Hilton P. Terrell, M.D., Ph.D.

In a chorus from his poem, “The Rock,” T. S. Eliot wrote:

“Endless 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 sister!)

There was a time when Western medicine, 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:

  1. Prayer, especially for others. It should not focus on the patient’s own illness.
  2. Doing something useful for someone else, especially if it can be done anonymously.
  3. A regular 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 battle!
  4. A time of quiet reflection on Scripture, regularly, preferably daily.
  5. Memorizing Scripture.
  6. Reducing 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 and spiritually.
  7. Worshipping with the saints on Sunday and at various other times, if not too impaired to do so by illness.
  8. Partaking of communion, the more regular the better.
  9. Reading a piece of good literature.
  10. Singing and listening to quality and/or spiritual music.
  11. Teaching a child something – a catechism section, how to weave a basket, how to make bread, enjoying the freshness that children bring to life.
  12. Learning something new – a language, a dance step, a craft — you can teach an old dog new tricks — because people are not dogs!
  13. Caring for and training a pet.
  14. Keeping the Lord’s Day in worship, reading God’s Word, and acts of mercy.
  15. Having a 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.
  16. 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 feelings.
  17. Writing a letter to someone who has not been heard from in awhile. Writing to someone whom you think never gets any mail.
  18. Throwing out unused possessions — as we clutter our houses, we clutter our minds and our lives, and vice-versa.
  19. Keeping a daily journal for presentation at the next visit to the physician to report on your adherence to this regimen.
  20. Bringing to 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.

Present-day medical 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 considering.

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.