DALLAS — At 83, Carl Smith found himself facing quadruple-bypass surgery and the real possibility he might not survive.

Within hours on this spring morning, Dr. Mark Pool would temporarily bring Smith’s heart to a stop in an attempt to circumvent its blocked passages.

And to help his patient confront the uncertainty, Pool did something unusual in his profession: He prayed with him.

The power of healing: Medicine and religion have both had their day, and they haven’t always been able to coexist. But as today’s medical treatment becomes more holistic, doctors are increasingly taking spirituality into account.

Studies show a majority of patients want their spirituality recognized, and most med schools now have classes related to the topic. In general, the new thinking asks doctors to note their patients’ spiritual leanings and open doors to expression, especially when life is at risk.

Pool, a highly regarded heart and lung surgeon at Texas Health Presbyterian Hospital Dallas, is fervent about his Baptist faith. For about a year, he’s routinely asked patients if they’d like him to pray with them pre-surgery — a gesture he says is always appreciated but one that exceeds advocates’ suggested bounds.

“A physician should be open to a patient’s spirituality but shouldn’t push religion on patients,” says Nathan Carlin, assistant professor at the University of Texas Health Science Center at Houston. “That’s confusing personal and professional roles.”

An inherent power differential divides doctors and patients, says Christina Puchalski, director of George Washington University’s Institute for Spirituality and Health and co-editor of the recently published Oxford Textbook of Spirituality in Healthcare.

“They’re coming to us for something other than prayer,” Puchalski says. “If I, as a patient, perceive (a surgeon) as having my life in his hands, and he asks me to pray and I say no, he may not treat me well. And that’s putting undue pressure on the patient.”

As the saying goes, there are no atheists in foxholes: The idea that your fate is out of your hands offers fertile ground for re-examination.

“The moment somebody tells you that you have cancer,” says Methodist Dallas Medical Center’s Rohan Jeyarajah, a gastrointestinal surgeon who prays with patients, “you’re going to believe in something.”

But the situation, he says, requires caution: “We have to be careful about being in a position of perceived authority and not overstepping that bound. This is like a teacher-student relationship. There’s a chance you could be inappropriate.”

Pool pushes forward, eager to share the belief that drives him without making people feel awkward or flouting that power imbalance.

“I don’t want to exploit their situation,” he says. “At the same time, I want to give them the opportunity to explore the faith that I know.”

You could say Pool comes from a religious background. His father, his grandfather, his father-in-law, his brother-in-law: all ministers. The family joke was that he started going to church nine months before he was born.

By age 6, he was well versed in Bible basics, but then something odd happened. One day at a prayer meeting, Pool says, he was touched by — well, not quite a vision, but an awareness.

“I had already understood that Jesus came to save the world,” he says. “That was nice. But then I understood: Jesus came to save me. And that changed everything.”

He’s pursued a path of faith ever since. Medicine seemed like a good way to help people. Even so, as a med student, Pool pondered ditching the whole thing to go to seminary.

As a member of First Baptist Dallas, he and wife Jessica lead relationship classes on Sundays for dozens of young married couples. Even in his crisp, black-patterned suit, Pool is impossibly youthful — lean and rosy-cheeked, posture straight as a fence post.

And as a cardiothoracic surgeon, another realization has set in: “I have a ministry. I don’t need to be standing in a pulpit. I have found a ministry I did not expect. I am able to minister to people in times of need.”

Since Texas Health is a faith-based hospital system, he felt at ease taking that step.

“The vast majority of people believe in God,” he says, “and yet when people come to the hospital, that’s completely ignored by doctors. If anything, they call the chaplain. It’s unfortunate that more doctors don’t try to engage that part of a patient’s life.”

That’s starting to change. Two decades ago, barely a few med schools offered classes on spirituality. Now, three-fourths of them do.

“Medicine has figured out that we ignore the more human sides of health care at our own peril,” says Craig Borchardt, interim chair of humanities and medicine at Texas A&M University.

Studies show 60 to 80 percent of patients want their beliefs noted, he says — not as affirmation but as a sign the doctor actually cares. But fewer than 20 percent of doctors bring it up.

The push has met with some backlash — from busy doctors reluctant to take time away from other concerns or others who don’t like talking about it.

“Some staff are more comfortable with it than others,” says Mark Grace, vice president of mission and ministry for Baylor Health Care System.

He doesn’t reject the idea of doctors offering to pray, but “if you don’t listen to the answer, that’s where you get into problems. The doctor needs to be prepared if the patient says no.”

George Washington University’s Puchalski says the bottom line is doing what’s best for the patient.

“Physicians are generally not trained to lead prayer,” she says.

To illustrate the power differential she says exists, she recalls a patient who was also a fellow parishioner. One day, she noticed the woman hadn’t been to church for a while, then realized the woman hadn’t come into her office either.

When the patient finally resurfaced, Puchalski pressed the matter: “She told me, ‘I thought you’d be upset that I switched churches.’ That gives you an idea of the power we have over patients. So I would really caution against (taking advantage of) that.”

Pool gleans his patients’ spiritual beliefs at their initial meeting. Then, on the morning of surgery, he says: “This is a time when a lot of people turn to faith. Would you mind if I prayed with you?”

No one, he says, has ever declined, not even those who believe differently or not at all.