Friday, November 6, 2015
By Farr Curlin, M.D.
from DIVINITY Magazine

Here is the not-so-secret truth about American health care practitioners: they are exhausted and bewildered. In two different studies, researchers have determined that the burnout rate for both doctors and nurses exceeds the general population, with nearly 50 percent of these medical professionals feeling as though they don’t have the resources to continue their work. Christian medical professionals seem at least as bewildered as everyone else. When I speak with Christian physicians and nurses, I notice confusion in their eyes, fatigue in their postures, and painful longing in their voices. Many are struggling to make sense of their day-to-day work: Why is it worthwhile? What does any of it have to do with what they thought they were called to be and to do as healers? Isn’t there a better way?

This should strike us as odd. Few human practices, after all, resonate more with Jesus’ ministry than caring for the sick. He used the analogy of a physician offering healing to describe his work (Matthew 9:12; Mark 2:17; Luke 5:31). He also identified himself with those who are sick, telling those who had visited the sick, “Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me” (Matthew 25:40). Through his concern for those who were sick and his powerful miracles of healing, Jesus demonstrated the inauguration of his kingdom.

His early followers startled their pagan neighbors with their practices of caring for the sick and discarded. In late antiquity, Christians formed the first hospitals. In the late middle ages, the church promulgated manuals for laypeople, instructing them how to suffer illness and live faithfully in the face of impending death. Even into the 20th century, the majority of community hospitals in the United States were sponsored by Christian denominations. No wonder, then, that attending to the sick has been considered a paradigmatic Christian vocation. Why, then, are Christian health practitioners now so bewildered? Why do they not readily experience their professional roles as consonant with who God has called them to be, or their work as resonant with what God has invited them to do?

The Challenge of the Current Health Care Environment
The United States has the most technologically advanced and expensive health care system in the world. Yet despite consuming almost 17 percent of the nation’s gross domestic product (GDP), that system has not made Americans any healthier than residents of other economically advanced and politically stable countries. Moreover, as the health care system has grown in scope and power, it steadily has become more complex, technical, and bureaucratic. Inside this system, practitioners increasingly feel like cogs in a vast machine, driven along by faceless forces, harried and prodded and disciplined to chase outcomes that seem far removed from the needs of the particular patients they encounter. No wonder, then, that the burnout rate among both physicians and nurses approaches 50 percent. No wonder that patients are so often distressed by the impersonal and bureaucratized “care” they receive.

The moral and spiritual bewilderment of Christians working in health care poses a challenge to Duke Divinity School. Our mission is “to engage in spiritually disciplined and academically rigorous education in service and witness to the Triune God in the midst of the church, the academy, and the world,” and we pursue that mission primarily by training pastors and teachers. But as Richard Hays, George Washington Ivey Professor of New Testament, has written, “Wherever the church experiences renewal, it discovers that it does not exist for its own sake; it exists in order to bear witness, in order to be ‘a light to the nations.’ ” With respect to health and medicine, then, our challenge is to form scriptural imagination so that the church might bear witness and embody light in these important domains of contemporary culture.

We have our work cut out for us. Few Christian health practitioners have received any deep theological formation with respect to their work. Almost two thirds of health professionals in the United States identify themselves as Christian, and most say their religious beliefs influence their practices. They often seek to link their work to Jesus’ healing ministry, yet few Christian medical professionals have learned to think theologically about foundational dynamics that shape American health care. Except where practices cross a bright line of moral impermissibility, Christian practitioners tend to take the structures and practices of medicine for granted.

For example, Christian health practitioners regularly work with patients and families at the end of life, but few have considered how the Christian tradition of living well in the face of death might inform decisions about how, when, and to what extent we use technology to prolong life. Christian doctors and nurses lament the loss of personal contact and connection with their patients, but few have reflected on how modern medicine tends to treat the body as a machine rather than a person, and the extent to which Christian communities have erroneously embraced this view. Christian practitioners have strong opinions about shifting health care policies, but few have examined how the Christian affirmation that Christ is present in the one who is sick might inform debates about health care reform. Christian health practitioners know that the gospel should matter for how medicine is practiced, but they are not trained to see or to say how.

This is a problem. This lack of theological formation, combined with the broader social dynamics toward more bureaucratic, instrumentally driven medicine, leaves Christian health practitioners alienated from their work. As a result, many relegate their faith to the personal sphere, thereby abandoning the task of discerning how to faithfully fulfill their professions. They experience distress, and their daily work becomes increasingly disconnected from their original sense of calling and vocation.  They do not know how to describe what is wrong or how to start afresh. Much less are they practiced in turning to the gospel and Christian tradition for guidance.

This is a problem also for the church, whose members are called to bear witness to the gospel in times of sickness and of health, not only within the halls of institutional medicine. In their book, Reclaiming the Body: Christians and the Faithful Use of Medicine, Joel Shuman D’93, G’98 and Brian Volck state the problem bluntly: “Most North American Christians approach medicine without much consideration of its relation to their theological convictions.” They suggest, as a matter of first importance, that “Christians should should always understand themselves as part of a gathered people, integral parts of a community called the Body of Christ. In other words, we never really go to the doctor alone.” But Christians do go to the doctor alone, in part because their pastors also feel marginalized within health care institutions, unable to exercise authority in guiding and caring for the sick and the faithful to whom they minister.

Cultivating a Scriptural Imagination about Health Care
Forming and renewing a theological imagination for health and medicine requires a particular kind of institutional space—one that Duke Divinity School is well-positioned to sustain. Today’s health practitioners receive the great majority of their professional formation within academic medical centers, which overwhelmingly emphasize empirical and instrumental modes of reasoning. Health practitioners have difficulty finding conversation partners for serious, sustained Christian theological engagement with the practices of medicine. They also find it challenging to gain the theological formation they need in churches or in other Christian contexts outside the university. Even faith-based health care institutions tend to divide the professional from the personal, the public from the private. Although many pastors and congregations care deeply about health and illness, churches are often not equipped to provide in-depth theological formation for people who work in the health and medical fields. Duke Divinity School, in contrast, provides a prominent institutional context in which these challenges can be overcome.

First, the Divinity School is committed to the practices of the church and to the formation of Christian ministers. Here, we can equip those being trained for the ministry to reclaim their ecclesial authority within the medical context. It is often said that doctors are the priests of the modern West, that when Christians and their clergy enter the hospital, the “real” authority lies with the medical team. The Divinity School can help Christians push back against this distortion—to help Christians understand themselves within the medical context as those whose bodies belong to the Lord. Here, we can explore theologically informed configurations of medicine, at the local level, that can serve as models for faithful and transformative Christian practices of healing and health care.

Second, the Divinity School is in close proximity to Duke’s world-class medical center, and our faculty includes four physicians as well as many others whose scholarship focuses on the body, health, suffering, illness, and death. We can bring health practitioners and ministerial students together in a context that is directly and deeply responsive to the realities of contemporary health care. Students can connect what they are learning in the classroom with what they have experienced and will experience in their clinical domains.

Third, the Divinity School is an internationally renowned center for theological scholarship and education that is committed to engaging the broader culture with the gospel and historic Christian tradition. Here, we engage the academy and the world as equal participants in ongoing public discourse about our common life, not merely as an enclave of individuals working out our “personal values” in private. Here, we bring together seminarians, clergy, students in the health professions, and practicing clinicians for deep theological study and formation that prepares them to reimagine and reengage their work in the world.

Finally, the Divinity School seeks not simply the transmission of knowledge but formation. Toward that end, formal study occurs within the practices of Christian prayer, worship, and service. In this way, we are all equal participants in a community of theological formation and Christian practice, whether we work in a parish or on a pediatric oncology ward.

In sum, Duke Divinity School is called to respond to the moral and spiritual bewilderment of Christians working in health care by inviting them to be transformed by the renewing of their minds. Through practices of the Christian tradition, practitioners might gain clarity about the purposes and meaning of their work, about how to attend faithfully to those suffering illness, pain, debility, and death. Through practices of worship and gratitude, they might find encouragement to begin again with joy, seeking creatively to participate in God’s ministry of suffering presence and healing. Through the formation of scriptural imagination, their eyes might be opened to new possibilities and practices that bear witness and bring light to contemporary health and medicine.