Alex Bunn on faith in the workplace.

Christians are rarely persecuted in the NHS but there is increasing marginalisation of faith in the workplace. More and more we are subject to secular imperatives that are detrimental for people of faith and atheists alike.

In October 2011, CMF participated in a day conference on work and faith at All Souls, Langham Place in London. A multidisciplinary group of healthcare workers (HCWs), including psychologists, students, managers, researchers, nurses and doctors, considered the challenges for Christians, and how the gospel is good news for the situations we face. We identified several secular trends:

Naturalistic reductionism: bad news for patients

Science works by breaking big things into small ones to see how they work. But we can dehumanise patients if we see them merely as complex physiological problems to be solved. Many of us will have innocently talked of the 'pyelonephritis in bed number 5'. X-ray vision is great for diagnosis, but looks through the person and misses their godlike dignity. A recent example is Joy Tomkins, a pensioner who got a tattoo to prevent futile CPR:

Targets, perfectionism, legalism:bad news for HCWs

As a result, healthcare is increasingly task-orientated, based on a utilitarian approach to ethics. We are increasingly judged on measurable aspects of care, targets, even when they mean little to our patients. 'If you can't score it ignore it!' When a patient presents with lack of hope after a relationship breakdown, the doctor may feel under pressure to record a depression score for QOF before he really listens or makes eye contact. Micromanagement from above leads to algorithmic medicine. Hence, both the patient and professional are dehumanised by an industrial approach, mere body mechanics on a conveyer belt of 'care'.

Christians are no less prone to basing their identity and worth in their productivity, driven by perfectionism. Even worse, when mistakes are made, healthcare workers can feel the curse of a codified law, and unforgiving legalism. Increasingly patients are turning to law to take health staff to task. Whilst guidance on best practice can improve clinical excellence, it can be difficult for flawed human healthcare workers to measure up, and forgive themselves for inevitable imperfections.

These trends have roots in a rejection of the Christian story, and the God who, contrary to popular opinion, is good news in all these areas. We traced the story in four episodes:

Creation

Work is a gift of a working God (1) who desires that humankind follow in the family firm. Wherever healthcare workers bring order out of chaos we image our creator. (2) That might include helping a dying patient put his house in order, treating an arrhythmia or implementing measures that improve communication for clinical safety. God launched science when he asked Adam to name and order creation, (3) and planted natural resources to be developed. (4) Wherever we harness the potential of the world for good, we continue his work. (5) That might include choosing the right medication for contraception, cancer or depression, most of which are still modified natural ingredients. Work was always personal, working to please a loving father who was more concerned with the health of our hearts than our merit awards. (6)

Fall

But sin tore apart the family and the firm. Work today is beset by futility and frustration. (7) Every patient we see is a terminal case, and much of the time we are only partially correcting degenerative processes, merely delaying entropy and apoptosis. A patient whose defibrillator repeatedly alarms or discharges is a chilling reminder that we are all living on borrowed time. (8)

Redemption

Yet the Bible uses a wonderful obstetric image to show how even now God is working:
'We know that the whole creation has been groaning as in the pains of childbirth right up to the present time. Not only so, but we ourselves, who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for our adoption to sonship, the redemption of our bodies.' (Romans 8:22-23)

Despite appearances, God does have purposes in a groaning and degenerating world. He is making a people for himself, and he delays out of mercy, as he holds out the offer of relationship with him through Christ, and renewed resurrection bodies. As we work in the gap between a broken world and a gracious God, we might even experience the privilege of the 'fellowship of sharing in Christ's sufferings', 'filling up what is still lacking as regards Christ's afflictions'. (9) Just as he shared the suffering of creation, Christian healthcare workers may be called to participate in our patients' suffering, and overcome it in some measure, that we might also share glory.

Future hope

How does this affect our work in the NHS in the meantime, and how is the gospel better news than the secular alternatives above? Firstly, contrary to naturalism, we are not merely hairless apes with degenerative diseases. We came from eternity and we have a future there: 'It is a serious thing, to live in a society of possible gods and goddesses, to remember that the dullest and most uninteresting person you talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship, or else a horror and a corruption such as you now meet, if at all, only in a nightmare. All day long we are, in some degree, helping each other to one or other of these destinations.' (10)

Secondly, we can put targets in perspective. Managers use algorithms because they set a high standard for care. Whilst the law is good when it restrains evil, ignorance or laziness, it doesn't change the heart. As Paul pointed out, the law is only weakly therapeutic, but it is certainly diagnostic of our fallen and needy state. (11) Legalism and perfectionism are natural reactions to our failures, and even high fliers feel the need to prove themselves:

'Every time I accomplish something I feel like a special human being, but after a little while I feel mediocre and uninteresting again. I find I have to get myself past this again and again. My drive in life is from the terrible fear of being mediocre. I have to prove I'm somebody (Madonna).

But thankfully our Creator is not a slave driver manager who expects perfection. Rather he is the God who releases his people from slavery, literally in Egypt, and now Christ's work releases us from the fear of law and the need to prove ourselves. 12 In fact there's nothing we can do to make him love us less, because he already sees us as we are. And there's nothing we can do to make him love us more, because he loved us first in Christ. The gospel is good news!'

So we are called to please God not appease God. He is not a utilitarian obsessed with measurable outcomes but a loving father who asks for faithfulness, not success. As the Puritans put it, our God loves adverbs: will we follow him faithfully, expectantly and lovingly, whatever the outcome?