Take Five: Music, Primary Care, and the Moral Limits of Time
Brewer Eberly, MD, Fischer Clinic, Family Physician; McDonald Agape Fellow, Duke Divinity School Theology, Medicine, and Culture Initiative
In Radical Hope: Ethics in the Face of Cultural Devastation, Jonathan Lear wrestles with the fate of the Crow Nation, opening with the puzzling testimony of Chief Plenty Coup: “after this, nothing happened.”
We could describe contemporary primary care as struggling to locate an ethic within a devastated culture of time—one that leaves both patients and practitioners bewildered. The more healing is hurried under time constraints, the more clinicians feel a dissonant, hopeless sense that “I didn’t have time to do what I wanted to do.” The more patients report “nothing happened.” Time is what Wendell Berry calls a “limit-in-ambush” that makes clear the boundary of possibility in our work.
Writing as a new graduate from residency in Family Medicine, I will explore how much discontentment with primary care is due to a broken moral relationship with time. Augustine confesses “I still do not know what time is [yet] I know myself to be conditioned by time.” Ecclesiastes speaks of the givenness and giftedness of time. But we’ve moved from an era of keeping time like one keeps bees to counting time like one tallies expenses. We measure time, spend time, waste time, kill time. Clinicians feel like they’re out of time, losing time, trying to find time—so they make time, manage time, hack time, and bill time. They experience time with patients as conditioned by metrics of efficiency and industry rather than the needs of the patient (“We can only discuss one problem today.”)
Drawing on physicians like Virginia Sweet, philosophers Calvin Seerveld and James K. A. Smith, as well as artists and theologians like Jeremy Begbie, I will explore how music might move primary care clinicians to recognize the moral limits of time. Drawing on Christian tradition, I will look to the attentive patience of Nehemiah, the margin of the Good Samaritan, and the timefullness of Christ. A theological aesthetic of music can complexify our understanding of what it means for something to happen, not only in a given healing encounter, but in bureaucratic systems where time is always running out.
How should we then practice? James K. A. Smith writes “discernment is a core virtue of temporal faithfulness ... having enough time is an act of hope.” How do forms of practice that break from traditional insurance-based models (direct primary care, for example) offer time to discern? How might medical trainees hope for having enough time?
The “Planck length” has been described as the smallest possible measurement of space—a unit so infinitesimal that physicists struggle to describe what it means for something to “happen” at that scale. Primary care within the world of efficient, industrialized medicine can feel like walking along Planck lengths. We struggle to make sense of our work within the units provided. And yet, physicists will point out that popular misconceptions surround the Planck length. Things can, in fact, “happen” at and from such bewilderingly small spaces—but things that require imagination, patience, and ears to hear what is possible.
We could describe contemporary primary care as struggling to locate an ethic within a devastated culture of time—one that leaves both patients and practitioners bewildered. The more healing is hurried under time constraints, the more clinicians feel a dissonant, hopeless sense that “I didn’t have time to do what I wanted to do.” The more patients report “nothing happened.” Time is what Wendell Berry calls a “limit-in-ambush” that makes clear the boundary of possibility in our work.
Writing as a new graduate from residency in Family Medicine, I will explore how much discontentment with primary care is due to a broken moral relationship with time. Augustine confesses “I still do not know what time is [yet] I know myself to be conditioned by time.” Ecclesiastes speaks of the givenness and giftedness of time. But we’ve moved from an era of keeping time like one keeps bees to counting time like one tallies expenses. We measure time, spend time, waste time, kill time. Clinicians feel like they’re out of time, losing time, trying to find time—so they make time, manage time, hack time, and bill time. They experience time with patients as conditioned by metrics of efficiency and industry rather than the needs of the patient (“We can only discuss one problem today.”)
Drawing on physicians like Virginia Sweet, philosophers Calvin Seerveld and James K. A. Smith, as well as artists and theologians like Jeremy Begbie, I will explore how music might move primary care clinicians to recognize the moral limits of time. Drawing on Christian tradition, I will look to the attentive patience of Nehemiah, the margin of the Good Samaritan, and the timefullness of Christ. A theological aesthetic of music can complexify our understanding of what it means for something to happen, not only in a given healing encounter, but in bureaucratic systems where time is always running out.
How should we then practice? James K. A. Smith writes “discernment is a core virtue of temporal faithfulness ... having enough time is an act of hope.” How do forms of practice that break from traditional insurance-based models (direct primary care, for example) offer time to discern? How might medical trainees hope for having enough time?
The “Planck length” has been described as the smallest possible measurement of space—a unit so infinitesimal that physicists struggle to describe what it means for something to “happen” at that scale. Primary care within the world of efficient, industrialized medicine can feel like walking along Planck lengths. We struggle to make sense of our work within the units provided. And yet, physicists will point out that popular misconceptions surround the Planck length. Things can, in fact, “happen” at and from such bewilderingly small spaces—but things that require imagination, patience, and ears to hear what is possible.