Physicians: too busy for patient care?

David Foster Wallace opened up his rather memorable 2005 commencement speech at Kenyon with the following story:

Two young fish are swimming along and they happen to meet an older fish swimming the other way, who nods at them and says, “Morning, boys. How’s the water?”
The two young fish swim on for a bit, and then eventually one of them looks over at the other and goes “What the hell is water?”

That is, the reality and culture in which we’re immersed can be quite hidden to us if we don’t continuously work to remind ourselves to stay aware.

There are parts of medical culture that I’ve come to take for granted; narratives I’ve rehearsed and excuses I automatically give for why things are the way they are, even when they seem at odds of serving the patient’s good.

It’s unsurprising that pride underlies a lot of these non-ideal realities, but being aware of how exactly we’ve let ourselves be gradually puffed up is harder because this is our reality.

A typical day in the hospital starts with pre-rounding, i.e. seeing the patient for 2-3 minutes in the morning to see if anything “acute” has happened overnight (i.e. is it something worth mentioning to the attending?) and then spending the rest of the hour pulling up “objective data” (i.e. labs, vitals, imaging) to present during rounds. In rounds, depending on the attending, you might sit in one room and discuss the patients without ever going to see them; you’ll maybe spend 10 seconds talking about the patients themselves; much longer presenting the objective data and discussing the consults you’re going to call and tests you’re going to run that day. Then the rest of the day you’re going to run around following through on these, fielding phone calls, checking the EMR (electronic medical record) often for updated information, and at the end of the day, what you’ve taken care of is more the data about a patient rather than the patient himself.

And this is in the more “humanistic” parts of medicine – during my surgical rotations, how often did we (half-)joke that patient “looks good from door” and write from day-to-day: “ambulating, urinating without catheter, positive for bowel movements,” as if that were the sum of the patients?

We grumble to one another about our lack of sleep and that there’s never enough time to take care of things in the hospital; we get impatient when a patient has a “complaint” (literally, that’s what the medical jargon calls it) or has something to tell us that “doesn’t change medical management.”

Inwardly we ask, “Why are you wasting my precious time?” right before we spend 20, 30 minutes chatting to our peers, holed up in the residents’ room. We always have more than enough time if another physician wants to talk to us about what recommendations they may have or even if a more senior physician wants to pontificate on some random tangent; we try hard not to give in to the urge to check our watches or restlessly tap our feet when a family member or a patient stops us and has something “important” to tell us. “Sorry, we have to go,” we say as soon as they pause to take a breath.

We make huge life-altering decisions within the confines of the physicians’ room and then ask the nurse to let the patient know as we scurry away to take care of something else.

I get it, we’re sleep-deprived and busy, but are we so busy we’ve forgotten to take care of our patients? Or are we justifying ourselves out of a misguided sense of self-importance ?

Anyway, I’m part of the problem, and recently I’ve been convicted, as James has some pretty harsh words about the sin of partiality (with some insertions of my own):

Show no partiality as you hold the faith in our Lord Jesus Christ, the Lord of glory. For if a man wearing a [white coat] comes into your assembly, and a [malodorous homeless patient in disheveled clothing] also comes in, and if you pay attention to the [one in the white coat] and say, “You sit here in a good place,” while you say to the poor man, “You stand over there,” or, “Sit down at my feet,” have you not then made distinctions among yourselves and become judges with evil thoughts? Listen, my beloved brothers, has not God chosen those who are poor in the world to be rich in faith and heirs of the kingdom, which he has promised to those who love him…

If you really fulfill the royal law according to the Scripture, “You shall love your neighbor as yourself,” you are doing well. But if you show partiality, you are committing sin and are convicted by the law as transgressors.

And elsewhere in the Bible we see Jesus going out of his way to bless the unimportant, those that wouldn’t have necessarily “changed his ministry” or in any way made him “more efficient” in proving his divinity.

Then children were brought to him that he might lay his hands on them and pray. The disciples rebuked the people, but Jesus said, “Let the little children come to me and do not hinder them, for to such belongs the kingdom of heaven.” And he laid his hands on them and went away.

So now that I’m aware of parts of the medical “water” — how, then, shall we live?

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A New Breed of Philosopher King

“Plato imagined philosopher-kings guarding his utopia. Here in Aspen, a modern day utopia, we have Bill Gates…” (The Atlantic, 2010)

My most recent post on technology discussed what it might mean for a Christian working in cyber security to commit to helping those who are weak and oppressed. In it, I attempted to draw a picture of the weak and oppressed in this field: they are those who are unable either to communicate without being spied upon, or to protect their information and data.

I also argued that working in the field of security does not mean that you are helping the weak and oppressed, just as its true that simply by working as a doctor does not guarantee that you are practicing a healing form of medicine. In the case of security, the injustice in the field stems from the fact that security technologies can be used either to help people find their voice, or it can be used to oppress it with even greater efficiency than ever before. Towards the end of the post, I briefly mentioned that this notion of helping the weak and oppressed can be hard to do in practice, because usually money or success – or both – is often on the line.

This idea – that in the business of security, a righteous decision to help those who are oppressed is often in direct conflict with profit or worldly success – is at its heart an issue of business ethics, and so I want to expand a bit on business ethics in the technology sphere in this post.

Developing an ethic around technology is elusive, partly because it’s so difficult to understand or foresee the implications of technology once it’s out of your hands. Most technologists would argue that this simply isn’t their problem: leave the ethical questions to the philosophers.

So, rather than struggle with these issues, a task which, to be fair, requires as much philosophy as it does technical knowledge, the approach for virtually the entire post-Industrial period has been “shoot first, ask the ethical questions later.” But that’s starting to change: those in the technology sphere are finally realizing that the pursuit and promotion of technology simply for its own sake can indeed be a great good, but also a great evil, and that an ethic of sorts to govern technology is needed.

“Don’t Be Evil”

An interesting take on business ethics, and in particular on business ethics as it pertains to technology, comes from Google’s well-known slogan: “don’t be evil.” Despite the flak that Google and the rest of the tech industry has taken about invasions of privacy during the past few years, if you think about it, it’s not a terrible slogan: much to its credit, it directly addresses a central element of ethics in technology, which is that technical innovators are often faced with a dilemma about the dual uses of their technology and quite regularly have to make what amounts to a moral decision (I’m thinking here of the obvious examples: nuclear technology, some of the interesting consequences  of 3-D printing, and even controversies over Google Glass, but surely there are others as well).

“Don’t be evil” seems to suggest that intentionality is the key to these ethical dilemmas: don’t intentionally create something for evil purposes. But there’s a problem with this approach: who’s definition of evil are we going with? There’s a sense in which such evilness should be blatantly obvious and apparent on first blush. But what about business choices which are cowardly, or deceptive, or unwise, but are not evil? Is there a responsibility as technologists to define business ethics more broadly than the affirmation of a negative: “not evil”? Is there a responsibility to do good?

These are some challenging questions – questions that seem to cut across a lot of the topics discussed on this blog. Last week, Daniel Song wrote a piece titled What Medicine Cannot Give. He points out that technology is fundamentally altering the way we do medicine, sometimes in ways that we haven’t really worked out. He’s asking essentially the same questions: what is the end purpose of technology? Is technological progress always good? What parts of technology are good?

The Jobs Ethic: “Be Simple. Be Perfect”

In contrast to Google’s “don’t be evil” is Apple, who have, implicitly, formed their own ethic (or rather, have inherited the legacy of an ethic shaped by Steve Job’s dominating presence). I highly recommend an essay by Andy Crouch which he wrote in 2011 about Steve Jobs and Apple – he addresses many of these same questions in the context of the rising phenomenon of the ubiquitous personal electronic device, and offers an extremely insightful look at the underlying ethics propelling many of the creative processes at Apple. Crouch makes the point that the Apple phenomenon has at its center a religious-like worship of technology as the Ultimate Answer (and perhaps Jobs as the medium by which the Ultimate Answer is revealed). That’s certainly a worldview!

But if Google’s ethic of “don’t be evil” fails because it lacks a central, positively defined anchor, the Jobs ethic fails because it centers around the wrong thing. Technology cannot save this world: its solutions are dazzlingly efficient, but not effective; its successes are proclaimed overwhelming, but not everlasting; its uses impart power, but not the ability to wield that power for good. An ethic centered around technology misses the key catalyst to real progress in this world: changed human hearts. This is something that only Christ can deliver on.

A Christian Technology Ethic Centered on Christ

Christian technologists have a mandate that goes far beyond the moralized “don’t be evil.” We’re instructed to “avoid every kind of evil”, but we’re also told to “hold fast what is good” and even more importantly to “test everything” (1 Thessalonians) by continually evaluating whether good fruit has been, or will be, produced.

Jacques Ellul makes an interesting point in his writings on technology: technology has a way of getting out of control. Increasingly, and especially since the industrial revolution, it rules us rather than us ruling it. The underlying truth of this is deeply ingrained in the human psyche: the concept of technology that has gone out of control permeates literature. Think of Babel. Think of Frankenstein. Think of Hal. (As a side note, I think hackers implicitly understand this idea as well, thus the thrill of excitement that happens when we do, at last, get technology to work as we will and do our bidding.)

As Christians, we have to find ways to ensure that technology remains secondary to the person, and that it does not take up the center of our belief system and crowd out Christ. The arc of history has made it clear that this won’t “just happen” on its own: it will take thought and the answering of difficult questions. It will mean admitting when technology is out of control and stepping on the brakes. And troublingly, it might mean turning away from or delaying promising technologies that go against what it means to be human, or what it means to thrive.

I want to be crystal clear that a Christian ethic for technology does not mean the rejection of technology as an inherent evil. It does not mean setting the default view of technology as something to be suspicious of. And it does not mean some sort of acceptance of neo-luddite thought.

Instead, it is a call for discernment. As much as the ancient world yearned for the philosopher kings, in this new millennium we need philosopher builders who, in their role as technology-creators, are anchored in a Christ-centered worldview and willing to take upon themselves the task of asking and answering these difficult questions.

Christianity, Journalism and Gaza: I do not know it all; I know very little at all.

“When I finally began to spend time in the place about which I had pontificated for so long, I discovered that I was much more interested in what the people I met had to say than in my own views. It dawned on me that I could only be a good writer on the Middle East to the extent that I was a good listener… The brash young man I was could write with a sense of mission in large part because he had never spent any time in the region; he was intoxicated by the sound of his own voice, the power that he felt it gave him.
—-

I wanted to give an account of their suffering, but I had to do so with a measure of humility, without pretending that I knew more than I did – or, more to the point, more than they did… Reporting on Algeria, I was forced to own up to my own uncertainty and to make it a part of my writing.”

I loved reading this piece today by Adam Shatz, long-time reporter in the Middle East. Partly because he is an eloquent writer full of insight, and partly because the brash, youthful presumption he describes is so familiar to me. One year ago, I thought I had answers to all the hard questions, from “What’s going on in the Middle East?” to “Whose fault is it?” to the biggest of all, “Who is God?”

Graduating from Princeton, I was confidently groomed to analyze, critique and defend political and religious views. I had the perfect blend of sureness, urgency and occasional condescension. I’d only studied the Middle East for four years, mostly from outside the region, but felt justifiably self-righteous, often indignant, and obliged to jump into punditry and political debate.

That changed this year. It doesn’t matter how hard I studied at Princeton or Oxford, how many books I read on Islamism, Zionism or Orientalism, how well I presented at the State Department or how many drafts I wrote of my thesis. I did not know the sound of church bells and calls to prayer in the mornings of Jerusalem, the scorch of beating sun on your 400th day in a refugee camp, the jostling of bodies as soldiers herd you like cattle through a checkpoint, or the rush of Mediterranean blue along Beirut’s Corniche as you pass old men smoking argileh and toasting kaakeh on its coals.

Journalism is humbling, especially from abroad, because I realize that I do not know it all; I know very little at all. Thankfully, reporting is not about projecting my own opinions but gathering knowledge, walking the streets, drinking tea, making friends, asking questions, and most importantly, listening.

My best friends now are from Syria, Palestine and Sudan. I’ve never felt my heart swell with an entire region’s revolutionary promise, then break as my heroes were killed, arrested or forced to flee. I’ve never fled across a border. I’ve never watched anyone that I love die. I don’t know what it’s like to live through war, occupation or genocide. I barely dare to imagine. But I can ask.

As a journalist in the Middle East, the most foolish thing I can do is to assume I know what’s going on. As a Christian, the same mistake applies. I am reminded of 1 Corinthians 13:9-12:

“For we know in part and we prophesy in part, but when perfection comes, the imperfect disappears. When I was a child, I talked like a child, I thought like a child, I reasoned like a child. When I became a man, I put childish ways behind me. Now we see but a poor reflection as in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known.”

This passage used to confuse me. So am I a child or a man? Surely I’m a ‘man’ by now, I’d think. But the longer I’m a Christian, the clearer it becomes that I am but a child.

This year, God is suddenly very real. I talk to Him, ask questions, seek Him hungrily, because I find that I do not know. My quiet times of repeating religious adages to self have been replaced by what I call “faith like a crazy person.” It includes tumultuous emotion, exuberant bouts of joy, really cheesy moments and a lot of me just sitting on the floor yelling WTF ARE YOU DOING? Who ARE You!?

In journalism as in faith, we must listen humbly and ask hard questions. That includes “What’s going on in the Middle East?” “Why?” “Who is God?” and one more: “What would He have me do about it?”

In Gaza, for example, more than 2,000 people have been injured and 268 people killed from Israeli attacks this week. 70% of them were civilians. 1 in 4 were children. Human Rights Watch, Amnesty International, the United Nations have all condemned the strikes as illegal human rights violations, but the killing continues.

Hard questions: Why is this happening? What role are America and Christian church playing in it? Who told me so? Why do I believe them? Could I be wrong?

Harder questions for Christians: What is justice? God, how am I to seek it?

Usual side question from me: Can we just avoid this topic? It’s so sensitive and contentious. Also I hate oppression and it’s easier to just pretend this isn’t happening.

Steady answer from Christ: No.

I bring up Israel specifically and intentionally because it’s a vortex of all the hardest questions of all. But dear friends, we must ask them.

People often ask me how to help refugees in Jordan and the Middle East. Donate to UNHCR and pray, I say, but also ask questions about the region’s current crises. Too often do we feel sad for innocent victims without realizing that our states and institutions are involved in ongoing injustices, ones that depend on constituents’ apathy and ignorance to continue.

Accountability is harder than charity because it demands our effort to seek out truth, and then strength to acknowledge that we might have been wrong. But we needn’t be defensive or afraid of admitting mistake, because God is for us, not against us. He is gracious and ready to show us who He is – as long as we ask genuinely, surrendered, willing to drop our comfort and assumed righteousness.

I ask a lot of questions. I don’t have answers for all of them. Re: Israel and Christian Zionism, for example, I do not know what will happen in the “end times” with the Israelites, the state, the temple, etc. Based on Jesus’ words in the Bible, I don’t think I’m supposed to know. But I do know this:

“And now these three remain: faith, hope and love. But the greatest of these is love.”

– 1 Corinthians 13:13

Faith and hope can be difficult. Last night I stayed up late writing about the refugee crisis in Jordan, thinking about the Syrians begging here in Beirut, scrolling through my Twitter feed to read about the plane shot down in Ukraine, fascist racism in Tel Aviv and children killed on the beach in Gaza. My mom sent me a text at one point: “I wish I can be next to you and hug you right now. Grieve the loss of a child’s innocent dream about the beautiful world.”

I closed my laptop and cried.

If I weren’t Christian, I would be scoffing at all the soft-hearted fools who believe in humanity and kindness and people’s rights. Obviously they haven’t read history or even current affairs. Obviously they don’t know that people just hate each other. In Darfur the paler Arabs hate the darker Africans, just like in Israel the Jews hate the Arabs, just like in Germany the Nazis hated the Jews, just like in America the whites hated the blacks, and so on. I’d be a skeptic and a realist, attributing everything to power and interests and safely removed from the foolishness of belief in compassion.

But I am a Christian, which means by the Holy Spirit and God’s grace I have this lunatic faith and hope that God is just, He is sovereign, He is for us, not against us, and He wins.

Meanwhile, I ask questions. I listen humbly. I pray for Christ-like love, which means to consider others above myself, resist violence and to seek the good of people that hurt me.

It means to keep my Twitter feed open, to look, read, listen and think long and hard, crying and feeling for children who play in the sand and dream of a beautiful world that suddenly stops.

It means ignoring the cynic that cries, “Fool!” in my head, insisting until the day I die that every human being is a human, Holy and Beloved, regardless of their color, race or religion.

We do not have all the answers. But we can and must ask the questions. In the meantime, we know enough to love.

Give us this day, our daily bread

Fusion

This post is going to be a bit of a strange one, melding the topic of food with work. A fusion of sorts if you will, although … to be honest, I’m usually not a fan of the whole fusion thing when it comes to food. It … it’s okay usually, the food tastes interesting and is sometimes good, but many times, the fusion of cuisines is pretty much forced. Hmmmm, well, if I’m honest, I haven’t really eaten much fusion, so perhaps I’ll reserve judgment on that topic for another topic.

Anyways, back on topic, I’ve yet to really write about my “real work” and how the Gospel speaks into that. Instead I’ve just been focusing on the topic of food, something I dream of doing for work someday. I work in economic consulting; briefly speaking, that means my firm generally will provide economic analysis/support to legal matters. At some point, I’d love to write more about my job and how I think the Gospel speaks into the industry as a whole, and how it speaks into my work as an individual in the firm.

Sabbath

For now, I want to take on the topic of Sabbath, or at least finding rest. When I first started work, I wondered if what taking a Sabbath would look like, given that I would have the weekends off. In college, it can often be very difficult to take a Sabbath because those weekends are actually the days where you can finally catch up with all the homework/studying you didn’t get to do during the week. But now, with the whole separation of work time and play time, things looked to be much easier! A lot of the topics/points that people will mention are that taking a Sabbath is not merely just “not doing work.” That’s certainly true, and that’s a mindset that I held going into the job. Little did I know, I would end up working my first real weekend, both days, haha. Throughout my first year (it’s actually been exactly one year to this day!), I’ve had to work a lot more weekends than I initially expected. I’ve greatly enjoyed my job so far, but it’s certainly made taking a Sabbath a lot more difficult. So what does it mean to take a Sabbath for someone who has occasionally has to work the weekend? (and what about those bankers who pretty much always have to work the weekend?)

There’s much to say about the topic of Sabbath and its purpose, but for now, I’ll just start with this part of the Lord’s Prayer, “Give us this day, our daily bread.” Obviously, there’s much to say about this clause of the Lord’s Prayer as well, but for me lately, this verse has been coming to me as a reminder to rest in God’s provision.

The cliché-ish part

One of the biggest barriers for me when it comes to taking a Sabbath is the concern of getting finished the work I am supposed to complete. In college, I often found this concern to be less impactful, given that my work only really affected me. It was a lot easier to trust that God would help me with a problem set or study for a test or write a thesis because at worst, only I would suffer. But in a corporate setting, where people depend on me to get things done, I’ve struggled to maintain a healthy trust in God’s provision. Can I really finish this exhibit in time for the deadline? Am I prepared enough for tomorrow morning’s meeting in front of my manager? Will my code for creating this dataset run fast enough, so that I can pass it on to my coworker? I often find myself asking these questions as the night approaches on weekdays or when considering whether or not I should go into the office on the weekend.

As I’ve gone through seasons of work that involve many late nights and weekends in the office, it’s amazing to see how much God has provided, in many regards. Whether it’s strength to work late nights, focus to provide quality work even when tired, insight into the problems we are solving, and more, God has truly given. And yet, even during weeks when I don’t have to work late nights or the weekends, I’ll constantly worry about needing to put in extra hours to get more work done, forgetting all about God’s provision in my time of need.

“Give us this day, our daily bread” is a request with very powerful implications. When we say this prayer, we are asking God to provide food for us, each and every day. If I think about it, my ability to eat food comes from the money I make at my work. By extension, my prayer for God to provide my bread, is actually a prayer to provide in my work. Ultimately, as cliché as it sounds, my ability to complete work is not something in my own hands. I can put hours and hours into a project, yet ultimately the success of that endeavor is in God’s hands. Quite the sobering thought. Yet also a very reassuring one as well. When God calls me to work, I should do so faithfully, knowing that God will see to it that my work is fruitful. When God calls me to rest, must I not rest? He is the provider, and as hard as I strive on my own power, it will not bear fruit.

So what about that Sabbath question you asked?

So what does taking the Sabbath mean for people who have to work the weekends and may not be able to take the whole day off? I haven’t quite figured this out yet at a practical level. But I do know, there are many reasons for us to take the Sabbath, and one of them is that it’s God reminder that our work is not what provides for us, it’s him. Even if there are weeks when I can’t take a full day off, I hope that I will remember that my work is only fruitful because God is providing my daily bread. Remembering this gives me the confidence to take real breaks while I’m working (I’m not talking about going on Facebook while working, which isn’t really a break), to block out my Sunday morning to go to church, to leave the office at a reasonable time even if there is a lot of work for the next day, and to not think or stress about work when I’m go home or am out with friends. While none of these are what we traditionally consider a “Sabbath,” I think it’s a right start towards finding true Sabbath rest at a demanding job.

Routine Walking

Last month, every little thing I was involved in outside of work finally caught up to me. I felt burnt out with everything in life, and it was hard to find joy in anything I did when there was not enough time to do them all. So I asked one of my mentors for advice. Sensing that I was not managing my time well, she suggested that I block out every chunk of time outside of work in a way that represents how I’d ideally divide up my time, focusing especially on my time with God and personal relaxation. Since I started this routine, it’s helped my focus greatly, and I’ve been more productive while being better rested as a result. By recognizing the importance of giving time to even the smallest, seemingly mundane things, I have been able to have a better schedule without being burnt out. And so, even as I’m writing this post, it’s during a specifically blocked off time in my calendar.

At first, I was wary of trying out this new lifestyle, since it would make my daily life much more routine and regulated. I had mixed feelings about it, since in the past it’s both helped me push through immense amounts of work, and been an ineffective burden that quickly bored me. However, the best result to come out of scheduling my time in this way was how I began to see joy in the small, routine aspects of my life. Subsequently, I realized that I was actually seeing God in the seemingly insignificant tasks that I had to do every day.

Trust in the Lord with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your paths straight. -Proverbs 3:5-6

This is a popular verse for many Christians, and I had the privilege to hear a great sermon on it a few months ago. In it, my pastor discussed the idea of our journey with God as being on a path and how paths are used for walking. Walking is a very routine process; we take left-and-right steps over and over again to reach a destination. Once you’re on a path, the only way to move forward (no cheating with other forms of transportation) is to take individual steps on the path, even though these steps seem meaningless on their own.

Similarly, when we’re walking with Christ, it’s the small decisions, attitudes, and disciplines that define this walk, not necessarily the big life experiences. In fact, these significant events help us see what we’ve become due to these small things we’ve done, and when we make decisions in big life experiences, these small steps are what lead us to have the wisdom to make those big ones. Therefore, through this experience, I’ve learned that one way to read these verses in Proverbs is this: On this path toward Jesus on which God sets us, we are called to take routine steps and follow every small discipline, so that during this walk, God can bestow wisdom upon us and guide us forward.

While there is always a happy medium between living a regulated life and living a completely schedule-less one, trying this out has helped me to see that even the smallest things I do, from checking my emails to doing laundry, can be routine disciplines that are a part of my walk with God. When I felt burnt out, it was because I viewed each of these things as less important compared to the big decisions or projects I needed to finish. But perhaps it’s not only the leaps we make, but also these routine steps we take that bring a new meaning to the idea of walking that straight path.

What Medicine Cannot Give…

Then Peter said, ‘Silver or gold I do not have, but what I do have I give you. In the name of Jesus Christ of Nazareth, walk.’

Last week, I took a seminar on medical ethics, held at Princeton through the Witherspoon Institute. The seminar explored many different topics, but ultimately converged on a central theme: physicians must know what medicine is for.

Medical imperialism is real. New technologies and advancements have given us the tools to achieve outcomes that were unimaginable before (think IVF, cosmetic surgeries, transplants, etc). In light of these technologies, the role of the physician has fundamentally changed.  Physicians are now expected to take on the roles of reproductive counselors, beauticians, behavioral modifiers, and scores of others that have varying degrees of relevance to medicine, traditionally defined. We are watching, quite spectacularly, a new Manifest Destiny unfold.

So here’s the million dollar question: is this a good thing? Should we increase in medical powers as harbingers of a brighter future? Or do we have reasons to resist a redefining of medicine?

It is important to raise the question of definitions, and relatedly, the question of limits, because merely accepting the new possibilities would inevitably lead to a sort of consumerism.  We are already seeing this. In parts of healthcare, physicians act as dispensing machines of healthcare services – the supplier that simply meets demand. And consumerism, we know, is a terrible substitute for the physician-patient relationship.

Secondly, without proper limits, medicine can become a bait-and-switch. This is especially true when patients seek what medicine ultimately cannot give. The woman who seeks plastic surgery will find that her disease was not her appearance but her insecurity. The man who demands aggressive end-of-life treatments will find that delaying death is fruitless. Medicine cannot give life, fulfillment, or love. Sometimes, it cannot even give health (the thing that medicine is ostensibly for!).

The passage in Acts is one I’ll remember in my journey through medicine. Here, Peter approaches a beggar sitting at the temple gates; the beggar is lame, and has resigned himself to asking passersby for money. Of course, money is not really what this beggar needs, and Peter tells him so (sidebar: can patient autonomy account for this kind of interaction?). Peter, rather, gives the beggar what the beggar himself has lost the ability to hope for: the restoration of his being.

That, I think, is what Christian physicians can do well – to have in mind both what medicine cannot do and what patients truly need. Both go hand in hand. In the world of ever-increasing possibilities and amidst a medical culture without a vision or language to challenge its expansion, Christian physicians can be witnesses to the Kingdom by staying oriented to the true goods.