In his international bestselling book Being Mortal: Illness, Medicine, and What Matters in the End, Atul Gawande argues that we’ve been wrong about what our job is in medicine. He writes “We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way” (259).
It’s not only that our goal is misguided; the way doctors relate to their patients is equally problematic. He describes three different kinds of relationships. One is “paternalistic.” This is the old-school method of telling people what to do. Take the red pill or the blue pill. The doctor is authoritative, self-certain, and busy with things to do.
Another common way today is “informative.” Here the doctor is the expert who gives the patient the facts and figures and the rest is up to you. In this approach the patient is a consumer and doctors know less and less about their patients and more and more about their science. He says this is his own default way of relating to patients, which he’s trying to overcome.
Neither way is quite what people need. Sure, we need a doctor with information and a degree of control but we also need guidance, which requires a frank and honest discussion that honors the humanity and the wishes of the patient. This third way is known as an “interpretative” approach. Doctors who use this approach ask their patients, “What is most important to you? What are your worries?” (201).
The goals and doctor-patient relationships that Dr. Gawande strives for are also relevant in creating a life-giving Christian fellowship. I find it easy to become moralistic and self-righteous about things like social equality. Preaching is easy, but how do we create a community that listens to each other and endeavors to actually relate to each one of us in ways that are authentic?
One of the most revolutionary aspects of the life of the early churches was the conviction that all are empowered by the Spirit of God. Putting this conviction into practice was especially radical in the midst of a hierarchical and paternalistic society. They insisted that even those with no legal rights were to be equally included as sisters and brothers in their fellowship.
An example of how this was put into practice is when Paul sent the slave Onesimus back to his former master Philemon. We don’t know the circumstances but it appears that Onesimus ran away after a conflict and then somehow met up with Paul in prison. All three are now followers of Jesus and this makes all the difference. Paul sends Onesimus back with a letter to Philemon instructing him to receive Onesimus “no longer as a slave but more than a slave, as a beloved brother.” It’s a powerful example of how following the way of Jesus turns social relationships upside down and empowers even the least among us.
Earl, I couldn’t wait to forward this to my relatives! I hope you and Ruth are well. Happy belated birthday! – Margie