Genesis chapter one is an account of the creation story. The author says that first, God made the heavens and the Earth, next God made light and separated it from darkness and then God made water and separated it from the sky. The author continues, describing how God made the earth full of vegetation, the seas full of fish and the air full of birds. On the sixth day, “ …God created humankind in the image of God.” At the end of the sixth day, when God stepped back and surveyed all that had been created, the author tells us “God saw all that [God] had made, and it was very good.” That is it. “It was very good.” No qualifiers. No exceptions. All that had been made was “very good.” There is no mention of things going wrong or how to troubleshoot any problems that may come up. All we know is that humans were made “in the image of God” and “it was very good.”
Ever since starting my clinical rotations, I have truly marveled at how much can go wrong in the human body. Honestly, I find it miraculous that more things do not go wrong when you consider the nearly endless possibilities. For example, on my family medicine rotation, I saw people with diabetes, hypertension, elbow pain and myriad lab abnormalities. On my psychiatry rotation, I saw borderline personality disorder, schizophrenia, anxiety and depression. On my neurology rotation, I saw patients in myasthenic crisis and people with amyotrophic lateral sclerosis. On my internal medicine rotation, I saw hyponatremia, hepatorenal syndrome, Heyde’s syndrome and chronic kidney disease. On a pediatric rotation, I saw children with ventricular septal defects, total anomalous pulmonary venous return and hypoplastic left heart syndrome.
So my question for today is: where does God fit into all of this? How am I supposed to reconcile the words from the creation story describing how we are each made uniquely in the image of God when my own clinical experiences have demonstrated time and time again a less-than-perfect existence? If a diagnosis means, by definition, something is abnormal, does that mean every patient I have ever seen was not made “in the image of God?” I think not. I think there is a deeper meaning in the scripture, as there often is. Perhaps being made “in the image of God” only means that I deserve love and compassion. Maybe being made “in the image of God” means we should embrace a mentality focused on the present that enables us to find joy in daily life. Perhaps it means that all people are innately good. Perhaps it means that, no matter what, the simple fact that you exist is enough.
My goal in writing this column is simply to raise questions such as those stated above. Only you, the reader, will be able to answer them for yourself. While I recognize this is an unusual type of article to be found in a medical journal, I am firmly convinced we need more like it. We must continue to think deeply about the role that God plays in medicine. We must continue to dive headlong into the unknown and try to answer life’s many complex questions.
If we look to the not-so-distant future, I think it is entirely likely, if not probable, that technology and machine learning will exceed our human ability to make a diagnosis. For example, ophthalmologists cannot accurately predict a patient’s gender from a retinal scan alone. They succeeded at a 50% clip — no better than the flip of a coin. However, Google’s artificial intelligence can accurately predict the gender of a person based only on retinal scans with 97% accuracy. This is just one of the countless examples of how technology is poised to change the current landscape of medical practice. In the present, we are faced with an increasingly educated census of patients. Patients leave the office googling their diagnosis on the way out; too often, I find this strains the doctor-patient relationship. Patients may disagree with their diagnosis or treatment plan based on the first search result they find online. However, they often lack the background knowledge required to know if they are looking at high-quality, accurate information that pertains to their specific case. On the other hand, physicians may feel defensive that patients do not trust their judgment or feel frustrated that patients did not ask questions based on the research they had done online.
I am convinced patients treated by another human being will have better outcomes than those diagnosed and treated online or by any machine, no matter how effective those machines may be. Why? The answer, I believe, can only be described by the power of God. When the day comes that machines make every diagnosis, the only thing that will be left is for us to be present for one another as we heal. Our job will be to create a community for patients and tell them we love them. We will pray for each other and trust that God is at work as they heal. As of today, while we as physicians are still the ones making diagnoses and guiding treatment, the underlying premise behind the doctor-patient relationship is that we love and care about the well-being of each other. God is hard at work in the lives of patients as they recover from illness, whether they know it or not. So too is God hard at work in our careers as physicians, but it is up to us to recognize it.
A disclaimer — I grew up in a Baptist, Christian Faith tradition that I continue to practice to this day, and the thoughts and opinions I express in this column will obviously be biased therein. I understand that while Christianity is the only way in which I know God, this is not the case for others of different faith backgrounds, and I respect and appreciate the various Faith traditions that are integral to all our lives.
This is the first of several articles to come on this topic, all of which address a single question: How is God involved in medicine? I hope you will follow along and I hope to, at the very least, challenge how you currently see God at work in medicine. I also hope this will be an interactive column; please email me your thoughts and responses. How do you agree? How do you disagree? Feel free to recommend future topics of discussion. Many of these articles will simply be collections of my thoughts, but I hope to also bring conversations and interviews with other doctors, medical students, religious leaders, clergy, hospital chaplains and more to this forum.
Image credit: Custom image provided by the author for this Mosaic in Medicine piece.