The Emergency Room and the Church: A Glaring False Equivalency

This morning, I received an email from the Alban Institute.  I had subscribed to their updates some years ago, but have not bothered to un-subscribe, even though (a) I no longer have much need of them, and (b) I have very mixed feelings about whether they are on the right track concerning the future of the church. There is little doubt they’ve probably saved a number of congregations from demise, and probably saved many ordained leaders from going insane.  But whether they have any idea that church “decline” (measured in lower attendance numbers or dollars given over the last few decades) might be an indicator that the Holy Spirit wants to do something radically different with the church, is another question.  Because Alban is so invested in congregational growth–and because so many ministry training institutions are heavily invested in the Alban model (which hasn’t been working for some time, measured in attendance growth or dollars given)–I don’t think Alban is going to be able to fix much of what is wrong with American Christianity.

Nonetheless, when an essay about what churches can learn from emergency rooms appeared in my inbox this morning, I was intrigued. I’ve mentioned my experiences in hospitals numerous times, in somewhat general terms such as this post, and as a result of direct personal experience like this one.  So, instead of doing what I do with most Alban e-mails (delete them), I read it to see what Craig T. Kocher and Keith Kocher–brothers, who are respectively  a pastor and an emergency room doctor–had to say about the parallels between church and hospital.

It was interesting, but it was an entirely false equivalency. I am more than aware of the numerous times, throughout Christian history, where hospitals have been used as a metaphor for the Church.  And yet, there is a glaring discrepancy:  hospitals (at least, modern ones, which is where the doctor half of this pair works) are not places we expect people to stay for any length of time.  If that is the plan, we make sure to call them something else.  A rehab or skilled nursing facility if we hope the patient might be able to leave at some unspecified point in the future; a nursing home or hospice if the patient is likely to remain until the end of his or her life.

For most hospitalizations, however–especially the emergency room (the point of reference for the physician co-authoring the article)–the intention is for the patient to leave.  Not only leave, but leave in a relatively short time.  That might be to a more specialized care unit, or it might be to go home, depending on the severity of the illness or injury which brought the person through those big swinging doors. The goal of the emergency department is to assess presenting conditions, and to begin treatment.  It is unlikely the entire process of treatment and healing will happen in the ER. It is almost universally considered undesirable for someone to enter the ER and never leave before the end of his or her life (it sometimes happens, although usually the stay is short), or to move on to another hospital’s emergency department.  Indeed, it is a bit of a warning sign if the same person presents to different emergency rooms on a regular basis–it’s a sign of drug-seeking behavior or a factitious disorder such as Munchausen syndrome (even less do we want people bringing their children from one emergency room to another on a regular basis).  Certainly, few emergency departments are clamoring for more people to come through their doors (despite the medical co-author’s claims a busy ER has better outcomes than a slow one)  and stay long enough to form relationships and community.

My personal experiences of emergency medicine from the patient’s viewpoing (fewer than can be counted on my fingers, but still more than I’d like) have given me cause for enormous respect towards the professionals. who work in that environment. Doctors, nurses, administrators, social workers, and a host of other people, each of them doing their jobs, but working in tight co-ordination with each other, providing the best patient experience and outcomes possible in exceptionally difficult circumstances, often at dizzying speeds.

The emergency department, moreover, is not able to provide long-term care and support for any and every patient–and does not pretend to do so.  The goal is to assess, stabilize, (if needed) refer and transfer a patient to the place where s/he can get the treatment necessary, and eventually to send the patient home (directly from the ER or from some other department, or even another facility entirely) to rest and recover. The emergency department is sometimes, for simple but dramatic cases the only medical assistance needed.  Sometimes, it is the point of entry for a longer and more elaborate process of care, involving surgical or medical interventions, physical and/or occupational therapy, social services, and a host of other modalities.  The emergency room itself, however, rarely provides or performs any of these functions.

And yet, all of this–the “once in, never out” expectation, frequent attendance, bringing children, forming relationships and community–is precisely the hope of “congregational development” initiatives.  The expectation on ordained leaders–including Craig T. Kocher, the pastor half of the co-authoring brothers–is to be the expert and provider for everything needed in a person’s spiritual journey.  The pastor, in conjunction with a local congregation, is to do intake/triage, begin assessments, stabilize the “patient”, consult as the expert on the “condition”, and apply appropriate treatments.

For life.  The church “patient” is, under current systems of operation, never meant to get well and live without the guidance and supervision of the ordained clinician.  The expectation is the congregant/patient will have all of his/her spiritual needs met within the local church–or if that is not possible, by people approved by the local church.  More and more, as churches can only afford (at most) one full-time paid ordained minister, who may be very good at particular aspects of pastoral work but not at others, the needs of the congregation members cannot be met with equal competence across the range of demands. And the position-protectiveness too often fostered in church culture (started like yogurt or sourdough starter during seminary training) prevents shared ministry with competent and interested lay people, or collaborative work with the ministers of other congregations, within or outside one’s own denomination.

Contrast this to the emergency room situation.  The patient presents, needs are assessed, priorities set for treatment (both whom to treat in what order, and what each person needs).  The ER staff does what they can to stabilize, but makes contact with the appropriate providers for further care–cardiologists, orthopaedists, trauma surgeons.  As soon as appropriate, the experts take over and make arrangements for more precise care, even if that means transfer to another hospital.    And the goal is never to see you again. You can be confident you’ll be taken care of if you come back, but the goal of all that treatment is so you don’t need these people and their work on a regular basis.

At present, the idea the church has much to learn from emergency medicine is correct, but there is a false equivalency between the two kinds of institutions which means the church cannot, under its current structures and assumptions, do that learning and implement those suggestions.  But the future of the church may rely on changing its structures and assumptions

Or, it could live out the rest of its very short life in its own emergency department.

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