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The Magazine: American Medicine: A Call for Healing

The Magazine: American Medicine: A Call for Healing

By Dr. Peter N. Purcell

I believe that American Medicine is suffering from a soul-sickness that is interfering with its ability to perform its mission of healing the sick. The system, composed overwhelmingly of compassionate professionals anxious to help their patients, needs the ministry of the Church to be healed.

 

I am not especially well-read on Church history or on the history of religion and medicine and their many intersections. However, as a surgeon, I am an expert at witnessing, almost daily, the pain, dissatisfaction, and grief that my patients experience because of the shortcomings of American medical care.

 

Like many in this country, the patients I interact with receive superb technical care for their serious illnesses. They have access to multiple hospitals, medical and surgical specialists, and sophisticated drugs and operations that often stop pain, prevent disability, and prolong life. But for many, the experience of illness and the resultant medical care is traumatic, frightening, and ultimately dissatisfying. I believe such patients sense that the experience of illness and recovery should result in some degree of emotional and spiritual growth and maturity, and often this does not happen. Why not? Can Western medicine help its patients heal?

 

I believe it can, and I don’t mean by turning doctors into religious leaders, any more than turning priests into therapists would help—I don’t think it would.

 

We first need to recognize that American medicine functions on a disease model, meaning that illness is perceived as an entity—a diagnosis—and once that diagnosis is made, the machinery of the medical system starts working to provide treatment for the disease. As doctors, we are trained in the disease model from almost the first day of medical school. People become “patients” when they present to a doctor with a “complaint,” which can be used to elicit other symptoms. In combination with a detailed physical examination this information suggests a “differential,” or list of possible diagnoses. Once the proper diagnosis has been established, treatments—usually medicines and/or a surgical procedure—can be instituted with the goal of restoring wellness, or at least preventing further deterioration.

 

Often, however, this method of approaching and defining disease leaves people exhausted, anxious and, even after successful treatment, still feeling unwell and unhealed. Technologically advanced medical care can achieve startling improvements in a patient’s physical condition—I see this nearly every day. Our data- and procedure-driven system is less successful at restoring wellness, because we are not equipped to acknowledge the fear, hopelessness, and exhaustion that comes with being sick and trying to get well. We are not equipped to discuss the trauma to relationships that occurs when loved ones become ill. And we are definitely not equipped to consider how illness awakens in all of us a spiritual need to acknowledge our mortality, our regret at not taking better care of ourselves and of not making different choices with our time, and our realization of just how important our affiliations with our friends and family are. These thoughts can be painful and traumatic, and without healing can leave us feeling damaged and sick—the opposite of wellness.

 

Why, then, is medicine ill equipped to help heal sick people? Shouldn’t that be our goal? I believe the vast majority of doctors are caring people who went into medicine with a desire, perhaps a need, to help others. We find ourselves, however, in a system that can feel sterile, impersonal, and even inhuman. Our interactions with our patients are driven by data, fear of litigation, and financial concerns and constraints. We are regulated by government authorities and increasingly by huge corporate hierarchies, who demand that we diagnose illness, institute specific treatments, and measure, document, and report outcomes. Noncompliance, we are told, carries the threat of sanctions, financial penalties, and public humiliation. Healing the sick? Better to diagnose, treat, and move on.

 

What can be done? Many patients benefit from kind and compassionate nurses and other caregivers. Doctors are often not around and a very sick person may receive more true healing from a kind word or a compassionate look at the right time, from a caring staff worker with relatively little medical training, but great experience at being human. This bonding and healing is wonderful when and if it happens, but shouldn’t healing be a part of medical care as well?

 

Is it just that doctors are too busy? I don’t think that’s it, though demands on our time from the forces I mentioned seem greater now to me than at any other time in my own career. I believe the real problem is that we suffer in our training from a fundamental lack of affirmation of and teaching about the human conditions of sickness, wellness, and healing. We are trained to use treatment, and response to treatment, as a proxy for healing. This method does not get patient and doctor where we need to be, and that’s where we, in medicine, need the Church.

 

Why not just teach our doctors empathy and compassion (or at least how to project it), or teach spirituality without religion (as a technique for relaxation and mental health), or set aside some funding to bring in more therapists and facilitators to our medical centers? These things may be important, actually (and in larger medical centers with luxurious budgets many therapists help patients and families greatly), but I am asking the Church to help American medicine find its lost soul, and in doing so to help us help our patients. We, the doctors, have taken the illness-driven model of health to its logical extreme. The system, so dependent on money and technology, has become open to influence from outside interests who divert our attention from our patients. We have been led to believe that our job is to provide, for a price, a commodity—health—to a group of purchasers, and have become co-conspirators in this lie. It simply isn’t so, and we need to acknowledge this in order to become better at our calling.

 

I believe the Church can help save American medicine, but we must work together differently. Priests and doctors both want healing for the sick, but our current model leaves little room for intersection and cooperation. What would a different, better model look like?

 

First, doctors must acknowledge that treatment, and its outcome, doesn’t necessarily involve healing (even though tissue healing may take place). Healing seems to me to involve a sense of wellness, or at least well-being, and of peace. I believe it is artificial, and incorrect, to dualistically divide the work of healing into the physical and the spiritual side, and to develop separate therapies for these “parts of ourselves.” We are treating a person who is primarily a spiritual being, subject to the joys and agonies of physical and emotional life, living with childhood traumas and, too often, suffering from a profound lack of example of how to live and love as Christ did. Healing requires trust, community, and forgiveness. It may also require powerful pharmaceuticals and aggressive operations, but clearly those alone are insufficient.

 

Doctors know we are suffering from some malady—make no mistake, American medicine is sick—and we need help if we are to survive to function as our calling demands. We sense that there is a hollowness to our work and feel betrayed, though we may have betrayed ourselves. We are ready, perhaps, to admit that we need comfort and guidance.

 

I’m not suggesting that medical schools and seminaries integrate and produce priest-physicians (though the lack of communication between these departments in major universities is, to me, unfortunate). Barriers to effective communication clearly exist. Diversity of opinion, culture, and background in medicine and in the Church is real, but it should not preclude conversation and cooperation. We must begin by acknowledging that we, the doctors, and we, the Church, are mandated to heal the sick. The sick (which is all of us) need help, and we need to work together for healing. If we recognize and accept our common imperative to relieve suffering, the teaching and learning will come.

 

It is time for medical leaders to acknowledge the sickness in our system, and for Church leaders to offer help and healing. Many, many conversations must take place. The intersection of two such powerful forces as Western medicine and Christianity, is fraught with the possibility of mutual misunderstanding and aspersions. Both are, to some degree, suspicious of the other’s motives. They function mostly in parallel, within a gentleman’s agreement of boundaries and prohibitions. We must disrupt these boundaries and come together.

 

Western medicine and Christianity have much in common. Both share a love of narrative: the Church offers the narrative of Christ’s redemptive incarnation, and medicine relies on the narrative of sickness in order to restore health. Both implicitly offer and rely on hope and the transformative power of trust. Both speak to what it means to be human.

 

Perhaps social media can be a means for this transformation, by bringing thinking persons together to share ideas and put them into practice. Perhaps the healing of modern medicine will not be a top-down process, but rather transformative and disruptive from below. Perhaps God will bring change, because God’s people need change to happen.

 

Medicine needs the Church, more than ever. We need healing to be better healers. The Church needs to help, and to do so will need to step out of some of its comfortable and accepted conventions and boundaries. I believe the Church is being called to help medicine transform itself into a vehicle for true healing and wellness, and I believe the Church will respond. It is time. Let us serve together.

 

 

Peter N. Purcell, MD, FACS, is a US-trained doctor, the product of an upbringing in the Church, as well as four years of medical school and nine years of surgical residency and fellowship training. Upon finishing training, he went into private practice, and has been very busy caring for surgical patients in the 18 years since. A layperson with no particular religious training, Dr. Purcell loves the Episcopal Church for many reasons, not least its three-legged stool of scripture, reason, and tradition. He writes, “I love the liturgy and believe the Book of Common Prayer is a wonderful and beautiful work of literature of divine inspiration.”

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Marshall Scott

I hope wherever possible Dr. Purcell and his colleagues are looking to the support of clinically trained and Board Certified chaplains, both for the support of patients and families, and for the support of physicians and other staff. Being clinically trained, they have a concrete experience of institutional settings of care, that are culturally so different from the normative experience of patients. Being Board Certified, they have been reviewed both by their own faith communities and by professional colleagues for their training and skills in supporting patients, families, and staff in those settings, working with respect and support for the traditions (or lack thereof) that those individuals bring with them.

While Board Certified chaplains have at least 1600 contact hours of clinical training, the Episcopal Church has benefited for a long time from the fact that 400 contact hours of such training has been normative for most seminary-trained clergy and lay professionals, and in many dioceses for those trained in alternative programs. Thus, with others, Episcopal clergy and lay professionals bring experiences and training to the support of the sick that colleagues in other traditions may not.

Folks know that I am a Board Certified chaplain myself, and Director in a large health care system rooted in the Episcopal Church, so my position is not unexpected. However, I believe that the Episcopal Church serves both our own parishioners and others very well in holding high standards for the care of the sick, demonstrated in the training required of so many of our professionals.

One note further I would make: if physicians are committed to these concerns for the wellness of patients, and will advocate for them, administrators will listen. I know we're long past the day when physicians (or anyone else, really) can always get what they want.. However, physicians still have great influence in their institutions.

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Maria Evans

Thanks for this, Peter. As the person at the other end of your frozen sections, I can't agree with you more...and part of how I began to recognize the callings of the priesthood inside of me was I started realizing that my surgeon, OB/GYN, and internist colleagues (and their residents) were beating a path to my door, ostensibly to "talk about the path report," and I found them sitting down sharing their latest lament, admitting their stress, or venting their frustrations at their inability to navigate the medical-industrial complex. Preach it, brother!

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Cheryl A Mack

Thank you, Dr. Purcell, for this thoughtful article. In my work as n RN I have observed the dichotomy you describe though it has been long since I believed anything could be done about it. I occasionally find I can work effectively one on one with a receptive patient or family and it occurs to me that all clients should have the same opportunity. Usually my practice is severely limited to the tasks at hand without much time to help any patient or family process the illness journey. I would very much welcome a way forward.

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