To the Editor: Koenig's rebuttal of some of the conclusions I drew in my recent article was perhaps more vigorous than can be justified given recent changes in Australian culture and the paucity of practice-oriented research.1,2

I accept that religious patients may be healthier in many respects, and being religious may help some patients cope with illness. However, it does not follow that having doctors in Australia enquire into their patients' religious beliefs almost as a matter of routine would be a cost-effective use of their time.

In hospitals, doctors are part of a team, and do not themselves have to identify religious concerns and mobilise spiritual resources. Nurses commonly ascertain whether patients are religious, identify concerns, and liaise with chaplains and pastoral workers. Chaplains themselves are highly regarded by all members of the healthcare team; they counsel and help patients cope with illness as part of their role, and are effective.3

For most Australians, religious affiliation is largely nominal. Consequently, only a minority of patients presenting to general practitioners are likely to have religious beliefs affecting their care. Rather than take a religious history routinely, it might be better if GPs were to enquire into religious beliefs when a patient or the family is known to be particularly religious or if the clinical situation warrants it.

Urging doctors to take a religious history ignores those patients who are not religious but who might have a spirituality that helps them cope with illness and their particular needs.4 It also ignores changes which have occurred in Australian culture since the mid-1970s.5

Organised religion has declined, while spirituality has surged.5 Moreover, whereas Christians understand spirituality in terms of their relationship with God, in the wider community, spirituality needs no God association. It is often seen as a previously ignored aspect of being human, alongside physical, emotional and social aspects.5 It is increasingly regarded as the integrating holistic factor in life, associated with healing, therapy and well-being.

The healthcare system as a whole will need to consider the relevance of these cultural shifts and how it is going to respond. Medical professionals should keep this in mind when discussing the relevance for medical practice and how they will respond. Spirituality has already assumed greater prominence in the practice and education of nurses, psychologists and social workers, and medical professionals should take account of the skills and experience of these groups.