God Talks Like Willy Wonka

Some people say God speaks to them. I do not doubt that He is able to speak to people in an audible fashion but I am not sure that He speaks to me in this way. If He does I do not hear very well. On the few occasions when I thought I was certain He was speaking things did not work out very well. As a result my confidence in my spiritual hearing is pretty low. Over time I have reached the conclusion that I may be listening for the wrong kind of voice.

While I do not hear God speaking directly to me, especially in an audible sense, that does not mean that I do not believe that God is silent or that I think He does not communicate with His people. His Spirit can speak to us through Scripture or by moving other people to share their thoughts with us. He can also speak quite powerfully to us through our conscience. When God does speak through our conscience He speaks a lot like Willy Wonka (Gene Wilder version, not Johnny Depp).

In the movie Willy Wonka and The Chocolate Factory a handful of children won the opportunity to tour Wonka’s chocolate factory. At the beginning of the tour the children were instructed on how to behave during the tour. As the children were selfish and bratty they each violated the rules rather quickly. Each time one of the children started to do something forbidden, Willy Wonka spoke and warned them.

Willy’s warnings were never yelled, never hollered. He did not run over to the children to restrain them. He remained where he was and quietly said, “No. Stop.” He voice was audible and recognizable, but it was also easily ignored and overlooked by those who were not inclined to listen. The children didn't listen and soon experienced the consequences of their disobedience.

I have found this to be true of the way God communicates to me through by conscience via the Holy Spirit. When I begin to do something wrong there is often a quiet “voice”, a thought in my head, that gently urges me to stop. When I am dead set in my ways and bad intentions the voice is easily ignored, yet if I train myself to listen for it, to look for it before I act, the warnings can be heard. God loves me enough to warn me, to move me and motivate me through gentle urgings such as these but like Willy Wonka He does not yell, and does not force me to obey.

If I am to stay out of trouble, I need to train myself to listen.

- Bart

Drug Secrets Your Doctor May Not Know

The patient was angry. His pain management doctor had written a prescription for a new pain medication and the patient expected it to be covered by his insurance. It wasn't, and the patient was stunned by the drugs $320 price tag. There was no way he could afford the drug and he went home empty handed and in pain. 

Stories such as this are not at all uncommon. Prescription coverage varies widely from one insurance to the next and seems to change daily. It is impossible to keep current. Previously covered and once inexpensive generic medications become uncovered and expensive seemingly overnight.

A week ago I wrote a prescription for doxycycline, a 48 year-old antibiotic that  a few years ago had a cash price of $4 at Target and Wal-Mart.  Imagine my surprise when the pharmacy called saying it was not covered by insurance and the cash price was now $65! How does that happen?

A few months ago a patient called asking for help with his sleep medication. His insurance would not cover generic Ambien and he could not afford the $85 his pharmacy charged for 30 pills. I had my staff check on what our cost would be if we ordered it ourselves. Our price- 100 pills for $3.10. The pharmacy was charging $85 for a medication that cost them $1!

100 mg Viagra tablets cost almost $30. Five 20 milligram tablets of the same drug from the same manufacturer, sold under the brand name Revatio, can be purchased for $4. When I asked the drug company salesman why this was he could not provide me with an answer.

There are many aspects of medical practice that are frustrating but medication costs and coverage are of particular concern. New drugs are always ridiculously expensive, with thirty day supplies of new medications consistently above $150. The prices are often concealed from doctors by sales people whose presentations focus on co-payments and discount cards instead of total costs. 

What can patients do to navigate such a system? I am often confused and perplexed by insurance coverage of medications, how can a lay person be expected to know what to do? We are in desperate need of greater transparency in how medications are priced.

While we wait for that day to come here are a few recommendations-

1- Tell your doctor when a medication is expensive. There may be less expensive alternatives. My daughter was once prescribed a medication that cost $700 a month. The doctor was shocked to learn of the cost and changed to a more affordable option.

2- Shop around. Prices can vary widely from pharmacy to pharmacy. A few years ago I called several pharmacies to check their price for generic Prozac. The four prices were, $7, $11, $25 and $40 for a one month supply. Do not feel as if you do not have choices.

3- Ask for an inexpensive drug. For common conditions such as high blood pressure, diabetes and sinus infections there are usually very inexpensive options. Target and Wal-Mart sell a 30 day supply of many common generics for $4.

4- Use coupons. Web sites such as goodrx.com can offer sizable savings. Almost every brand name medication will have coupons on their websites.

5- Fight when needed. I recently had a patient who was taking a medication twice a day for chronic pain. It worked well but wore off in the middle of the day. I gave him a sample and suggested he try taking the medication three times a day. He was thrilled to report dramatic improvement so I sent the new instructions to the pharmacy. His insurance denied the claim saying they would only cover the medication twice a day. I wrote two letters and personally called the insurance but they did not budge. He appealed the denial all the way up to the California Board of Managed Care. The Board notified him yesterday that his insurance would be required to pay for the medication. It took more effort than it should have, but he won!

- Bart

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Rescued From A Temporary Hell

The world is filled with suffering people. Millions are hurting yet most of us are immune to the day to day struggles of the poor, the destitute, the abused and the neglected. We go about our lives comfortable and secure with hardly a thought about our responsibility to serve others. The question arises, what should we do?

Social Justice has become a big deal in the church. Hardly a week goes by when I do not read or hear someone saying how important it is for Christians to be making a difference in local communities. Out of this philosophy a multitude of service ministries have arisen my local area. Medical clinics for the uninsured, food banks, homeless shelters, homework and tutoring centers, marriage counseling services and even free legal services are available to community members free of charge. The church has made a profound commitment to improving the life circumstances of others.

Service ministry has become, for many churches, the primary goal, the standard by which true Christianity is measured. Timothy Keller, in his book Generous Justice, wrote that when we understand what Christ has done for us, “The result is a life poured out in deeds of justice and compassion for the poor.”

The result of this new found emphasis on social justice has been the explosion of ministries like the ones described above. More than that, it has led many churches to get involved in the perceived structural problems in society that have allowed injustice to develop. Keller writes that a biblical perspective could lead Christians to be involved in such things as pressuring police departments to “respond to calls as quickly in the poor part of town as in the prosperous part” and to form organizations that prosecute “loan companies that prey on the poor and the elderly with dishonest and exploitive practices.” He further suggests Christians work to improve struggling schools and to give generously to the poor, going so far to suggest that if you do not “actively and generously share your resources with the poor, you are a robber.”

As I read through the words of social justice advocates I find myself asking, “Is this the message we are called to preach? Is the problem with Christians that we don’t do enough for the poor and needy in our communities? Is it that we need to be more involved politically to change the circumstances in which the weak in our society find themselves?"

As I consider questions such as these I am struck by the realization that the social justice emphasis is a safe road for the church to travel. It is politically correct and inoffensive. No one attacks the church when its focus is on the external condition of suffering people, no one argues when we address temporal suffering. But is this truly the mission of the church?

A few years ago I met with the US director of a social justice ministry in the Philippines. His church had the wonderful idea to build and maintain a safe house for women who were rescued from sexual slavery. Young women who had been stolen from their families and subjected to horrific abuse were given a place of comfort and refuge, a place where they could be comforted and restored as they transitioned to the possibility of a normal life. Such ministries have a special place in my heart and the meeting was an opportunity for me to learn more about their work and determine if it was something Lisa and I could support financially.

The man shared about their work, how the women were rescued, how the house was staffed and how over 95% of the money raised went into the ministry. As the meeting neared its close I asked him, “How does your program ensure that every woman brought to your home clearly hears the gospel message?”

He seemed surprised by my question. “I am sure that they hear the gospel,” was his reply. I pressed on, “Do you have a policy of how they will be intentionally taught what it means to be a Christian?” They did not.

I then told him my greatest concern. “We do these women no favor if we rescue them from a temporary hell and not the eternal one.”

And this is my fear for the church. It is socially acceptable to address temporary hells but that can never be why we do what we do. We need to proclaim the good news that delivers us from eternal suffering and that brings us into lasting relationship with the Living God. We must emphasize the next life more than the present one.

The problem with the eternal message is it is not socially acceptable. The Christian message is not that God wants to fix your outer poverty, it is that God wants to fix the destitution of your soul. If we address only the visible suffering, we are not fulfilling our purpose nor truly serving the world. It is my hope and prayer that the eternal message of the gospel returns to its central place in our preaching and practice. We need to continue to serve the poor and needy in this life but we serve them best when while doing so we lift their eyes toward heaven to the one who delivers us from ultimate suffering.

-          Bart

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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