Embodying the Clinical Story: Incarnation and the Practice of Presence in Healthcare

Sep 13

****Adapted from a paper of the same name shared at Duke University at the Practice & Presence Conference.

We talk often about burnout, compassion fatigue, and fragmented care. These are not abstract words but lived realities in medicine today. Yet research keeps showing something striking. When clinicians practice presence—full attention, attunement, and availability—patients heal better, and clinicians themselves find resilience. Anxiety can fall in as little as forty seconds of compassion (Fogarty et al., 1999). fMRI studies show that pain responses shift when care is patient-centered (Sarinopoulos et al., 2013). Even symptoms of post-traumatic stress after medical emergencies are lower when patients experience care as compassionate (Moss et al., 2019).

From Research to Practice

So why does presence work? Theologically, the Incarnation offers the clearest grammar. “The Word became flesh and dwelt among us” (John 1:14, ESV). God heals by drawing near. That was the offer I made to my fellow clinicians at Duke: presence is not an “extra” in healthcare. It is constitutive of healing itself. Compassion is where theology and empirical evidence meet, and where medicine can rediscover both courage and hope.

Therapeutic presence is one way the medical literature has described this practice. Presence goes beyond simple proximity. It is a way of being-with characterized by mindful awareness, relational depth, and attentive listening, such that patients feel seen, safe, and dignified (Back et al., 2010; Epstein, 2017; Geller, 2013). Presence requires clinicians to regulate their own inner state while remaining oriented toward the patient (Krasner et al., 2009). It is distinct from detached efficiency on one side and over-identification on the other (Epstein & Street, 2011; Geller & Porges, 2014). Instruments such as the Consultation and Relational Empathy (CARE) Measure and the Therapeutic Presence Inventory have sought to capture it empirically (Mercer et al., 2004; Geller, Pos, & Colosimo, 2010). Across contexts, presence has been linked to reduced anxiety, better communication, stronger adherence, and higher satisfaction, while training in mindful communication has been shown to decrease emotional exhaustion and improve empathy (Beach, Keruly, & Moore, 2006; Krasner et al., 2009).

Compassion extends this stance into active movement toward suffering. It is empathy that takes form in concrete gestures and words. Compassionomics, a field synthesizing more than 250 studies, argues that compassion improves outcomes, enhances safety and quality, and also protects clinicians from burnout (Trzeciak & Mazzarelli, 2019). Even brief moments matter. In oncology, a short empathic statement reduced patient anxiety in under a minute (Fogarty et al., 1999). Patient-centered interviews have been shown to alter neural pain responses (Sarinopoulos et al., 2013). Prospective studies demonstrate that higher perceived clinician compassion during medical crises is associated with fewer PTSD symptoms one month later (Moss et al., 2019). Compassion shapes physiology, psychology, and behavior while simultaneously restoring meaning to the work of medicine (Krasner et al., 2009).

The Incarnation as Deep Grammar

Christian theology offers a deeper grammar for this practice. From the earliest centuries, theologians recognized that the Incarnation was God’s way of healing through nearness. Athanasius of Alexandria described the Son’s coming not as spectacle but as solidarity: Christ descended “not to make a display, but to heal and to teach those who were suffering” (Athanasius, 4th c./1953). Augustine called Christ the “suffering physician” who entered the epidemic of sin to heal from within (Augustine, trans. 1998). Gregory of Nyssa emphasized that divine majesty was shown precisely in the willingness to share human weakness (Gregory of Nyssa, 4th c./2007). Thomas Aquinas later gave this intuition scholastic clarity, insisting it was “most fitting that by visible things the invisible things of God should be made known” (Aquinas, 1914).

The Reformers carried this emphasis forward. John Calvin stressed that Christ “clothed himself with our feelings,” affirming that our Mediator is not remote but truly attuned to human frailty (Calvin, 1559/1989). Martin Luther portrayed Christ as the Teacher of children who stooped with pedagogical humility (Luther, 1520/1962). Later voices such as Jonathan Edwards and Charles Spurgeon returned repeatedly to the image of Christ’s benevolence and tender nearness as the pattern for pastoral care (Edwards, 1738/2000; Spurgeon, 1860/2014).

Modern theologians and writers have continued this thread. T. F. Torrance spoke of Christ’s “vicarious humanity,” a healing presence “apt for our humanity” that sanctifies every stage of life (Torrance, 2008). C. S. Lewis described “transposition,” higher realities made known through ordinary tone, gesture, and touch (Lewis, 1949/2017). J. R. R. Tolkien’s notion of “eucatastrophe”—a sudden eruption of hope within despair—captures the way compassionate presence can transform suffering (Tolkien, 1947/2008). More recently, Timothy Keller emphasized walking with others through pain as the truest shape of pastoral wisdom (Keller, 2013). Across centuries, these voices converge in a shared confession: the Incarnation reveals divine healing through embodied presence, humble descent, and compassionate solidarity.

When Theology Meets the Clinic

What theology affirms, clinical research increasingly demonstrates. Compassion lowers anxiety, modulates pain, and reduces trauma. Healthy work environment studies show that organizational culture matters as much as staffing levels. In hospitals with supportive nurse environments, surgical patients had lower rates of ICU admission and mortality than those in less supportive contexts, even when staffing ratios were similar (AACN, 2022; Lake et al., 2019; Bettencourt et al., 2020). Institutions that foster trust, moral voice, and respect create the conditions in which presence is sustainable (Aiken et al., 2011; Malinowska-Lipień et al., 2024). In this sense, organizations too can become incarnational—taking on “flesh” in policies and practices that either dignify or diminish those within them.

The implications of incarnational presence can be seen in everyday clinical life. In primary care, it may take the form of a clinician turning from the computer, sitting at eye level, and asking, “What feels most important for me to understand today?” In an emergency department, it may be a nurse pausing at the threshold, taking a breath, and clasping a patient’s hand. In trauma-informed settings, it may look like slowing down, offering choices, and restoring agency to those who have been stripped of it. At an institutional level, it might mean creating protected time for family meetings, developing forums to process grief, or recognizing relational excellence as a measure of clinical quality. These examples are not exhaustive. They are glimpses of how presence can be embodied in ways both small and systemic, each echoing the pattern of Emmanuel, God with us.

A Word of Hope

The conclusion is both simple and profound. Not every illness is curable, but no encounter is beyond the reach of incarnational presence. To sit, to listen, to linger. These are not extras in healthcare but essential acts of healing. In an age of depersonalization, such practices rehumanize medicine. They remind us that God’s way of healing is nearness, and when clinicians take up that posture, they find that presence does not drain them but restores them. Research confirms it. Theology explains it. And lived practice testifies that presence heals both patient and caregiver.

Embodying the Clinical Story: Incarnation and the Practice of Presence in Healthcare

From Research to Practice

The Incarnation as Deep Grammar

When Theology Meets the Clinic

A Word of Hope

Further Reading

Care Collective Podcast

“I Put Myself Back in the Narrative”: Toward a Foundational Rebuilding of Healthcare