WCF 5.3: What does it mean that God uses means and can work without, above and against them?

>God, in his ordinary providence, maketh use of means, yet is free to work without, above, and against them, at his pleasure. - Westminster Confession of Faith 5.3. I have three related questions - 1. What does it mean that "God...maketh use of means"? 2. What is meant by "without, above, and against them"? 3. What does it mean for God to "work...above" means? **Conclusions** A sick person prays and then goes to the doctor. If the doctor provides the correct treatment and the patient recovers, the doctor is the "means". If the doctor is clueless, but the patient recovers anyway, this is "without means". If the doctor applies an incorrect treatment that should make the condition worse, but the patient recovers anyway, this is "against the means". If the doctor applies a treatment that should not cure the condition but only alleviate the symptoms, but the patient recovers anyway, this is "above the means".