The Limits of Holistic Medical Care: Why Social Context Matters for Medicine, from St. Basil’s Hospital to American Hospitals Today
Kayal Parthiban, Theology, Medicine, and Culture Fellow, Duke Divinity School
Medical teams in US teaching hospitals often consist of several types of specialists. Physicians, nurses, physical therapists, social workers, respiratory therapists, medical assistants, and more stand at the foot of the patient’s bed. This is what passes for “interdisciplinary” care, but it falls short in several ways. Physicians are burning out at incredibly high rates today, and even the best medical care cannot provide a patient with the social needs that play a critical role in keeping good health. In other words, the social context of American healthcare does not provide medical care that adequately addresses social needs. In this paper, I look at St. Basil’s hospital in Caesarea, often cited as the first Christian hospital, and analyze what makes this institution radically different from what we see in healthcare today using historical and modern sources.
The Basilea started differently from most hospitals today. With an overtly Christian mission to provide a place for the poor, the orphans, the widows, the lepers, the elderly, and the sick, Basil’s hospital situated medical care in within a hospitable social context. I will include Basil’s Sermon to the Rich to show how his Christian commitment manifested publicly in monasterial medical and social services. Healthcare today puts medical care at the forefront of hospitals, but the uninsured, disenfranchised, and marginalized still struggle to heal in these spaces. Attempts at interdisciplinary care fall short for patients that need deep social care, further revealing the limits of current medicine. In contrast stands the Basilea: with inpatient facilities, a professional medical staff, and charitable care, it certainly was a hospital. But it provided much more than clinical care because of its wider Christian social commitment for a flourishing society. I will also draw from Gary Ferngren’s Medicine and Health Care in Early Christianity and Andrew Crislip’s From Monastery to Hospital to show that how Basil’s hospital combined Christian charity, social services, and medical intervention in a creative monastic setting.
I will then argue that the limits of American healthcare do not allow medical interventions to be properly nested within charity and social services. As he traced American healthcare from its inception in The Social Transformation of American Medicine, Paul Starr noted, “hospitals had gone from treating the poor for the sake of charity to treating the rich for the sake of revenue and only belatedly gave thought to the people in between.” What made the Basilea unique from prior medical institutions was its monastic origin, where there was a focus on providing multi-faceted services in a single large institution. On the other hand, American hospitals were created to consolidate the power of physicians. This immense difference in inception serves as a point of contrast, and now hospitals and the societies within which they are sustained often fall short of providing holistic medical care. Instead of having clear practices that the Basilea outlined, the lack of a framework of social care leads to an overwhelming task for physicians as they attempt to provide clinical and social care.
The Basilea started differently from most hospitals today. With an overtly Christian mission to provide a place for the poor, the orphans, the widows, the lepers, the elderly, and the sick, Basil’s hospital situated medical care in within a hospitable social context. I will include Basil’s Sermon to the Rich to show how his Christian commitment manifested publicly in monasterial medical and social services. Healthcare today puts medical care at the forefront of hospitals, but the uninsured, disenfranchised, and marginalized still struggle to heal in these spaces. Attempts at interdisciplinary care fall short for patients that need deep social care, further revealing the limits of current medicine. In contrast stands the Basilea: with inpatient facilities, a professional medical staff, and charitable care, it certainly was a hospital. But it provided much more than clinical care because of its wider Christian social commitment for a flourishing society. I will also draw from Gary Ferngren’s Medicine and Health Care in Early Christianity and Andrew Crislip’s From Monastery to Hospital to show that how Basil’s hospital combined Christian charity, social services, and medical intervention in a creative monastic setting.
I will then argue that the limits of American healthcare do not allow medical interventions to be properly nested within charity and social services. As he traced American healthcare from its inception in The Social Transformation of American Medicine, Paul Starr noted, “hospitals had gone from treating the poor for the sake of charity to treating the rich for the sake of revenue and only belatedly gave thought to the people in between.” What made the Basilea unique from prior medical institutions was its monastic origin, where there was a focus on providing multi-faceted services in a single large institution. On the other hand, American hospitals were created to consolidate the power of physicians. This immense difference in inception serves as a point of contrast, and now hospitals and the societies within which they are sustained often fall short of providing holistic medical care. Instead of having clear practices that the Basilea outlined, the lack of a framework of social care leads to an overwhelming task for physicians as they attempt to provide clinical and social care.