Every doctor has angry patients. But it’s especially difficult when they are angry at you. I know others have been dissatisfied with my care, but no one was more direct than a woman who told me that she was discharging me as her doctor. She would seek care elsewhere, she said, because despite my efforts to treat her, she still had pain. As I wondered what I could have done differently, I knew that she deserved more than I was able to give her. A major obstacle in this case was that she was uninsured-many medications were too costly to prescribe, and I could not refer her for a surgery that almost surely would have helped her.
Injustice in health care is a question I ponder regularly in caring for those who are mostly poor. But it has forced me to ask another question: “What can we reasonably expect healthcare to do for us?” Even if I were able to obtain every available service for my patient, I could not guarantee her freedom from pain. I could not promise her satisfaction. In my experience, even with the best of hopes and intentions, and despite modern preconceptions to the contrary, I have found that our needs and expectations for care of the body always exceed what is possible. If this is true, is there is anything we can reliably hope for in health care? And what might it look like to live faithfully in the resistant gap between what we have and what we hope for?
Ideal vs. Reality
When sick and in fear of what will happen, ideal health care would be available where you are, given when you need it, by caregivers who know what you need, because they both know their craft and know you. They would choose your care based on value, not cost, and continue to care for you until it is no longer needed. In short, we would have found a care we can trust, because it is competent, unaffected by limitation of resources, and delivered personally in response to our unique needs. That is a Blue Cross/Blue Shield (pardon the branding) guarantee that anyone would accept. (Please notice that promise of a good outcome is not included.)
The reality, as we know, is quite different. For most of the world, it is not even close. At the time I lived in the Democratic Republic of Congo (then Zaire) the country spent little more than $1 per year for a person’s health care. With limited public health to ensure clean water, little access to primary care, and few doctors and nurses to care for the population, then, and still today, children younger than 5 die daily of preventable illnesses while many others succumb to diseases that would easily respond if treatment were available.
In the resource-rich environment of North America, we have the ability to spend more on health care than any other nation—yet the majority still lack many elements of our ideal model. Most of our health care is unattached from and unaware of the community where we live. It is often given by people who do not know us, and rarely do they stay through the course of our illness. Concern over who is paying enters into health care decisions with increasing visibility, as co-pays and deductibles increase for the patient, and health insurers demand greater performance for pay from providers. Yet most patients still come to the encounter with strong expectations for good outcomes irrespective of the condition. The whole situation fosters an environment more like a contract for delivered goods than a covenant of care based on trust and relationship.
Who Will Give Us What We Need?
I can think of one time when ideal health care happened. There was a man attacked and beaten up at the side of the road. He was stripped of his clothing and left nearly unconscious. One traveler, among several who passed by, was deeply moved when he saw him. After approaching the man, he began to treat him with the health care resources he had available. He brought the man to a facility for rest and further treatment. After arranging for his care, he promised to return, offering to reimburse the “provider” for any further costs.
Philospher and theologian Arthur McGill, in his exposition of this well-known passage in Luke 10:25-37, explained that the Good Samaritan’s response to the injured man—what each of us would desire if ever in such need—represents a quality of care beyond reasonable limits. Besides binding the wounds, he pours on oil and wine, precious commodities of this man’s world, akin to the most expensive dressings we would now use on open wounds. He takes the man to the inn, but since the man cannot walk, he sits him on his animal, while he most likely walks alongside. At the inn, he cares for him all night as the need requires. And in the morning he offers the unthinkable: “Whatever more you spend, I will repay.” In the midst of all this care, as McGill wisely perceived, we see the single-mindedness of the Samaritan—all his actions are focused unconditionally on the needs of the injured man.
By bringing up this story, I am not suggesting that the health care systems we create can ever give this care. But the parable shows that our hope for such care comes from deep within us. It is not surprising why our failure to create what we really need is so frightening to us, or that our health care debates produce more heat than light. We crash upon the rocks of our dilemma—the chasm between our deepest needs and the reality of our limited world. Reduced to our expectations that this world can give us this care, we end up unfulfilled and angry; even worse, we become demanding, to the point of caring little for others as we fight for our right to the health care we want. In this zero-sum world dominated by fear, taking and holding rather than receiving and giving, we are destined to fail having any “always” that we can depend on in health care.
‘Always’ in Health Care
I do believe we should expect more from the health care of our day. But it can never be what the messages of our culture tell us we should have. Countering the noisy cacophony of demand and promise that surrounds the modern medical agenda is the quiet wisdom of nine simple words of old: “to cure sometimes, to relieve often, to comfort always.”
There was a time in the Golden Age of Medicine, as advances in technology in the 20th century were completely altering the landscape of disease, when we wondered if we could cure always. The dominance of chronic diseases in the 21st century has burst that bubble. Our more recent efforts at pain control, admirably led by the hospice and palliative care movement, at times has acted as if we can always relieve. This premise must also fall before the inevitability of pain and suffering and, despite diligent efforts that should never be abandoned, the impossibility of alleviating all pain. Beyond these good pursuits, one “always” still remains—to comfort.
In the limitations of this world, there is little we can guarantee. Yet we can always ask, “Who is my neighbor?”—not as the lawyer asks in the parable, but as hopeful inquirers at the end of the story who have seen what the neighbor did. Is there anyone I can depend upon no matter what the circumstances? Arthur McGill taught:
Who will take care of me in my need in this way? Not my landlord, not my banker. Not my policeman. Not my doctor. I have to pay them for care. I have to earn their care. Where can I find a Good Samaritan? . . . The answer is clear. Who in the New Testament is present as the one who loves us without stint? Who gives up for us, not only his time and effort and money, but who also gives up his life for us? . . . The Good Samaritan is Jesus Christ. He is our neighbor.
To know there is an unlimited source of care in Jesus Christ gives me hope for health care today. Not only that I can depend on his care for me. But that each one of us, if we accept his care for our deepest needs, will no longer demand this perfect care from the systems we create. Better able to ask for less, perhaps we might be empowered to give more.
Here lies that common paradox—the love we need becomes the love we give, able to love because he first loved us. Beyond the good of the most professional and competent health care available both now and ever, the hope for a “comfort always” in health care will only happen if all of us who need it can also give it.
And so the parable of the Good Samaritan concludes. Jesus Christ, the Good Samaritan, is the one we imitate in our love, the one who will repay us for all the care we expend on behalf of others when he comes in clouds of glory. The comfort we seek becomes the comfort we give, making possible the one “always” in health care.