In reply: Despite recent changes in Australian culture, Peach underestimates the importance of religious beliefs to older Australians likely to see physicians today.1-3 As people age and experience negative life events, such as medical illness, longitudinal studies show that they become more and more religious.4

Given the potential impact that spiritual issues have on treatment decisions, the physician–patient relationship and medical outcomes, physicians cannot simply defer these issues to nurses or chaplains, nor do many physicians wish to do so.5 Deferring such issues could, in fact, be more costly than the few additional minutes necessary to take a spiritual history, particularly in patients with serious or chronic medical illness.

For patients who are not religious, the doctor should enquire about secular beliefs that could influence medical decisions or that give the patient's life meaning and purpose in the context of their illness.

I do agree with Peach that physicians should always phrase enquiries in terms of "spirituality", allowing patients to determine for themselves what this involves — whether it be God, church, or the random forces of nature. Keeping the spiritual history "patient-centred" in this way ensures that no one is excluded and provides many additional safeguards.