As a medical intern in the late 1980s, I occasionally saw priests and rabbis in the hospital wards, but basically ignored each other. When we doctors entered a patient’s room, they quickly left, and when we left, they entered. They seemed to be operating in a completely different field. After all, we were scientists. They weren’t.

But in recent years, as the attitudes and religious, spiritual and existential needs of patients and their families have changed, so have chaplains. Our nation’s religious landscape is changing, affected by, and affecting broader political and religious polarization. In recent decades, self-identified Christians have declined by about a third. In the last 15 years, the number of religiously unaffiliated Americans has nearly doubled.

As a physician, I wanted to understand what these transformations mean for patients and their families, especially those dealing with serious, life-threatening, and dying illnesses. I soon realized that hospital chaplains address these challenges the most, so I set out to study them by talking to 38 people from across the country and conducting a study. in-depth formal study from 23. What I have learned continually amazes me.

Amid new technologies, declining religions, changing faiths, fractured health systems, aging populations and post-Covid health worker burnout, chaplains are more important than ever. But they are often unappreciated.

Death terrifies most of us. We deny it until serious illness breaks through our psychological defenses. Even religiously unaffiliated patients commonly struggle with “Why me?” and “What is the meaning of my life?” and/or feeling guilty about past actions. People seek connections to something beyond themselves that will continue after death — through spirituality, children, nature, creative work — or escape through classic drugs, sex and rock and roll. Increasingly, those facing their own mortality also face decisions about whether to start or stop new medical treatments that extend the quantity but often not the quality of life—whether to allow doctors to “play by God”.

In recent years, chaplains have evolved and are now often seen as a “post-religious” profession, adopting non-denominational, multi-denominational and humanistic approaches and commonly receiving counseling training. They help patients, from evangelicals to agnostics, atheists, and “nothing in particular,” reset priorities and find sources of connection, meaning, purpose, and hope. Strongly dedicated to helping vulnerable and underserved populations, chaplains remind physicians to uphold the dignity of every patient. Often, chaplains are the only hospital staff who have time to talk at length with patients and families to understand patients’ experiences and perspectives in ways that physicians miss, gaining trust and uncovering critical information.

Sometimes patients and families clash with medical staff over needs for more or less aggressive treatment, and chaplains serve as mediators. A chaplain I spoke with, for example, told me about an elderly patient with advanced, incurable cancer and dementia. Doctors wanted to write a do-not-resuscitate order, but the patient’s daughter continued to object, causing a tense standoff. Finally, the chaplain spoke to this daughter, who did not want her mother to “die next week, on my birthday. She always seems to get sick right before my birthday.” As a result, the doctors understood the daughter’s position better and waited.

Chaplains also help medical staff who struggle with growing morale and burnout from spending less time with each patient and more hours typing data into computers.

However, hospitals and physicians tend to marginalize, undervalue, and underfund chaplains, 62% of whom feel excluded from medical team discussions, according to a study. About 25% there is a complete lack of chaplains in hospitals.

Unfortunately, the functions of chaplains are not easily quantifiable. Research on these professionals has begun but remains limited. Studies have tried, for example, to show that patient and family satisfaction with hospitalization is higher if they have seen a chaplain. But the results were mixed, as sicker patients may be more likely to see chaplains, but also more likely to die, lowering overall satisfaction with hospitalization.

Examining the stories and details of chaplains’ actual experiences, however, tells a different story. One chaplain, for example, described an unresponsive 94-year-old patient on full life support. The family fought the doctor, wanting more aggressive treatment because they were “praying for a miracle.” The chaplain told them, “We’re getting in the way of what God’s plan might be here.” Through compassionate discussions with the chaplain, the family finally accepted the inevitable.

Another chaplain helped a 13-year-old boy with cancer whose mother traveled the country looking for a cure. She couldn’t face that she might die. He couldn’t even talk about it. When the doctors asked the chaplain to meet with her, one chaplain told me, this mother literally “put her fingers in her ears and said, ‘La-la-la-la-la.’ I can’t hear you! … I don’t want to talk about it! “

After long discussions with the chaplain, the mother was finally able to tell her son, “I’m worried that the treatment isn’t working.” This comment gave the boy an opening to say, “OK. So, mom, when I die, I don’t want flowers because they’re for girls. I want stuffed animals. Then after the funeral, bring them all to the hospital to give them to all the kids.” He had it all planned out, but he could never talk about it because she wouldn’t let him. He could see that he was not coping.

One day he told her that he had seen angels in his room, which disturbed her. However, the chaplain worked with her. Mother “finally said to him, ‘When you talk about angels, it makes me sad, because I think it means you won’t be here much longer.’ But he said, “No, mother. Angels are here for Help I. When it’s time for me to go, Jesus will come for me!’”

Social workers could address some of these issues, but their work often doesn’t allow them to because they usually have to focus on hospital discharge planning, finding nursing home beds, and applying for insurance. Mental health professionals rarely see hospitalized patients and families.

A key way to help our strained healthcare system is therefore to encourage and make greater use of chaplains. Hospital administrators, physicians, nurses, and other staff members should continue to recognize and support chaplains, who can help countless patients and families, even if in ways that statistics do not fully capture.

When the boy with cancer died, his mother filled the funeral with stuffed animals, not flowers, then hired a U-Haul and distributed them to her son’s fellow patients throughout the ward. Then he called and thanked the chaplain.

Robert Klitzman is a professor of psychiatry at the Vagelos College of Physicians and Surgeons and the Joseph Mailman School of Public Health at Columbia University, and director of the in-person and online master’s and certificate programs in bioethics. He is also the author of the book “Doctor, Will You Pray for Me?: Medicine, Chaplains, and Whole-Person Healing.”