Obedience, Not Outcome: The Humble Medicine of Everyday Care
George MacDonald is often remembered for his influence on literary giants like C. S. Lewis and J. R. R. Tolkien. But before he was a novelist, he was a pastor and theologian. His Unspoken Sermons are rich meditations on trust, humility, and quiet faithfulness—the kind that takes root not in spectacle but in steadfast action. In one of his most piercing insights, MacDonald insists that “the doing of the will of God is the way to knowledge,” suggesting that healing often comes not through dramatic outcomes but through the moral act of showing up. This blog reflects on how that vision speaks into modern healthcare. In a world obsessed with metrics and miracles, MacDonald’s theology reminds us that there is a quieter form of healing in simply doing the next good thing.
In an era dominated by performance metrics, rapid service delivery, and cost-efficiency models, public health systems are increasingly being challenged to return to their foundational ethos: serving people, not merely treating conditions. This requires redefining what it means to heal, particularly for those managing long-term illness. In recent years, global health authorities and U.S. health policy experts have converged around the need for care that honors the full dignity of the person. This kind of care values presence, persistence, and patient-defined progress over short-term or easily measurable outcomes.
The Myth of the Measurable
“Not in thunder, but in a still small voice.”
MacDonald resisted the assumption that truth must justify itself through visible outcomes. He argued that truth is made known through faithful practice, not through dramatic results. Healthcare holds a parallel misconception: that success is evidenced only in cured disease, corrected numbers, and normalized labs. Yet for the roughly 60 percent of U.S. adults living with at least one chronic condition, health is not a finish line but an ongoing practice of endurance and care (Centers for Disease Control and Prevention [CDC], 2023). Healing here looks like steadiness: renewing prescriptions, attending therapy, performing daily mobility routines, eating regularly, and waking each morning to continue the work of living.
There is a growing recognition of this reality. The World Health Organization (WHO, 2016) has called for people-centered systems that respond to the full complexity of patients' lives rather than focusing solely on acute episodes. Likewise, the Centers for Medicare & Medicaid Services (CMS, 2023) frames person-centered care as care guided by what matters to patients, not merely what is medically possible. Yet naming the value is not the same as doing it. Operationalizing people-centered care requires redesigning workflows, supporting longer relationships, coordinating across fragmented settings, and building structures that honor patient goals in practice, not only in policy language.
When healthcare measures only what can be counted, it risks missing what matters most. Presence, continuity, and trust are not incidental to healing. They are its daily work.
The Gospel of Small Things
“An act of obedience is better than a thousand speculations.”
MacDonald preached that our task is not to foresee the outcome, but to do what is right in front of us. The same ethos animates the best of clinical work: the unnoticed chart review, the gentle phone call to clarify meds, the hand held during discharge. These moments rarely earn billing codes or merit inclusion in performance dashboards, yet they define the patient experience. As Devidal and Sarnin (2023) note, “slow work” is a way of working that honors qualitative goals and human rhythms. Within healthcare, slow work manifests in the deliberate pace of care that privileges empathy, comprehension, and follow-through over speed.
This is not inefficiency; it is integrity. When clinicians are allowed to practice with patience, to notice the details of human need, they enact MacDonald’s vision of obedience. The willingness to do the good that is near, even when it is unseen. These are the gospel moments of medicine, the ones that remind both patient and practitioner that healing has as much to do with faithfulness as with physiology.
The Patient’s Practice
“The will of God is not a thing for you to seek, but to do.”
MacDonald’s line above points to a vision of faithfulness that is ordinary rather than dramatic. For many patients living with chronic illness, this form of faithfulness looks like persistence: taking medications even when symptoms do not immediately improve, returning to appointments after discouraging news, maintaining daily habits that feel small in the moment but shape health over time. MacDonald would describe this as moral clarity. It is the commitment to do the next right thing not because the outcome is guaranteed, but because the act itself testifies to hope. Healing, in this sense, is less an event and more a posture of steady participation in one’s own well-being.
Contemporary public health increasingly affirms this reality. Behavioral and chronic care models emphasize self-efficacy, continuity, and the cumulative effect of sustained adherence over time. Graham et al. (2022) describe precision public health as the intentional directing of time, resources, and relational support to those who most need them, enabling care that adapts to individual lives rather than asking individuals to conform to rigid systems. This approach suggests that effectiveness in chronic care is not derived from intensity, but from alignment between clinical guidance and daily practice. In other words, systems scale healing not only through interventions, but through sustained attention.
When healthcare structures recognize that consistency is itself a form of care, they begin to honor the kind of healing MacDonald pointed toward: the healing that unfolds through fidelity, patience, and the repeated choice to keep going.
The Clinician’s Vocation
“Obedience is the soul of knowledge.”
Burnout among healthcare professionals is often rooted in the gap between effort and visible impact. Clinicians spend long hours documenting, coordinating, troubleshooting, and advocating, yet many of those actions do not produce immediate or measurable change. When healthcare systems prioritize throughput and quantifiable outcomes, the deeper meaning of clinical work can become obscured. The result is moral dissonance: knowing that care is fundamentally relational, while being asked to perform it as if it were primarily transactional.
MacDonald’s theology offers another frame. He taught that obedience is not a pursuit of outcomes, but a posture of faithfulness. To show up with integrity, presence, patience, and humility is itself a form of wisdom. In this view, the work of care is not validated only when it “fixes” something. It is validated when it honors the human being in front of us. This reframing does not ignore the need for evidence-based practice, clinical excellence, or measurable progress. Rather, it restores meaning to the aspects of care that are often undervalued because they resist easy quantification: listening, bearing witness, and remaining present when nothing can be quickly resolved.
Leget, Gastmans, and Verkerk (2020) define human dignity as the recognition and respect for the integrity of persons in their full lived experience. When clinicians orient their work around that dignity, they recover a sense of vocation rather than mere productivity. Presence ceases to be an interruption of care and becomes its core. The work is still demanding, but it is not hollow. It becomes possible for clinicians to see themselves not only as providers of interventions, but as companions in the unfolding story of a patient’s life.
In this light, the daily work that often feels small or unseen is revealed as essential. The act of sitting with someone in uncertainty is a form of care. The act of returning to the bedside, even when improvement is slow, is a form of faithfulness. And the act of continuing to believe that the person in front of us is worth our time and attention is a declaration that the work matters, even when the metrics cannot show it.
Scaling Slow: A Storyline Vision
“To do the truth is the only way to know it.”
Burnout among healthcare professionals is often rooted in the gap between effort and visible impact. Clinicians spend long hours documenting, coordinating, troubleshooting, and advocating, yet many of those actions do not produce immediate or measurable change. When healthcare systems prioritize throughput and quantifiable outcomes, the deeper meaning of clinical work can become obscured. The result is moral dissonance: knowing that care is fundamentally relational, while being asked to perform it as if it were primarily transactional.
MacDonald’s theology offers another frame. He taught that obedience is not a pursuit of outcomes, but a posture of faithfulness. To show up with integrity, presence, patience, and humility is itself a form of wisdom. In this view, the work of care is not validated only when it “fixes” something. It is validated when it honors the human being in front of us. This reframing does not ignore the need for evidence-based practice, clinical excellence, or measurable progress. Rather, it restores meaning to the aspects of care that are often undervalued because they resist easy quantification: listening, bearing witness, and remaining present when nothing can be quickly resolved.
Leget, Gastmans, and Verkerk (2020) define human dignity as the recognition and respect for the integrity of persons in their full lived experience. When clinicians orient their work around that dignity, they recover a sense of vocation rather than mere productivity. Presence ceases to be an interruption of care and becomes its core. The work is still demanding, but it is not hollow. It becomes possible for clinicians to see themselves not only as providers of interventions, but as companions in the unfolding story of a patient’s life.
In this light, the daily work that often feels small or unseen is revealed as essential. The act of sitting with someone in uncertainty is a form of care. The act of returning to the bedside, even when improvement is slow, is a form of faithfulness. And the act of continuing to believe that the person in front of us is worth our time and attention is a declaration that the work matters, even when the metrics cannot show it.
Closing Reflection
It is not difficult to imagine MacDonald suggesting that the best care plans include patience. His theology consistently resists the demand for immediate proof or dramatic results. Healing, for him, unfolds through faithfulness. In healthcare, the same is true. The medicine of everyday care is not measured only in changed laboratory values or completed documentation. It is expressed in the act of returning, tending, aligning one’s life with what sustains health, and doing so again tomorrow. Patience is not passive in this frame; it is an active commitment to remain present to the long work of healing.
When we understand care this way, we begin to see that much of healing is carried in what appears ordinary: shared decision-making conversations, incremental behavioral changes, adherence supported rather than policed, and the quiet, continuous labor of accompaniment. These moments rarely appear in quality dashboards or utilization reports, yet they shape the trajectory of a person’s life. They honor the dignity of the patient as an agent in their own story rather than a problem to be solved.
Our healthcare systems, like our moral and spiritual lives, are strongest when they are anchored not in spectacle but in steady grace. Patience allows space for trust. It allows space for the body to respond, for the mind to adapt, and for meaning to emerge. It acknowledges that the work of healing is not something done to a person but something done with them. In this light, patience is not a delay of care. It is part of the care itself.
References
Catholic Health Association. (2022). Our mission and values. https://www.chausa.org
Centers for Medicare & Medicaid Services. (2023). Person-centered care: What it means and how to deliver it. https://www.cms.gov
Devidal, P., & Sarnin, P. (2023). Slowness at work: A literature review and a research agenda. Journal of Business Ethics. Advance online publication. https://doi.org/10.1007/s10551-023-05553-5
Graham, G. N., Curry, S. J., & Holmes, J. (2022). Achieving health equity in the rapid response to COVID-19: A framework for precision public health. Health Affairs, 41(3), 345–352. https://doi.org/10.1377/hlthaff.2021.01229
Leget, C., Gastmans, C., & Verkerk, M. (2020). Dignity and the practice of medicine: Ethical questions for the 21st century. Cambridge University Press.
World Health Organization. (2016). Framework on integrated, people-centred health services. https://www.who.int/servicedeliverysafety/areas/people-centred-care/en/
