Humans comprise mind, body and spirit and therefore a holistic model of health would include spiritual and religious dimensions. Despite significant supporting evidence, modern western healthcare systems often have a dualistic approach leading to significant gaps that are still largely unexplored. These gaps can be anthropological (separating body/mind vs spirit), professional (lack of training in how to assess and address spiritual needs), belief based (traditional religion versus a more general spiritual outlook) and cultural. We will explore these gaps and discuss how to practically assess and address spiritual needs in healthcare in a patient centred framework.