Intimate Questions Research Articles

Assessing ChatGPT's ability to answer questions pertaining to erectile dysfunction: can our patients trust it?

Erectile dysfunction (ED) is a disorder that can cause distress and shame for men suffering from it. Men with ED will often turn to online support and chat groups to ask intimate questions about their health. ChatGPT is an artificial intelligence (AI)-based software that has been trained to engage in conversation with human input. We sought to assess the accuracy, readability, and reproducibility of ChatGPT's responses to frequently asked questions regarding the diagnosis, management, and care of patients with ED. Questions pertaining to ED were derived from clinic encounters with patients as well as online chat forums. These were entered into the free ChatGPT version 3.5 during the month of August 2023. Questions were asked on two separate days from unique accounts and computers to prevent the software from memorizing responses linked to a specific user. A total of 35 questions were asked. Outcomes measured were accuracy using grading from board certified urologists, readability with the Gunning Fog Index, and reproducibility by comparing responses between days. For epidemiology of disease, the percentage of responses that were graded as "comprehensive" or "correct but inadequate" was 100% across both days. There was fair reproducibility and median readability of 15.9 (IQR 2.5). For treatment and prevention, the percentage of responses that were graded as "comprehensive" or "correct but inadequate" was 78.9%. There was poor reproducibility of responses with a median readability of 14.5 (IQR 4.0). Risks of treatment and counseling both had 100% of questions graded as "comprehensive" or "correct but inadequate." The readability score for risks of treatment was median 13.9 (IQR 1.1) and for counseling median 13.8 (IQR 0.5), with good reproducibility for both question domains. ChatGPT provides accurate answers to common patient questions pertaining to ED, although its understanding of treatment options is incomplete and responses are at a reading level too advanced for the average patient.

‘We should no longer sit on packed suitcases’: German expellees’ emotions in post-war West Germany

ABSTRACT This article examines the integration into West Germany of those Germans expelled from Silesia, Pomerania and East Prussia after the Second World War through an emotional perspective. The focus on evangelical communities serves here the purpose of exploring the significant role of evangelical churches and pastors in comforting the expellees, as well as their wishes and expectations. Since expellees used to share existential and intimate questions with their pastors, this correspondence provides a closer look at their multifaced emotional universe, which often diverged from the stereotypical image proposed by the expellee political representatives. The discrepancy between these two images reflected the political rupture that occurred between the expellees and their political leaders from the mid-1950s. The article’s aim is to show that significant emotional reasons underlie this progressive political detachment that deals both with the transformation of the expellees’ idea of homeland and with the desire to look forward from the Nazi legacy.

Italy ∙ Italian DPA on the Vaccine Booking Procedure: Intimate Questions Possible, but Information Obligations Still Key

Italy ∙ Italian DPA on the Vaccine Booking Procedure: Intimate Questions Possible, but Information Obligations Still Key

The Death of an Author

The Death of an Author Henghameh Saroukhani (bio), Sarah Lawson Welsh (bio), and Michael Perfect (bio) What does it mean to critically examine a writer's life, her work, and the relationship between the two? As literary critics we work within and at the limits of distinctive paradigms and structures of interpretation. A text often takes on a new life as it is distilled through a critic's analytical pen and as it is embedded within specific intellectual traditions. But what are the assumptions that constitute our methods of interpretation? Roland Barthes' notion of the "death of the author," for example, continues in some ways to dominate literary studies. It is now instinctive to grimace at the thought of placing a writer's intentions at the heart of any form of criticism. How might we retain our autonomy as critics if we relinquish the labour of interpretation to the seemingly incidental whims of the personal life and intentionality of the writer? If we agree with Barthes that it is a mistake to treat authorial intention as the source of a text's meaning, might we maintain nonetheless that it should be considered a source of such meaning? If we are to make the case (as we surely must) for a multiplicity of sources of literary meaning, how might we go about negotiating and calibrating these sources when we undertake literary analysis? We have asked ourselves these questions many times while co-editing a special in memoriam issue on Andrea Levy over the last two years, published in the pages of ARIEL in 2022 (53.1–2). Engaging with her legacy through new critical approaches, her archives, and her unpublished works provoked us to dwell on the process of interpretation itself. We were keen to curate a publication that would radically contextualize her work and stand as a material articulation of Levy's global significance. (This is why we chose to publish with a Canadian rather than British journal.) Our contributors grappled with the difficulty of writing [End Page 131] about Levy in the aftermath of her passing. Andrea Medovarski, for example, meditated on her own mother's death alongside Austin Clarke's as a means to understand the psychic constitution of her comparative approach, while John McLeod drew from his personal experience of adoption to enunciate the complex acuity of Levy's writing on the politics of adoptive being. In writing about Levy after her death, we have noticed something shift in the scholarship (not just within Levy studies and, by extension, postcolonial studies). The personal has become a key discursive terrain of contemporary scholarship. The personal is not just political here; it's critical. Bill Mayblin, Levy's widower and partner for over forty years, wrote a short accompanying text to "Two," a stunning meditation on death and mortality that was probably the last piece of creative writing Levy ever produced and which was published for the first time in our special issue. He drew attention to how the piece was immediately part of an archive; it was "quickly handwritten in a Moleskine notebook" (311). He does not know why she wrote the piece; thus, he movingly yearns to know her intentions: "Was she trying to confirm, or alternatively to question, her feelings about her life and her impending death? Was it therapeutic, or was it an anxious questioning?" (311). These intimate questions return us to some of the foundations of literary studies and, consequently, bring us to Mayblin's most recent work, "Speaking from Memory: Thoughts and Recollections from a Life with Andrea Levy." In thinking about his position as Levy's partner, Mayblin offers an example of how scholarship can be shaped by the personal. "The role of a long-term spouse or partner to an author," Mayblin argues, "is an informal and generally undocumented one. It can encompass the roles of confidante, interlocutor, research assistant, secretary, personal assistant, first reader, editor, close observer, and companion" (136–37). Mayblin reminds us of an acutely under-explored genre within literary scholarship: the archival knowledge, intellectual paradigms, expertise, and revelations proffered by the writing of those close to an author and her work. It is a modality of scholarly...

Association between Gender and Clinical examination frequency and confidence of Medical Students in Saudi Arabia: A Cross-Sectional Study

Objectives: Determine the student's confidence and capability in performing examinations by both gender on the same and opposite sex.Methods: A valid questionnaire has been distributed to College of Medicine students at Taiba University in Saudi Arabia. This questionnaire includes questions about the factors which may be related or affect the medical experience during general or intimate examination and questions about the frequency of examinations on the same and opposite sex. Comparison of males and females was done using Chi-square tests analysis using the SPSS version 23.Result: Out of 150 final year medical students, 108 male and female students (72%) have participated in this research. There were 82.8% of males and 62% of females that have agreed that cultural and religious traditions have impacted their clinical experience with the opposite sex. In regard of respiratory examination for patients of the opposite sex, only 1.7% of the males have performed respiratory examination for patients of the opposite sex more than (10) times, compared to 34% of females. Also 44.8% of males have performed male genitalia examination (1-5) times, compared to 12% of females. On the other hand, 1.7% of males have performed vaginal examination compared to 12% of females.Conclusion: This study showed that there is an association between gender and clinical experience in some aspects. Researchers emphasize minimizing the negative effects of gender nature on the clinical experience by using alternatives or encouraging the patients to allow students to complete their clinical examination while ensuring patients privacy and integrity.

Childhood Trauma Predicts Positive Expressive Suppression During Social Affiliation in Adults With Anxiety and/or Depression: Implications for Social Functioning

Experiencing childhood trauma (CT) can create barriers for developing relationships and is a risk factor for anxiety and depression. Expressive suppression (ES; i.e., reducing expression associated with experiencing emotions) might explain the link between CT and relationship formation difficulties. We examined the association between (1) CT and ES during a dyadic paradigm intended to facilitate connectedness between unacquainted partners and (2) ES and desire for future interaction (DFI). Individuals with an anxiety or depressive disorder diagnosis (N = 77) interacted with a trained confederate; partners answered a series of increasingly intimate questions about themselves. Participant ES for positive and negative emotions, and participant and confederate DFI were collected during the task. Participants completed global anxiety, depression, and CT measures. CT correlated with positive (r = .35, p = .002), but not negative, ES (r = .13, p = .273). In a multiple linear regression model, CT predicted positive ES beyond symptom variables and gender, β = .318, t = 2.59, p = .012. Positive ES correlated with participant (r = −.38, p = .001) and confederate DFI (r = −.40, p<.01); and predicted participant DFI beyond symptom variables and ethnicity, β = −.358, t = −3.18, p = .002, and confederate DFI, β = −.390, t = −3.51, p = .001, beyond symptom variables. Mediation analyses suggested positive ES accounted for the relationship between greater CT severity and less desire for future interaction from participants, 95%CI [−0.26, −0.02], and confederates, [−0.38, −0.01]. Positive ES may be an important factor in the reduced capacity to form new social relationships for individuals with a history of CT, anxiety, and depression.

The Dispute Over a Children’s Book Related to Sex Educatio

The sexual education of kids is an important topic, which despite its delicacy should be publicly discussed and analysed so that it can be helpful primarily for parents. As their children's first teachers, parents are often faced with the intimate questions, asked by their children and for which answers they are not prepared. The possibilities for sex education of kids are numerous and one of them are the books, which encourage families to talk with their children about these topics. The present text explores the appearance of one such book on the Czech marke

Implementing the Fast Friends Procedure to Build Camaraderie in a Remote Synchronous Teaching Setting

Introduction Improving students’ experiences in courses has always been important; one important method for facilitating discussions is an effective icebreaker activity. Statement of the Problem The move to remote learning during the COVID-19 pandemic presented new challenges for fostering connections among students. Given the constraints in remote learning, teachers need effective and feasible ways to improve student experiences. Literature Review We reviewed traditional icebreaker activities and highlighted the potential for implementing the Fast Friends procedure in a remotely delivered synchronous class. This procedure involves a discussion guided by a series of increasingly intimate questions meant to enhance connection between unacquainted people. Teaching Implications Undergraduate and graduate students reported having a positive experience and building connections from the procedure, including enhanced classroom motivation. We share materials so interested readers and teachers can easily implement this. Conclusion The Fast Friends procedure is a promising icebreaker activity to include at the start of the semester that can help students have a positive experience and build connection with classmates.

Savage Staging (Savage/Love Performance) Staging Absence in The Pursuit of Physical and Tactile Extension of the Self. Reflections On the Social Crisis of Love Relationships

Abstract The main subject of this research is the transition from a professional point of view to another artistic form and the subtle reorientation from acting to directing and choreography. The process of transition and implementation of different creating techniques has been analyzed and theorized using the `practice as research` method in the following study. Applied and practiced methods of creation have been dissected and subjected to a series of professional enquiries, also due to personal intimate and aesthetic unanswered questions.

Psychometric Evaluation of a Controlled Social Affiliation Paradigm: Findings From Anxiety, Depressive Disorder, and Healthy Samples

Social impairments are common across many psychiatric conditions. Standardized dyadic assessments intended to elicit social affiliation between unacquainted partners are used to elucidate mechanisms that disrupt relationship formation and inform possible treatment targets; however, the psychometric properties of such paradigms remain poorly understood. This study evaluated the psychometric properties of a controlled social affiliation paradigm intended to induce connectedness between a target participant and trained confederate. Individuals with an anxiety or depressive disorder diagnosis (clinical group; n = 132) and those without (control group; n = 35) interacted face-to-face with a trained confederate; partners took turns answering a series of increasingly intimate questions about themselves. Social connectedness, affect, and affiliative behavior measures were collected during the interaction. Participant symptom and social functioning measures were collected to examine validity. The paradigm elicited escalating social connectedness throughout the task for both participants and confederates. Parallel forms (i.e., different question sets) elicited similar affiliation outcomes. Self-reported (but not behavioral) affiliation differed across some demographic variables (e.g., participant gender, Hispanic ethnicity). Within-task affiliation measures were associated with one another and with global social connectedness and social anxiety symptom measures, but not with somatic anxiety measures. Clinical participants reported lower social affiliation and positive affect reactivity and higher negative affect reactivity than healthy participants. These findings provide initial psychometric support for a standardized and controlled dyadic affiliation paradigm that could be used to reliably probe social disconnection mechanisms across psychopathology.

Using a Quality Improvement Model to Implement Distress Screening in a Community Cancer Setting

BackgroundQuality cancer care includes routine screening for psychosocial distress. This quality improvement project focused on the implementation of distress screening at a licensed affiliate of Cancer Support Community, a community-based non-profit organization that provides professionally led cancer support.MethodsAn advanced practice oncology nurse assisted the staff in implementing and evaluating the process of distress screening. CancerSupportSource (CSS), a validated web-based distress screening program developed by Cancer Support Community for use in community cancer settings, was employed to screen for distress, identify potential resources, and improve in-house and community referrals. For purposes of this quality improvement project, CSS was administered in interview format by staff. The Plan-Do-Study-Act (PDSA) quality improvement approach was used to implement CSS.ResultsTo implement the practice of distress screening, 21 patient participants were initially screened and evaluated for distress, including risk for clinically significant levels of depression, using CSS. The tool identified participant concerns and flagged thirteen persons as at risk for depression. After implementation and evaluation of distress screening using PDSA, in a year, 51 participants were screened. Participants stated that distress screening allowed for discussion of intimate questions that may not have otherwise occurred in an intake interview.ConclusionIt was demonstrated that CSS identified psychosocial and practical needs, facilitating the referral process and identification of community resources. Application of the PDSA model was an effective quality improvement model that can be used for the implementation and sustainability of distress screening across settings.

Utopisk slægtskab i udryddelsens tid

This article examines how utopian and ecological thinking connect in light of the ongoing eco-catastrophe. While the dystopic genre might be timely as it depicts an affective landscape of fear and hopelessness and communicates ideas about how things can get much worse, the article suggests that utopian imagination is necessary but only possible if it connects with an existing ecology. It presents three utopian perspectives on the entanglements of reproduction and ecological sustainability –Inger Christensen’s circular energy, Donna Haraway’s non-reproduction, and Hiromi Ito’s radical kinship – that link utopian imagination, feminist temporalities and questions of sustainability. The focus on birth, childhood and kinship illustrates how biology, social practices and phantasms affect one another and how ecology brings these levels together, while connecting intimate questions and global problematics. The analyzed texts articulate instances of “utopian kinship” that sidestep the mechanisms of reproductive futurism or reproduction understood as a confirmation and continuation of the way things are. As such, they point to the reproductive sphere as a place for resistance: queer growth, multispecies kinship, nature’s work against capitalism’s principles of development.

Birth Outcomes Among Women Affected by Reproductive Coercion.

Reproductive coercion is a form of intimate partner violence that includes behaviors that interfere with autonomous decision-making over reproductive outcomes. Unintended pregnancy is associated with exposure to reproductive coercion; however, little is known about the outcomes of continued pregnancies. The purpose of this study is to assess whether women who reported reproductive coercion during their last pregnancy experienced differences in birth outcomes compared with women without contemporaneous reproductive coercion. This was a cross-sectional survey study administered in obstetric and gynecologic offices. A survey comprised of standardized reproductive coercion, birth outcome, and intimate partner violence questions was given to English- or Spanish-speaking women with at least one prior pregnancy. Self-reported birth outcomes of interest included late or no prenatal care, low birth weight, prolonged neonatal hospitalization, preterm birth, and intrauterine fetal demise or neonatal death. Descriptive and bivariable comparisons were performed. Of 202 participants, 8.6% of women reported reproductive coercion during their last pregnancy. Women with a reported reproductive coercion history were younger, more likely to be a student, more likely to have anemia and anxiety at the time, and less likely to be married to the father of the incident pregnancy. Women with this history were more likely to express that they never wanted to be pregnant (29.4% vs 6.2%, P = .04), report other forms of intimate partner violence (35.3% vs 11.9%, P = .02), and have low-birth-weight neonates (17.6% vs 3.1%, P = .03). There were no observed differences in other birth outcomes. The response rate was 68%. In this exploratory study, women who reported reproductive coercion during their most recent completed pregnancy were more likely to report pregnancy ambivalence, other tactics of intimate partner violence, and low-birth-weight neonates. These data provide insight into the impact of violence on women's reproductive outcomes.

The role of eye-contact in the development of romantic attraction: Studying interactive uncertainty reduction strategies during speed-dating

The present study employed a real-life speed-dating methodology with three conditions: a face-to-face (FTF) condition, a video-mediated communication (VMC) condition without eye-contact (Skype) and a VMC condition with eye-contact (an Eye-Catcher). The first aim of this study was to investigate the effect of eye-contact on the development of romantic attraction. Second, this study analysed the role of four interactive uncertainty reduction strategies (URSs) in the relationship between eye-contact and romantic attraction, namely (intimacy of) self-disclosure and (intimacy of) question asking. The results revealed no direct effect of eye-contact on romantic attraction. Moreover, there were more (intimate) self-disclosures in conditions with eye-contact, but fewer (intimate) questions asked. These findings suggest that communication conditions with eye-contact result in less information-seeking behaviour, in terms of question asking. However, people share more personal, intimate information about themselves to their interaction partner. Conclusively, eye-contact in initial interactions induces less uncertainty and more intimacy, compared to interactions without eye-contact.

BARRIERS TO BULGARIAN PRIMARY CARE PHYSICIANS TO ADDRESS AND DISCUSS THE ERECTILE DYSFUNCTION PROBLEM WITH THEIR PATIENTS

Introduction: Several factors play the role of barriers to GP-s and most of them avoid discussing the erectile dysfunction (ED) problem with their patients, even though a part of the patients hope the doctor would initiate such a discussion. Taking into account the relationship of ED with a number of socially significant diseases, these barriers impede the diagnostic process. Objective: To identify possible barriers to Bulgarian primary care physicians to address and discuss the ED problem with their patients. Materials and methods: The opinions of 12 GP-s from the town of Plovdiv, randomly selected, were studied using qualitative research methods, interview with standard open-ended questions, asked by the research investigator. An audio recording was made and transcribed by the interviewer and by two other research investigators. The obtained data are the result of a consensus. Results: Even though the majority of participants point out that doctors do not avoid and should not avoid commenting on problems, related to the sex life of their patients, only one participant declared to always raise this issue before them. Constraining factors (barriers), pointed out by the colleagues, are lack of training in this aspect of health, also lack of training in asking intimate questions, the perception that sex problems of patients are not among "essential" diseases, associated with "survival", refusal of the patient, lack of time, waiting for the patient to raise this issue first and "personal taboos" of the doctor himself. The respondents point that doctors share the same inhibitions as their patients, as they are a part of the same society and are influenced by various cultural factors. Other factors, that play role of a barrier, are patient – physician gender discordance, lack of confidence and lack of experience with the patients with ED, physician personal sexual experience, when doctors do not apply holistic approach and when physicians do not percept ED as a disease. Conclusion: This survey is the first of its kind in Bulgaria. The results of the survey show that a variety of factors, including factors, related to doctor's personality, acts as barriers that impede doctors from proactively asking about and discussing sexuality issues and ED in particular. The overcoming of these barriers would present an opportunity to improve the therapeutic result.

Health Topics of Medical Online Inquiries at the University Hospital of Zurich: Experiences of the Last 12 Years

Digitization in the healthcare sector leads to new requirements and challenges in the doctor-patient relationship. Since 1999, the UniversitätsSpital Zürich has been offering a web-based medical online consultation service for laymen. The aim of the retrospective study was to analyze which health topics are of special interest for the inquirers. All questions and answers between 2005 and 2016 were included. The calculation of the frequencies included the ICD-10 chapters, the age and gender of the inquirers, the number of recommended visits to the doctor, as well as the rating of the service. Changes in the frequencies were examined by regression analysis. The mean age of the 23 131 inquirers was 37.9 ± 16.63 years. The age as well as the proportion of male inquirers increased significantly with yearly 1.22 years respectively 1.6 % male proportion. The most common health issues according to the ICD-10 classification included symptom-oriented or general inquiries about complaints without a particular disease (chapter XVIII:13.8 % and XXI: 11.6 %), followed by inquiries about the skin (XII: 8.8 %), about the musculoskeletal system (XIII:7.5 %) and to the genitourinary system (XIV:7.4 %). The inquiries to Chapters XVIII and II (new formations) increased significantly. With "good" to "very good" 80.2 % of the users rated the benefit and with 96.7 % the comprehensibleness of the online answers. A web-based online consultation service can strengthen patient empowerment and the health literacy of medical laymen through the individual provision of health information. This included, in particular, unclear symptoms and findings without diagnosis. The advantages of an anonymous online consultation were used especially regarding intimate questions and progressively by men. The increase in inquiries concerning new formation may be due to the complex treatment strategies in the field of oncology.

Feasibility and Acceptability of the Gerontological Personality Disorders Scale (GPS) in General Practice: A Mixed Methods Study

ABSTRACTAlthough the Gerontological Personality Disorders Scale (GPS) can aid in detecting personality disorders (PDs) in older adults in general practice, its availability does not guarantee its use. This study therefore aimed to examine the feasibility and acceptability of the GPS from an older adult, informant, and professional perspective. A convergent parallel mixed methods study was conducted. Qualitative data were collected through semistructured interviews with four general practitioners and four nurse practitioners and were analyzed thematically. Quantitative data were collected through a 5-item questionnaire completed by 329 older adults and 329 informants. The thematic analysis revealed five major themes regarding feasibility and acceptability according to the professionals: taboo to ask intimate questions, quite unfamiliar with these disorders, assets, PDs are a topic of interest in general practice, and preconditions. Descriptive statistics showed that most older adults and informants found the GPS items to be clearly phrased, easy to understand, and nonconfrontational or not unpleasant to answer. The GPS is a feasible and acceptable instrument for detecting PDs in older adults in general practice. Educating professionals about PDs in older adults and the GPS is important prior to its use in daily practice and might further increase its acceptability.

The Intricate Process of Psychoanalytic Research: Encountering the Intersubjective Experience of the Researcher–Participant Relationship

Qualitative research in general and the psychoanalytically informed research interview method specifically, can be emotionally demanding on researchers as they form relationships with participants. This is especially the case when researchers and participants share particular identities and experiences. In this paper I reflect on my experience of interviewing mothers raising children with a visible physical disability about their maternal subjectivity. At times this was an emotionally demanding and ethically challenging process as participants closely identified with certain aspects of my identity, particularly with my visible physical disability and motherhood peculiarities. Often participants unexpectedly reversed our roles, asking me intimate questions. I will deliberate these dilemmas using interview material. I argue for a mindful blurring with participants when this occurs. Using certain psychoanalytic‐researcher concepts of intersubjectivity, transference–countertransference and psychoanalytic‐researcher thirdness helped me successfully navigate these encounters. I will also explore the rich participant psychic functioning that was generated from this intersubjective relationship between myself and the participants.

Kaip emociniai, kognityviniai ir socialiniai sveikatos ištekliai susiję su sveikatai nepalankiu elgesiu? Lietuvos atvejis

Introduction. In most research studies, health is analysed from the unidimensional perspective, e.g. medical studies are usually based on the biomedical model, which posits that health is an absence of illness, and that illness is caused by abnormality within the body. In this model, mental phenomena are not important, an individual has no or little responsibility on one’s health, and the treatment of a disease in most cases is passive (Wade, Halligan, 2004). The WHO (1948) definition of health suggests that health is not only the absence of illness, but also a good subjective and social state, i.e. health is a multidimensional, biopsychosocial construct. Therefore, alongside the analysis of the biological aspects of health, there is also a need to study the relationship between psychosocial aspects (resources) of health and health behaviour. The aim of the study is to explore the links between different emotional (feelings of depression, sadness, anxiety, happiness), cognitive (beliefs that other people are helpful, supportive, trustful) and social (religiousness, meeting with friends, participation in social activities, possibilities to discuss private, intimate questions) health resources and their relation to health behaviour (eating fruits, vegetables, smoking status, number of cigarettes, alcohol use frequency, amount of alcohol consumed on workdays and weekends, physical activity) in a representative sample of Lithuanian males and females. Research methods and participants. Single-item questions generated by experts from the European Social Survey round 7 were used to assess the emotional, cognitive and social health resources and health behaviour. The research sample (n=1865) was drawn from the general population in Lithuania (40.2 percent of males and 59.8 percent of females). The mean age of participants was 49.59 (SD=18.29). The youngest participant was 15 years old and the oldest one was 92. Participants were interviewed in 2014. [...]

Spirituality is Not a Four-Letter Word

Back to table of contents Previous article Resident’s ForumFull AccessSpirituality is Not a Four-Letter WordHannah Roggenkamp,M.D.Hannah Roggenkamp,Search for more papers by this authorM.D.Published Online:7 Oct 2016https://doi.org/10.1176/appi.pn.2016.10a20AbstractIn our climate of strong religious convictions and polarizing public fights over doctrine, breaching the topic of religion and spirituality as a young physician can seem like the shakiest of shaky ground. For the inexperienced psychiatrist, the struggle is real. We are scared of offending people with any of the intimate questions we ask, and religion feels no less private than sexual history. Religion and spirituality, when approached correctly, can provide a beautiful window into the psyche of our patients. It’s also unavoidable—religious topics are an ACGME-required part of our psychiatric training.My father was a Lutheran pastor, and my mother was raised a born-again Christian; I grew up in a progressive but religious household. My father loved ministering to sick people in hospitals, and he handled parishioners’ deaths with fearless compassion. I believe I mirror some of my dedication to patient care based on his example. In times of severe illness, however, even the strongest faith can be questioned. When my mother was diagnosed with ALS, she spoke of wondering what she had done, spiritually, to deserve her fate. I think she struggled with the issue until her life ended.Despite knowing this, I don’t always ask my patients about spirituality. Why not? Too often, as trainees, we feel the need to narrow our exam to what is necessary for an assessment; we give a treatment recommendation and then move on. But religion and spirituality are at the core of most patients’ lives: a 2014 Gallup poll revealed that 86 percent of the general population is religious or spiritual. And our colleagues are, too: 76 percent of psychiatrists, according to one survey. More science: high intrinsic religiousness can predict more rapid remission of depression, especially in patients with poor physical functioning. Religious and spiritual involvement appears to buffer patients from stress, and offering therapies augmented with a spiritual component to religiously or spiritually oriented patients is associated with increased efficacy of treatment. Nonetheless, the potentially negative effects of religion should not be overlooked; we’ve all encountered the gay or lesbian patient who feels deep shame due to a prohibitive religious upbringing.So how do we incorporate religion into our training and our care? A fan of checklists, I have used the following four questions (which were developed by a consensus panel of the American College of Physicians) as a basic approach to the spiritual history:Is faith (religion, spirituality) important to you?Has faith been important to you at other times in your life?Do you have someone to talk to about religious matters?Would you like to explore religious or spiritual matters with someone?Here are some additional tips gleaned during residency:Engage hospital chaplains in your inpatient psychiatric and consult-liaison work, utilizing them for patient interviews and family meetings, when appropriate.With permission, collaborate with your patient’s pastor or spiritual guide for context and coordination. When doing cognitive-behavioral therapy for psychosis, for example, a patient with religious delusions may be able to question the delusional content more safely with his or her pastor.If a patient asks you about your religious beliefs or spirituality, deal with it like any other personal question, responding with, for example: “I’m wondering why this question came up. What do you imagine?” Once the motivation has been explored, it becomes a judgment call. Less experienced practitioners may want to avoid disclosure as a rule; however, in the right setting, it could deepen the therapeutic alliance. For example, a patient struggling with feeling internal religious judgment could have a corrective emotional experience when the therapist reports that he or she does not share that same religious judgment of the patient. In the end, every psychiatrists needs to be prepared to tackle this issue, so careful self-reflection is highly suggested.Listen to spiritual or religious concerns carefully, but avoid giving an opinion. (I have found that aligning myself religiously has the potential to disrupt the therapeutic alliance.)As residents, we are so intently focused on keeping patients alive and learning psychiatry that we sometimes miss the intangible parts of our work. Regardless of our religious beliefs, or lack thereof, patient care can be a way to serve a higher power and receive spiritual nourishment. Evidence-based treatment and spiritually informed care are compatible. As we help patients share their spiritual beliefs with us, our work becomes deeper and more meaningful and can lead us to the core of the human experience. ■Hannah Roggenkamp, M.D., is an advanced research fellow in the Mental Illness Research, Education, and Clinical Centers (MIRECC) at the Puget Sound VA Healthcare System in Seattle. ISSUES NewArchived