The Day I Learned Not to Trust Doctors

When I entered medicine I believed I was entering a field comprised of noble professionals committed to taking care of others. I did not expect to encounter doctors who would put personal convenience before the needs of a patient. When I did, I did not handle it well.

I remember well when I first learned that not all doctors put the patient first. It was 1991 and I was an intern working on the OB floor. It was a Saturday and I was responsible for managing the residency program patients who were in labor. There was an experienced obstetrician supervising me, there to observe and provide guidance and to be available should a c-section be necessary.

I had been managing the care of a young woman whose labor had not been progressing well. There had been no significant change for a few hours and we were debating giving up and performing a c-section. The decision was made for us when the woman developed a significant fever and the fetal monitor showed early signs of distress. I went to the charge nurse to make arrangements for the surgery and was told that we could not go to the operating room, that a doctor had scheduled a c-section for another patient who had presented in early labor with the baby in breech position. As both patients “needed” surgery and the other doctor had asked first she told me that I would have to get the other doctor to agree to being “bumped” if I wanted to take my patient back to the operating room.

I asked a few questions about the woman with the breech baby and learned that she was in very early labor. Her cervix was only dilated 1-2 cm, which meant that there was no urgency in performing her surgery. As it was clear to me that my patient’s need for surgery was more pressing I sought out the other OB for what I assumed would be a simple and collegial conversation. I was wrong.

When I presented him with the details of the cases, he replied, “You will have to wait. My patient is breech and in labor!”

“She 1 cm and contracting irregularly! Why not get her an epidural, keep her comfortable, and wait the hour until our case is done? There is no risk to your patient but there is risk to ours!” I was incredulous.

He repeated his same assertion. I was dumbfounded. I was just an intern, but I was a good intern who was knowledgeable in the management of labor. This was not even a close call. It was a no-brainer. Good medical care demanded that he allow our case to proceed. I went to the charge nurse and asked her to tell him that he had to wait. She refused. She might have agreed with my position but in a debate between an attending and an intern she knew who was going to win. It wasn’t me.

I was overcome with anxiety. A million agonizing thoughts and questions were racing through my mind. Was I supposed to just give up? How could I? I was supposed to advocate for my patients, to fight for there care. But how could I fight when I had no power? The obstinate obstetrician was an established member of the medical staff and a faculty member in the residency program. What would happen if I pushed back to hard?

I decided that personal consequences were irrelevant. It was about my patient and her baby. I went back to the resistant obstetrician to again plead her case. I asked him for details about his patient and why should could not wait. He got angry and told me I was out of line. I wish I could say that I took it well. I didn’t. I told him in no uncertain terms (and with significantly elevated volume) that he was willfully and knowingly putting my patient at risk and that if anything happened to her it would be on him. Defeated but realizing I had done all I could I went back to check on my patient.

I walked away disillusioned. I had honestly believed that the other doctor would do what was right. I later learned that his recalcitrance was based on the fact that he had family plans that would have been disrupted if he waited. Knowing that a patient was put at risk out of convenience was unfathomable to me. I had looked up to this doctor before, had sought his counsel and learned from him. My trust and confidence were permanently damaged. The fact that my patient was not ultimately harmed by the delay did little to ease my frustration.

My frustration increased a few days later when I was called in to the office of the Residency Director. He sat me down to lecture me on my impertinence, telling me how inappropriate it was for an intern to challenge an attending physician. In typical Barrett fashion I did not back down. I apologized for my tone but made it clear that regardless of my standing or level of training I would always put the patient first.

As we talked, I realized that he didn’t really disagree with me. He knew that the attending was in the wrong. He also knew how the world worked. In order to run a residency program he needed faculty, and the only source of faculty he had was the medical staff at the hospital where we were located. Not all of them were noble and excellent but they were all we had. He admired my convictions but wanted me to understand the need to carefully choose my battles.

It was a difficult lesson for me to accept and it is one with which I continue to struggle. I have lost many battles that I should have known to be futile, died on too many hills trying to do what I believed to be the right thing for my patients. I have also saved lives by speaking out. I have learned that most doctors are good people but we are still people, with all the selfishness and inconsistencies personhood brings.  The learning process that began 24 years ago on that OB floor continues to shape me. Although I use less anger and volume one thing that has not changed is my commitment to doing the right thing.

- 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

Does Easter Still Matter?

Why care about Easter? What importance can there be in isolated event from over 2000 years ago? Billions of people have been born and died since then, thousands of important leaders have entered and exited the world stage, and we have seen the rise and fall of many global empires. Compared to these events, what does one event on one day matter?

Sometimes a single event on one day changes the course of history. Archduke Ferdinand was unknown to a majority of the world on the day he was assassinated in 1914 but his death triggered a chain of events that resulted in the deaths of 37 million people in World War 1. Alexander Fleming was a brilliant researcher with an untidy lab. One day in 1928 he returned from vacation to discover that a fungus has grown in one of his Staph cultures, inhibiting the growth of the bacteria. Penicillin was discovered and medicine changed forever, one event on one day.

Jesus of Nazareth was an itinerant preacher in the land of Israel. His public ministry lasted only three years. Dramatic miracles led to a following that was initially large numbers dropped significantly when His teaching became more challenging. He still commanded enough of a following to be considered a threat by the Jewish leaders who feared He might lead a revolt against Rome. Determined to end the threat they had Jesus arrested, tried, convicted and executed in less than 24 hours. When He was placed in a borrowed tomb late one Friday He was, to all appearances, just another failed rebel, a philosopher rabbi whose words would likely fade over time.

Then Easter Sunday came. The tomb was empty and He was seen alive by many who had followed Him.  A new religious movement arose based on the story of Jesus' resurrection. Reports of His resurrection could have been easily disproven if false,  simply producing His body would have put an end to such claims. But no body was forthcoming and not a one of His followers retracted their story. Many even died for it. All of the evidence pointed in the same direction. Jesus of Nazareth had come back to life.

His resurrection did not just bring back His body from the grave. It did far more. It brought credibility to his teaching and affirmed His remarkable claims of divinity. The Apostle Paul summed up the meaning of Easter, writing that Jesus. “through the Spirit of holiness was declared with power to be the Son of God by his resurrection from the dead: Jesus Christ our Lord.” Romans 1:4

One event on one day 2000 years ago changed the world. By His resurrection Jesus proved that He was not just a rebel, not just a prophet, not just a teacher and not just a man. He was, and is, much more. He is the Son of God and as such must be dealt with.

The question the Roman Governor Pontius Pilate asked on the night Jesus was crucified is one that we all must ask ourselves, “What shall I do with Jesus?”

Easter demands an answer.

-          Bart

Who Killed Jesus?

Who is to blame for the death of Jesus? In some ways the case seems open and shut. The Jewish religious leaders of that time conspired with the Romans overseeing Jerusalem to have Jesus arrested and then tried in the Jewish religious courts and then in front of Pontius Pilate, the Roman governor. Who else could we blame?

This simple answer overlooks an important detail. Jesus knowingly and willfully walked into the trap. His death was not something that caught Him off guard, was not an interruption of His plans or a defeat of His strategy. His death was the plan, it was the strategy. Knowing in advance what lay ahead of Him  Jesus spoke these words to His disciples- “The reason my Father loves me is that I lay down my life — only to take it up again. No one takes it from me, but I lay it down of my own accord.” John 10:17-18

The gospel writer of Luke described Jesus heart and intentions as the end of His life approached- “and it came about, when the days were approaching for His ascension, that He resolutely set His face to go to Jerusalem” Luke 9:51-52

He resolutely set His face. With purpose and intent he turned toward the city where death awaited Him. Knowing this, He chose to go anyway. He chose to die. He chose to die not because He had a death wish for Himself but because He had a life wish for us. The writer of Hebrews described what His death accomplished for His people “He sacrificed for their sins once for all when he offered himself.” Hebrews 7:27

So who killed Jesus? He offered Himself. He offered Himself for the sins of all men. The Jews and Romans were the instruments by which His death was accomplished but the reason His death was necessary is because of what all men have done. We all are guilty.

- 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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