Being Fired Isn't Always the End

“This is it. I am going to have to let you go.” And with that a 5 year relationship with one of my favorite employees ended. I have always hated letting people go but this one was especially difficult.

I hired her when she was 19, the sister in law of one of my other employees. I was not sure she would be up to task, being the primary receptionist for a busy family doctor with high standards is not an easy job. She excelled out of the gate, handling the phones and patients with grace and aplomb. They all loved her as her natural sweetness and willingness to help were impossible to resist. In the 5 years she worked for me I cannot remember single complaint from a patient.

I genuinely cared for her, and as she is Hispanic, often called used the term of endearment “Mija” when I talked to her. She talked to me about her life and her family and I felt as if we were as close as a boss can be with an employee.

So what happened?

Overtime she began to make mistakes. I wondered if it was due to the fact that she was trying to go to college in the evenings or if it is was financial pressure. Whatever the reason was, things started to fall through the cracks. I talked to her about it, counseled her about it and even warned her about it. She improved for a while but when one morning I discovered some patient results had not been forwarded to me for several weeks due to an oversight, I felt I had no choice but to say good-bye. I had to draw the line at quality of care. She was heart-broken and so was I.

A short time later she applied for a job with the Medical Group I contract with. They called and asked me about her and I gave them the best recommendation I could, telling them how she had been so wonderful for so long. To her credit she had been honest in the interview about all that had happened. They offered her the position.

We had limited contact over the next few years, she would occasionally answer the phone when I called the Medical Group and her sister-in-law gave me updates every once in a while. There were never any negative words exchanged and she never spoke ill of me to anyone. I never thought that our relationship would improve but was grateful that there seemed to be no hard feelings.

A few months ago the staff wanted to change cleaning services for the office. Her sister-in-law asked if she could do the weekend cleaning. “Why not?” I thought. So I hired her for that position. The job is on the weekends when the office is closed so I did not see at all and we talked only once or twice for brief moments.

In the last two weeks we have had staff shortages in the office due to vacation and family illness. Normally we would call a temp office for help or just struggle a long, but she is on winter break from college and the office staff wondered if she could fill in. “Why not?” I thought again!

And so she is back at the desk, answering phones and smiling at the patients. When she came in for her first shift we embraced, genuinely pleased to see one another. We have talked some and updated each other on events in our lives and I have been reminded of the sweetness and kindness that have always been a part of who she is. I have even called her “mija” again.

Her story reminds me of how life is supposed to work. Mistakes sometimes have unavoidable consequences. Bosses need to make changes and employees need to move on. Good people, kind people, can still care about one another and still wish each other well. We can forgive one another and sometimes even work together again. If only we could all forgive and love in this way!

-          Bart

Why Physicians Can't Care Anymore

Since the day I began training as a Family Doctor I had one goal- to make a difference in the lives of my patients. I soon realized that I had my greatest impact in the context of relationships with my patients. The better I knew the patient as a person, the more accurate my diagnosis was. Further, when they viewed me as a person, they were more likely to follow through with the treatment plan I recommended. With this in mind I have spent the last 20 years trying to build relationships with my patients. I am wondering if those days may be disappearing.

Building relationships takes time and many patients aren’t staying with their doctor long enough for a relationship to develop. This is not something they are choosing. Most patients have insurance through their employer or ObamaCare and employers, insurers and the government do not care which doctor the patient sees. They simply want affordable coverage. As a result many patients are seeing their insurance provider change every one to two years. Often they are switched to a plan that does not include their doctor. When this happens they are forced to switch to a new doctor as seeing an out of network provider would mean paying cash for visits and most patients simply will not pay the standard $80 charge for an office visit. The result is that strong relationships are increasingly rare.

These economic realities mean that January becomes a month of good-byes for doctors. Just this week I received two emails from families asking if there was any way I they could stay in my practice. One family has been with me for 17 years. I delivered their children and have been their doctor through depressions, anxieties and the loss of a parent. As much as they want to stay in my practice, the insurance won't pay, so they are moving on.

I wonder how long it will take for the new doctor to develop the closeness that will allow for effective care for emotional and family issues. Given the current environment such closeness may never develop, for within a few years the family may be forced to change again.

There is another problem facing patients and doctors as well. Insurers are cutting what they pay (up to 50% on some ObamaCare plans). In order to stay doctors are cramming more visits into their schedule, racing through the office day with nary a moment for conversation. I wonder how many diagnoses will be missed and how much poor communication will occur as the pursuit of cheap care results not only in new physicians but in shorter office visits as well. It is hard to get to know someone in 7-10 minutes!

For me personally, there is sadness. It is hard to say good-bye to people you have taken care of for years. I could contract with these lower paying plans in order to keep patients, but if I am forced to rush people in and out in order to pay the bills relationships will all of my patients will suffer. As I will not compromise the quality of care I provide and have already cut expenses as much as I can, I have no choice. I cannot contract with plans that do not pay a reasonable rate. So I watch patients leave. How tragic.

Healthcare reform has brought many changes. I do not think that the end of caring physician-patient relationships was supposed to be one of them.

- Bart 

The Key to Relationships Across Generations

I was standing outside the ESPNZone at Downtown Disney in Anaheim talking to some friends after dinner when up walked a young man with a sweet, silly grin. Recognition was delayed by the unexpected context but within a few seconds I realized who he was. He was a long term patient, a young man of about 19 who had been my patient since he was just an infant. The fact that he said, “Hi Doctor Barrett!” made recognition easier.

I greeted him with a hug and a “good to see you!”

He hung around for a few minutes, as did his grin, before he said good-bye and returned to his work. We didn't say much to one another, but the brief interaction was special to me.

What was special to me was how obvious it was that he was genuinely glad to see me. My friends could tell from his smile and demeanor that I was someone he considered important and that he thought it was pretty cool that he ran into me that night. I was touched by the realization that over the course of 18 years and less than a dozen office visits I had managed to have such an impact on his life.

I thought back to one of his recent office visits. I don’t recall what the reason was for him coming to the office but I do remember what we talked about other than medicine. He is a young man who has faith and we talked about his girlfriend and his relationship with her. We talked about moral purity and honoring God in life. I was not sure at the time if he welcomed the discussion but the joy he displayed at our unexpected meeting told me that the conversation had been well received.

Recent events have increased the significance of that night and what it said about our relationship with one another. I have heard and read many things about how Christian people of my generation need to reach out to and connect with the younger generation. Usually the conversations center on styles of dress, music preferences and other external issues.

What strikes me about my young patient is how unimportant all of those things are. I am 35 years older than he is and usually wear slacks, a well-ironed shirt and a tie. He wears casual clothes appropriate for his age. I do not even know what kind of music he listens to. So what created the bond between us?

I think it was genuine caring, true affection.

For most of his life I have cared for him and about him. I care about his spiritual and physical health, care enough to ask him about it and enough to encourage him to be a better person. I have been genuine in the words I use, the way I say them and the manner in which I have cared for him, and he has responded in kind.

Something to think about when we talk about developing relationships across generations. I am wondering, if in our desire to connect with younger people we are missing something important-that what is inside our hearts matters far more than any of the external qualities we typically use to define and categorize one another.

- Bart

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Surviving When Love Dies

He looked down and depressed, as if his spirit was wounded. The spark was gone from his eyes, there was a slouch to his shoulders and he spoke in more of a monotone. He was physically and emotionally exhausted. Physically from a persistent illness that had badgered him for more than a month and from overwork at a demanding high pressure job, emotionally from a marriage that had been without love for far too long.

We talked for quite a while and he shared with me how difficult his home life had become. His wife had lost respect for him years earlier and by his account the vast majority of their communication, on the rare occasions there was any, was negative and demeaning. Intimacy had disappeared and been replaced by cold silence. While divorce would be in many ways welcome he was committed to his children and to his vows, so on he suffered.

I wanted so much to help him, to come up with some brilliant advice that could lift his spirits and bring hope, but found myself at a loss. What do you tell a man in this circumstance? Platitudes and trite phrases such as “Hang in there” or “It will get better” seemed so empty and inappropriate. I thought of what I knew about him. I knew he had a desire to be good, to do good and to be the man God wanted him to be, so I simply told him that while he may not be able to do anything about the feelings and attitude of his wife, he could still be good. He could honor God, with the hope that this life is not all there is and that someday he would stand before God knowing that God would know his heart and his effort.

I encouraged him to not deal with the pain alone, but to share with others that he was struggling and to ask others for their prayers and support. I hugged him and prayed for him before he left. The ache in my heart stayed throughout the rest of the morning. I think what bothered me the most was that both he and his wife profess Christian faith, they go to church and attend Bible studies, but the most important area of their lives, their marriage, is an empty shell. I wondered how many families I see were just like his, dying on the inside while putting up a façade for the outside world.

I wonder if there may be some who read this who are in a similar circumstance, trapped in unhappiness, feeling alone and unsupported. My prayer for you is the same as it was for him, May God give you wisdom and peace and strength to get through today, and the peace and strength to get through each day as it comes. May God give you encouragement and comfort in the knowledge that He understands and will always be with you.

• Bart

When Pastors Don't Believe in God

Sometimes pastors don’t believe in God. I don’t mean that they don’t believe in His existence or would deny that He is active in their lives. What they seem not to believe is in His greatness, His wisdom and in the way in which he accomplishes His plans. Sometimes they act as if they do not believe that God knows what He is doing.

From what I have observed, it seems church leaders have been taught such things as “the signs of a healthy church” and “strategies for growth” and “how to reach your community.” Instead of viewing these concepts as a source of ideas that may or may not fit God’s plan for their church, they use them as a measuring stick to determine whether or not their church is performing as it should. They check the boxes- If the church does not have the right demographic makeup, the right music, the correct percentage of young people, and the right programs, then God is not moving.

The response to this conclusion that God is not moving is to change the church. Gradual change, the kind that comes through relationships over time, is not acceptable. At times using a language of fear, leaders declare such things as “something has to be done” or “a generation is being lost,” implying that serious harm will come to our church and our culture if we do not act. The actions suggested are often superficial, focusing on décor, clothing and music styles. These changes are often associated with a watering down of the sermon content as the message is made more “accessible” to the lost and seeking. Implied in all of this is that whatever was happening before was not God’s doing, that God could not and would not work in such fashion, for if God was working, they would be able to see it and measure it.

This is what causes me concern. When I think of how God works I remind myself of the people He chose over the generations. He chose a nation of slaves to be His people. He led them out of bondage through an 80 year-old murderer shepherd named Moses. For their greatest king He selected another shepherd, this time the young boy David who was the runt in his family, who would later become an adulterer who schemed to kill a loyal friend. When He sent the Savior, God picked a virgin in a backwoods town who gave birth in a stable. For the proclaimers of His message he included uneducated fishermen and a hated tax collector, and ultimately filled their ranks with a murderous Pharisee. God has never worked in the way man would think! It seems to me that we like to talk about God moving in unpredictable and unorthodox fashion in the past tense but when it comes to the present day we like to be more in control. We need to see it!

I have witnessed the danger of putting God in such a box first hand. Years ago I was a candidate for a senior pastor position in south Orange County. It was a church of a few hundred people that had at one time numbered over 1200. Within 10 miles of the campus were two megachurches, Saddleback and Mariners, each with over 9,000 members. In the course of my interviews it became apparent that the search committee had reached the conclusion that these two churches had “figured it out,” that we needed to do whatever it was they had done to grow. I didn’t agree. When asked about my philosophy and approach I said, “We can’t try to be like Saddleback. Saddleback will always do Saddleback better than us. We can’t be Mariners, Mariners will always do Mariners better than us. We should try to be a place where the Bible is taught and taught well, trusting God to bring people to Himself.”

I didn’t get the job. They selected a more experienced pastor who had a vision for change and attracting younger people, someone who “knew” how God was moving. 18 months later the church went belly up. The pastor drove away the core of the membership with unwise changes. He did not believe that God could work in a unique way in each church, tried to implement a vision that did not fit, and as a result the church was ruined.

We need to believe in God again. We need to believe that even in a place where life is not obvious to our eyes, He may be working. We need to trust that He is the one who draws people, that His Spirit is the agent of change. We need to be patient, believing that God will, in His time and in His way, do His work in us. We need to reject the dangerous message that apart from us, God cannot reach the world, the belief that we are either the obstacle or the draw for people to come to God.

-          Bart