“First, do no ‘assume’”

By Khalid Elzamzamy, MD, Johns Hopkins Medicine & Fatima Özin, MD, Pro Persona, Netherlands 

A 15-year-old came to clinic with his mother after finally receiving an autism diagnosis elsewhere. Their previous clinician had waved off years of social difficulty with the statement, “I thought his shy and reserved demeanor was just part of being Muslim.” That single assumption resulted in delayed services and left the family’s distress unaddressed for years. The fix isn’t complicated—slow down, stay curious, and check your narrative against the family’s narrative. 

Why religious sensitivity matters 

“Faith has always been an essential factor in the practice of medicine. —Dr. William Osler 

The question in modern, often secular settings, isn’t whether religious patients need a “different” approach, but whether we see the whole person. For many Muslim patients, faith shapes identity, coping strategies, daily routines, and family life. For some, it’s a deep source of strength—for others, it can be tangled with shame, conflict, or stigma. Our job is to find out what’s true for this patient today. 

Safety first 

“Maybe I can share this with you since you look like you also believe in God,” a Christian patient once told a female Muslim therapist who wears the hijab (headscarf). Patients often scan for cues of safety. Therefore, establishing emotional safety is the first clinical task. Patients are silently asking: Can you understand me without judging? Safety invites candor and collaboration. 

Humility as a foundation 

We all sit on an “invisible throne” as doctors. Recognize power differences and be mindful of how your own beliefs, values, and assumptions inevitably show up in the room. Beware of two common pitfalls: avoidance (sidestepping faith altogether) and over‑identification (assuming shared worldviews). Both can lead to misattunement. Notice countertransference, seek supervision, and repair ruptures. 

The art of not knowing 

Ask before you infer. Try: “Are there spiritual or religious practices or values that help you make sense of what you’re going through?” Follow with curious, nonleading questions about the meanings of illness, support systems, and concerns. Remember—Muslim communities, and other religious groups, aren’t monolithic—there’s wide variation by generation, ethnicity, language, and personal devotion and within the same person across time.  

Two heads are better than one 

Some patients may interpret illness as a test or punishment—others fear being seen as having “weak faith.” Stigma can delay help‑seeking. Explore potentially maladaptive beliefs, but also look for strengths, including meaning‑making, hope, community, and adaptive habits. When welcome to the patient, collaborate with chaplains, community clergy, or culturally knowledgeable colleagues. And yes, advocate for access to these resources if your setting lacks them. 

Practical tips for working with religious patients:

1. Open with curiosity.

“What should I know about your family, culture, or faith to take good care of you?”

2. Use respectful language.

Avoid pathologizing religion; express curiosity without judgment.

3. Mind the details.

For example, for Muslim patients, ask about diet‑related ingredients in medications (e.g., pork-derived gelatin, alcohol), prayer times, and Ramadan dosing; offer alternatives or timing adjustments when possible.

4. Engage.

If faith is part of coping, include it in goals and strategies.

5. Repair and reflect.

If something doesn’t land well, acknowledge it and try again. Humility is a core clinical virtue and skill.

In the end, you’re caring for a person who, in anthropologist Clyde Kluckhohn’s words, is in certain aspects “like all other humans, like some other humans, and like no other human.”

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.