Misunderstanding Marriage

He loved her and told her she was his “why”, the reason he did everything that he did, but he was not ready to marry her. There was a lot he wanted to accomplish first. He wanted to be more established in his career, wanted to buy a house and wanted to give her a chance to finish her education. Once he had his life in order he would propose.

I told him I did not understand his answer and asked, "If she is the person you want to spend the rest of your life with, why isn’t she the person you want to build your life with?" I told him I wondered when it was that society decided that marriage was couldn't do until you had it all together.

When I met Lisa, my life was nowhere near “together” status.  I had almost no money in the bank, was working part-time while I went to school (making just enough to survive) and sharing a one-bedroom apartment with a roommate. I had just finished my first year of community college and wasn’t even sure of my major or ultimate career choice. Lisa was working full-time as a dental assistant and living at home with her parents. None of my deficiencies factored into our marital decision.

For us, getting married was not about what we had accomplished or what goals we had reached, it was about reaching our goals together. We wanted to be husband and wife, to share every step of life’s journey together. We had no idea what the final destination would be but that did not matter. The one thing of which we were certain was that we wanted to find our future together. It was about who we were going to be and what we would become and the family we would have.

In conversations with this young patient and with so many others like him I have learned that young people do not view marriage as a “we” thing anymore. For many it is a “you and me” thing, an “I’ll be me and you’ll be you” arrangement. This focus on self-fulfillment and self-realization is not fertile soil for growing a healthy marriage.

Individual success and achievement are not the indicators for when commitment should be considered, nor are individual happiness, personal fulfillment and feelings of happiness the standards by which marriages should be measured. When individual needs, desires and accomplishments are of primary importance, committed relationships are in jeopardy.

Perhaps this is why so many of those contemplating divorce speak of their personal disappointments. When people say, “I’m not happy,” or “I’m not fulfilled,” or “I don’t feel the way I used to,” they are showing a profound ignorance of the nature of marriage. Marriage should never be about looking out for oneself. It should always be about one selfless union.

- Bart

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Open Mouth, Insert Pastoral Foot

Communication is hard. It is especially difficult to speak clearly when one has his foot in his mouth, something Eugene Peterson learned a few weeks ago. Peterson is a retired pastor well known in Christian circles for his paraphrase of the bible, The Message. At the age of 84 he is no longer active in ministry on a regular basis but he recently gave an ill-fated interview to Religion News Service. In the article he was asked about his views on homosexuality and gay marriage. It was then that he unwittingly seemed to swallow his toes.

In his answer to the question about homosexuality he said- “we’re in a transition and I think it’s a transition for the best, for the good. I don’t think it’s something that you can parade, but it’s not a right or wrong thing as far as I’m concerned.”

To the follow up question on whether or not he would officiate a gay wedding he replied, “Yes.”

The backlash from the Evangelical Community was both intense and rapid. Respected Christian leaders took to their blogs and other platforms to denounce Peterson, many for his statement that the issue was not a “right or wrong thing.”

His words implied either a dramatic departure from traditional Christian teaching or the reality that Peterson had never held to such teaching to begin with. Whatever one concludes about the morality of a specific human behavior, Biblical faith does not allow for such fuzziness. A religion that teaches about sin and its eternal consequences will of necessity require clear teaching about what is and is not sin.

It seems that Mr. Peterson understands this truth, for he retreated from his doctrinal haziness the next day, saying that he would not perform a gay wedding and that he affirmed “a biblical view of marriage: one man to one woman. I affirm a biblical view of everything.”

Although he did not fully retract his statement, his response was embraced by many religious leaders. Those who believe same-sex relationships are consistent with the Christian faith were not similarly pleased. Some felt betrayed and abandoned. One writer went so far as to say Peterson’s retraction would “be used to fracture relationships, to kick people out of churches and tell them God is disgusted by them,” and that “Peterson's good intentions will not change the destructive impact of his words.”

Peterson’s struggle has implications for all people of faith. As our culture evolves in an increasingly secular direction we will all be required to answer questions about sexuality. We will be invited to gay weddings, we will have gay friends and co-workers, and we will be asked, “What do you think?”

I arrived at my answer years ago. I think the actual question, the important one that underlies the sexual question is, “Where do our values come from?” Do our values come from God, and remain as constant as he does? Or our values based on evolving cultural beliefs and attitudes and thus destined to change?

As a Christian I believe that God’s position on sexual issues is constant. I believe that the teaching of the Bible is meant to be a definitive, enduring and authoritative guide for life and faith. Because of this I believe God’s plan for sexuality is that it be expressed in the context of heterosexual marriage. This belief may be considered oppressive, bigoted and hateful, but for those who profess allegiance to scripture, it is the belief most consistent with Biblical teaching. There is no option but to affirm it. Contrary to the response of Eugene Peterson, it is a right and wrong issue.

What about those who take the other side, those who believe that loving same-sex relationships are consistent with God’s plan for humanity? People have every right to that position, and to express it passionately. If they are honest, they will also declare that they no longer view the Bible as inerrant or God as unchanging in his morality. Further, they will need to abandon traditional understandings of right and wrong, or to put it in religious terms, of righteousness and sin.

What no one can do is find a comfortable middle ground on which to stand, for no such ground exists. Ask Eugene Peterson.

Bart

Your Doctor Just Might Disappear

Many Family Doctors hate their jobs. They love taking care of patients but direct patient care is on the decline. More and more of each day is spent on administrative work. Staring at a computer screen all day entering useless data that has nothing to do with the patient’s condition is no one's idea of rewarding work. Busy work has taken the place of diagnosis and management of illness. Doctors who routinely saw 25 patients a day 20 years ago (with time to spare) now find themselves struggling to see 15.

At a recent physician meeting I attended I was surprised to hear of how bad things have gotten.  Many of my colleagues are spending over three hours a day in charting and other administrative tasks. Work days routinely stretch well into the evening hours with one doctor not leaving the office until after 8 PM (even though his last patient was scheduled at 5).

It is not surprising then that many doctors are looking for a way out. Doctors who once planned on working into their late 60’s are analyzing their retirement plans in the hope that they can retire as soon as possible. When these doctors retire they will leave behind a shortage of primary care providers. The impact on society will be profound, as the resultant lack of access will leave patients waiting weeks or longer to see a doctor.

Those who are too young to consider retirement are looking at other options. “Direct Primary Care” is on the rise, a style of practice in which doctors do not accept any insurance at all. Patients pay cash for the services they receive. In exchange for the personal service and attention doctors charge rates well above what they receive from insurance providers. Physicians also care for far fewer patients, making access, especially for poorer patients, even more difficult.

This dissatisfaction and work stress is in large part due to the advent of electronic medical records. Hailed as a way to improve documentation and limit error they have instead become a burden and a curse. Insurers, particularly Medicare, can now easily review doctor’s charts for “quality”. This sounds wonderful, but the definitions of quality set forth by these outside entities have almost no relationship to actual patient care.

Each month I get an updated report on patients who have not received “needed” tests. It is disheartening to see my performance score lowered because patients with terminal cancer and end stage Alzheimer’s Disease have not had a recent colonoscopy! I find myself wondering, “How did it come to this?”

The loss of longstanding patients is another cause of physician burnout. Primary care physicians typically enjoy having relationships with their patients. More and more we see patients we have known for years leave our practice due to a forced change in insurance. In my practice we see a large number of new patients each week without seeing a significant increase in overall volume. New patients bring new stress as doctors must work to gain confidence and deal with the insecurity of making diagnoses in a patient they do not know well.

Making matters worse is the reality that there is little chance of things getting better. As with many problems in America the problem is likely to get worse over time, ignored until a crisis is reached. None of the health care options under consideration by the government, not Obamacare or its proposed replacements, do anything to address these causes of physician burnout.

This is not to say there are not things patients can do to help their doctors. One of the best ways is for patients to do what they are asked. Get your mammograms, pap smears and colonoscopies the first time you are asked. Go to the lab for your blood work when your doctor requests it, without having to be repeatedly reminded. Keep your appointments and follow up when asked. This seems simple, but it can make a difference!

Finally, be kind. They won’t say anything to you, but your doctors may be hurting. Patience from our patients is desperately needed for doctors who feel overwhelmed.

- Bart

35 Years of Heart

Not all marriages last for 35 years, especially when the couple only knew each other for 5 months on their wedding day. But here Lisa and I are, celebrating 35 years together, much older and even more in love with one another. We often ask ourselves, “How did we do it?”

I think it comes down to heart. Lisa has the most amazing heart I have ever seen, as well as an ability to see the hearts of others. She has a tenderness and compassion for others that flows naturally from within. This was readily apparent to me even on our first date, so much so that I found myself thinking, “This is the type of woman I would want to be the mother of my children someday.”

She is incredibly genuine has a remarkable ability to see into others, to see people for who they really are, not for who they pretend to be. With me, she saw through the jokes and bluster and saw a man who in his heart who wanted to be good. It was the goodness in her heart caused me to fall in love with her and allowed her to fall in love with me.

Over the years there have been many times when I struggled. Insecurity and anxiety have caused me to be defensive and short-tempered. She loved me anyway. More than that, even in my worst moments, she never criticized who I was, never attacked my character, never stopped believing in me. She was strong enough to challenge my actions but always kind enough to never question my heart.

Because of her love and support I find myself closer to being the good man the young Bart hoped to be. I always wanted to be a father but my upbringing in an abusive home made parenting difficult. Lisa  taught me what it meant to be a loving parent. She consistently modeled patience, kindness and grace with our children, and delighted in their personalities and idiosyncrasies. Just as she did with me, she saw their hearts and loved them for who they were and who they could be. When my anger and insecurity made it hard for me to see the best in my children she was my eyes.

I think this is how we made it, by believing in each other’s hearts. When two people love each other enough to believe in one another, even in the difficult times, marriages last.

- Bart

Shaming Your Doctor on Facebook

My wife was upset and angry when she called me. She had been scrolling through a community Facebook page for Huntington Beach and come across a scathing post against me and my office. An angry and upset patient had written multiple paragraphs, accusing me of billing for services I did not provide, of being rude, arrogant and mean, and saying my staff reflected the same attitude. The page has over 20,000 followers and many of them, some of whom had no personal experience with my office, had joined the mob of commenters,  supporting the patient and her opinions. Many of the negative comments were personal.

I was at breakfast with a friend when she called. I excused myself and hurried home to deal with the online damage. My wife had gallantly tried to defend my honor only to see some of the attackers turn on her as well. I stared at the screen for a few moments and debated how to respond. Doctors cannot respond as other businesses do as privacy laws do not allow us to reveal any personal details about patients or their conditions. I typed out a general response, trying to graciously and kindly explain that the statements did not accurately reflect my interaction with the patient or the nature of my practice. That post was criticized and attacked by strangers as well.

In the meantime a few of my patients noticed the post and came to my defense. Many shared personal stories of care they had received. Others reached out to the administrator and asked that the negative post be removed. The post was taken down within a few hours but not before hundreds of local residents had read it. I wondered if any lasting damage had been done. My wife and I were both shaken by the nature of the attack. She even said, “If I were you I would want to quit!” At that moment I did.

I thought about the patient who had written the post (which she also left in the form of a review on my office Facebook page) and wondered at the intensity of her anger. I looked back on her single visit, which had been uncomfortable from the outset. She did not like the fees that we charge and had made her feelings clear to the receptionist on her arrival. It seemed her unhappiness carried over into the exam room. I nevertheless spent a great deal of time with her and did the best that I could to meet her needs. I failed. A few weeks later she went to another doctor and first made her accusations of false billing. When that office called me and questioned the billing I waived all charges and asked that she not return. I hoped that waiving charges would calm her anger. I was wrong.

My wife and I spend much of the morning talking about the incident. As we reflected on what had happened we kept returning to the meanness of it all. While we could understand someone being unhappy with their care we could not understand the intent to harm and destroy. When posts are shared with thousands of people the harm is real. (The following day a new patient told me she had read the post and nearly cancelled her visit! It was only when she read my reply that she decided to give me a chance.)

We wondered, “What has happened in our society that people so easily attack one another?” In the old days patients could file a private grievance with their health plan or medical group and have the incident investigated. Because the matter wasn't public doctors could openly share their side of the story. In the vast majority of cases all would see that the doctor had been misunderstood or that the patient did not understand what was going on and the problem would simply go away. The patient would move on.

Things are different today. One slight misstep, one mistake, one bad day or simple miscommunication can result in anger raining down. This is not unique to doctors. Everyone is under the microscope. Just a few months ago on the same community Facebook page someone posted about children playing roughly with baby ducks at a public fountain while their mother did nothing to intervene. At least one of the ducks was seriously injured. The poster, furious with the seemingly uninvolved mother, attacked her on the community page. People searched Facebook, found the mother’s profile page and publicly outed her. She was viciously attacked and publicly shamed.

The mother’s story, and mine, are important reminders that social media attacks hurt people. People who may be doing the best they can, people who may just be having a bad day. The patient who attacked me had no knowledge of how hard I have worked over the years to be a kinder and more compassionate physician. She had no knowledge of the free care given, the house calls made, the hands held, the tearful hugs shared or the prayers offered. All she knew was her single experience, and even then she only knew her side. For her that was enough to pass judgment.

If we are to be kind and generous we need to be more cautious in our judgments. We need to give people the benefit of the doubt, to assume the best and not the worst in others. All people have bad days and bad moments. We need to be understanding forgive and when we can’t we should strive to keep our anger private. No one wants to live in a world where every mistake is public record. Life is hard enough.

I need to change my attitude as well. I need to extend more grace to others. There are times I have left a negative review of a restaurant based on single bad meal or rude server. This recent experience reminds me of how wrong that is. What right do I have to judge someone’s business based on a single interaction? This is someone’s livelihood, something into which they may have invested their life’s savings. Negative reviews can do real harm not just to a business, but to a person. They hurt. I need to be less critical.

I intend to intentionally look for ways I can be more gracious. It may seem silly, but after this experience I went on my Yelp account and deleted negative reviews. It was a small step but it is a step.

As for my professional life, I will continue to do what I have always done. I will try to be better each day, to communicate kindness and compassion as best as I can. When I fail, as I did with this patient, I will do my best to learn what I can and apply the lessons to my practice. Not just because the world is watching, but because it is the right thing to do.

- Bart

PS: I called the patient later that day. The conversation wasn't wonderful but I was able to hear her concerns and why she was angry, and was able to show her that I wasn't the man she had accused me of being. "If it is possible, as far as it depends on you, live at peace with everyone." Romans 12:18

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