Show Notes
What happens when the deep questions forged in exam rooms, hospital corridors, and long nights on call are brought to the forefront? In the modern medical economy, clinics and hospitals have become fast-paced hubs of technical performance, where patients and practitioners alike can easily feel reduced to mere commodities.
Healthcare professionals are suddenly being asked to carry overwhelming physical and emotional workloads, leading many to suffer from severe compassion fatigue.
The question is no longer whether our medical systems can cure physical ailments, but how practitioners can sustain their own humanity, empathy, and faith in the process.
In this follow-up Q&A episode of Nuance, host Case Thorp welcomes back gastroenterologist, professor, and author Dr. Mark Topazian to answer real-world questions submitted by practicing physicians. Dr. Topazian pulls back the curtain on the realities of clinical life, sharing insights on everything from unexpected miracles to the practical role of prayer at the bedside. From surviving 12-hour shifts to navigating the dehumanizing aspects of modern medicine, Dr. Topazian explains how to connect with God’s presence to mitigate burnout.
Through their discussion, Dr. Topazian helps listeners see how a mature, Christian worldview can withstand the intense pressures of a modern healthcare culture.
📚 Episode Resources:
Healing Purpose: Finding Satisfaction in a Healthcare Career by Dr. Mark Topazian – www.ivpress.com/healing-purpose
InterVarsity Press – www.ivpress.com
Nuance is a podcast of The Collaborative where we wrestle together about living our Christian faith in the public square. Nuance invites Christians to pursue the cultural and economic renewal by living out faith through work every facet of public life, including work, political engagement, the arts, philanthropy, and more.
Each episode, Dr. Case Thorp hosts conversations with Christian thinkers and leaders at the forefront of some of today’s most pressing issues around living a public faith.
Visit wecolabor.com for resources, events, and more.
Episode Transcript
Case Thorp
One of the marks of a serious book is that it does not close a conversation, but rather it opens one. Well, after reading Dr. Mark Topazian’s book, I reached out to a number of physicians that I know, that I trust, individuals who are practicing medicine in hospitals, clinics, academic settings. I asked them to reflect honestly on Dr. Topazian’s argument in his new book, Healing Purpose: Finding Satisfaction in a Healthcare Career. I asked them to think about Mark’s arguments and to offer their questions, not theological hypotheticals or things to publish in a journal, but the questions that are forged in exam rooms, in hospital corridors, long nights on call. And so today’s conversation is shaped by those voices. Welcome to Nuance, where we seek to be faithful in the public square. I’m Case Thorp. Mark, welcome back, thank you.
Mark Topazian
Great to be here, Case. Thank you so much for the chance to talk with you.
Case Thorp
So Dr. Mark Topazian, as I mentioned, is the author of this book, Healing Purpose, by InterVarsity Press. And he has a long career as a gastroenterologist, a professor, and an author, with training having been accomplished at Yale and the Mayo Clinic. Now, his work grows out of years of engagement at the intersection of theology and professional formation in the healthcare system. He’s been trained to think carefully about vocation, meaning, and moral formation, and passes along that wisdom to us. So I appreciate this. Now, Mark, last time we explored a number of the elements of your book, how to, as a clinician, explore and understand the spiritual state of your patients, how to be attentive to the Lord at work all around you. Well, so like I mentioned, I have asked a number of doctors that I know to give me some questions. So are you ready?
Mark Topazian
Sure, let’s go for it.
Case Thorp
All right, so from a retired cardiothoracic surgeon, a dear friend and a wonderful supporter of The Collaborative, he asks, what’s the most spectacular, unexpected cure in one of your patients and its explanation?
Mark Topazian
Yeah, wow. Well, I don’t know, I’m guessing a cardiothoracic surgeon might have something more spectacular to tell me that you should ask him to come on the podcast. I would say that in general, to me, the distinction between miracles and non-miracles is I’m not sure I completely accept that distinction. So that’s the first thing I’ll say.
Case Thorp
Tell us more about that.
Mark Topazian
I think that I have seen a number of things in my career that are medically improbable. And especially working in low resource situations, I have seen where we’ve had to improvise to try and get something right for a patient. That wouldn’t be the case in America, a very resource-rich place, but I’m just talking about the bits and pieces and equipment and medicines and tests that are available.
Case Thorp
Yeah, because you’re serving actually right now in Ethiopia.
Mark Topazian
Yes, I am, and I’ve worked in multiple Sub-Saharan Africa settings. And you know, there’s just times when you think, okay, let’s try this, and it actually works. You can say to the patient or their family afterwards, God has done something really special for you. And that’s a heartfelt statement. And so it’s the improbable. You know, I’ve seen in my career a couple of tumors disappear. Praise God. Is there a possible natural scientific explanation? There may be. Does God heal through the laws of the universe sometimes? I think probably so. Yeah, those would be my examples.
Case Thorp
I do believe in miracles and I have seen them over the years. I was quite moved when in Madagascar a number of years ago that the various churches there will have what’s called a “toby.” And a “toby” is a structure behind the church where you were to bring friends and family for healing.
And this structure will have a number of apartments, so to say, rooms to keep individuals over a certain term of period. They have a medically trained nurse on staff to help administer medicines and keep track of things. But several times a week, the elders from the church come and walk from room to room and lay hands and anoint with oil to pray God’s healing on this individual. And I’m a little suspect, of course, coming in with my Western, empirically trained and formed mind, and yet my heart is rooted in the scripture and I know that it happens there, so it’s possible. And we heard testimony after testimony from both the patients as well as their family members to say, we’ve been everywhere, and it was only after coming here that our loved one was helped with this combination of both medicine and the healing work of God. Wow.
And what got me is how even a “toby” is kind of structurally part of this massive denominational system. Like you have a women’s ministry and a Sunday school, you have “tobys.” They just are normal. And that was powerful.
Mark Topazian
Well, and I do think, to follow up on that, that the occurrence of spiritual healing that’s based in spiritual intervention rather than medical or technical intervention, I think that this is a phenomena that happens more in some places than others, that, let’s say, more in some times than others, and that it’s oftentimes part of God’s work breaking into a culture. Surely, my friends who know the history of the Protestant movement in Ethiopia will tell you that here, 70, 80, 100 years ago, the supernatural miraculous healing was a routine event in churches.
Case Thorp
For sure.
Mark Topazian
Perhaps not so much anymore. And why? What is the Lord doing there? I don’t know. But I do think that that is true, that in some places and cultures and periods of time, this may be a commoner or less commoner phenomenon.
Case Thorp
Well, in my travels and partnership with mission work around the world, it’s our Western empirical view that does not leave room for the miraculous and the work of God, whereas you go in some other places, especially that are so resource-poor, people are desperate, and so they are much more open and eager for God to intervene. And it’s more visible. It’s more visible.
Okay, next question, who is not a surgeon but a cardiologist. He asks, how does a Christian health professional avoid or deal with burnout in today’s world? You mentioned a term in our last episode, compassion fatigue.
Mark Topazian
Compassion fatigue. Yeah. So compassion fatigue and burnout are related, and people define these terms a little differently. But let’s talk about compassion fatigue.
It’s a complex phenomena and it’s very common in healthcare. During the COVID epidemic, surveys showed that in some surveys over 90% of working healthcare professionals were suffering from compassion fatigue. And it’s a major reason why there’s an exodus of healthcare professionals from the field. People are quitting, or they go into administration or somewhere where they don’t interact directly with patients. So it’s a really important issue around the world and certainly in American healthcare right now. And it’s a complex phenomena. We talked last time that we’re body, souls, and spirits, and it’s true of us healthcare workers, we are body, souls, and spirits. And there’s definitely a physical limitation component to compassion fatigue. We know that work hours are particularly important. If you’re working too many work hours, you can sustain that for a week or a couple of weeks. But if it’s the routine, month after month, you will end up in a place of compassion fatigue and burnout.
Case Thorp
Right. Okay, explain this to me. I’ve never understood why, especially residents, they let the ER doctors do 12-hour shifts. I mean, I don’t want an emergency on somebody’s 11th hour.
Mark Topazian
Well, I don’t quite view that one that way. Most emergency physicians I know will work three 12-hour shifts a week. So that’s 36 hours in the week. And I think that’s quite doable, frankly.
Case Thorp
Okay, I’m sure there’s studies on this, it makes me think after 12 hours you’re too tired.
Mark Topazian
Well, but you’ve had a day of rest before, a day of rest after, and they’re not all working 12 hours. Sometimes it’s 10 hours or occasionally eight hours in emergency medicine, I think. But it’s more the cumulative number, at least the science says it’s the cumulative number of hours in the week. And the limit for different people is different. It’s not like it can tell you here’s the exact number. But you can look for all the spiritual solutions in the world, but if you’re working way too many hours a week, long term, or you have more responsibility at work than one person can reasonably handle, you’re going to be compassion fatigued. And so those elements shouldn’t be minimized at all, Case, but you can get all those things working right and you can still have compassion fatigue. And because there is a spiritual dimension to it, compassion fatigue is the weariness that builds from the constant exposure to difficult situations and the giving of yourself to others. And it’s the feeling that the satisfaction you get from taking care of people is outweighed by the fact you have nothing left to give. And the diagnostic signs of it are irritability, quick to become angry and frustrated, loss of a sense of purpose and meaning in my work. What I’m doing seems increasingly meaningless. Loss of interest in the rest of life outside of work. These are very common sorts of symptoms of compassion fatigue.
And there are actually online tools. You can go and do an online survey and figure out if you have compassion fatigue. And that’s something I think very relevant to pastors actually as well as to healthcare workers. A lot of the same issues apply. So there are a number of faith-based tools that can help with compassion fatigue. And we even have some data, scientific data in medical literature that faith-based approaches help with compassion fatigue. And for Christians, those include integrity, they include lament, they include the use of scripture in your own life in a clinical context. They even include seeking in the midst of your fatigue a new experience of God. And the reason all of those strategies, which we could talk about work, is that God is the source of compassion.
The first verses of 2Corinthians tell us that God is the source of compassion, and with the compassion we receive from him, we’re able to show compassion to others. So we are conduits of compassion. We are not generators of compassion. And that’s why being able to connect to God at work mitigates compassion fatigue. Like I said, if you’re working too many hours, you’ve got to deal with that, et cetera. Being able to connect with God takes a burden off your shoulders in the middle of a stressful situation and puts the burden on His. And the Spirit in real time will bless you with his love. And that in turn gives you love to show to others. And we have, again, scientific evidence that when we work in healthcare, when we’re motivated by compassion, which is a caring concern for others, when we’re motivated by compassion, we get a lot more satisfaction from our work than if we’re doing it just because it’s our job. So the spiritual element, it’s very helpful. For me, scripture memory has been a part of this. So there was a time in my life when I, a spiritually dry time in my life, Case, where I just felt that, you know, I felt some distance from God and from spirituality. And out of frustration, I decided to try memorizing scripture. When I was a kid, I would memorize the verse of the week on the way to church so I could recite it in Sunday school and get a candy and then I would forget it on the way home.
So memorization was never all that big a thing in my life. But kind of mid-career, out of frustration really, I read the Bible and there was never anything that was speaking to me. So I started memorizing in Philippians and I thought maybe I can memorize a whole chapter.
So I printed out the thing on a piece of paper and about the only time I truly had to myself away from a beeper or anything else was when I was jogging. So I would take the piece of paper with me jogging and try and get one phrase down. And it took me, I don’t know, a month or two to memorize that chapter. And then I kept going. So one day I was in an interventional procedure with a patient. I mean, they’re out, they’re asleep, I’m doing endoscopic surgery on them, and there’s a problem. Things are not going according to plan. And so, you know, this happens in healthcare, and there’s a strategy to deal with those moments, and I’m working through the strategy, and it’s just not helping. And it’s a problem. And a very natural reaction at that time is either to get angry, or to get frustrated or to look for someone else to blame, but none of those are actually helpful in that situation.
And I had been memorizing Philippians 4 at the time, and so I’m looking at this technical problem. My mind is full of the technical problem in front of me, and all of a sudden, clear as day, these words are in my mind, “Rejoice in the Lord always. I will say it again, rejoice. Let your gentleness be evident to all because the Lord is near. Don’t be anxious about anything. But in every situation, by prayer and petition, with thanksgiving, present your request to God.” And it was just there in my head. I wasn’t looking for it. And wow, that was such a powerful experience for me. And I don’t think anyone else in the room realized it. It’s just going on in me. But all of sudden there was peace and clarity. And that’s what I needed right then. And that was such a remarkable experience for me, and it became a recurring theme actually, and has been to this day in my practice, when those moments come where things are not going according to plan. And frankly, that’s what you want in your doctor. You want someone who’s gonna have peace and clarity in those moments. And it’s such a blessing to me for that to have happened in my life. But it came through having decided to just try memorizing. So I think there’s a lot of pathways to get to what we’re talking about.
Case Thorp
I love that, partly because I have attempted, and I’m not very successful with, Scripture memory and I’ve always thought, okay, if I get imprisoned in another part of the world, I hear about those missionaries in tough situations and God’s Word just flows, flows, flows and supports them. And I think, well, I’m not going to have that. But what I will have are hymns. The wonderful hymnody that is deep down and so I imagine myself in a jail just singing at the top of my lungs, Be Thou My Vision. So there’s a lot of scripture in hymns.
Mark Topazian
Nice. Yeah, there you go.
Well, I relate to that because I know that if I’m on my commute to work, if I listen to some praise songs, it is likely that some snatches of that will come to mind during the day. Almost subconsciously, there’s a little humming. And you’re busy in healthcare. There’s no time to sit and meditate, have lengthy prayer.
You’re just busy all day long, but if you’ve sort of prepared yourself in a way, if you know the hymn, if you’ve listened to some music on the way to work, if you’ve been memorizing scripture, I mean, then it’s amazing what these things can actually do at work.
Case Thorp
Okay, you mentioned prayer. This next question comes from a pediatrician and he asks, what role does prayer have, if any, in the doctor-patient relationship?
Mark Topazian
Yeah, that is such a beautiful question. And I’m going to answer it as a doctor for adults. I’m an internist and gastroenterologist. So the question’s coming from a pediatrician, and that puts an interesting slant on it. And I might have to say we’re going to have to go back to your friend to hear more about the pediatric side of that. But let me speak as an internist and gastroenterologist.
I would say that prayer is an important tool in encouraging our patients’ spiritual health. And that most Americans believe in God or higher power. Most Americans who have a serious or chronic health condition are asking themselves questions about the meaning of that illness, what we might call spiritual questions.
Some of them are dealing with what we talked about last time, religious struggle, right? So I think prayer can often be appropriate and helpful to our patients. But that’s true for patients who are interested. And I think that if we’re going to offer prayer to our patients, it should be with their permission. We should be offering the prayer with sensitivity and respect. And it should be about the patient’s need and what’s going to help them and not my own compulsion to pray. So it’ll depend in part on what I learned from taking a patient’s spiritual history. And we talked about that last time. But if I find out that spirituality is a part of my patient’s life or it was in the past, maybe long ago, and now in this health situation it’s kind of coming up again, then I may offer prayer, and especially before an interventional procedure, because I do a lot of that. I find that it’s, among other things, it’s an antidote to fear, because faith is an antidote to fear. The Bible makes that very clear. And so a couple of examples.
In a procedure room, patient lying on an operating table, there’s pumps, medicine pumps beeping, it’s a little cold, the nurse is getting the patient a blanket, and the patient looks up at me and says, Doctor, I’m afraid. And more people think that than say that, but I’ve had patients say to me, Doctor, I’m afraid. And what I will say in that setting is, I want you to know that we have a great team here to take care of you today. And we’ve all done this many times before. We’re really good at this, and we’re gonna do everything we can to make it turn out well for you. And I also want you to know that I believe in God, and I think God is here, and He loves you, and He’s here with you. And if you’d like, if it would help you, I’d be happy to pray with you. And you know, that patient who says to me, I’m afraid, they’re always gonna say yes.
The other times that I’ll offer prayer is just if I have a sense for spiritual turmoil, spiritual distress, or if the spiritual history has told me this patient sees the spiritual side of things. And this is a, they’ve reached a critical point, be it an intervention or a decision about treatment. And then, some of my colleagues will say to their patients, is it okay if I prayed with you? And personally, I’m not a big fan of that way of asking, because I think that’s more about me and what I want to do. I much prefer what I learned from a colleague, which is to ask, would it help if I prayed with you? Because I want it to be about the patient and what’s going to help them. It’s not about me and my need. I also, I don’t want them to feel like an object being prayed over. I want them to actually feel like a participant in the prayer. Now, often a silent participant, you know, I think prayer for some of our patients, it’s an opportunity to start wading into the ocean of faith, trying it out, you know, even if they’re distant from faith or they’ve left it behind in the past, or they’re asking themselves questions about spirituality, it’s a chance to put their toes in the water. And so I don’t only offer prayer to people who I know share my faith, but I try to always, I let the Spirit prompt me about when to ask. I’ve tried to get my 3D glasses on about who my patient is, and I ask, and I want it to be about the patient, what they want, what’s going to help them. And then when I pray, I try and pray using the lament form.
And so the acronym I use for that is TREAT. Tell God your complaint. Remember his past love and faithfulness. That’s the RE. Remember. Ask boldly for help. That’s the A. And then the last T, trust in God. So these are common elements of lament in scripture. And so I don’t claim healing in prayer for the patient. I don’t make any promises in prayer, if you will, about what’s going to happen. But I’d love to give you a brief example here.
If the patient says yes, it would be great if we prayed together. I’d say, OK, let’s do it. “Lord, Mrs. Smith is here today because she has to have this tumor removed or because of this chest pain she’s having, whatever it is. And that’s the T. And then R.E., Remember, Father, I know you’ve been with her through life. And even when she hasn’t been aware of it, you’ve been providing for her and you’ve brought her this far. And you’re so good, you’re so good. So we ask you to be present today. We ask you to give us success. I ask you for wisdom as I’m working with her today. And we both trust in you. We put this in your hands. That’s the final thing, the final T.
So in my own life, I find that if I pray a lament about some issue rather than just asking God to fix it, then there’s a peace that comes. Because when you pray a lament, you not only bring the issue to God, but you align yourself with him, you remember his faithfulness, and you put your trust in him. So when I pray with a patient, I’m also trying to use that format.
Case Thorp
So good, so good. Okay, next question from another pediatrician, actually my own children’s, and he asks, what aspects of our US healthcare system are uniquely dehumanizing to both patients and practitioners?
Mark Topazian
Well, first off, I would say that our system is not all dehumanizing. Our healthcare system in the US is full of compassionate people who went into healthcare because they wanted to help people. And so I think more often than not, that’s the case. So I would push back a bit on saying we’re treating people like robots. But there is…patients can feel like they’re on an assembly line, that they’ve been reduced to their physical condition. And that is a real issue. I think in part it’s because we’re so good at what we do. I mean, we are. And the healthcare, not that we can fix everything, I’m not saying that. But modern medicine is amazing. And it’s a gift from God. And it’s powerful.
And so that becomes enough for a lot of people. And for some patients, that’s all they need, as we talked about last time. But I also think that healthcare work in the US is busier and busier. The demands are higher and higher on the caregiver. More and more patients in an hour, more and more documentation and paperwork. Interestingly, AI is helping with that in some ways, which is a beautiful thing. It may help with this issue, but if you’re pushed to the point where you have to start dropping stuff and just focusing on some essential, you’re going to focus on the technical details of what you do in medicine, which actually your patient needs that, those details, and you’re going to let go of a lot of the other stuff. So especially when you’re stressed, when there’s too much work, patients start to become commodities. And in the long term, that steals the satisfaction of the healthcare worker.
And it also makes the patient feel like they’re being treated like a commodity. So for me as a healthcare worker, part of it is working in a system that allows, that’s humane and that allows sufficient time to care for a patient. For some of us, that means we have to make a decision that we’re just not gonna be as financially productive. And for some of us, you know, if we’ve decided that the career path we’re gonna take is the one that maximizes our income, well, there’s a trade-off there. And don’t be surprised if you start to feel like there’s no space in your practice for anything but the bare medical essentials. Sometimes, though, we’re working in a healthcare system that has its priorities wrong and that doesn’t treat even its employees like full human beings. And then either we’re advocates for change in that system or we just find a better place to go.
So there are solutions, but I also think there’s hope for our system. And like I said, I think AI is actually gonna help us with this because the paperwork and the logistics and even many of the technical algorithmic details of medicine, AI is increasingly gonna take care of all of that. But what it will never be is one spirit talking to another spirit.
Case Thorp
So Mark, last question, and this is from a family practitioner who serves the underserved and the vulnerable. He asks, what would you tell first year medical students to prepare them for what’s ahead?
Mark Topazian
First year…I think I’ll answer for a third year. So when you go to medical school, the first part is mainly classroom stuff and learning the science. And then you start, and it’s not always divided this way, but then you start going to, start learning about interactions with patients and you’re observing. And I remember being in a situation as a medical student where I was shadowing a pediatrician and a teenage patient came in with her mom and this patient was dealing with a condition called ulcerative colitis. I didn’t know at the time I was gonna become a gastroenterologist and see a lot of patients like this. But anyway, the patient came and most people with ulcerative colitis, it gets better with medicine and they carry on with their life. But this girl, it wasn’t getting better. And it was time to seriously consider having her colon removed so she could carry on with life. You know, she’s a teenage girl, body image issues, they’re huge. And you could see she was just completely freaked out by this idea of having an operation to remove her colon and a temporary ileostomy, gut emptying into a bag, at least temporarily. And her mom was freaked out and the pediatrician could only give them “stick to the medicine.”
You know, talking about medicine and surgery and the pros and the cons and the risks of surgery. And there was just such a huge disconnect. And the patient and her mom left in such turmoil. And I left, I was just the medical student watching in the corner, you know, but I was in turmoil, you know. Afterwards, I was like, I never want that job if that’s how patients are going to walk out of my consultation room. And I had like no way to make progress with that in my head.
And so I was like, maybe I just need to go into some field where people always get better. It’s easy because, you know, I don’t want to have to deal with that. But in fact, in that situation, there’s a completely different way of dealing with that situation. You know, to learn about your person, your patient as a whole person and what are your concerns and okay, let’s work with those concerns and let’s work together through all of this.
And as we talked about before, what social, family-based, emotional, what spiritual resources do you have that are going to help us get through all this and get you to a better place than you are now? Let’s work on it together. So there’s such a different way of approaching those tough situations that I was clueless about as a medical student. And I would say, find a wise older colleague who’s been around the block, and who’s found some good answers to this and spend some time with them in their clinic and just learn from them how in a difficult situation you can be such an agent of peace and grace and change in those situations. That’s what I would say. And then you could, you know, you could read a book, you could take Saline Process training, those would be good too, but there’s nothing like shadowing somebody who has insight into this.
Case Thorp
Right, right. Or they could also read your book. Mark, thank you so much. I really appreciate your time and especially your coming to us from Ethiopia. God’s blessings on your work there.
Mark Topazian
Thank you so much, Case. It’s been a huge privilege to talk to you and to share. I’d love to hear from anybody who’s listened to this and has something they want to teach me about or share a story or give me some more insight, because I’m still learning about this stuff.
Case Thorp
Well, to do just that, is there a website or a social media platform to best learn more about you and your work?
Mark Topazian
Yeah, so you know I’m over 50, so the social media thing has never really clicked for me. I do have a website, www.marktopazian.com
Case Thorp
Yes, okay. Well, and we will put that link in our show notes. Friends, please go out and pick up Mark’s book published by InterVarsity Press, Healing Purpose: Finding Satisfaction in a Healthcare Career. Well again, I want to thank you for spending your time with us, whether you are working out or running errands or just enjoying the view, we appreciate your listening. Share this episode with a colleague or even your doctors, that they could be encouraged by this conversation. You can learn more about our work at The Collaborative by going to wecolabor.com. That’s wecolabor.com. Drop us your email and we will send you our journal on faith, work, and culture called Zeitgeist. Many thanks to the Stein Foundation for making today’s episode possible. I’m Case Thorp, and God’s blessings on you.
