Worst. Employee. Ever

Working as a receptionist in a medical office can be challenging. A recent employee came up with a unique way of dealing with the stress that comes when the phones got busy. She answered the phone, politely listened to the patient’s concern and then hung up. She didn’t write anything down or enter a note into the chart, didn’t do anything to actually make sure the patient’s needs were addressed. She simply moved on to the next call. She had a similar solution to entering patient insurance information into the system as well. Skipping work was the easiest way to catch up.

It took several weeks for me to discover the problem. When patients began complaining that their calls were not being returned I searched for a cause. It did not occur to me that my new receptionist might not be recording messages. Message taking is such a crucial component of the job that I did not think it possible for someone with years of experience in the medical field to intentionally avoid it.

My blindness to the cause of the problem was in part due to the fact from my limited observations of her work she seemed to be doing well. She was polite, the other employees liked her and she seemed to be keeping up with her duties.

It was not until a few weeks later when I noticed that a phone message had been entered into the chart hours after the office had closed that I investigated the possibility she was not entering messages into the chart at the time a patient called. The delayed message discovery was the clue that led me to consider that the source of the patient complaints might be her. She was off on the day that I discovered the problem and I called an impromptu meeting with my other employees.

A few minutes into the meeting we realized we had a big problem on our hands. Each of us had individually fielded patient complaints about unreturned calls, unaware that the others had done the same. Together we were aware of 15-20 message failures. I wondered if I should counsel her on her performance and warn her that her job was in jeopardy. When the employees told me that had each already done so I knew this was not a matter of her simply making mistakes. The receptionist  clearly did not care enough about our patients to do her job well. I had no choice but to let her go.

That afternoon I sent a message to every patient on our electronic mailing list letting them know that we had discovered an issue with messages not being recorded. I apologized and asked all who had not received responses to messages to let me know. We had 5 replies within the first 24 hours. I was shaken by the news as I realized important medical care might have been delayed. I was grateful that many patients were supportive and understanding of my efforts to rectify the problem.

As shocked and disappointed as I was at the employee’s intentional neglect, subsequent events were more discouraging. The afternoon of her discharge she deposited a duplicated paycheck she had promised to destroy a month earlier, in essence stealing over $1300 from me. I filed a report with the police.

She filed an unemployment claim. My challenge to the claim was initially upheld but later overturned by an administrative judge who concluded that her misconduct was not excessive and ruled her entitled to up to $15,000 of benefits, charged to my account. It seems that in California employers have almost no protections under the law. It has been six months now and the police have yet to file charges. 

What troubles me the most is not the financial loss. The charges to my account will be stretched out over a long period of time and I will be able to absorb them. What troubles me is that I placed my trust in such an untrustworthy person. I had thought that I was a reasonable evaluator of character but in this case I was fooled, which means it will be harder to trust future employees. This is particularly sad for an office that has always had a family feel about it.

My only comfort is in the knowledge that I was a just and fair employer. I paid her an excellent wage, gave her and her family free medical care and advice and even paid for her first few work uniforms. In spite of her breech of trust I will strive to do the same for others God brings my way. The fact that others are unfaithful does not mean that I cannot be. 

Her story reminds me that we love not because others will love us back but because God loves us. We serve because Christ served us. While recognition and appreciation are often lacking in this life, we serve a God who has promised to reward the faithfulness of His people.

- Bart

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Ungrateful Students and a Thankful Syrian

Some Thanksgiving thoughts-

Campus protests are erupting across the country. In response to perceived racial injustices students have disrupted football games, libraries, lectures, and every conceivable aspect of academic life. Administrators have struggled with how to respond, with most deciding to meet as many of the demands as possible and in so doing validating the claims of the aggrieved.

The outside world, of which most of us are a part, is less supportive. Columns and blog posts mock the students, calling them spoiled, entitled and ignorant. These criticisms overlook what I think is at the heart of their dissatisfaction and at the heart of many of the problems we face today.

They aren’t thankful.

We live in the richest nation the world has ever seen, with blessings and benefits that previous generations would have viewed as impossible fantasies. Most young people hold in their hands smart phones that have hundreds of times more computing power than that which powered the space shuttles, that can take and store photographs without film, and from which they can teleconference with anyone around the world. Today’s students have boundless educational opportunities, most of them subsidized by fellow citizens. They live in dorms that are luxurious, with movie theaters, restaurants and work out centers.

In spite of all of the blessings, they are dissatisfied and angry. There is no sense of gratitude, no consideration of their privilege. People their age in all corners of the globe battle poverty, disease and oppression on a daily basis and can only dream of what these young Americans possess but American students are mindless of the plight of others. Lacking any sense of gratitude, they protest over silly slights.

We as a society would do well to remind ourselves and our families of how blessed we are. A person living at the “poverty line” in the United States, $11,770 a year for an individual, is in the top 15% of income earners worldwide. The poorest Americans are wealthy compared to the rest of the world!

Perhaps it is time to change our focus. How different would our lives and conversations be if we stopped focusing on the things that we do not have and instead focused on what we do have? We who have been surrounded by plenty all of our lives can easily lose sight of the blessings we have received.

I spoke yesterday with a man from Syria. He left there many years ago. Today he works behind the parts counter at a Kia dealership. It is not a high paying job by American standards, but he spoke of the incredible blessing of living in the best nation in the world. He considered himself to be rich. He was grateful and content and it showed in his face.

I want to be more like him.

Happy Thanksgiving.

-          Bart

Confident, Offended, and Dead Wrong

He was mad at me, convinced that I was attacking our church and its leadership. Although I did not once mention our church by name he was certain that the sermon illustrations I used were intended to  call attention to the challenges our church was facing at the time. There were many points in the message that closely paralleled issues our church was confronted so it was natural to assume that I had crafted the message with the intention of emphasizing those problems. 

His assumption was logical, reasonable, supported by his observations, and wrong.

I was part of a team of teachers who had been asked to each teach about one of the Kings of Israel or Judah. I requested one king, but was assigned a different one, so the lesson I taught was not one I had chosen.I had first outlined and taught on that king and the associated passage of scripture seven years earlier, at a different church, long before our current church’s problems had begun. Recognizing the potential that some might think I was attacking our church, I agonized and fretted and worked hard to stay true to the passage. I repeatedly edited and altered the message, taking out portions that I thought might be interpreted negatively.

In spite of my efforts, my friend reached the conclusion that I had selected the passage and crafted the sermon with our church in mind. It was several months before we talked face to face and I was able to correct his assumptions. When he heard the whole story his apology was genuine and sincere.

After we talked I reflected on how many times I had similarly and confidently reached a wrong conclusion about others, the occasions when I had misjudged others based on limited information.

I thought of patients I had written off as non-compliant, only to later learn that they had lost their jobs and their insurance. I remembered the many times I had wrongly thought my children were rude or disrespectful only to discover that I had misheard them. There is no shortage of examples of me confidently making quick yet erroneous assessments.

My friends, family and patients deserve better from me. It is my prayer that I will, over time, develop the habit of assuming the best in others, that I will be someone who gives others a chance to explain before I choose to condemn. I have a long way to go

- Bart

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When a Patient Wants to Die

What if he asked me to help end his life?

George was dying. I did  not expect him to last more than a few weeks. The esophageal cancer had spread to his liver and to his lymphatic system, mutated and spread beyond the reach of all known treatments. His esophagus was narrowed to the point where solid foods were impossible to swallow and he was starving. The impact of the cancer on his digestive system had resulted in intractable nausea. None of the four anti-nausea medications he was taking had made a difference. Every day was miserable. All pleasure was gone from his life and he was simply waiting to die.

He signed up for hospice care to ease his passing. He was too weak to come to the office so I went to his home to see him. He was a shell of the man he once was. He was once obese but was no longer. He had lost over 100 pounds, his clothes hung loose and his face was drawn.

During the hour I was in his home we discussed many things. He asked me many unanswerable questions-, wondering what caused the cancer, what would have happened if the specialist he had seen had made the diagnosis earlier when he first had trouble swallowing. He asked how long it would take for him to die. Having provided care to many hospice patients over the years I told him that only a foolish doctor would deign to predict a time of death. Death comes when it comes. Sometimes in comes in days, other times it comes in weeks. All I could promise was that I would be there for him, that he would not suffer.

Waiting can become the hardest part of dying. Once the inevitability of death has been accepted, when the goodbyes are said and the prayers have been made there is nothing else to do but wait, to watch each change in symptoms and wonder what it means, to wonder if the final countdown clock has started to tick or if it is just another meaningless change. 

For many patients and families the waiting is unbearable. As the suffering increases and the end approaches it is natural to ask, “Can we just do something to end it?”

Because physician assisted suicide has been illegal in California I have never had to directly answer the question. This could change at any moment, as the governor has signed a bill that would legalize the practice. When the law is implemented it will be legal for me to give patients like George a lethal dose of medication. The question of "When?" will become answerable and the agonizing days of waiting avoided. Family and friends could know the time and place and plan accordingly. Everyone would feel a sense of control.

And my role as a physician would change forever.

For patient's like George  it seems straightforward. He had at most a month or two to live, and his suffering was real. Why not provide definitive closure for such patients? What is the harm in providing a quick and easy passing?

George's case provides an answer to these questions. Under the law as written, George would have been a candidate for assisted suicide 4 months ago, when he was first diagnosed with the aggressive cancer. If he had not elected to attempt treatment his life expectancy would have been less than 6 months and he would have met the conditions of the law. Any doctor could have ended his life any time he wanted. He could have been given a large dose of morphine or other medications and the months of suffering avoided.

He also would have avoided hundreds of conversations with friends and family, including the spiritual conversations he had with me and others. A professed atheist, he specifically asked for prayer and if I would advise him spiritually as he went through the process of dealing with his disease. That 4 month process changed him. He became a different man with a different perspective. I would not have wanted to take that from him, nor should anyone.

Many will say that it should be the patient’s choice. In a godless world where man is the ultimate arbiter of his fate this makes sense. If there are no enduring consequences, if there is no ultimate meaning in life, if there is nothing good that comes from suffering, these choice advocates are right.

But we do not live in a godless world and man is not god, as much as many may wish that we were. Death reminds us of that.

As a Christian physician I will not play the role of God, I will not help a patient end his life. What I will do is relieve his suffering. I will aggressively treat his pain without reservation, even if that requires middle of the night visits. I will come to his home to pray for him, sit with him and comfort him, and do all I can to facilitate a death that is filled with dignity and comfort, knowing that each moment, even the ones filled with pain, provides an opportunity for love, reflection and faith.

- Bart

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Pizza, Porn and Making a Stand

It was supposed to be a pizza party. It soon became a porn party. The members of the high school basketball team went to the local pizza parlor to hang out after a game. After a while the conversation took an unexpected turn. Several players took out their smart phones and brought up pornographic images. They laughed and joked and thought it was funny. For the one Christian member of the team it was anything but. It was awkward, and it was wrong. He called his parents and got an early ride home

When I heard this story I was heartbroken. I felt terrible for the young man who had been placed in such a difficult circumstance and I grieved over the lack of shame displayed by his team members. One thought repeated in my mind, “How did our society end up like this?”

There was a time when right and wrong were clearly defined. Not everyone chose to do the right thing but just about everybody knew what the right thing was. Wrong things included lying, cheating, foul language, underage drinking and alcohol use, and sex before marriage. Good things included respecting your elders, politeness, honesty and morality. Somewhere along the line these definitions were abandoned. Wrongness now only applies to such things as violent crime and political incorrectness and goodness is defined as whatever one wants as long as it does not directly hurt someone else.

How did this happen? It is the natural consequence of moral relativism. When right and wrong are no longer universal absolutes but are instead based on individual perceptions, moral decline is inevitable. Human nature leads people to think highly of themselves, so it is natural that people will define good as “what I do” and bad as “what someone else does” when given the opportunity. When good is determined solely by our personal desires there will be no need to rein our desires in.

When our nation embraced the moral relativism of humanism and  turned from its Judeo-Christian roots it also turned away from the well-defined moral code that guided our nation since its inception. Absent the boundaries of a clear moral code, immorality is boundless. Pizza parties become porn parties.

In such a world not only will immorality increase, morality will be attacked. Those who declare immoral behavior to be wrong will face accusations of intolerance, bigotry and of being judgmental. In such a context people of faith will endure difficult times.

When I deal with individuals who are caught up in an immorality I have learned that a simple question can bring clarity. My favorite question when I talk to someone caught in a moral failing is- "Is that the best you can do?" I challenge people to set goals of excellence for themselves, to strive to do their best, not to the minimum, in every area of their lives. I tell people that my goal in life is to be the best man, husband and father I can be, and that when confronted with a choice about a behavior I have trained myself to ask how the activity in question can help me be the best. 

I could go out and get drunk, but I want to do better than that, to have a clear mind and to remain in control.

I could look at pornography but I want to be better than that, to value my wife and allow her to be confident and secure in the knowledge that she is my ideal.

I could lie, I could cheat, but I want to be better, I want to be someone who is trustworthy, respected and believed.

The reason I want to give me best? Because God gave His Best for me.

-          Bart

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