Our Newest Dilemma- Deciding What Bathroom to Use

To pee or not to pee. That is the question.

North Carolina recently passed a law about bathrooms. The text of the law is 5 pages long, but it essentially states that when it comes to multiple occupancy bathroom and changing areas (such as locker rooms) in government controlled facilities, people will need to use facilities that correspond to their biological sex. Boys must use male facilities and girls must use girl facilities. It also prohibits law suits against private entities that institute similar policies.

The response to the law has been one of vehement anger by many corporations, individuals, celebrities and politicians. Those who support the law have been labeled as hateful and bigoted. Curt Schilling, a former All-Star baseball pitcher, lost his job with ESPN for tweeting in support of the law. Is it is easy to wonder how our society came to arrive at such a place.

I grew up in an era where the girl’s bathroom was a place of mystery. No male dared enter the girl’s bathroom for fear of eternal punishment. Accidentally walking into the wrong bathroom was one of the most shameful acts imaginable. It could take years for the facial redness to fade.

Shame was not limited to opposite sex facilities. As an adolescent male there was more than enough shame for a boy in the boy’s locker room. Puberty is cruel and it arrives on an inconsistent schedule. In the 7th grade locker room some boys were already men while for others signs of manhood had not even begun to appear. While I have no firsthand knowledge of the girl’s locker room I am certain there was similar variability. Young women at opposite ends of the pubertal spectrum dealt with similar angst. The thought of changing in the presence of someone with the opposite biologic gender would have been terrifying!

Yet a new variable is being introduced into the locker room equation, a transgendered one. Individuals born male (with male genitalia) who identify as female have sued school districts for the right to use girl’s locker rooms. Their belief is that it is unfair for them to not be able to have access to the same facilities as all of the other “girls”. Many of the other girls, who do not have penises, have expressed discomfort with having to change in the presence of someone who does. Remarkably, a federal court sided with the transgender student and against the district.(1)

The battle is not limited to middle and secondary schools. Elementary schools have been met with similar law suits. While there are typically no common circumstances in which fully disrobing occurs in elementary school, there have been arguments regarding bathroom use. Parents are understandably concerned that their young children who have not yet learned about the birds and the bees may not be emotionally equipped to process transgender issues. The problem is compounded by studies that have shown the overwhelming majority of “transgender” school age children ultimately identify as their biological sex. (2)An argument can be made that given the potential harm there is no need to accommodate what is likely to be only a temporary preference.

There are different concerns when it comes to adults. For the overwhelming majority of adults who are transgendered the reality is that if they have taken steps to appear as the gender with which they identify and use a bathroom stall there is very little chance of anyone even knowing their biological identity, much less objecting to it. Even if the law “prohibits” them from a facility the risk of prosecution is miniscule. The risk most often cited by proponents of laws such as North Carolina’s is instead the possibility of sexual predators taking advantage of the opportunity the law affords and preying on innocent women. While the risk of sexual assault is minimized by those who oppose the law, it is nonetheless real. There are documented instances where such assaults have occurred. (3,4)

Lawmakers are left with a difficult decision. Apart from the extremely costly and unrealistic option of mandating that all facilities be single user and non-gendered any policy implemented will favor one side of the debate over the other.

An often overlooked part of problem is the rarity of transgenderism (estimates I have seen range from 1/3000 to 1/12,000 or less). Rarity results in it being very difficult to make any scientific assertions as to the normalcy of the condition. It also makes it less reasonable to demand governmental protections. Even if a biologic cause is ultimately discovered it will not necessarily constitute evidence of normalcy, for there are many genetic conditions that are considered abnormal (sickle cell anemia, cystic fibrosis and other such diseases). Normalcy for such things is always a matter of value judgments rather than facts.

It is obvious that there is no solution that will be universally acceptable. There is nevertheless a common sense answer available. If a policy or practice has been followed for centuries without significant or widespread negative consequences, and there is not overwhelming evidence that it should be changed, it is best to leave it alone. A law such as the one in North Carolina should not be necessary but it is. The definitions of male and female that have been the foundation of societal relationships since the dawn of humanity need to be defended, as does the innocence of our children.

-          Bart

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1.       http://www.chicagotribune.com/news/local/breaking/ct-transgender-student-locker-room-palatine-met-20151012-story.html

2.       Wallien MS, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 2008; 47:1413.

3.       http://www.crossmap.com/news/sexual-predator-jailed-after-claiming-to-be-transgender-to-assault-women-in-shelter-26962

4.       http://www.dailywire.com/news/330/university-toronto-dumps-transgender-bathrooms-pardes-seleh

You Get What you Pay For!

The office manager was angry. One of the front office employees and failed to collect a payment that was due and the patient had left the office without paying a significant balance on their account. She was planning on writing up the employee for the error, hoping to make an example of her. As far as the office manager was concerned mistakes like this could never happen.

I knew the employee well and knew that she did not have a pattern of making mistakes. She was typically conscientious and tried to do a good job. While I did not like the fact that charges were not collected I saw the situation differently. In my mind the employee had made an honest mistake. I said as much to the manager.

“We can’t have mistakes like this!” she replied.

“What do you think an acceptable error rate is for her job?” I asked. The manager looked befuddled. “Why zero, of course!” she replied.

“I can’t afford a zero error rate,” I explained. “perfection is expensive. You don’t get perfection for what we pay!” I reminded her that our front office staff consisted entirely of women with high school educations and a few years of experience in the medical field. They made an hourly wage of $12 (about $16 in today’s dollars). I reminded her of the adage, you get what you pay for.

15 years have passed and I am now in solo practice but I still get what I pay for. (Although I pay much more.) It is my desire to have the best office staff in town so I pay my staff handsomely. They make 30-50 percent more than what they would make in some other offices but their performance is exceptional. We are the top rated family practice office in town when it comes to customer service.

While the relationship between salary and performance is obvious it is often ignored. Every applicant I interview wants a high wage. Most do not understand the expectations that come with higher pay. I recently hired someone who had an impressive resume and wanted to start at $20 an hour. As this was above the rate I had budgeted for the position I told her she would need to excel. When her job performance was at a level consistent with someone new to the field with no experience we felt compelled to let her go. I was emotionally conflicted but knew that it made no sense to pay $20 for $12 worth of performance.

We live in a world where many believe they deserve to be paid a higher wage for many reasons other than performance. Longevity on the job, personal financial needs and even the profits of the company are all cited to support demands for higher salaries. For businessmen, none of this matters as much as return on investment. The question is always "Is the employee worth what we are paying?"

It is my belief that both employers and employees need to be realistic and fair in their expectations. I do not expect perfection, nor do I seek excellent employees at bargain rates. I expect to pay people what they are worth.

-          Bart

Missing From the Pulpit- Fear

 Teaching the Bible makes me nervous, especially when I am invited by a church to preach on a Sunday morning. The pulpit is a scary place. While I can deal with life and death situations in the office without batting an eye, I approach every sermon opportunity with a healthy dose of concern and anxiety.

I am nervous because I take teaching the Bible seriously. The thought of making a mistake, of leading people astray or causing them to stumble, brings significant fear. It is a tremendous privilege and honor to teach God’s Word and I want to do my very best. I spend hours in preparation, typically going through 8 drafts of a sermon before I feel ready to teach. Even then I am often making adjustments the morning of the message.

My preparation is not limited to the content of the message I deliver. I spend time preparing myself on the outside as well. When invited to a church for the first time one of my first questions is, “What is the dress code?” I do not want anyone to be distracted by what I wear and I want my attire to communicate seriousness and dignity. I always wear dress slacks and a collared shirt and have worn coat and tie on several occasions. I want to respect the pulpit and the congregation. When in doubt I error on the side of formality. 

The seriousness with which I approach the pulpit appears to be outdated. Dignity and respect seem to be viewed by many current pastors as negative attributes. In many cases it seems little thought is given to the feelings of those in attendance. At times I feel as if the feelings and attitudes of the congregation, particularly older members, are treated with disdain. Casualness in dress and informal speech are badges of honor, a statement that the speaker has broken free from meaningless traditions. If there is a line marking the boundary between appropriate and inappropriate speech or appearance many modern preachers appear to have the goal of walking as close to that line as they possibly can. Edginess, hipness and relatability have surpassed dignity, integrity and respect in the hierarchy of pastoral values.

The words of James in his letter to the church at large hundreds of years ago seem to have been forgotten. He cautioned, “Not many of you should become teachers, my brothers, for you know that we who teach will be judged with greater strictness.” Because we are often the face of the church, teachers need to be better than everybody else. We need to be examples of excellence, grace and decorum. Instead of living on the edge we need to be raising the bar.

I have heard some express concern that such formality may be harmful, that church services and sermons need to be accessible and relevant to young people. These concerns lead to some pastors sharing stories and jokes of questionable taste in the name of accessibility and authenticity. What is missed is the fact that those who want maturity and decorum from the pulpit are not out of touch or out of date. They are correct!

Consider the instructions given by the Apostle Paul to his very young pastor protégé Timothy. Paul gave Timothy specific advice on how he was to handle himself in the church. “Let no one despise you for your youth, but set the believers an example in speech, in conduct, in love, in faith, in purity.” Paul’s words strike a powerful contrast to the positions of many modern preachers. According to Paul, the young man should act like a mature man, not the other way around.

With this in mind, I offer some advice to those who feel called to preach. Be afraid. Be fearful of dishonoring your calling, of being a poor example, and of disrespecting those you serve. A stricter judgment awaits you.

- Bart

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The Wrong Definition of Hate

 “You keep on using that word, I do not think it means what you think it means!” So said Inigo Montoya in The Princess Bride. In the movie he was speaking of the word “inconceivable.” He could say the same thing today about the word “hate.” When people disagree with one another over moral issuesthey no longer simply declare one another wrong, misguided or mistaken. The other side, most often the side supporting traditional values, is declared to be “hateful.”

I saw this recently in an unexpected place, a sports column on Yahoo. The author, Jay Busbee, wrote an article about the potential fallout resulting from the Georgia legislature’s passage of a bill protecting religious institutions and individuals who do not perform services that go against the tenets of their faith. The bill, HB 757, does not specifically address a particular service, but no one denies that it was designed to address potential recrimination against those who do not perform same sex weddings or allow the use of their facilities for that purpose, and for religious individuals such as florists, photographers, and bakers who similarly wish to decline participating in same sex ceremonies.

Mr. Busbee wrote that the city of Atlanta might lose out in its bids to host major sporting events such as the Super Bowl and NCAA Final Fours as a result of the legislation. In his article he made his thoughts about the legislation clear. He called the legislation a “so-called Religious Liberty bill” and said that the bill was “discrimination, plain and simple” and suggested that the bill arose out of “anger crossbred with fear.” He closed the piece by writing that Georgia is “The State Hanging on to Hate.”

It seems that in the eyes of Mr. Busbee (and those who think as he does) hate is the only possible motivation for those who do not want to participate in same sex wedding ceremonies. It is never a result of a kind and loving person following a sincerely held religious belief. He seems to be either ignorant or intolerant of what the Bible teaches on the subject. There are a number of passages (such as Romans 1) that communicate dire consequences for those who live contrary to the moral teachings of Scripture. He dismisses out of hand the idea that if someone believes a lifestyle to be harmful, refusing to participate in it or support itcould be construed asan act of love, not an act of hate. 

His words imply a profound disrespect of faith, a position that religious belief should not intrude into everyday life, endure beyond Sunday mornings or extend outside the walls of the church. To Mr. Busbee it seems religion is at its best quaint and at its worst evil. This is a convenient position to take, for when religious belief is marginalized, when it is considered to be mythical, false or deceptive, there is no need to respect its teachings or the people who follow them. We are reaching a point where our society respects an individual’s right to believe what they want but only respects the individual’s right to live according to those beliefs when they are inoffensive to others. Faith only matters in matters that are insignificant. When it comes to serious issues that impact society, faith is irrelevant.

The unpleasant truth overlooked by Mr. Busbee is that when acceptable religious practice is determined by those outside of the faith, faith loses its significance. If God exists, He by definition will not be bound by the values of any culture. Morality and righteousness will be determined by Him alone, independent of the desires, beliefs and practices of those He created. More significantly, when defined by God, morality does not change.

God does not change but societies do. As societies become more secular conflict between individuals of faith and society at large are increasingly likely, for people who truly believe will not likely yield. Mr. Busbee was correct in writing that there would be adverse consequences should the Georgia legislature side with those whose faith puts them in conflict with changing social values. As our society is evolving rapidly, these conflicts will become more frequent.

As people of faith find themselves in the minority they will also find themselves in increasing danger of being persecuted for their beliefs. Those who call religious liberty laws hateful and who threaten boycotts are inadvertently making the case for the proponents of religious liberty laws. It is a fear of recrimination and punishment, of being treated as if religious faith is hateful, that inspires such legislation. The Georgia law, and others like it,  was designed to protect people of faith from those who disagree with them. Calling the law hateful is a simplistic denial of this reality.

While there are compelling arguments on both sides of the debate it is important to remember that if we wish to be a truly tolerant society, tolerance will need to be bidirectional. If only one side of a debate is tolerated, tolerance does not exist.

-Bart

A Prescription Error, A Relationship Preserved

The refill request was for a muscle relaxant, one with significant potential for addiction. I opened the patient’s chart to see when it has last been filled. I had approved a refill 25 days prior. This request was 5 days early.

Early requests are not entirely unusual, as patients are often afraid that waiting to the last minute can result in them running out of medications. A pattern of early refills can indicate a problem so I decided to log into the state controlled substance database to view the patient’s prescription history. It seemed that he had consistently been filling the medications 3-5 days ahead of the due date. I decided to investigate further.

I scrolled back through the online history and saw something that made my heart sink. The database showed that 2 months earlier the patient had filled the medication at two different pharmacies one day apart. If this was true, the patient was abusing the medication.

I could not believe it. This patient was one of my favorites, our interactions had been consistently enjoyable, often with interesting conversation. (He is a passionate and hard working man and we have much in common.) The thought that he might have been abusing his medication, that I might be forced to confront him and possibly dismiss him from the practice filled me with dread. Unfortunately, the evidence on my computer screen was hard to ignore.

I called my receptionist over and asked her to call each of the pharmacies to confirm that they had indeed filled the medications on the dates indicated. A few minutes later she handed me a note. Both pharmacies had confirmed the refills.

I wondered how to address this with the patient. The evidence was pretty clear but something just didn't feel right. I wondered if my unease was more about the possibility that I had been deceived than it was about the patient’s circumstance. I decided that I did not need to be confrontational immediately, that I would give the patient a chance to explain.

I called him on the phone and he answered immediately. “I received your refill request,” I told him, “but it was a few days early.” I went on, “ So I checked the state database to review your history, and according to them, you refilled the medication twice in January only a day apart, on the 16th and 17th.”

“Doc, there’s no way. I didn’t get two prescriptions. Let me call the pharmacies!” He was adamant, yet not defensive. I told him that I would not be able to fill the medications without him coming to the office, as we would have to address the issue and I would need to document it in the record. As much as I wanted to trust him it would be a mistake to assume that the pharmacies were at fault. I told him he would need to sign a controlled substance agreement and that his practice of using different pharmacies based on his work schedule would need to end.

He did not argue at all. “Of course, I understand. I will come in tomorrow!”

I received a text from him within a few minutes, saying he had just called and only one of the pharmacies had confirmed a refill. The state database must be wrong.

I decided to call the pharmacies myself. The first pharmacist came on the line right away and looked up the patient’s medication history. She read off the record for the date in question. “We show a prescription on January 26th that was deleted. The patient never received the medication.”

I was so relieved! The patient had been telling the truth! (When it comes to controlled medications this does not often happen.) I called the patient back and gave him the news. I told him I could refill his medications but that it would need to be on the due date, that I could not refill the medications early. He was in total agreement.

When I hung up the phone I breathed a sigh of relief. I had dodged a bullet. There was a time not so long ago when I would have assumed the worst and been more confrontational. If I had done that, a relationship might have been lost. Giving him the benefit of the doubt had made all the difference.

-Bart