Thinking About… Incremental Care

Three months ago I read an article that has stuck with me. In our information-overload society, I usually forget articles minutes after I read them. But this particular article crawled inside my brain and curled up. Ostensibly the article was about medical treatment for migraines, but its implications were much more far-reaching. After describes the changing landscape of medical care over the last few decades, it suggests that primary care has the greatest overall impact on people’s lives. Since reading the article, I’ve been thinking about the power of incremental care like that provided through primary care physicians.

“We have a certain heroic expectation of how medicine works,” Atul Gawande writes in the article.  Subsequently, he traces some of the post-WWII medical advances (antibiotics, vaccines, surgical techniques, transplantation) that contributed to a view of medicine as interventional heroism. He admits that it was the allure of definitive surgical intervention that first attracted him to medicine and shaped his own path within the field.

However, more recently Gawande has recognized that primary care may do more good in the long run than surgery. He wanted to find out how primary care makes its impact. As he talked to primary care doctors he discovered the power of their work was tied to the relationships of trust they build with patients over years and decades. He determined that primary care physicians must be comfortable with waiting and must tolerate the anxiety of non-acute sicknesses that lack immediate remedies. In short, they are incrementalists who, Gawande says, “focus on the course of a person’s health over time—even through a life.” He quotes one migraine specialist who explained her approach with new patients: “You ask them to tell the story of their headache and they you stay very quiet for a long time.” 

Incremental Ministry

As I read this article about physical health I couldn’t help but think about a how that same principle applies to spiritual health. The very ideas Gawande explains in medical care resonate with spiritual care—the work of ministry. In ministry as well as medicine, we can harbor certain heroic expectations. It is easy for ministries to focus on the heroism of dramatic spiritual intervention like conversion stories or miraculous life transformations. But over the course of my 15 years in professional ministry I have come to realize the true heroism of incremental care in ministry. 

Spiritual growth is often slow and gradual, even undetected except when measured across a long timeline. Like effective primary care ministry depends on relationships of trust that only develop through time as anxiety is tolerated and as no immediate answers are apparent. To be effective as a spiritual primary care provider you must ask people to tell the story of their heartaches and then stay very quiet for a long time.

Quiet for a Long Time

The heroism of incremental spiritual care has a biblical precedent. Around the time when I first read this article a friend posted a few verses from the book of Job on social media. The book recounts the immense suffering Job endures, along with bad advice he receives from three friends, who are frequently excoriated for their poor counsel. However, at the beginning of the story, the friends get it right. They hear of Job’s suffering, they are moved with compassion, and they show up to care for Job. Chapter 2 concludes, “And they sat with him on the ground seven days and seven nights, and no one spoke a word to him, for they saw that his suffering was very great.” 

They stayed very quiet for a long time.

Another example of this sort of faithful presence is evident in Jesus’ ministry. In Mark 5, Jesus is busy with important ‘Son of God things’. He is calming seas and casting out demons. Crowds are pressed around him to hear his wisdom. Rulers of high influence seek his expertise in healing. In the midst of Jesus’ dynamic, high-impact ministry, an old woman, who has been chronically ill for many years and who had “suffered much under many physicians”, reaches out to Jesus. When she touches Jesus, immediately she is made well—an outcome which may make us think only of Jesus’ flair for heroic one-time intervention. 

But Mark continues the story. He tells us that Jesus stopped in his tracks. He looked around. The woman, trembling, fell down before him. And she told him the whole truth.

The whole truth. 

Twelve years of pain poured out of the woman. Twelve years of the ways she had suffered under various doctors and their various prescriptions for healing. In the midst of a crush of people vying for his attention, longing for dramatic displays of his divine power, Jesus stayed very quiet for a long time. 

Yes, Jesus is capable of dramatic one-time interventions. But Jesus also models that full healing often comes slowly, gradually, by staying with Him over the long-term. 

An Incremental Church

As I think about the next 15 years of my ministry, I’m hoping to trust the power of incremental care. I look forward to the ways that City Church will do more good in the long run by being committed to people for the long haul. Suffering with them through mysterious and undiagnosed pain. Sitting with people in their ashes. Listening as people tell the whole truth. 

We may discover that the way we are made well is by Jesus’ incremental care for us and our incremental care for each other.