Forgotten: Prescription for Health
P. Terrell, M.D., Ph.D.
In a chorus from his
poem, “The Rock,” T. S. Eliot wrote:
invention, endless experiment, brings knowledge of
motion, but not of stillness; knowledge of speech, but
not of silence; knowledge of words, and ignorance of the
Word. All our knowledge brings us nearer to our
ignorance, all our ignorance brings us nearer to death,
but nearness to death no nearer to God. Where is the
Life we have lost in the living? Where is the wisdom we
have lost in knowledge? Where is the knowledge we have
lost in information?
In teaching medical
students and others, I have noted a limitation of thought in
what should be done about a diagnosis in a patient. In the
Western World, physicians practice almost exclusively in three
ways: we cut (surgery), we burn (radiation, electrocautery, and
cryosurgery), and we poison (pharmaceuticals). All other
treatments are considered “adjunctive.” Research focuses on
these three areas, since research is expensive and financial
incentives are concentrated in these three activities. The
older notion of a “regimen” has virtually disappeared. Some
doctors do not even know how to spell it, adding a military “t”
at the end of the word. Others stick “pharmacological” in front
of regimen as the only regimen they know. We have reaped from
this narrow conception a harvest of polypharmacy (treatment with
many drugs) which staggers the imagination at 15 to 20 daily
drugs per person in some cases -- a now uncommon phenomenon.
These three activities are also popular since each of them has
the doctor as the active agent, while the patient is usually
passive. “Hold still while I freeze this wart.” “Wait a minute
while I write these medication prescriptions.”
We now require
computers to help us remember all the available drugs, their
side effects, their doses, their costs, and interactions with
other medicines. We have masses of data at our fingertips.
Increasingly, our patients are also accessing the same data
files. Yet, with all of our getting, we have not improved our
understanding proportionate! Rather, we have avoided
understanding. These three mainstay approaches, along with some
of the “adjunctive” ones, make us think that the issue before us
is a disease. We
have forgotten that the issue is the patient.
The patient is a unity
of body and spirit. It is foolish to try to cleave neatly the
one from the other, though in the very short-term analysis, it
seems advantageous to do so. We lack wisdom -- Biblical wisdom.
We act as though a great deal of data will suffice without much
wisdom. We imagine that heaps of data will self-organize itself
into knowledge, a process that we Christians call evolution, and
our application of it in medicine has as much validity as it
does to origins of man. (Ponder that correlation, brother and
There was a time when
possessed of only a few really helpful options for cutting,
burning, and poisoning, offered something else – a treatment
regimen. It is quite an ancient practice. The patient was
actively involved. Under consideration were such matters as the
patient’s character, disposition, intelligence, station in life,
and habits. The physician would recommend a fairly comprehensive
course of action for the patient. Not being handed anything
pharmaceutical, the patient apprehended that following the
regimen was his responsibility. A regimen could be
crafted of a wide array of practices. We retain a few of these
today – diet and exercise mostly. Trying this ancient practice
through the years, clumsily and without the support of a medical
or general culture for it, I have found it well-received with
some benefit. A physician really skilled in the matter might
make it actually shine even in our culture. I suspect that
some “alternative medicine” practitioners commonly address at
least some of these issues.
Here are some
ingredients which may be pulled from the shelf to construct a
regimen beyond or instead of cut, burn, poison:
especially for others. It should not focus on the
patient’s own illness.
something useful for someone else, especially if it
can be done anonymously.
bedtime and a regular time to get out of bed. It
staggers my mind the numbers of Christians who live
chaotic lives in terms of a schedule. By so doing,
they have lost the war before they even get into
A time of
quiet reflection on Scripture, regularly, preferably
some of the nonessential noise of daily life. The
radio and television remain off most of the time.
Any programs that are watched are selected carefully
with the saints on Sunday and at various other
times, if not too impaired to do so by illness.
of communion, the more regular the better.
piece of good literature.
listening to quality and/or spiritual music.
child something – a catechism section, how to weave
a basket, how to make bread, enjoying the freshness
that children bring to life.
something new – a language, a dance step, a craft --
you can teach an old dog new tricks -- because
people are not dogs!
and training a pet.
Lord’s Day in worship, reading God’s Word, and acts
regular plan for each day and each week, with due
allowance for providential interruptions. Most of us
schedule 30 hours into 24. Again, we have lost the
war, before we get into battle.
Due care in
self-grooming. However bad you feel, you must bathe,
comb, dress. I am still amazed at what a good shower
will do for aches and pains, as well as one’s
letter to someone who has not been heard from in
awhile. Writing to someone whom you think never gets
out unused possessions -- as we clutter our houses,
we clutter our minds and our lives, and vice-versa.
daily journal for presentation at the next visit to
the physician to report on your adherence to this
memory a past relationship which needs mending and
seeking to mend it.
Somewhere in such
things is likely to be found “the Life we have lost in the
living.” Somewhere in such things, real preventive medicine may
reside. For those whose illness is intractable, there may be in
these practices a nearness to death which is nearer to God.
There may even be recovery of that wisdom we have lost in our
knowledge and data of modern medicine.
training and practice are covertly, and sometimes overtly,
hostile to such a conception of medical practice. The private
corporation which has charge of granting accreditation of all
specialty training, the Accreditation Council for Graduate
Medical Education, imagines that it has captured the essence of
what all physicians should know in six general categories.
Though it does not forbid it, I have yet to see any development
of these categories which practically implements the notion of
regimen. The diagnostic categories which comprise modern
medicine permit consideration only of the material aspects of
the issues that we face. At most, there is only a pro forma
bow to the individual and spirit who is a patient, since
these data are not suitably quantifiable. The financial
arrangements in medicine powerfully limit practices of
stillness, reflection, and broad, or “soft” interventions of a
regimen. Payment for services rendered by physicians is
connected to books of codes which discriminate in favor of
“endless invention” and “knowledge of motion.” Role models for
young physicians are lacking of practical inclusion of a
regimen. Diagnostic and therapeutic pathways in hospitals
and elsewhere are blind to these options.
Many medical ethical
guidelines instruct physicians and nurses that we should take no
notice of any defects we note in the character of our patients,
which advice is absurd. How can one treat another human being
after stripping away who he is at his most important level? How
can comprehensive healing neglect the very attitudes and habits
of thought which may lie at the root of the problem and at the
door of opportunity for relief? Bringing up habits and character
is a dangerous enterprise for a healer to undertake. I have
approached it timidly, lest I offend my patient. I do not
believe it can be quickly rubbed onto a patient like an ointment
or plunged in like a needle. Yet, introduction of regimen
in the right spirit, with the patient willing to be a
co-laborer, is usually well received. At worst is the literal or
figurative rolled-eyes. More often, there is an immediate
torrent of connections on which the patient has already been
The woman in Scripture
who was crippled by a chronic issue of blood represents a large
constituency still among us. She had used all of her money and
yet was not healed, but rather made worse by physicians. If
there is to be a recovery of regimen, soldiers in the contest
for it probably exist among those Christian patients who have
been ridden down by the commonplace, narrow biomedical model of
cut, burn, and poison. Recovery will likely arise outside of the
guild of medicine. Gifted teachers in the Church, active elders,
or some collaboration between pastors and physicians might be
one place to start, for those who see merit in regimen. It would
make a great application in a sermon on texts having to do with
ethical Christian living.