God and Doctors
By William Hasker and Jonathan Kopel
Through relational leadership, a physician reflects God’s relational nature to heal the emotional and physical needs of patients and themselves.
The physician-patient relationship is an intimate relationship fostering open communication while respecting patient autonomy. Without this therapeutic alliance, patient confidence and compliance with treatment goals would be impossible to maintain. Traditionally, the leadership role in the physician-patient relationship rested primarily on the physician. This model, known as medical paternalism, placed responsibility on the physician to determine what treatments or choices a patient should take with respect to their illness. In this model, the physician-patient relationship is the ship; the physician is its captain.
Although this may be helpful in complex medical situations, patients prefer having shared decision making in understanding their diagnosis and treatment options. As a result, medical paternalism can cause ineffective communication between the physicians and patients, leading to poor management and coordination in a patient’s treatment. Furthermore, a patient’s satisfaction and treatment outcomes improve when leadership in the physician-patient relationship is understood to be a partnership whereby each member contributes towards a common goal. This relational leadership between patients and physicians requires an openness and mutual participation between both parties. Such a relationship resembles aspects of open theism, which challenges the theological doctrines of divine impassability and of God’s complete, perfect and unchangeable plan for our lives.
Yet, what exactly is a relation? We may initially draw metaphors from marriage or friendships to gain some intuitive feel of a relation. In a marriage, the interactions of love and unity between two individuals provides the foundation for the relationship. As within the relationship of friends, physician and patient exist in deeply intertwined relations. The physician-patient relationship requires both individuals to have unique personalities embodying their identities, worldviews, and interactions. The physician-patient relationship is subject to change and may grow or diminish. In medical practice this often occurs through patient hand-offs or referrals to other clinical departments or institutions.
A patient also exists independently whether he or she has formed a therapeutic alliance with a physician or other caregiver. Given this complexity, a relational leadership model is necessary to balance the intrinsic and extrinsic relations within the physician-patient relationship. In this model, a physician seeks to cultivate an authentic relationship with patients and healthcare workers towards achieving a common vision, connection, and interdependent action. A physician trained in relational leadership seeks to understand people’s motivations, how they acquire and utilize information, and how they influence the physician-patient relationship. An effective relational leader seeks to foster teamwork, to coach and develop, to improve self-management, and to accelerate change in an organization. Furthermore, a relational leader embraces and encourages the relations inherent within the healthcare system to foster and encourage cooperation and unity towards a common goal.
God’s Perfect Plan
But what does all this have to do with God? Of course, God is seen in the Bible as our healer and comforter, one who is very much present with us in time of illness. But how does this relate to the doctor-patient interaction? The doctor is not God, and the doctor’s role is specific and limited. All the same, ideas about the doctor’s role say something about the part patients are expected to play in their own healing, and this in turn says something about the way we should think about God’s care for us. It would be troubling if our best understanding of God and our relationship with God should urge us to adopt a stance that does not fit with our best understanding of the doctor-patient relationship.
One common, but flawed, way of thinking about this is the idea of God’s perfect plan—a plan God has for your life that will work out exactly right, so that everything turns out exactly the way God intended. But what if things don’t go so well for you? There is a saying among Presbyterians that a Presbyterian is a man who, after he has fallen down a flight of stairs, says “Thank goodness that’s over!” The fall was obviously part of God’s plan for him, so there is no use complaining about it; he is only glad it wasn’t worse!
This suggests that our approach to things that happen in our lives should be one of passive acceptance—this is just the way things were meant to be. And this resembles the paternalistic model of the patient-doctor relationship in which the doctor is completely in control and makes all the decisions. But as we have seen, it may yield better results if the patient is seen as an active participant in the relationship, using her own judgment in combination with the doctor’s superior knowledge—in other words, relational leadership. And it may be better if the Christian’s life is seen as a journey together with God, using a person’s own judgment together with the wisdom God provides. (God rather seldom issues explicit instructions as if they were written out on a sheet of paper!) So maybe God’s plan for us is best seen as open-ended, allowing for Plan B or Plan C in case Plan A doesn’t work out.
Can God Suffer?
Another point worth noticing is the traditional doctrine of divine impassibility. This means God can never be caused to suffer or to feel any negative emotion. It is meant to underscore God’s invulnerability; nothing that ever happens can diminish God’s happiness in any respect. But in relating to a doctor, we very much want the doctor to care how our treatment comes out. Even more, we expect our friends and loved ones to be happy or saddened depending on the result. Excluding God from this “circle of care,” as is done by the doctrine of impassibility, does not have a good feel about it. It’s as though we must push God away from us, lest God be compromised by being affected by our troubles! But God can’t be compromised; God is the Greatest One, who has compassion on us and suffers when we suffer, without being diminished by this in any way. Once again, there is a parallel between how we think of our relationship to a doctor, and of our relationship to God, the Great Physician.
Overall, the physician-patient relationship and personality exist as rich relational entities producing profound impacts on communication and patient outcomes. A relational leadership model provides physicians with a framework to apply a relational or open theist theology—a theology in which God interacts with human beings, sympathizes with their joys and sorrows, and maintains a flexible plan that can adjust to events as they occur—to their practice and their relationships with patients. This framework fosters deep relationships between physicians and patients by acknowledging their numerous and rich qualities. A relational understanding of physician-patient relations presupposes a relational universe, and a relational universe requires physicians to be relational in their approach to patients, in service to the Hippocratic Oath, an oath of respect for human life. This oath is itself an invitation to relationality. Through a relational leadership model, a physician reflects God’s relational nature in order to heal the emotional and physical needs of patients and themselves.
William Hasker is the Distinguished Professor Emeritus of Philosophy at Huntington University. He is the author of several books, including The Emergent Self and The Triumph of God over Evil. He is a former editor of the journal, Faith and Philosophy.
Jonathan Kopel is an M.D.Ph.D. student at Texas Tech University Health Sciences Center in Lubbock, Texas.
To purchase the book from which this leadership essay comes, see Open and Relational Leadership: Leading with Love.