Working in an outpatient clinic, I picked up the next chart from a stack of charts for patients waiting to be seen that morning. It was the chart of a patient new to the clinic, a 67-year-old man, whom I'll call Mr. Henry. The working diagnosis on the transfer sheet from his last clinic read, "glioblastoma multiforme, high grade, of the left temporal-occipital lobes.' According to previous notes, his brain tumor was not resectable. Now it was my job to go see this patient, make an assessment of his condition, and consider a plan. What I did not know was what I would really be able to do for my patient.

With a little more than a medical student's usual apprehension, I entered the exam room and found Mr. Henry with his adult son and daughter. Mr. Henry's motor deficits due to his tumor had left him wheelchair bound, without the use of his legs, and completely dependent on his children for daily care. I took a history from him and his family, and then set out to assess his neurological deficits.

My simple effort to examine his extraocular movements caused him a mild seizure when he tried to look in a certain direction, only worsening his agitation and hindering the interview. The most striking deficit was his expressive aphasia, which made communicating with me frustrating for him, and a lesson in careful listening for me. It became apparent that Mr. Henry still had all his cognitive faculties, but was trapped by a mouth that would not cooperate with him.

Mr. Henry's children told me of their exhaustion from trying to care for their father, and relayed to me how they came to our clinic. They believed that other doctors had seen the case as hopeless, and therefore offered chemotherapy, but wouldn't even talk to Mr. Henry because of the effort required. They had come to our clinic in the hope that we, that 1, could help them. I no longer had one patient, but three.

After presenting Mr. Henry's case to the attending oncologist and formulating a plan of chemotherapy and acjuvant radiation, I, like Mr. Henry's previous doctors, had options to consider, too. I could choose to explain the medical treatment to Mr. Henry and his family, and then excuse myself from a difficult situation, or I could sit down with them and try to do more. I asked the father and his children some open-ended questions: What's getting you through all this? What's your source of strength? How do you view God in all this, if at all? They directed the conversation where they wanted it to go, and I ended by offering to pray with them. A little taken aback at first, they decided this was a good idea, and so we prayed for strength, endurance, and a sense of peace for Mr. Henry and his family.

After frequent return visits for chemotherapy, Mr. Henry became less agitated and frustrated, as his aphasia subsided. His daughter filled out the necessary paperwork to get financial support to help her better care for her father. The family had resolved not to be incapacitated by hopelessness despite Mr. Henry's medical prognosis. They would do the best they could, because we were doing the best we could for them.

Major universities, the National Institutes for Health, and other educators have studied the role of spirituality and prayer in health and illness, publishing their investigations in such medical journals as JAMA. The Medical Strategic Network instructs physicians, dentists, nurses, and students of these disciplines from around the country in how simple and necessary It is to incorporate spirituality into the patient history. The Joint Commission on Accreditation of Healthcare Organizations mandates that accredited health care institutions address spiritual care as any other aspect of patient care.

Physicians talk to patients about everything else, so why not ask them about religion too? With open-ended questions, patients will direct such a conversation. Asking about a patient's spiritual dimension conveys that it is acceptable to discuss it, if the patient wants to. While some physicians may feel uncomfortable raising this issue, it is important to remember that patients do not expect us to be experts in this area. The goal of including the spiritual history is to individually validate the role it plays in the experience of health and illness for many patients.

Mr. Helton is a second-year medical student at Loma Linda University School of Medicine, and an AMA and CMA medical student section alternate delegate.