“She’s catatonic. I’m heartbroken,” he told me at the gym. “She’s only 26! My youngest daughter. She had her whole life ahead of her. Chances for anything close to a full recovery are incredibly low.”
“Goodness, brother, what happened?” I responded.
“She was severely fatigued. She went to the ER. Sodium was low. The doctor restored her sodium levels far too quickly, and it shrunk her brain. It’s called Osmotic Demyelination Syndrome.”
Tragedy is horrible. Preventable tragedy is worse. Tragedy that ensues from another’s folly is worst, understandable, and angering. In medicine, iatrogenics (from two Greek words, iatros: healer, genesis: origin) is the field of study that looks to make sense of illness caused by medical intervention. According to a 2016 Johns Hopkins study, medical error (iatrogenic death) is the third leading cause of death in the U.S., behind only heart disease and cancer.[1]
Now, don’t get me wrong, I think the medical community saves more lives than it takes, and it’s not even close. Nonetheless, we’d be foolish not to soberly look at the realities of when the Hippocratic Oath of “do no harm” is violated either because of neglect or folly. Undiagnosed, late-diagnosed, or untreated but treatable conditions certainly are associated with fatalities. But how many are harmed by failure to act compared to failure of action?
As pastors, I want us to map similar evaluative measures onto our work. In a world where “church hurt” is cited so often as a cause of deconstruction or unbelief, we need to be clear-headed in recognizing not merely where we’ve failed to act, but also where we’ve failed in action.
Failure to Act
The Apostle Paul does not envision pastors as being in a conflict-avoidant role:
- 1 Thessalonians 5:14: “And we urge you, brothers, admonish the idle …”
- Acts 20:28–31: “Pay careful attention to yourselves and to all the flock, in which the Holy Spirit has made you overseers, to care for the church of God, which he obtained with his own blood. I know that after my departure fierce wolves will come in among you, not sparing the flock; and from among your own selves will arise men speaking twisted things, to draw away the disciples after them. Therefore be alert, remembering that for three years I did not cease night or day to admonish everyone…”
- 2 Timothy 4:2: “Preach the word; be ready in season and out of season; reprove, rebuke, and exhort…”
Those pastors with a proclivity toward passivity or people-pleasing, walking in fear of man or motivated by sloth or phony peacekeeping ought to feel cut to the heart by those passages. I know I do. There are dozens of other passages like them.
In medical terms, how trustworthy would a doctor be who withholds bad news—whose goal in meeting with a patient is their short-term emotional wellness over and against their long-term flourishing? He’s “doing harm” by virtue of avoiding words that would be harmful! The capacity to diagnose accurately is why he went to medical school, but without his willingness to communicate that diagnosis, he’s useless. Nowhere do I see Paul giving license to pastors to passively “let things play out.”
Some of the best surgeons in the world have poor bedside manner—but they still save lives. That option isn’t so much on the table for pastors, however.
Failure of Action
Where many pastors fail is not in failing to act, but in failing to act. I cut off the ending of those verses above—look with me at how those passages above resolve:
- 1 Thessalonians 5:14: “And we urge you, brothers, admonish the idle, encourage the fainthearted, help the weak, be patient with them all.”
- Acts 20:28–31: “Pay careful attention to yourselves and to all the flock, in which the Holy Spirit has made you overseers, to care for the church of God, which he obtained with his own blood. I know that after my departure fierce wolves will come in among you, not sparing the flock; and from among your own selves will arise men speaking twisted things, to draw away the disciples after them. Therefore be alert, remembering that for three years I did not cease night or day to admonish everyone with tears.”
- 2 Timothy 4:2: “Preach the word; be ready in season and out of season; reprove, rebuke, and exhort, with complete patience and teaching.”
Help the weak… with tears… with complete patience. Some pastors are wired for conflict. Like a carpenter with a hammer, they know how to swing at a nail. Poor “bedside manner” is not merely a matter of tact and strategy; it’s a matter of fidelity.
We don’t rebuke the weak; we help them. When we’re admonishing the wayward, we ought to have tears in our eyes. Patience, I think, is rightly and best understood as long-suffering. To suffer long with a congregant, to weep over their folly and rebellion, is painful and taxing. In a role where we’re often already drained, choosing the way that is more draining can feel like poor stewardship of our energy and time. Not to Paul. It is the right mode of engagement. Far easier said than done.
We ought not let the ends justify the means. “They’re going to leave anyway, so I might as well not waste my emotional energy loving them.” Or, “They’re not going to see what I see, so spending a whole lot of time on this isn’t good bang for my buck.” From a worldly “return on investment” perspective, this is true. When you’re trying to grow a healthy church, it certainly seems like hard-heartedness towards the wandering in favor of pouring more gas where the fire is already burning makes sense. But when we make that calculation, we’re choosing “fruitful” over “faithful,” and ultimately, we won’t get either.
From an iatrogenic perspective, this is where most of the church hurt I’ve caused has come from. I’ve not emotionally gone the way of Jesus and Paul, admonishing with tears, but I’ve gone the way of non-profit business management, and, like an award-winning surgeon, justified poor bedside manner in the name of stewardship and efficiency.
The Pain Calculation
I do believe a large amount of what has been called “church hurt” comes from faithful pastors acting faithfully in accordance with their call. Those who desire to sin or persist in unsound doctrine will feel judged and misunderstood and will correspondingly say “the church hurt me.” This is inevitable and unavoidable in our cultural moment that celebrates and incentivizes victimhood.
At the same time, there is church hurt that stems from failure to act and from failure of action. Not rebuking sin harms the body. Rebuking sin without complete patience and tears harms the body. Running post-mortem iatrogenic analysis on pastoral failures of every kind should be something we regularly engage in. We have nothing to prove to Jesus, but we do desire to grow as effective, Christlike, and courageous shepherds of the household of God. Perhaps we may win some we would have otherwise lost.
[1] Martin A. Makary and Michael Daniel, “Medical Error: The Third Leading Cause of Death in the US,” BMJ 353 (2016): i2139, https://doi.org/10.1136/bmj.i2139.