An Atheist Asks for Prayer

“Doc, you know I’m an atheist, but I know you are a man of faith and I am going to ask you to pray for me.”

Atheists do not usually ask for prayer but this was a special circumstance. Being diagnosed with cancer causes people to reconsider beliefs they had previously rejected, to look for help in new places. Although my phone call to him delivering the biopsy results was not unexpected the diagnosis still hit him pretty hard. He had cancer and it was serious. He took only a moment to absorb the information before telling me he was not ready to die and he was afraid.

He had been battling a number of health issues for several months. First had come an unusual cancer of the skin and superficial tissue of his back, a cancer so rare that none of the doctors had seen it before. Shortly after the final surgery and radiation treatments for that cancer he developed an irregular heartbeat and was diagnosed with atrial fibrillation. Blood thinners became a part of his life. He had always been strong and healthy and now he was on chronic medications. He was no longer invincible.

While he dealt with the stress of these diseases he began to battle another problem. He developed severe stomach upset that made it difficult for him to eat. Heartburn, indigestion and nausea became his daily companions. He lost 50 pounds. He saw a specialist, but the specialist was concerned about doing an endoscopy and biopsy while he was on the blood thinners so definitive testing was delayed. After several weeks of waiting he called me and asked for a new GI doctor. A few weeks later the new GI doctor called me to let me know that he had done an endoscopy and discovered a cancer in the stomach. That news led to my call to the patient and to his unexpected prayer request.

A few weeks later he scheduled an appointment with me to go over his options and ask my opinion. We discussed what we knew (which was too little for me to give him a decent prognosis) and we discussed several possible outcomes. Although the cancer is serious and life threatening he is determined to survive. He again asked me to pray for him. I told him that I had been praying and would continue to do so.

As often happens during life and death conversations the discussion drifted to other areas of his life. He talked being estranged from his son and how difficult that had been for him. He shared about a recent school reunion that was bittersweet, as the joy of renewing old friendships was tempered by the gravity of his diagnosis. He told me about his journey away from faith many years ago, how travels to Europe and Africa had included visits to concentration camps and  areas of mass genocide. Faced with such evidence of evil he had rejected the idea of God's existence.  

Time and circumstances made deeper conversation inappropriate but it seemed to me that there was much he wanted to discuss, many more issues of the heart he desired to explore. It seemed that my years of caring for him had resulted in me being someone he felt he could trust. I wrote down my cell phone number and handed it to him.

“Anytime you want to talk, I’ll buy the food or the coffee. Not as your doctor, but as your friend.”

He promised he would take me up on the offer. I pray I will be an encouragement to him if and when he calls.

When he left I was again reminded of how important it is to not only care for my patients but to care about them. Sometimes the greatest therapeutic tool available is our ears. We just need to listen.

- Bart

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Celebrating Freedom on the 4th of July

Freedom. It is a universal value but an American foundation. While all people may desire it, Americans have fought and died for it. Our constitution is devoted to it. The First Amendment specifically delineates those freedoms we hold most valuable- The free exercise of religion, freedom to speak, the freedom of the press, and the freedom to assemble. The pursuit of these freedoms is what led to the existence of the United States. We celebrate these freedoms on the 4th of July.

While we joyfully celebrate these freedoms, there are some who seem to have forgotten the source from which these freedoms spring. Our Founders were clearly aware as they made it clear in the Declaration of Independence, “men are endowed by their Creator, with certain inalienable rights, among them life, liberty and the pursuit of happiness.”

Our rights come from our Creator. It is He who gives us minds to reason, hearts to love and hands to work. It is He who gives value in meaning to life and a purpose for living. It is He who gives us the freedom to not only do what we want but an even greater freedom, the ability to do what we should.

-          Bart

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Doctor! My Brain is Broken!

Doctors are supposed to get things right. We interview patients, perform an exam, analyze and process data and reach a conclusion. Patients depend on us to make good decisions and reach accurate diagnoses. For the most part most of us do a pretty good job. We get things right most of the time, more because most common diagnoses are straightforward and most patients have common conditions than because of any brilliance on our part, but we are trained to figure things out. It is what we do.

In spite of all of our training we still make mistakes in thinking. This may be rare in our professional lives but it is common in our personal lives. We can be as selfish and short-sighted as anyone and we are more stubborn and arrogant than most. We have grown so accustomed to trusting in our intellect and ability to figure things out that we are blind to errors in our thoughts and conclusions in the rest of our lives. We forget that no amount of education and experience can change the fact that we are human and humans make mistakes.

We make mistakes because we are broken people. Selfishness, judgment, pride and anger are a part of who we are. If we are going to become loving, kind, giving and understanding people we are going to have to change. This change cannot come from within us. Relying on our broken thinking to solve our problems will result not in healing but instead in different ways of expressing our brokenness. So what do we do?

We need to quit trusting ourselves. We need to question and challenge out emotions and conclusions and be willing to change. Most of all, we need to ask God to help transform us into the people we need to be.

Understanding our universal brokenness and need for change is the topic of a series of lessons I have uploaded to my vimeo page, www.vimeo.com/bartbarrett. The first lesson has been uploaded and more will be available in the coming weeks. The series is intensely personal. I share some areas of personal brokenness I have dealt with over the years and how God has helped me overcome. I pray that my struggles will be a source of encouragement for others.

-          Bart

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The Future of Primary Care Under ObamaCare

“I won’t be able to see you anymore.” When these words are a spoken in a Nicolas Sparks’ romance movie they are to be expected. When a physician hears them from a patient it is a surprise. Well, it used to be a surprise. More and more patients are being forced to find a new physician due to a change in their insurance plan.

ObamaCare has been in effect for over a year now. The public and media focus on insurance coverage and costs to the consumer but they overlook the profound impact on providers and health systems. Methods of care delivery, attitudes to customer service and access to providers are all evolving as the health care system struggles to adapt to a changing marketplace. As primary care providers are the point of access for most care we are seeing these changes directly impact our practices and our livelihoods. Doctor responses to these changes are likely to result in it becoming increasingly difficult for a patient to see a physician, so it is important that patients understand what is happening and what their options are.

As with many things in a capitalistic economy, it all comes down to money. The Affordable Care Act places limits on what insurers can charge for coverage, particularly for the sick and the elderly. In order to continue to make a profit (which is why companies are in business) they must find ways to cut costs. Costs are cut by decreasing payments to providers, both hospitals and doctors.

For primary care doctors in Southern California, ObamaCare plan cuts have been dramatic, 40% or more on already discounted rates. Insurers that once paid $75 for a routine office visit billed at $110 are now offering to pay $45 or less. Many doctors, especially those in private practice, cannot survive at this level of reimbursement.

Understanding the struggles faced by doctors in the current system requires an understanding of the costs of maintaining an office. A typical Family Doctor in private practice has a minimum monthly overhead of over $21,000 a month (for many it is much higher), or $160 per hour of patient care. (a cost breakdown is below.)Typically, a doctor’s day is 6 hours of direct care and 2-3 hours or more of additional work (paperwork, review of lab results, refills, phone calls, emails etc.) If a doctor saw only Obamacare patients at a rate of $45 a visit and saw the standard four patients an hour, he would be making a profit of only $20 per hour of patient care. That works out to $600 a week or $30,000 a year! At the previous level of reimbursement of $75 per visit, doctors would make $140 per hour of patient care, $4200 a week, or about $200,000 a year. A reasonable salary for the years of training and level of responsibility, but it is no longer a given.

Doctors faced with such drastic changes are faced with limited options-

1-      Increase the number of patients seen. At a payment of $45 per visit, doctors would need to see 8 patients an hour to keep pace. It is hard to provide good care in 7.5 minute increments, so the quality of care will drop dramatically. This is the reality for many patients on Medicaid (Medi-Cal in California)

2-      Hire Physician Assistants or Nurse Practitioners. PA’s and NP’s earn about $70 an hour, so the profit on a busy midlevel provider could make up for some of the loss in income. This requires an additional 120 visits a week, (about 2500 patients in the practice), and as it could take years for a practice to double in size this is not a viable option for most providers.

3-      Give up and join a hospital practice. An increasing number of doctors are leaving private practice and becoming employees of hospitals and medical groups. The financial pressures are not removed, they are simply passed on to a larger entity. The need for increased volume and the resultant decrease in quality remain.

4-      Refuse to participate in lower paying plans. This is the current option of choice and explains why there is a fear that it may become increasingly difficult for patients to find a primary care doctor. This is the option I am currently choosing, but it means saying good-bye to many long term patients.

5-      Charging extra fees. This is the wave of the future. Insurance contracts prohibit charging extra on a per visit basis, so doctors are charging “membership fees”, annual fees for access, email communications, and annual fees to cover such things as insurance appeals and form completion. In my community these fees range from a low of $400 to a high of over $3000 for the high-end concierge practices.

Patients are having to make choices as well. Some of my patients are choosing to see me outside of their insurance plans and pay cash for their visit. They view their ObamaCare plan as something to cover emergencies and catastrophic illnesses and injuries. Other patients are leaving my practice for physician employees of large medical groups. Almost all of my patients are wondering what the future will bring. My answer is always the same, “I have no idea.”

Bart

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Monthly Cost Breakdown: (very conservative estimate)

Rent- $3500

Staff Salaries and Benefits: $10,000

Billing Service: $3000

Malpractice: $1200

Phones (office and Cell): $700

Workers Comp & Liability: $500

Utilities: $300

Medical Supplies: $1100

Equipment (computers/Ecg): $100

License and Membership Fees: $100

Miscellaneous expenses: $500

Total                                      $21,000

Patient care hours/ month: 130

Overhead per hour:        $161

A Christian Doctor's Thoughts about the Supreme Court's Decision on Marriage

The Supreme Court has declared that marriage is a fundamental right that must be extended to all regardless of their sexual orientation. Opinion polls indicate that the majority of Americans agree with the decision. How should Christians respond?

If we consider the current state of marriage in America it would seem that the Supreme Court might have got it right. For the vast majority of Americans marriage is little more than a social contract between two consenting adults. It is an agreement to share resources, divide assets and assign legal rights such as survivorship, inheritance and power-of-attorney. That it is no more than a legal construct is supported by people’s utilization of pre-nuptial agreements, which are a contract specifically delineating the limitations of the subsequent marriage contract.

A key aspect of contracts is the manner in which they can be broken or resolved. We have an entire segment of our civil code dedicated to governing the termination of marital contracts. Everything from homes, pets and even children are treated as assets to be divided. The rise of “shared custody” agreements, where time with children is parceled out by a judge, is the natural consequence of viewing marriage as little more than a contract.

If marriage is just a contract between two consenting adults, why shouldn’t same sex couples be allowed to enter into such an arrangement? What rational argument can be made to the contrary?

The Christian teaching is that marriage is more than a contract. It is a covenant. It is founded not in a commitment to share resources for mutual benefit but in submission to God’s divine plan for humanity. It was ordained and created by God as a declaration of His provision and love, an expression of His plan for creation. Scripture teaches that He created Male and Female and that in so doing He created them different and complementary, designed to achieve full expression in the oneness that comes from marriage. The marriage covenant is intended to last and to reflect God's unbreakable commitment to His people.

This understanding of marriage as covenant was abandoned by our nation, including many who profess to be Christian, long ago. When essential components of the marriage covenant such as fidelity, sexual purity, and an unbreakable life-long commitment were set aside, when the church turned a blind eye to pre-marital and extramarital sex, pornography, and divorce, the definition of marriage was beginning to change. When the authority to define marriage was delegated to the government further change became inevitable. In a representative government state policies evolve and adapt to changes in the attitudes and beliefs of the governed. As societal values change over time so will laws and statutes, so a departure from a traditional definition of marriage was inevitable.

It is for this reason that those who look to constitutional amendments, judicial appointments or presidential elections to return marriage to its traditional definition are wasting their time and energy. The best defense of traditional marriage will never arise from the eloquent arguments of an attorney or the blistering dissent of a judge. It will be found in the powerful testimony of Christians living in covenantal marriage in full view of a critical public.

While our nation and our courts may proclaim that marriage is defined as a commitment made by any two consenting adults, Christians who adhere to Biblical teaching are compelled to say it is much more. It is a covenant established by our Creator, intended to be symbolic of His love for His people. While we must say this with our words, we will say it best when we say it with our actions. If we do not fight for covenantal marriage in our own homes, families and churches, we cannot expect to be heard when we take the fight into the secular world.

My prayer for the church is not that the Supreme Court decision will lead to greater political action. My prayer is that the decision will result in personal action. May Christians be motivated to a renewed commitment to purity, fidelity and faithfulness, may divorce become a rarity in our churches, and may true love and commitment between husbands and wives become defining characteristics of our families. This is the greatest argument for marriage that we can make. If we fail to make this argument no other argument will matter.

- Bart

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