By: Richard Gunderman, MD, PhD
IU School of Medicine 

Topics too rarely addressed in physician wellness are spirituality and faith.

Most discussions of distress and flourishing in medicine focus on physicians, medical practices, hospitals, and health systems as the sole responsible parties, presuming they alone cause burnout and that only they can take steps to reduce it.

Physicians are often blamed for working too hard, for too long, and taking too little time off. Medical practices are blamed for setting productivity targets too high and reframing medical practice as mass production. Hospitals and health systems often introduce processes that reduce efficiency and effectiveness and foment frustration.

To combat burnout, physicians are encouraged to develop interests outside of medicine and devote more time to self-care. Medical practices are advised to develop more humane scheduling practices and sponsor wellness programs. Hospitals and health systems are encouraged to examine their policies and practices from physicians’ points of view.

Yet what if burnout, moral distress, and discouragement have causes that lie outside medicine, the health system, and even human hands altogether? Suppose, for example, that true fulfillment in medicine is possible only when we acknowledge the presence of forces greater than any hu-an being or human institution?

It is no accident that the art of healing was linked throughout most of its history to divinity, including such figures as the Greek god Asclepius and Jesus of Nazareth. Nor should we be surprised that hospitals in general, as well as many specific institutions, like Methodist Hospital, St. Vincent Hospital, and Mt. Sinai Hospital, sprang from faith traditions.

The human impulses of healing and compassion – making whole what has been broken by injury or illness and reaching out to and caring for those in distress – are deeply rooted in spirituality and faith. If the creator of all is a caring and loving God, it is only natural that human beings, health professionals included, should feel called to care and love as well.

In this sense, careers in medicine and nursing afford opportunities to adopt as professions the actions that all human beings should naturally seek to do. We most fully express what is best in ourselves not by acing tests, collecting paychecks, or advancing our careers, but by making a difference in the lives of others.

I have cared for many patients who expressed deep gratitude for the opportunity to pray together. To be sure, they place their trust in the knowledge and skill of the members of the team, but they place their faith in something higher, recognizing what we all too easily forget: that health and flourishing are more than merely medical matters.

A physician may help a couple attempting to conceive to become pregnant, but no physician or scientist can even begin to create life. A surgeon may perfectly appose the edges of a wound, but ultimately it is the human organism’s innate power that heals. 

We create favorable conditions for healing, but the process itself is ultimately out of our hands.

Will a patient overcome an addiction? Will a depression lift? Will a lost soul find a new reason for living that helps guide them back to life? We can share words of wisdom, even schedule regular visits and check in from time to time to see how a patient is doing, but in the end, it is not up to us whether the patient thrives or not. 
 
Many features of contemporary health care distract us from these realities. We pretend that if only patients would comply with medical recommendations, they would recover. We blame mistakes on failures to follow established protocols and policies. We operate as though perfecting systems will raise medicine to the level of perfection.

Yet our powers are profoundly limited, a truth that should not be regarded as a counsel of despair but an invitation to gratitude and awe. We are privileged – blessed, really – to be present at signal moments in human life, not just as spectators but as participants. We see the wonders of birth and death, rejoicing and heartbreak, from inside the arena.

And there is so much to be grateful for. To pursue a profession that, by its very nature, cultivates essential human virtues, such as compassion, generosity, and wisdom. To work every day on the side of the angels, attempting to heal and comfort. And to give the very best we have to offer, even our lives, love for something greater.

Medicine is a human endeavor, but it is also part of a larger design -- something more real than any diagnostic or therapeutic plan ever devised by even the greatest of health professionals. Insofar as we stray from this plan, our gooses are cooked. But insofar as we, by grace, align with it, we can know true wonder, gratitude, and love.

Richard Gunderman, MD, PhD, is the chair of the ISMA Wellness Steering Committee.