Cultivating Faithful Imagination for Healthcare: Christian Tradition and the Formation of Medical Practitioners
Moderator: Therese Lysaught
Panelists: Brett McCarty, ThD, Assistant Research Professor of Theological Ethics and Instructor in Population Health Sciences, Duke University; Warren Kinghorn, MD, ThD, Duke University; Danielle Ellis, Duke University ; and Ben Frush, Vanderbilt University.
Over the past several years, a growing chorus of voices have cried out ever more loudly that the world of healthcare is not healthy. They point to rates of burnout: 44% of US physicians report pervasive levels of burnout (depersonalization and/or emotional exhaustion), a rate similar to physicians in the UK, but much higher than the US working-age population. [1] They also point to alarming suicide rates among physicians, particularly among women, that far outpace those of the general population.
Discussions of the cause of physician burnout in medical journals tend to focus on increasingly regimented productivity expectations, layer on layer of routine quality measures, onerous expectations for documentation in electronic medical records, and the tendency of physicians to neglect their own self-care. [2] Correspondingly, interventions for burnout tend to center on changes to systems and structures (e.g., duty-hour restrictions for medical residents) or on individual well-being interventions (e.g., mindfulness meditation and resilience training). [3] When these interventions have been studied empirically, they are associated with consistent but marginal reductions in burnout scores. [4]
This medical burnout literature is a cause for both alarm and frustration. The very real harm that is named by burnout, both for clinicians and for patients, is a real source of alarm. But what is not being asked in the literature is a reason for frustration. Jeffrey Bishop has argued that modern biomedicine, birthed from a commitment to the body as “anticipatory corpse” and methodologically committed to the “metaphysics of efficient causation,” tends to address problems by quantifying them, reifying them as pathological entities, and then seeking technical solutions for them. [5] Medicine’s response to burnout has followed this pattern: quantify “burnout” and reify it as a concept, and then seek control over it through standardized, scalable, quantifiable, technical interventions.
These solutions, we argue, threaten to reproduce the problem. Health professions students and clinicians, depersonalized and desiccated within bureaucratic, technological health care systems, are offered bureaucratic, technological cures. But what if burnout is at least in part names a hollowness at the heart of the depersonalized, technological logic upon which modern biomedicine is built? What if burnout is not a problem in need of technical solution, but rather a symptom of the moral and human failure of a medical system that prioritizes technical solutions to quantifiable problems above all else? There is no quantitative scientific way to answer these questions, since a medicine that is myopically focused on efficient causation cannot use methods committed to efficient causation to determine the limits of its own approach. One needs resources to imagine a different way of being with those who are ill.
Medical schools and training problems have developed some efforts in this direction, such as reflection groups and narrative writing workshops that invite students and clinicians to explore and to clarify their values and to seek to practice congruently with them. But as Bishop has observed, corrective movements that arise within medical schools are often subsumed into the technical logic of modern medicine and/or presented as peripheral, elective, add-on options that are not allowed to question or to challenge the authority of the medical school and its technical logic.
In response, this panel explores the possibility for Christian tradition to play a helpful and vital role. And in particular the panel seeks to describe how theological formation of clinicians might offer an imaginative and practical response that secular medical education, based within the institution of the medical school, cannot. Christian tradition can offer medical practitioners both new ways to think about medicine, and also more faithful ways to inhabit the world of healthcare.
This panel explores this possibility through an extended case study, describing a program of theological formation for persons with vocations to health care based within a seminary with deep connections to an academic medical center. So far, forty students have come through this program, which consists of required courses and weekly lunchtime discussions serving as a language lab for learning to speak in new and faithful ways about the moral challenges faced within the practice of healthcare. Students also participate in a weekly spiritual formation group and put their theology to work through practicums at area nonprofit organizations. Through this imaginative cultivation of practices, students deepen their own sense of vocation and explore new dimensions of Christian engagement with the body. Additionally, the friendships developed among students strengthen their imaginations for the possibilities of their own vocations.
The first panelist is a physician and a theologian who will offer an overview of the problems in healthcare described above. This panelist will also articulate the need for traditioned theological responses to these problems in light of how secular responses perpetuate many of the same underlying issues. The second panelist is a theologian who will provide a conceptual overview and detailed description of the case study. This panelist will detail how this yearlong program of intensive study, formation, service, and friendship seeks to create the conditions of possibility for a particularly Christian response to these challenges and witness to a more faithful way.
The third panelist will be a current student in the program, reflecting on how their imagination is being shaped as a part of this particular Christian response to the challenges of modern healthcare. The fourth panelist will be an alumnus, reflecting on the challenges and opportunities they have encountered upon reentering the world of healthcare. The moderator will ensure that at least fifteen minutes of time remains at the end for engagement with the audience.
[1] Tait D. Shanafelt, Colin P. West, Christine Sinsky, Mickey Trockel et al., “Changes in Burnout and Satisfaction with Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017,” Mayo Clinic Proceedings, 2019, doi:10.1016/j.mayocp.2018.10.023 [2] Tait D. Shanafelt, Edgar Schein, Lloyd B. Minor, Mickey Trockel, Peter Schein, and Darrell Kirch, “Healing the Professional Culture of Medicine,” Mayo Clinic Proceedings, 2019, 94:1556-1566. [3] Larissa R. Thomas, Jonathan A. Ripp, Colin P. West, “Charter on Physician Well-Being,” JAMA, 2018, 319:1541-2; Tait D. Shanafelt, Lotte N. Dyrbye, Colin P. West, “Addressing Physician Burnout: The Way Forward,” JAMA, 2017, 317:901-2. [4] Colin P. West, Liselotte N. Dyrbye, Patricia J. Erwin, and Tait D. Shanafelt, “Interventions to Prevent and Reduce Physician Burnout: A Systematic Review and Meta-Analysis,” Lancet, 2016, 388:2272-81. [5] Jeffrey Bishop, The Anticipatory Corpse: Medicine, Power, and the Care of the Dying (Notre Dame, Ind.: University of Notre Dame Press, 2011).
Discussions of the cause of physician burnout in medical journals tend to focus on increasingly regimented productivity expectations, layer on layer of routine quality measures, onerous expectations for documentation in electronic medical records, and the tendency of physicians to neglect their own self-care. [2] Correspondingly, interventions for burnout tend to center on changes to systems and structures (e.g., duty-hour restrictions for medical residents) or on individual well-being interventions (e.g., mindfulness meditation and resilience training). [3] When these interventions have been studied empirically, they are associated with consistent but marginal reductions in burnout scores. [4]
This medical burnout literature is a cause for both alarm and frustration. The very real harm that is named by burnout, both for clinicians and for patients, is a real source of alarm. But what is not being asked in the literature is a reason for frustration. Jeffrey Bishop has argued that modern biomedicine, birthed from a commitment to the body as “anticipatory corpse” and methodologically committed to the “metaphysics of efficient causation,” tends to address problems by quantifying them, reifying them as pathological entities, and then seeking technical solutions for them. [5] Medicine’s response to burnout has followed this pattern: quantify “burnout” and reify it as a concept, and then seek control over it through standardized, scalable, quantifiable, technical interventions.
These solutions, we argue, threaten to reproduce the problem. Health professions students and clinicians, depersonalized and desiccated within bureaucratic, technological health care systems, are offered bureaucratic, technological cures. But what if burnout is at least in part names a hollowness at the heart of the depersonalized, technological logic upon which modern biomedicine is built? What if burnout is not a problem in need of technical solution, but rather a symptom of the moral and human failure of a medical system that prioritizes technical solutions to quantifiable problems above all else? There is no quantitative scientific way to answer these questions, since a medicine that is myopically focused on efficient causation cannot use methods committed to efficient causation to determine the limits of its own approach. One needs resources to imagine a different way of being with those who are ill.
Medical schools and training problems have developed some efforts in this direction, such as reflection groups and narrative writing workshops that invite students and clinicians to explore and to clarify their values and to seek to practice congruently with them. But as Bishop has observed, corrective movements that arise within medical schools are often subsumed into the technical logic of modern medicine and/or presented as peripheral, elective, add-on options that are not allowed to question or to challenge the authority of the medical school and its technical logic.
In response, this panel explores the possibility for Christian tradition to play a helpful and vital role. And in particular the panel seeks to describe how theological formation of clinicians might offer an imaginative and practical response that secular medical education, based within the institution of the medical school, cannot. Christian tradition can offer medical practitioners both new ways to think about medicine, and also more faithful ways to inhabit the world of healthcare.
This panel explores this possibility through an extended case study, describing a program of theological formation for persons with vocations to health care based within a seminary with deep connections to an academic medical center. So far, forty students have come through this program, which consists of required courses and weekly lunchtime discussions serving as a language lab for learning to speak in new and faithful ways about the moral challenges faced within the practice of healthcare. Students also participate in a weekly spiritual formation group and put their theology to work through practicums at area nonprofit organizations. Through this imaginative cultivation of practices, students deepen their own sense of vocation and explore new dimensions of Christian engagement with the body. Additionally, the friendships developed among students strengthen their imaginations for the possibilities of their own vocations.
The first panelist is a physician and a theologian who will offer an overview of the problems in healthcare described above. This panelist will also articulate the need for traditioned theological responses to these problems in light of how secular responses perpetuate many of the same underlying issues. The second panelist is a theologian who will provide a conceptual overview and detailed description of the case study. This panelist will detail how this yearlong program of intensive study, formation, service, and friendship seeks to create the conditions of possibility for a particularly Christian response to these challenges and witness to a more faithful way.
The third panelist will be a current student in the program, reflecting on how their imagination is being shaped as a part of this particular Christian response to the challenges of modern healthcare. The fourth panelist will be an alumnus, reflecting on the challenges and opportunities they have encountered upon reentering the world of healthcare. The moderator will ensure that at least fifteen minutes of time remains at the end for engagement with the audience.
[1] Tait D. Shanafelt, Colin P. West, Christine Sinsky, Mickey Trockel et al., “Changes in Burnout and Satisfaction with Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017,” Mayo Clinic Proceedings, 2019, doi:10.1016/j.mayocp.2018.10.023 [2] Tait D. Shanafelt, Edgar Schein, Lloyd B. Minor, Mickey Trockel, Peter Schein, and Darrell Kirch, “Healing the Professional Culture of Medicine,” Mayo Clinic Proceedings, 2019, 94:1556-1566. [3] Larissa R. Thomas, Jonathan A. Ripp, Colin P. West, “Charter on Physician Well-Being,” JAMA, 2018, 319:1541-2; Tait D. Shanafelt, Lotte N. Dyrbye, Colin P. West, “Addressing Physician Burnout: The Way Forward,” JAMA, 2017, 317:901-2. [4] Colin P. West, Liselotte N. Dyrbye, Patricia J. Erwin, and Tait D. Shanafelt, “Interventions to Prevent and Reduce Physician Burnout: A Systematic Review and Meta-Analysis,” Lancet, 2016, 388:2272-81. [5] Jeffrey Bishop, The Anticipatory Corpse: Medicine, Power, and the Care of the Dying (Notre Dame, Ind.: University of Notre Dame Press, 2011).