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Medicine and accepting the difficult truths

Kristin Collier, MD, has a lot of interesting jobs.

She is an assistant professor of internal medicine at the University of Michigan, and the director of UM Medical School’s Program on Health, Spirituality and Religion.

Collier also serves as an associate program director of the university’s Internal Medicine Residency Training Program, where she oversees the primary care track.

Kristin Collier, MD. Courtesy photo.

But here’s what makes her really interesting: Collier started her career as a pro-choice atheist.

Today, she’s a committed Christian and avowedly pro-life.

Her academic work is in the overlap of spirituality, religion and medicine and she has a lot of thoughts about the role of faith and conscience in the practice of medicine — and they are serious thoughts. Her peer reviewed work has been published in Journal of the American Medical Association, Internal Medicine, the Annals of Internal Medicine, The Journal of General Internal Medicine, the American Journal of Hospice and Palliative Medicine.

Collier talked with Charlie Camosy about her own conversion, and about her work to foster a space for people of faith in the world of modern medical practice.

How does one go from being a very pro-choice anti-theist to directing the University of Michigan Medical School's Program on Health, Spirituality, and Religion and giving talks on pro-life feminism?

That is a very good question and the answer still surprises even me. I was raised as what I would call a secular humanist.

I never attended a church service or heard Scripture growing up, and was completely indifferent to those who held religious views. I do not ever recall a time when I was not a pro-choice person. I think that [pro-choice] belief was something that I grew up around and I accepted it as fact and never had an opportunity to hear what arguments could be had in favor of another approach.

As I went through my medical training, I became more entrenched in the views that I held and, am ashamed to admit, developed great animosity towards those who held either pro-life views or deeply held religious commitments.

As years went on, I started wrestling with making sense of the immense suffering I was seeing on the wards on which I was taking care of patients. In doing so began the process of wrestling with God. During this time, my husband, who I’ve known since high school, started attending a Christian church and became a committed Christian. This was a challenging time for us as I was hostile towards his conversion, but Tim was patient with me, and I know he prayed for me during this time.

We started having children and he would take the kids to church by himself. This went on for some time, until I had my fourth child Isaac; he developed some growth problems and I sought out the assistance of a lactation consultant by the name of Brandy who helped me, and Isaac, to get through an exceedingly difficult time.

A year later, on Isaac’s first birthday, I reached out to Brandy by email thanking her again for being an instrumental part of getting us to that point. She emailed me back and told me that, although she had not told me during our time together, she was also a pastor’s wife and was hosting her first women’s Bible study soon. She invited me to attend. I very much did not want to attend, but given how much she had helped me, and at Tim’s encouragement, I reluctantly attended. That session was a turning point.

It was the first time that I felt truly moved by Scripture and something in me changed. People often ask me what it was in Scripture that especially moved me, and it was two things. The first was the person of Jesus Christ — his promise of a redemption where every tear will be wiped away and that He will accompany us until the end of the age was incredibly comforting to me.

The second was the realization that this current state of the world is not the way things are supposed to be, and the promise that everything someday will be restored.

As a physician, this moved me in a way that I had never known. After the Bible study I became motivated and inspired to read and memorize Scripture and many people came into my life and were instrumental in helping me grow.

The ground for this though, I believe was set by my husband Tim, who through his actions as a selfless parent and husband demonstrated the gospel. A few years after this Bible study, I had an experience while I was in my car driving to work: I felt an overwhelming sense of shame – that everything that I had was a gift from God and I had taken it all for granted. I had taken pride in things that were gifts. Shortly after I was baptized into the Christian faith.

My conversion to a pro-life person came much later. I had been challenged on my views by my husband after his conversion, but I had difficulty accepting the truth of what abortion was after having had such firmly entrenched views for so many decades.

In 2018, after I invited you, Charlie, to be a guest speaker at my program on heath, spirituality, and medicine at the medical school, you encouraged me to read your book “Beyond the Abortion Wars” and engage with you in discussion on the topic, which I did.

So, yes, when I think about my work now as a director of a program on religion and spirituality at the same medical school where I was a staunch anti-theist, my head sort of spins. I think it is good to be reminded that people can change their minds on beliefs they have held for a very long time, through a culture of encounter with others and ultimately through the grace of God.

I've written at length about the secularization of contemporary medicine and benefited from your experience and feedback in so doing.

How does the program you lead, and your personal work create space for explicitly religious belief in health care?

We know that many physicians come into medicine in part because of their religious or spiritual commitments. But then, often, physicians are made to feel like they must check their faith at the door to be considered a legitimate scientist. We know that religious beliefs and/or spiritual practices can be a way for people to create meaning in medicine. Having meaning within one’s work has been shown to be protective against burnout.

My team wrote on this for Journal of General Internal Medicine last year, about how we should help healthcare providers have an integrated personal-professional identify so that, if they desire, they can better understand how their religious and or spiritual commitments inform their vocation as a physician.

Our program at the medical school helps support this work by mentoring students, funding research projects, running curriculum on the topic and hosting talks at the intersection of medicine, spirituality, and religion. Michigan Medicine has a policy that allows for exercise of physician conscience for people who may have religious and or spiritual commitments and it has been in place since the late 1990s.

We also have done work within our internal medicine residency program to create a policy that helps balance physician opt-out requests that come out of physician conscience with patient-centered care. This provides space for physicians in training who have religious and or spiritual commitments to be able to be whole persons at work, in the vocation of medicine.

Let's talk about some specifics. Do you think physicians should be able to pray with their patients?

For faculty to share their faith with their health care students?

Patients often have religious and spiritual concerns while they are in a medical setting. A 2011 study showed that among inpatients, 41% wanted to discuss religious or spiritual concerns with someone while in the hospital, but only half of them had the opportunity to do so.

Healthcare providers need to be responsive to the requests of patients with regards to prayer. Only about sixty percent hospitals have chaplains and requests for prayer may come to a physician at a time in which a chaplain is not or cannot be available.

The AMA Journal of Ethics has published guidelines on how healthcare providers should respond to patient requests for prayer and if patients request prayer and the healthcare provider feels comfortable, they should be allowed to pray together. Because of the power differential between physicians and patients, care must be taken to respect the patient’s tradition, to never proselytize a patient who may be in a vulnerable situation and to, if possible, let the patient lead the prayer in the tradition or manner in which they feel comfortable.

Regarding the question of whether faculty should share their faith beliefs with learners, this is also an arena that can be considered controversial. Again, there is a power differential between a learner and a faculty member. But in the right context, a sharing of one’s most deeply held commitments can be not only appropriate but beneficial for both parties. We recently held a debate at my institution on this topic where I debated a fellow colleague on this very question.

We are a public medical school, yes, and we can’t espouse formally one value set over another as an institution. But at an individual level, we should rely on our faculty to share their ways of making sense of what they see in medicine, in order for the students to better understand their own sense of the world. I would argue that it is helpful for students to hear how various people live out their value system within medicine as they are trying to make sense of things.

Many faculty have a value system embedded within a spiritual philosophy or a religious tradition. Yes, they will be interacting with others who may have a different world view or value system. That’s OK! Those commitments form the very basis of who they are. Your identity is not the opposite of your openness to others, but the basis for any possibility for it.

Why should we believe that we need to hide our true selves to be in relation with those who are different from us?

Without a way for students to think about how their own values affect how they see medicine and their purpose therein, we are setting them up for confusion.

We give students big terms like ‘ethics’ and ‘professionalism’ but they often aren’t anchored into anything of substance and what happens, in my opinion, is that we are contributing to the students’ sense of moral vertigo without any conversations on the foundational principles we believe undergird these topics.

We should help provide opportunities for the sharing of our most deeply held commitments with those with whom we are in relation in the educational space. And at a very basic level, we are a university. And to remind us, the word comes from Uni- and – diversity. We should be a place where we are unified in our diversity!

Both unity and diversity at the same time are necessary for deep learning to take place – we cannot learn deeply from another if we are forbidden to share certain perspectives which may be different from colleagues based on a culture which penalizes or discourages such sharing. The university experience should provide students with opportunities to ask deep questions of meaning and existence, which seem to be increasingly overlooked in contemporary academia.

And what about conscience protections?

You've presented on this topic at national meetings. What's the future look like here?

My group was able to present our work on conscience protection within our residency program at the national Academic Alliance of Internal Medicine meeting in Charlotte this spring. When we were creating the policy, we discussed it with our colleagues from other institutions on a blog that we are on with other program directors. The response that we’ve had has been quite mixed.

Some folks are highly appreciative that our program has taken on this issue and made a policy that both supports our learners and our patients in a way that is thoughtful and sensible and, under the tenets of [diversity, inclusion, and equity], helps to make space for learners with religious commitments.

Some folks have expressed their belief that we should not allow for the expression of physician conscience, as they believe that a physician’s own values should not be brought to bear in a medical encounter. For the latter, I argue back that a physician’s conscience should be considered a valuable tool within the vocation of medicine, and we should start treating it as such.

I do not believe that we should ever force a healthcare provider to perform or provide therapies or interventions to which they have a moral objection. It is generally accepted that a patient's right of autonomy does not trump the physician's parallel right to conscientiously abstain from a practice on religious or moral grounds provided that (1) the physician provides the patient information that would allow her to seek care with another health care provider who does not have such reservations and (2) the physician's refusal to treat does not endanger the patient's life or result in serious harm.

And while it’s the physician’s right to not prescribe a medication or perform a therapy/procedure that they have objection to, it is never acceptable to refuse to see an individual/person. The refusal can be to therapies or medications, but never to persons.

According to the AMA, “Preserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience in their professional practice is important for preserving the integrity of the medical profession as well as the integrity of the individual physician, on which patients and the public rely. Thus, physicians should have considerable latitude to practice in accord with well-considered, deeply held beliefs that are central to their self-identities.”

When we consider diversity in the medical profession, religious diversity is not — should not — be exempt from this goal. Again, many of our trainees have faith commitments that inspired them to go into medicine and are a source of meaning making and wellness for them.

We should continue to think thoughtfully on how to incorporate our trainees with religious/faith commitments in a way that avoids discrimination/bias/targeting while at the same time honoring our commitments to their training and to our patients.

The Dobbs decision highlights what is at stake in perhaps the most controversial issue in medicine: abortion.

Emma Green recently did wonderful reporting for The New Yorker about abortion law and the next generation of OB-GYNs, but I found the negative reaction on social media to anything that would make space for pro-lifers to be something close to overwhelming.

Any advice for how pro-life health care providers and students can navigate these waters?

That was such a well written piece, as you would expect from Emma Green. And it was very brave of Dr. Buskmiller to be interviewed for it.

She and many other practicing and aspiring OB-GYNs believe in the moral status of the fetus and believe that abortion ends the life of human being. For these aspiring and practicing physicians however, the medical profession can be less than welcoming of them and their beliefs — even though there are plenty of patients who also believe the same and desire an ob/gyn who shares in these beliefs.

Again, for a profession which - rightly so - professes the desire to be more diverse and inclusive, why does it seem like this inclusivity only includes those who fit a narrow view of what healthcare is or could be?

I have provided mentoring and advice at our institution to students who are thinking about becoming OB-GYNs but are naturally hesitant to do so because of the discrimination they fear they will face. My advice to them is, in part, something you taught me: It behooves those of us who speak on the sanctity and value of human life to speak on what we are for, not for what we are against. And we are for such beautiful things!

We are for the expansion of rights for some of the most vulnerable members of the human family – our prenatal brothers and sisters! There is no more beautiful testament to the growth of society when it extends rights to a vulnerable population that did not have them before. We should speak to this! I also encourage them to develop an apologetic to be able to speak about what they believe and why they believe it and encourage them to read your book “Beyond the Abortion Wars” to help them develop this. Your book is also excellent because it explicitly explores the counter arguments so that one can best understand both ‘sides’ here.

I also encourage them to have nothing except a sense of gratitude for what they believe and to never look upon their conversation partner with disdain. They should be grateful that they have been able to see this topic in a way that is life giving and life promoting and never disparage someone who might not have had those opportunities to do so.

And lastly, they need to network and get to know their “friendlies” as I call them in this space. Those would be others who are like-minded and who can help them navigate these tricky roads as they pursue their training.

Dr. Buskmiller’s network that she developed called “conscience in residency” can be helpful for trainees as they decide upon residency application and other local and national groups such as the Catholic Medical Association, the Christian Medical Dental Association or Physicians for Life and finding local mentors who can help them navigate these conversations are of the utmost importance.

It is concerning though that a study published in 2021 in Linacre Quarterly found that roughly a quarter of residency-program directors expressed strong negative reactions to residency candidates who say that they won’t perform abortions.

One would hope that we can have ongoing discussions in the profession and allow for a diversity of opinions on this issue in the spirit of wanting a trueness of diversity within the vocation that should be large enough to accommodate all.

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