"So, what brings you in to the doctor today?"

I recently had to write a paper on the theories and models of the doctor-patient relationship. There is the paternalistic model, in which the doctor knows best and tells with patient what is wrong and dictates the care plan. There is the engineering model, in which the doctor gives the patient the facts and allows the patient to decide their own health plan. Then their is the collegial model, which emphasizes the need for relationship between the doctor and patient. It states that the doctors role is to listen, ask questions, advice the patient based on medical fact but the ultimate care plan is to be shaped by both the patient and the doctor, so that it takes into consideration the patient as a whole person, not just an isolated illness.

These all have different pros and cons, and (in my very limited experience) it really depends on the patient. In general, you (are supposed to) start with the collegial model, and adjust if you have to. The paper led me to think about the general role or job definition that physicians have. Although the obvious answer might seem to be, "heal people/improve their health," I'm learning how debated that answer is in the medical community, both in what it means and in its legitimacy as an answer to the question. A lot of the debate ends up centered around the doctor-patient relationship, and how the doctor is supposed to view the patient.

If the doctor views the patient primarily as a disease or illness, rather then a person, then the goal is simple: fix it. It might sound kind of harsh to say that these kinds of doctors don't see patients as real people, but as something to be cured, but they also get a lot more done. They see more patients a day (ie. they technically have more chances to heal), and the patient generally always receives the best care in the medical/scientific sense. Some patients seem to want this in their doctor, others don't.

If the doctor views the patient as a friend, or younger sibling, they might be really great at hearing the whole story behind the illness or injury, getting all the social/psych/family background, sympathizing or empathizing well, and maybe even sharing a personal fact about themselves. But after all of that, a lot of time has been spent and nothing has been done about the acutely medical need. Yet, a great relationship has been built, trust built, and whatever advice the doctor does give might be carried out more effectively by the patient because of that relationship. Again, pros and cons. Some patients think this is just a waste of time, others need it before they can trust the doctor.

I'm going through the gospels as my Advent reading, and its making me wonder: how would I classify Jesus' doctor-patient relationship. Sure, it gets more complicated because, well, He's the Son of God and knows people lots more intimately then I will ever know my patients. So maybe the question is more: what kind of doctor-patient relationship does Jesus teach others to have (noting the difference between following/imitating Jesus, and actually being Jesus)?

I'll let ya know what I think after I read a little more. After all, its only the second day of Advent :)

Built to Last

I am in the midst of studying for my anatomy exams, so this is just a quick thought.

When I buy something, say, a piece of furniture, or electric appliance, or article of clothing, I always hear my mom's voice in the back of my head, "you get what you pay for." And behind that little saying is the implication that things don't last forever. Applicances break, furniture gets shabby, and clothing wears thin. Sure, we can take good care of our belongings and they last longer, but very rarely do we buy something with the intention of keeping it in tact and working for the rest of our life.

As I've studied anatomy, one thing I have found so amazing about the body is that it is really built to last. Of course, we age, things go wrong, and we die, so still the physical body has its limits. (and yes, it really matters that the physical body as we know it on earth has limits, but that is a whole different topic) But in comparison to the vast majority of possessions we have, the body really is built to last a long time. What else do we use every day with so much stress that lasts for so long? It is amazing to take apart the body and see all of the tiny ligaments, tendons, joints, and muscles that hold us together. Every movement our body makes, from a long run to the slightest twitch in our sleep, relies on the fact that all these body parts are put together properly, and are doing what they are supposed to do. Individually, each of these parts are so delicate and vulnerable. I can squeeze two vertebrae in my hand with enough force to cause life-long pain in a person, but when they are inserted into the vertebral column, with all of its protections and connections, they are one of the sturdiest parts of our skeletal system. And aside from surgery, we don't really revamp our body the way we would refurbish a computer or load batteries into a flashlight. It comes with the machinery to do that itself.

Pretty cool :)

Leaf Blowers: a lot of hot air

Leaf blowers. There are probably a very select few situations in which they are appropriately used. Mostly I think they serve no real purpose and just contribute to pollution, but I suppose if you had a really really large quantity of leaves in some area, they could blow the leaves together into a pile for you to rake up more easily.

Needless to say, this is not the way leaf blowers are used typically. Every morning on the walk to school there are several men blowing leaves off of the sidewalk and into the street. Over the course of the day, the cars on the street push them back onto the sidewalk, or the staff of other businesses in the area have to deal with them (often just by blowing them back).

Perhaps you know where I’m going with this…

Why should the leaf blowers care where the leaves go, as long as they aren’t on the property that pays them to get rid of the leaves? They did they job they are paid to do. Should anything else be required? A question that at some point that all individuals and groups have to ask: Why should I/we care about anyone or anything that is not directly related to me/us? (if there is such a thing...)

The leaf blower example is over simplified, but I think it goes a long way. Not caring about what happens to the leaves, as long as it isn’t your problem, is inefficient. It gives you more work (ie. you’re not really getting rid of the problem), it diminishes the value of your work, and it creates unnecessary work for other people. I wonder how often we function like this in day to day work: simply through the routine of the work, not stopping to think about its effects. There’s more to be said about why it is important for a society to feel that the work they do has value, but for now I’ll just say that even if there is no emotional or justice-related concern for what happens to those leaves or if they actually get taken care of, it is still advantageous on a personally economic (and psychological) level to care about it.

It’s one thing to spend extra time raking up leaves, but as soon as the analogy gets extended to apply to national, international (and actually even familial) policy and practice, the situation becomes more complicated. I think this is partially due to the fact that it is harder to see and feel the personal gain that comes out of caring more deeply about the welfare of others or the quality of a particular job and how it is connected to the welfare of others.

I think that scripture affirms the notion that “your welfare is found in the welfare of others,” both in Jeremiah 29, but also more widely as a general theme. (I’m going to pull a Laura and choose not to exegete that right now). I will say though that it is a pretty dramatic command to find find one's welfare in the welfare of others while you are in exile, which was the case in Jeremiah. My own opinions on how much that philosophy of welfare, in addition to the general idea of grace, should shape and influence government and policy are in constant transition. Even if I come up with an opinion, it’s hard for me to know where to begin in terms of application. In many ways, I think addressing the topic on the level of leaf blowers is more practical, and just as biblical. At least that is how my brain is wired. Where are some practical places that small adjustments in policy and practice can be rethought to improve the value of work and move towards an economy that recognizes our interrelated welfare?

*not trying to attack the guys who blow leaves, just using them as an example.