Month: February 2016

Grander RoundsThe Lord Thy Surgeon

Where has the doctor-patient relationship gone?

“We used to treat patients. Now, we treat computers.”  Such is some of the frustration facing the 21st century doctor today.  In 2014, implementation of Electronic Health Records was mandated across the board in healthcare facilities in the United States.  This was done with the goodwilled hope that quality and efficiency would improve. Legible and easily transferable records would ultimately help the patient and decrease costs. Unfortunately, these systems have increased costs everywhere. Doctors are now less efficient because of tedious interfaces and the necessity of documenting unnecessary information.

One thing that has improved: monitoring… Now CMS can monitor doctors’ performance, and on the basis of what they’re [not] doing or documenting [in]correctly, decide their compensation.  It takes coders on both sides to determine the right codes to describe what the doctor did in order to bill correctly.  Entire degrees have been created just to become a medical coder.  What happened to the good ol’ days of seeing your doctor and just paying him what you could afford for your visit? Perhaps you could have bartered a goat or a chicken with your doctor.  Honestly, I can’t even tell you exactly what it costs to come see the doctor.  At our hospital, we have a 24 hour nurse (probably more than one) that is there just to determine whether your admission is “observation” status or “full admission” status.  Their daily job is to review the status of a patient’s admission because the hospital may be partially paid or forfeit payment if it is listed incorrectly. Have we really come so far that our job as healthcare workers is to make sure that we collect enough costs and document thoroughly so that we can keep our jobs?  I’m not against collecting money for services but it seems like we’ve lost the heart of what medicine is: The doctor-patient relationship.

Obstacles, barriers, curtains, walls.  These are what we have set between our doctors and the patient.  We have so many middlemen in the temple of healing now.  What occurred to me this week is that men are great at setting up barriers.  Our new emergency department (about 5 years old now) went to completely private rooms. There are 2 doors to enter the ED waiting area, 1 door to get to the back area of the ED, 1 door to get into the patient room, 1 door to get into the inner core of the ED pod, and 1 door still that can separate the doctor “fishbowl” from the inner core.  6 doors separate the doctor from the patient outside the hospital.  The suffering patient can be physically separated from the healer.  It is easy to see how, to the doctor, the patient could become just a name on a list in the computer, sitting in a room down the hall.  Even while in the room, the computer’s information may dominate the words coming out of the patient’s mouth or sound of their lungs in the stethoscope.  Is not being a doctor more than processing the data in a computer?  Why are politicians, bureaucrats, administrators, coders, and everybody else telling the doctor and the patient what their relationship should be? Yes, clinical decision aids are helpful in computers. Yes, legible data that is easily transmittable is good.  But have we forgotten what was basic to the healer-healed relationship?

I think the same is true in our spiritual lives.  We have forgotten the Doctor-patient relationship.  We have set up barriers to our worship and praise.  We have set up barriers in our relationship with God.  We do not want to be naked before our Creator.  We put doors between God and our transgressions.  We put gowns over our iniquities.  We put traditions and religiousness in place of intimacy.  But isn’t orthodoxy a good thing? The priests, pastors and congregation can then monitor our holiness!?… Is this the kind of relationship our Creator wants?

At first, it was from a distance. It was for our own good. The temple of Israel had regulations. God’s holiness was separated from us because He could not identify with our sinfulness.  Sin was utterly sinful and God completely Holy. To approach Him, certain steps had to be taken.  The entire book of Leviticus is filled with the regulations for worship in the temple.  Wash here, purify there, separate here, slay there, pour blood here, sanctify there.  Most importantly, separate the holy from that which is stained.  Keep them apart! In fact, “holy” means “set apart” or “to be sanctified.” How could He Who was Holiness identify with a fallen creation?  How could He possibly have a relationship with us?…It is because HE TORE DOWN THE BARRIER!

In Christ, God tore the curtain between man and Himself! (Mark 15:38, Luke 23:45, Matthew 27:51) God came in the flesh and suffered with us! He had compassion on us. Compassion is made of two words. “com-” or “con-” or “co-” prefixes meaning “together/with” and “pathos” meaning suffering.  “Path-ology” is the department we send diseased tissue.  It is “the study of suffering.”  It is He Who identified with our suffering. He suffered WITH us. He knew what the pain felt like. He was tempted in the same ways.  As Hebrews states, “For we do not have a high priest incapable of sympathizing with our weaknesses, but one who has been tempted in every way just as we are, yet without sin. Therefore let us confidently approach the throne of grace to receive mercy and find grace whenever we need help.” (Heb 4:15-16) Jesus was offered as the perfect offering to God so that we could have relationship with Him!  (Heb 9:11-25) This is the meaning of the communion.  It is the Thanksgiving offering. It is the Passover.  It is togetherness with Him.

Why do we set up these barriers? Why do we make excuses? Why do we not just turn to Him in our time of need? Why do we make everything a complicated procedure? Faith and trust is what He is looking for.  As Habakkuk says, “My righteous one will live by faith.” (Hab 2:4) And to David He said, “if My people who are called by My name will humble themselves, and pray and seek My face, and turn from their wicked ways, then I will hear from heaven, and will forgive their sin and heal their land.” (2 Chr 7:14) In Hebrews it says, “But without faith it is impossible to please Him, for he who comes to God must believe that He is, and that He is a rewarder of those who diligently seek Him.” (Heb 10:6) And to Micah He says, “He has showed you, O man, what is good. And what does the LORD require of you? To act justly and to love mercy and to walk humbly with your God.” (Mic 6:8) Should we not walk closer with Him?

John explains our relationship with Him well. “Now this is the gospel message we have heard from Him and announce to you: God is light, and in Him there is no darkness at all. If we say we have fellowship with Him and yet keep on walking in the darkness, we are lying and not practicing the truth. But if we walk in the light as He Himself is in the light, we have fellowship with one another and the blood of Jesus His Son cleanses us from all sin. If we say we do not bear the guilt of sin, we are deceiving ourselves and the truth is not in us. But if we confess our sins, He is faithful and righteous, forgiving us our sins and cleansing us from all unrighteousness. If we say we have not sinned, we make Him a liar and His word is not in us. (My little children, I am writing these things to you so that you may not sin.) But if anyone does sin, we have an Advocate with the Father, Jesus Christ the righteous One, and He Himself is the atoning sacrifice for our sins, and not only for our sins but also for the whole world.” (1 John 1:5-2:2)

Why do we continually set up barriers between the doctor and the patient? Why do we set up barriers between the Lord thy Surgeon and ourselves? A doctor must take a history and do a physical examination.  It requires talking with and touching the patient.  As doctors, we use light to see where the problem is.  It is hard to see exactly what the disease is without being in the room.  I cannot tell you if you need stitches if you don’t show me your laceration. So why is it we do not want to come into His light to show Him where our problem is? Our sin is painful. We are ashamed of it. It is the part of us that is ugly and deformed.  But the Surgeon has the healing we need if this sin is exposed to Him. He provides the sin covering in the blood of Christ  He provides the healing in the body of Christ.

Computers and technology are not bad. Orthodoxy is not bad.  The temple was not bad.  The temple was complicated.  So, let us (as doctors) get back to listening to the patient and examining them and identifying the problem. Let us stop treating computers and and go back treating to the patient. As patients, let us seek a doctor that listens to our problem and examines our iniquities. As patients, let us seek the Surgeon in prayer and seek His Word.  Let us seek the intimacy that He wants.  Let us go by boldly to the throne of grace. (Heb 4:16) Let us restore the Doctor-patient relationship by communion with Him.  It was God Himself Who established Doctor-patient relationship when He tore the veil on Calvary. (Mat 27:51)  It is God who is our Healer. He is the Lord thy Surgeon.

 

The Lord Thy Surgeon

This sentence created itself.

“This sentence created itself.” Does that sentence have any meaning? Is it correct? It is grammatically correct English. It has a subject, a verb, and a direct object. However, the sentence is utter nonsense. It has no intrinsic meaning. It has as much meaning as “A potato unhinges exuberantly on lava tree paintings.” The second sentence is nonsense because the words don’t really make any sense together. The first sentence is nonsense because by experience we know that sentences do not create themselves.

If one were to stretch a strand of human DNA out, it would be approximately 2 meters long. It would be comprised of approximately 3 billion base pairs of adenine, cytosine, guanine, and thymine. About 1.5% of that DNA would code for 20,000-25,000 proteins that allow for all of the functions of human life. The ENCODE project found that over 80% of the rest of the DNA has regulatory function and is transcribed but does not directly code into proteins that are used. The proteins are coded by 3 letter sequences in the DNA. 20 amino acids are coded to assemble the proteins. These proteins have primary, secondary, tertiary, and even quaternary structure. Meaning that these proteins are folded and combined at several different levels into their functional formations. The DNA is replicated with an error rate of 1 error in 10 billion base pair transcriptions. This is the equivalent of copying about 3,200 KJV bibles and only mistyping 1 letter. Did I mention that each of the 37.2 trillion cells in the body have this DNA folded up inside it and functioning properly? It is one of the most complex sentences that one could imagine. Did this sentence create itself?

It takes a lot of faith to believe that this magnificently well-orchestrated chorus created itself. Having just had our first child, it is nothing short of a miracle that we brought a new person into this world. Think of all the possibilities for malfunction of this biochemistry and physics. But my daughter is more than just biochemistry and physics; she’s a new person. Reproduction may be the godliest thing that we can do. But our creation is different from His creation. It doesn’t take a biochemistry or physics degree to create a baby. The machinery of life is already in place. We create from that which is already given. The substance that we live in is already present and available to create a new human being. The Bible says that God created from nothingness. He said, “Light BE.” And from nothing came everything. The Bible says, “For with You is the fountain of life; In Your light we see light.” (Psalm 36:9) Isn’t life more than cells working together? Are we not more than just meat? (“They’re made out of meat” by Terry Bisson.) Isn’t the mind more than a brain? Where does the body end and the soul begin? I wish it were so simple.

Science must start with some basic faith statements. Yes, science starts with “faith.” Let us first define two terms: science and scientism. Science and Scientism are different. Science is the study of the natural world. Scientism is the “belief” that the natural world is all that there is. Scientism believes that nothing exists outside of the natural (i.e. the supernatural). Scientism starts with this faith statement. All science must function within faith. Faith and science are not enemies. To do science, we must believe that the universe is an ordered universe. For example, if we do an experiment and we know all of the variables, the substance of the universe will behave in an orderly way.   If we repeat the experiment, we will obtain the same results. We can deduce certain principles about the universe from these experiments. We also must have the faith premise that the universe is worth studying. We believe that there is some benefit to understanding the universe around us. If the universe were not orderly and worth studying, how could we possibly even start to do science? However, would not an orderly God make an orderly universe? And on what basis can Scientism tell us that the universe is all there is? At the bottom, science has Heisenberg’s Uncertainty Principle. (In a nutshell, you can know the position of a particle or the speed of a particle but not both.) We don’t understand gravity. We haven’t found the “God Particle” or ultimate substance that makes up all the substance. We cannot know it completely because of Heisenberg’s Uncertainty Principle. (Side note: “Atom” means “indivisible. “ We are now “dividing the indivisible” and haven’t found the bottom yet…) At the bottom, we have scientists telling us about “invisible” particles because they have faith that the machines that they created are reporting correctly readings from their experiments. Nobody has ever actually seen a proton or an electron, not to speak about quarks or Higg’s bosons. We believe that these exist on faith. But there is obviously evidence for that faith.

At the top, we have only the known “visible” universe or the observable universe. What is beyond? We do not know. Science has told us many things. We have traveled the world on wings of great airships. We have harnessed electricity. We communicate instantaneously around the world. And yet as much as science has told us, it cannot tell us what is beyond what we can see with a telescope. Isn’t it true also that the things that are most important to you can’t be measured scientifically? Things like love, beauty, and goodness? Science can tell you what “is” but it cannot tell you what you should do or what is good. It cannot tell you what is beautiful. It cannot tell you what true love is, just as it cannot tell you what is beyond the edge of the 28.5 gigaparsec (or 93 billion light-year) wide universe.

And the atheist asks, “But how can you believe in God without evidence? I need evidence to believe. How can you be so unreasonable in your beliefs?” And now, they’re hooked… Is not reason the tender balance between believing everything and doubting everything? If one were to doubt everything, we would call them insane. You could not even leave your bed with so much doubt. You would doubt that gravity would work. You would doubt that your food wasn’t poisoned. You would doubt that you would float when jumping into a pool. You could not live with so much doubt. On the other side, if you believed everything, you would be paralyzed as well. You would believe that almost all food is bad for you. (Even water can be deadly in high quantities…) You would believe everything was a conspiracy. You would believe all sorts of other things that would keep you from being able to function. Reason is the stability found between doubt and belief. Reason expects some things and doubts others. Reason keeps our ship upright.

Is not “in the beginning God created the heavens and the earth” just as good of a starting point as “the natural is all there is?” (Perhaps when God said, “Light BE,” there was quite a BANG!) Science makes theories of what we think happened historically. However, science cannot rule out God. At the bottom and the top, science has no answers. Science cannot tell us what is good.   It takes a lot of faith to believe in the infinitesimally small possibility of life existing and continuing without God. A Christian’s faith is based in Christ faith.  It starts with Christ resurrecting from the dead based on the evidence. The historical accuracy of the Bible has been well studied. At the same time, the Bible is not a science book.   Based on the evidence, the Bible gives a better explanation of our experience than Scientism. Much of the science of today would not have been possible had men not believed that their Creator was orderly. It takes an orderly universe for a miracle to be possible. The resurrection defies what is natural. It is supernatural. But my belief in the resurrection is based on the evidence, not on blind belief. The evidence for the resurrection is enough for another post so I would recommend, “Who moved the stone?” by Frank Morrison for a good overview of that evidence.

Did this sentence create itself? What about the 3 billion base pair sentence of human DNA? The evidence stands high against life happening by “chance.” When I look at my daughter, it does not occur to me that she is only meat or only physics and biochemistry. She is a real person. At so many levels, the universe is amazingly complex and interesting. Is He not the God of wonders? If you want to feel tiny and insignificant, then listen to science tell you how vast the universe is and how cold and dark it will become. But you’re not insignificant. God created you and knew you before you even were. God chose us in Him before the foundation of the world. (Eph 1:4) The miracle of life is no accident. God created us in His image. (Gen 1:27) This sentence did NOT create itself.

Lord, you have searched me and known me!
You know when I sit down and when I rise up;
you discern my thoughts from afar.
You search out my path and my lying down
and are acquainted with all my ways.
Even before a word is on my tongue,
behold, O Lord, you know it altogether.
You hem me in, behind and before,
and lay your hand upon me.
Such knowledge is too wonderful for me;
it is high; I cannot attain it.
Where shall I go from your Spirit?
Or where shall I flee from your presence?
If I ascend to heaven, you are there!
If I make my bed in Sheol, you are there!
If I take the wings of the morning
and dwell in the uttermost parts of the sea,
even there your hand shall lead me,
and your right hand shall hold me.
If I say, “Surely the darkness shall cover me,
and the light about me be night,”
even the darkness is not dark to you;
the night is bright as the day,
for darkness is as light with you.
For you formed my inward parts;
you knitted me together in my mother’s womb.
I praise you, for I am fearfully and wonderfully made.
Wonderful are your works;
my soul knows it very well.
My frame was not hidden from you,
when I was being made in secret,
intricately woven in the depths of the earth.
Your eyes saw my unformed substance;
in your book were written, every one of them,
the days that were formed for me,
when as yet there was none of them.

Psalm 139:1-16