"Too Christian" to be a Doctor

I have gathered a collection of insults over the course of my 25 years as a physician. I have been called stupid, old, racist, arrogant, ignorant, too young (okay, this was a long time ago), unkind and once I was even called "a threat to children." This week I became the recipient of a new label. I heard that a specialist colleague told a potential patient that I was “too Christian” to be his primary care doctor.

I was taken aback by the news, surprised that a colleague would view my faith as a negative for my practice. In response to his words I stopped and considered the ways in which my faith has entered into my interactions with patients. I wondered if there were times I had crossed that an invisible line and gone too far, if I had gone from encouragement to offense. I discussed the topic with my staff, not all of whom share my faith and perspective. I realized that there are many ways in which I allow my faith to influence patient care but that these ways have for the most part made me a better person and doctor.  I have described many of them previous posts but decided to take the opportunity to share some the things I do differently because I am a doctor who is a devout Christian.

1-      I pray for my patients, and when appropriate, I pray with my patients. When I do pray in the office, I intentionally avoid denominational or theological lingo. Unless I am certain that the person has a Christian faith, I do not use the name of Jesus (He knows who I am talking to anyway!) I try to carefully assess the patient’s openness and then always ask for permission. Since studies have shown that half of patients actually want this, it seems reasonable. My experience is that patients are grateful for the additional expression of concern.

2-      I try to be more forgiving. My staff says I do this too often, but because of my faith, I intentionally extend more grace when patients are late, non-complaint, or unhappy. The Golden Rule requires it of me. I find my patients are more forgiving of me as a result.

3-      I give more hugs. I continually pray that God will help me love my patients more and serve them better. Overtime this has led me to listen better and care more, which leads to hugs, which seem to be appreciated!

4-      I stand up for my patients more. Since my faith is more concerned with doing right than being accepted, I find myself defending my patients and standing up for their rights. This means going the extra mile in fighting to get medications or therapy approved.

5-      I am more available. My office hours have become more of a suggestion that a rigid rule. When it is truly needed I come in early, stay late or work through my lunch hour. Just this last Saturday I met a patient at the office to suture a hand laceration. I did it because I could.

6-      I am more respectful of my patients time. My faith teaches me that I am no better than anyone else, that my medical degree does nothing to change my standing before God. I am a wretched sinner just like anyone else. This has led me to be more respectful of the time and needs of my patients, and is in large part why I give away Starbucks gift cards when I fall behind schedule!

7-      I often refer to Biblical passages when I talk. Some might call this risky but I have seen it have a powerful impact in my counseling with patients. Truth is truth and wisdom is wisdom and I see no reason to avoid either just because they originate from Scripture. The passages I refer to the most have common applications. I use Adam and Eve to illustrate the truth that people in trouble tend to hide their problems and run from help. I quote the wisdom of Romans 12 to people dealing with depression or addiction as a reminder that we are all broken in our thinking and that trusting in our own thoughts can lead to trouble. Passages such as these are often a source of encouragement to patients.

I am not boasting in this post. None of the behaviors I describe come naturally to me, and for the most part were not a part of my early practice. These things came about through a lot of prayer and a lot of work. I am not by nature a very nice or kind person. I am a Christian who asks God to change me every day, to allow me to be His hands to touch and heal others.

After thinking about it, I have decided that being “too Christian” is a criticism I can willingly accept. It is far better than someone saying I am not Christian enough!

-          Bart

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A Little Boy's Birthday, A Mother's Suicide

On their birthdays, nine year-old little boys should not come home from school and find their mother dead. John did.

I met John when he was in his early twenties. My church had decided to rent a large home in a local neighborhood and open it up to young men who were homeless and needed a fresh start. My best friend was put in charge of the ministry and he invited me to come along and help. I cooked and cleaned and supervised the house when he was gone. I was only 19 but I was committed and responsible. I was also ill equipped and unprepared for men like John.

John was down on his luck, jobless and out of money when someone from the church happened to meet him. The home had just opened and the church member thought we could help John get back on his feet so he brought him by. We sat down with John, told him the house rules and agreed to let him stay. It did not take long for me to learn John’s story and discover how difficult his past had been and how challenging the road ahead was going to be.

On John’s 9th birthday he had come home from school and found his mother in the garage, hanging by her neck from the rafters. She had committed suicide. Happy Birthday John. The remainder of John’s childhood involved temporary homes and terrible insecurity. He did not receive the counseling and love he needed and his young life was filled with more emotional pain than he could handle. When he became a teen he took solace in drugs and they ravaged his body. His gaunt, pale and pock-marked face declared to the world that he was someone who was unhealthy both inside and out. He lacked social skills, job skills and self-discipline.

John was a talker and we spent many late evenings together in conversation. Whenever we talked about the future, about what he would need to do to make a life for himself, he would turn the conversation to the tragedy of his past. It was as if he was saying that it was impossible for someone with his past to ever succeed in life, as if what his mother had done had sealed his destiny. It seemed he thought he was supposed to fail and that as a result any effort he made to succeed, any attempt at normalcy, every job interview and each day of sobriety, was to be praised and celebrated. He craved the unconditional love that he had been denied as a child.

Unfortunately for John, each small step forward was typically accompanied by a stumble or a fall. It was difficult to give him the praise he desired and desperately needed as it would have required us to ignore behaviors that were harmful. He needed so much more than we were able to give. Eventually he left, unable to keep a job our follow the rules. I do not know if he ever turned his life around.

Looking back, I think our church leadership was naïve in its approach to the ministry. It was as if they believed that all troubled young men needed was a place to live and Jesus. The thinking seemed to be that if they had a bed to sleep in, food to eat and a Bible to read that all would be okay. There was no talk of providing professional counseling or 12-step programs, no concept of the years it would take for someone like John to change and grow. We had good hearts and intentions but lacked the training and expertise.

In spite of our inadequacies it was not the church’s fault that John did not succeed. We did give him a chance he otherwise would not have had. He was given some good advice and an opportunity to change yet because of his troubled past he was unwilling or unable to listen to and receive the counsel of others. In spite of the reality that all of his choices had resulted in disastrous outcomes he continued to make his choices alone, refused to submit to the leadership of others. He could not fully trust others and trusting himself was futile. He needed so much more than we could give and needed to do so much more than he was willing.

I will never forget John and the lessons he taught me. I have encountered many “Johns” in my 20 years of practice, men and women with terrible pasts who face terrible futures. I still struggle to find a way to encourage them to get the help they need and still mourn when I see them make bad decisions. Whenever I counsel people like John I am reminded of how crucial love and direction are early in life, how children need to be taught to be healthy. Without a healthy foundation a healthy life is hard to build.

-          Bart

Comments, questions and feedback are always welcomed and appreciated. A reminder, my book on the Ten Commandments, Life Medicine, is available on Amazon. If your church or small group is interested in using the book contact me directly, as I have set aside books for donation. A small group study guide is accessible via this website. Finally, please share information about this blog with your friends!

Being Popular Can be Bad for You

I was not popular in high school. I was well known (identical twins usually are, twice the exposure at half the price) but I was not popular. I lost more elections than Mitt Romney including for sophomore class president, Student Body leadership and the ultimate defeat, president of the Chess Club. I was a dweeb.

It is one thing to pursue popularity as an adolescent, it is another thing altogether to pursue it as an adult. It seems that for some adults the need to be popular increases with age. If there is anything reality TV teaches us is that people will go to ridiculous lengths to be a celebrity. Ordinary life just isn’t good enough. Everybody wants to be a star and nobody wants to admit that achieving stardom is not dependent on how badly one wants it.

It seems fame is incredibly addictive, as even in small amounts it leads to people wasting their lives trying to gain it again. Almost every high school reunion includes once popular people incapable of dealing with the reality that no one cares anymore. There are a number of reality shows such as “The Apprentice” and “I’m a Celebrity Get Me Out of Here” that provide fading stars with one last chance to shine and there seems to be no shortage of formerly famous people willing to participate.

Watching these shows leads me to ponder how much these people have lost in their pursuit of fame. Multiple marriages and rehab stints seem to be a common theme. True happiness, contentment and meaningful relationships are rare. It seems that the price of fame is tragically high.

I flirted with fame a few months ago. My blog post on measles spread around the world. It reached over 5 million readers and was published in a Norwegian newspaper. Over 3000 people subscribed to the blog and comments flooded my inbox. It was pretty heady stuff. It didn’t last. My follow up post reached 30,000 views and subsequent posts were seen by fewer and fewer people. I found myself wondering what I could write about that would catch fire, what it was that people wanted to read, how I could reach that summit again.

Then I gave up. I realized that if I focused on what people wanted to hear I would lose something in the process. There is much about which I am passionate that is not popular. My Christian worldview is not universally embraced and is even offensive to some. Popularity might require that I constrain myself and not share my heart. I realized that success wasn’t worth it. I returned to writing what was on my heart. The number of subscribers has dwindled but I am okay with that. I have learned the lesson of high school, that being popular isn't what it is cracked up to be.

What leads to popularity and success in high school does not often translate to success in the next life. While I was easily discounted back in the day the life I have today is truly remarkable. I have a successful marriage, wonderful children, a strong faith and a rewarding career. My life after high school is so blessed as to make any of the lost recognition irrelevant.

I think this is true in the eternal sense as well. Success and praise in this life is often not compatible with success in the next one. People who pursue fame and adulation here on earth may be sacrificing what matters in the next. The ultimate winners are those who grasp this truth and live with eternity in mind. The adulation of millions means nothing compared to the joy that awaits those who have gained the favor of God.

-          Bart

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One Man's Nightmare, Another Man's dream

He was worried. He had been a well paid executive manager for years and had climbed the corporate ladder to a salary of $300,000 a year. His outlook had been positive and his future secure. Then the market crash came. Now he was out of a job and watching his savings rapidly disappear. He was stressed and worried and his blood pressure was way too high.

We talked about life, financial security and what the future might hold. He was in the midst of a job search but had no solid leads. He expressed concern that he might lose his home if he did not find a suitable job but then talked about his faith and how he was trusting God to help him through the difficult times.

“But what if He doesn’t?” I asked. He was surprised by my question. I explained that while I often hear people talk about trusting God for material blessing and support through difficult times I wasn’t sure that He had promised the level of support people hoped for. Here in America when we think about our "needs" we think of keeping our houses and having a good paying job. In poorer parts of the world people pray for the true necessities of life such as a meal and safety. I shared that what we would consider terrible would be anything but for most people on the planet.

“What is the worst thing that could happen to you?" I asked, "Losing your house and winding up living in a one bedroom apartment in Santa Ana flipping burgers for a living? There are people dodging Border Patrol agents and coyotes for an opportunity like that!” I shared that a one bedroom apartment in Santa Ana would be an answer to prayer for many people in the world.

He paused for a moment, “You’re right,” was his simple reply. As we talked I reminded him that none of the difficulties he currently faced threatened any of the things that mattered most in his life such as his faith or his relationships with his family.

I think about our conversation often, usually when I hear someone's prayer request. It causes me to reflect on what really matters in my life and reminds me not to cling too tightly to my “stuff.” I remember that Lisa and I aren’t really any happier now than we were when we were living in an apartment and barely making ends meet. Back then we found joy in trips to the laundry and cooking meals together. We lived paycheck to paycheck and scrounged up loose change for trips to McDonalds, but we were happy. Even now we realize that our best times are our best times because of who we are with and not because of what we have. True joy comes from our family and not our possessions.

I am also reminded of the danger of putting too much emphasis on what happens in this life. When all is said and done and I am called to give account for my life my financial achievements will not matter at all but the love I gave and the sacrifices I made for others will. Like all men I well be measure by the content of my heart and not the contents of my bank account.

-          Bart

A Jerk Like Me

The email seemed downright mean, albeit efficient. In just two paragraphs the patient managed to criticize my attitude, my responses, my office staff, my computer system, my scheduling system, my treatment of patients and my overall business acumen. Although I was taken aback at the meanness of the message it was the basis for the outburst that most caught me off guard. The email was written in response to a brief message I had sent. My message was, “You are overdue for a visit, please schedule a visit so we can process your refill request.”

I had typed my message quickly in response to an email query from the patient asking me to clarify a previous message. His message seemed straight forward and to need only a brief reply. I was obviously mistaken.

My initial response to the email was defensive. I had done nothing wrong to my knowledge and if there had been an error it was clearly unintentional. The patient had no reason or right to be demeaning. As I thought about what to reply a thought came to my mind. “If your motives are pure, why worry about defending yourself? Why not ask the patient what you can do for him?”

I called the number in the chart and followed up with a brief email saying any failure to communicate on my part was unintentional. To make sure he knew I was sincere I included my personal cell in each communication. We finally connected after a few email and phone tags and he shared with me why he was unhappy. He had struggled with our online system  and he wanted me to know how bad it was. There were a number of system failures and it took a while for him to share them all.

As we talked to things became clear. First, he had indeed struggled with our online system. It is glitchy at times and he had definitely been glitched. Secondly, he was someone who desired excellent service. Excellence was his goal in his business and he expects the same from others. What's wrong with that?

Sometimes excellence is not possible. His struggles were the type of understandable and inevitable communication difficulties associated with email and computers in general, the frustration that comes when we quickly type out questions and answers. Because the communication was about something personal, and because it took of too much of his time it was easy to see each mistake as a personal affront, as an insult to his time and person. In his frustration and impatience he reminded me of… me.

For years I demanded excellence from every vendor, service provider and business with whom I interacted. If I was paying for a service I expected the very best. It took me years to realize that perfection is impossible and that excellence is an elusive goal. I thought I was a professional pursuing excellence. Everybody else saw me as a jerk.

On the majority of occasions I complained about unmet expectations I did so ignorant of how hard the other party had worked to meet my needs. I did not take the time to understand what they were up against, what the standards were in the industry or how much time my demands required. I fear that on many occasions I reacted negatively when someone had done all he or she reasonably could have done to respond to my requests. It never dawned on me that I wasn't paying for perfection, that if I wanted perfect performance from the person handling my medical billing or processing a referral it would cost me a lot more than $20 an hour! How unreasonable I must have seemed to others.

I still struggle with adjusting my expectations. Balancing a desire for excellence and a commitment to grace requires constant effort. I have learned that the effort is absolutely worthwhile. As I grow more patient and understanding my stress levels drop and I still manage to meet the goals I set for my practice. I am also considered to be less of a jerk.

I pray that my patient will learn the lessons I have learned and continue to learn. It is much better to be considered kind and gracious than it is to be viewed as excellent and demanding!

-          Bart

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