism
felt it should not be offered to other patients.” After seeing can be maintained provided the prayer is offered in a non-
that anxiety was increased in a few patients by the prayer confrontational manner and reflects the spirituality of the
offer from this survey, I now preface my offer by stating, patient. Surgeons who want the best for their patients need
“Even though this is a relatively safe operation, I know that to utilize every tool available, and to quote one of my
some patients like to say a prayer before surgery. If you patients, “Prayer is a powerful tool.”
would like me to pray with you, just ask.”
The offer should be an opportunity for the surgeon, if he
or she feels comfortable, to share the spirituality of their
patients, and perhaps help alleviate their preoperative anx- References
iety. It is not appropriate for this offer to be a religious
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onto the vulnerable patient. Professionalism involves sub- alternative medicine (CAM) awareness among neurosurgeons in
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views to those of the patients. Prayer shared by a surgeon prevalence of complementary methods use by cancer survivors. Can-
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ality? Surgical professionalism requires respect for cultural vitro fertilization-embryo transfer? J Reprod Med 2001;46:781–7.
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support the patient’s prayer without confrontation, and
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surgery?” While there is not conclusive scientific proof that sician-initiated prayer prior to ophthalmologic elective surgery. South
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