Treasure of the Heart

[C]hurches need to talk about money. Not only the kind that members give, but how the portion that members retain is spent. Church members give something on the order of 2% or so of income. Medical care is consuming 13% of the gross national product. There is an idolatrous disproportion here. The gospel message has competition in the world, and it is measurable at a pocketbook level. Where a man's treasure is, there will his heart be also. Some of the other places in which money can be spent than on services labeled “medical care” may have as much or more actual productivity for health.


Excerpts from Physician and Pastor: Co-Laborers

Family Assistance

Often an ill person will need some sort of assistance that is not strictly medical -- financial, nutritional, transportation, information, etc. I have noted a reflex has developed within medicine to turn first to civil governmental agencies of a social service nature. While not necessarily implying that the family or church should duplicate services needlessly, I have found it illuminating to ask a patient who expresses such a need, "Does your family know about this need?" Most commonly, the answer is, "No." If I ask why not, a common response is, "They have their own lives to live. I don't want to bother them." I restrain myself, usually, from saying, "You don't seem to mind bothering anonymous taxpayers with your request that they underwrite what God gave families the privilege and duty of providing." Sometimes I discover that the reason the patient is reluctant to let their family know is some unresolved family conflict. What an opportunity! I recommend that the family be notified of the need and offer to be the one to do so. In almost every case, when I have notified a family, they have responded -- either out of love, duty, or perhaps merely because they would be embarrassed to say 'no' to a doctor.

Not only is the need met, the family is strengthened by doing what it is designed to do. The family has been instructed by the very asking of the question. We physicians are so consequentialist in our practice. If we know it won't "work" to accomplish a given end, we economize by not bothering. The problem comes when our focus is sometimes on too narrow a set of consequences. Both pastors and physicians can teach by maneuvers of this sort. We need to see if there is some way to diaconally institute it.


Excerpts from Physician and Pastor: Co-Laborers

The Parents' Job

Habits for life may be established early, for good or for bad. Are your church's parents abandoning their responsibility? Don't trust the schools to do the parents’ job. “A paternalistic state has no room for fathers.” (David Chilton) Neither leave part of it up to physicians. The orthodox practice in medicine now, including, of all things family medicine, is to hold what dependent young people say to their doctors confidential from their parents! This tenet has it that the value of that confidentiality with a doctor exceeds in health value the value of having informed parents. Explain not that parents often do not care. Of course, many do not. For those outside the church, the physician will not be able to make much of a parent. For those inside the church, the chore for such children begins with holding the parents accountable for their responsibilities.


Excerpts from Physician and Pastor: Co-Laborers

At the Deathbed

When a person knows that he is near death, there may be some final business to transact, such as those seeking reconciliation or a final word of encouragement or instruction. When nothing else physically speaking can be retrieved in a case of someone dying, sometimes something spiritual can. Teaching at the end can be potent. Thomas Hooker, a formerly well-known Puritan pastor of Connecticut, on his death bed was asked, "Sir, you are going to receive the reward of all your labours." He answered, "Brother, I am going to receive mercy." At his death, my father's last words were, "My cup runneth over." A summary for the entire family, who knows it to be true, to reflect on for ourselves. For the likes of that, in pursuit sometimes of the last full second of life, we have notably unmemorable deathbed scenes from the ICU: "Is that a flat line?" "Set it at 300 joules." "Another amp of bicarb." "Let's check the ET tube placement."


Excerpts from Physician and Pastor: Co-Laborers

Pastoral Counsel on Death

The issues of “living wills” or (the preferred) durable power of attorney for health care should not be left to the medical profession alone… Until the 1950's, the majority of deaths in the U.S. occurred in the home. Since that time dying has largely been an institutional phenomenon. Why should dying be inevitably medicalized? (It is clearly a metaphysical event. The enfolded spirit leaves the body. [James 2:26] Inasmuch as the spirit is by definition beyond the method of natural science to measure, we depend only upon indirect measures.)

Pastoral counselors, prepare your church members for the inevitability of death. Prepare them in detail. Prepare in grisly detail. The techno-wonders of medicine so capture families that the hard, needful questions never get asked:
(a) what are the prospects for recovery without treatment?
(b) what are the prospects for recovery with treatment?
(c) what is the treatment like?
(d) what is life like with treatment?
(e) What is life like without treatment?
(f) how much does it cost?
(g) what kind of treatments are available to maintain function as long as possible?
(h) what kind of treatments are available to relieve suffering?
(i) why do I have to go into a hospital? what can be done there that can't be done somewhere else?
(j) will the family and close friends be allowed access if the patient wants it?
(k) bring up the issue of “CPR” or “Code status.”


Excerpts from Physician and Pastor: Co-Laborers