Although great progress has been made in medicine, the spiritual and religious needs of patients have been slow to be acknowledged as a core principle of professional practice and care at end of life. Spiritual care, once regarded as the sole province of chaplains, has recently become increasingly recognized as part of a holistic management approach and the responsibility of all health care professionals. Almost two decades after the appearance of first recommendations, doctors still find it difficult to initiate discussions on religion and spirituality with their patients. In a local survey we conducted among junior doctors and nursing staff, only 2% of doctors would regularly enquire, whereas more than 50% never asked about religion. It appears that doctors are generally poorly prepared to tackle this issue, both during their medical student years and later as trainees. We present a case study that illustrates the intricacies of trying to deliver comprehensive care to an elderly patient with a potentially life-ending condition where the cultural, personal, and religious opinion of the relatives have played an important role in the patient's management. We then discuss the results of our survey and explore the literature as to why doctors, in particular, tend not to enquire about the religion and spirituality of their patients.