Mean Doctor Learns to Be Nice

“Why are you always so mean?”

The question surprised me. I was meeting with the business manager of our medical group about some issues I had with the billing and support staff. My expectations had not been met and several requests had been ignored so I arranged a meeting with her to address my concerns. I was not the most tactful person in my business relationships but I thought bluntness was acceptable in the businesses arena. I had high standards and was a firm negotiator but I did not think I was mean.

She obviously disagreed with my personal assessment and apparently had a number of employees who agreed with her. The staff were intimidated by me and felt that I had a tendency to make demands and deliver ultimatums. I paused a moment to reflect on previous interactions before I responded to her questions. It only took me a few moments to realize the truth implied in her words. I was mean at times. Why? The answer came to me a moment later.

“Because you don’t respond when I ask nicely,” I said, “I tried that and was ignored. I learned that when I was mean, people listened.” I went on, “I would much rather be nice. If you promise to listen when I ask nicely, I won’t be mean again.”

“Deal!” she replied.

That was over 20 years ago and we still have a business relationship. She is the manager of the management company that administers my medical group and handles all of my billing and insurance contracts and we interact frequently. We have worked together on numerous projects and dealt with many complex issues. Meanness and anger have never once been necessary. She kept her promise and I have done my best to keep mine.

The lessons learned from that conversation have had a profound impact on the way I run my practice. My staff and I work hard to make sure there is never a need for patients to raise their voice or make demands. Complaints are rare because patients know we will always do our best to meet their needs and exceed their expectations.

I have been mean and I have been nice. I have learned that nice is better.

-          bart

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The Irrelevant Church

“Relevance has always been a priority and value for us as a church." So wrote a leader of a large church as he articulated the reasons for the youth oriented emphasis of his church. The leaders were deeply concerned about the fact that young people were migrating away from church and the leaders were striving to address the disturbing trend.

I admire the leader's passion and cannot argue with his stated goal of reaching out to young adults who are outside the faith. What I do argue with is the misguided emphasis on social relevance as a priority and purpose of the church. My argument begins with the definition of relevance and with its inappropriate place on a church’s list of priorities.

The definition of relevance most often put forth by church leaders is an approach that addresses the concerns and needs of the intended audience, young people. Young people today seem to be more concerned with how the church interacts with the less fortunate or marginalized and less concerned with traditional values such as morality, purity and holiness. Church leaders often cite studies by researchers such as George Barna showing that the millennial generation considers Christians to be harsh, judgmental and unloving. The most common reasons given for this negative impression are the "church’s" positions on hot button issues such as same sex marriage and sexual morality.

No one wants to be called harsh and judgmental, especially churches.  In an effort to counteract negative perceptions churches are beginning to emphasize programs that “prove” Christians to be nice people. Community service projects, neighborhood beautification efforts, after school tutoring programs, food banks and the like abound. All are worthy and noble causes, but the priority given to these works and their promotion suggests that service is not the only goal. The goal is to also show that the church is relevant to modern culture.

Relevance is defined in more superficial ways as well. Many churches intentionally remove all possible signs of pretense or formality. I know of one church in South Orange County that went to great lengths to obscure its pipe organ from view. It was beautiful, but it was not relevant. Many churches have taken steps to remove any semblance of formality and casual dress is the standard pulpit and platform attire. Informality is the new ideal, with parishioners often arriving in shorts and flip flops and carrying lattes into worship services. Concert style lighting and bands playing contemporary Christian music are all intended to add to the cultural accessibility.

While there is nothing inherently wrong with any of these changes and one can argue against formality in worship there is one thing of which I am certain. None of these changes in focus or style has anything to do with relevance.

The relevance of the church is not defined by the culture in which it exists. It is instead defined by the message that is preached and the God who is served. Some of the greatest works of God in the present day can be found in cultures where the Christian message has been declared not only irrelevant but illegal. An example is communist China, where millions of Christians worship in “underground” house churches whose message defies, rather than appeals to, the dominant culture.

The pursuit of relevance is dangerous. Circumstances will inevitably arise in which the doctrines and teachings of the church will be considered outdated and judgmental. The temptation to compromise values, alter emphasis or change focus may be difficult to resist. The church should instead pursue truth, holiness and grace, in any style it can.

When the church is defined by holiness, grace and truth, cultural relevance becomes- irrelevant! 

- Bart

A MasterCard Weekend. Priceless.

Some life goals are noble, some are selfless and some seem silly. All are important to the person who sets them. As I accept the reality of my 55th birthday (and eligibility for the senior discount at Sizzler and IHOP) I am blessed in knowing most of my life goals have been met. I have a wonderful marriage, incredible children and a rewarding career. This week I was able to do something I have wanted to do since I was a child.

When I was a kid baseball was one of the few sources of joy in my life. I collected baseball cards, cherished each Dodger card and even memorized the stats on the back. I read every baseball book in the local library including biographies of Hall of Famers and histories of the game. One of my most embarrassing childhood memories was the day in 5th grade that I was so engrossed in the biography of Cleveland Indians pitcher Bob Feller that I sat right through the pledge of allegiance.

After cartoons on summer Saturdays was the Major League Baseball game of the week on NBC. Tony Kubek did the play by play and Joe Garagiola was the color man. I learned about all of the teams and the players and knew all of the ballparks in all of the cities. Two ballparks stood out from all of the others, Fenway Park in Boston and Wrigley Field in Chicago. Fenway had the Green Monster in left field. Wrigley had the bricks and the ivy on the outfield walls. Wrigley also had the distinction of being the only baseball stadium without lights. Every game at Wrigley was a day game. Attending games at each stadium has been on my to do list for almost 50 years.

I made it to Fenway in 2015. Last spring Lisa and I took a trip to Cape Cod. While there we took a day trip into Boston and I was able to go to the ballpark. It was a wonderful experience. The only thing missing was my son, who shares my love of baseball but wasn't on that trip with us. Fenway left me with a strong desire to make a trip to Wrigley with my son. The challenge was finding a time we could go. He married 4 years ago and just started his legal career. A long vacation together wasn't feasible. If we were going to make a trip to Chicago it would have to be a weekend trip just for a ball game, which wasn't practical. I am a frugal person and did not think I could justify spending money on round trip airfare and hotel just to see a baseball game.

A few months ago I changed my mind. I decided that a weekend with my son going to one of America’s greatest ballparks was worth the cost. The potential of a lifetime father/son memory was something I could not resist. I called my son and made plans to go to Chicago for two days over the Labor Day weekend. Friday afternoon Nate and I boarded a plane to O'Hare. We woke Saturday morning and walked the mile from our hotel to Wrigley Field. We arrived early enough to walk around the stadium, joining the crowds viewing the statues of Cubs greats outside. Every name had meaning to me- Ernie Banks, Billy Williams, Ron Santo and Harry Caray. We lined up early to enter the stadium as soon as the gates opened.

Our seats were a few rows up in the second section on the first level, behind the screen looking down the third base line. We settled in and took a moment to survey our surroundings. There is less foul territory than at modern stadiums and lower walls so we were close to the playing field. We soaked in the sights, looking out across the field to the ivy covered walls, down the foul lines where the brick walls seemed just inches away from fair territory, above the centerfield wall to the large manual scoreboard, as green as the monster in Fenway, and beyond to the bleachers built on the roof-tops across Waveland Avenue. My son and I had made it, we were at Wrigley field. My son said, “It’s kind of silly, but I could tear up right now.” He was not alone.

Nine exciting innings later, after many close plays and a few heartbreaking mistakes, the Cubs lost by a run. Thousands of unhappy fans headed for the exits. We joined them on the journey but did not share their emotions. It had been a wonderful day.

We returned the next day to sit in the bleachers. We arrived at the stadium 3 hours before the game and took our place in line. The bleachers at Wrigley are general admission, no assigned seating. We wanted to get their early enough to to get good seats. We ended up in the second row in left-centerfield. Perfect seats with a perfect view of the action. The game started slow but featured a 9th inning comeback by the Cubs that sent the game into extra innings. We stayed long enough to see Aroldis Chapman the Cubs reliever hit 100 mph on the radar gun and then made our way to the exit for the walk back to the hotel and the Uber ride to the airport. As we walked we talked about our two day whirlwind of a trip. I decided it was a MasterCard weekend. The airfare, hotel and game tickets had cost well over a thousand dollars, but the opportunity for me to spend a weekend with my son at Wrigley was absolutely priceless. Lives are sometimes measured in moments and memories and this weekend was filled with wonderful ones.

- Bart

When the Doctor Makes a Difference

I didn’t want to go in to the hospital. It was my internship year and I was tired from being on call every fourth night. It was my night off and I wanted to be home with my wife and son. 100 hour work weeks are hard on a marriage. I wasn’t in the mood for more work so I was not happy when my pager went off and I saw the number of the labor and delivery unit in the display. I called back and was told that one of my clinic patients was in labor. The resident on call was calling me to see if I wanted to come in for the delivery.

I was not obligated to respond. No one expected residents to come in on our nights off and the policy was that doing off-night deliveries was entirely optional. There was a resident physician on call in the hospital whose job it was to manage the obstetrical unit so my presence was not needed. I had every right to decline the request but in spite of my exhaustion I knew staying home it wasn’t an option. I had made myself and my patients a promise that I would attend every delivery I possibly could so I sighed the deep sigh if the sleep deprived and told my wife I was going back to the hospital. I scrounged around for a set of scrubs and headed out the door.

I sleep walked to my car, drove to the hospital and took the elevator to the 5th floor obstetrical unit. I made a right turn when the doors opened and headed down the hall towards her delivery suite. As I walked I could see that the door was open to her room with a current drawn for privacy. Curtains are a poor noise barrier and I could hear her cries of pain as I approached. Epidurals had not yet become routine and she was going through the last stages of labor medicated only with narcotics. It was clear that the narcotics were completely inadequate. I knew her well enough to know pain was not her only challenge, I detected fear and anxiety in her voice.

As I pulled the curtain back to enter I saw the on call doctor standing near her bedside. From a medical standpoint her presence rendered mine completely unnecessary. A doctor was needed for the delivery and a doctor with the skills and knowledge to care for the patient was present. I briefly wondered why I had felt the need to come and whether it mattered.

The patient’s response made my wonder disappear. She looked up at me as I entered and a look of relief come over her face. “Thank God you are here!” she said. She calmed instantly and I realized that what mattered to her in her time of need was not that some doctor was present, what mattered was that her doctor was present, the doctor she trusted.

I have never forgotten that moment. In those few seconds I realized a new career goal. It was no longer enough for me to be a good clinician, to simply get the treatment right.  I decided that I wanted more. I wanted to make a difference in people’s lives, not solely because of my medical knowledge and expertise but because of who I was as a person and the relationships I built. I wanted to have an impact on patients not solely for the care I provided, I wanted to make a difference because I was a caring provider.

The goal of making a difference has proven to be a challenging one. My own fears, insecurities, and stress can make it easy to overlook a patient’s emotional needs. The mental focus required to make a challenging diagnosis can at times cause me to lose sight of the big picture. It is easy at times to be “just another doctor.” My patients deserve more, and because of that pregnant patient 25 years ago, my patients get more.

-Bart

PS: After writing this post I decided to see if I could find the patient on Facebook. I did, and I sent her a message. The baby boy I delivered that night is now a man of 25. In spite of the years the patient remembers the night well and how grateful she was when I arrived. She wrote, "The anxiety wondering if someone whom I did not build a relationship with, someone who was well qualified but unknown to me was to deliver my child scared and worried me. I was truly concerned that you would not get there and appreciated it more than you might have known. The fact that neonatology was called due to meconium and a concern of NICU, I was a small disaster of nerves and prayers. Seeing you walk in calmed me and reassured me that all would be right with the world that early morning.  God placed you in my life for just that reason. Again thank you for being who you are and what you chose to do."

Thanks for reading, and a special thanks to all who take the time to share and let others know about the blog. Comments and questions are always welcomed.

Best. Business Decision. Ever.

I needed a day off but couldn’t take it. I had been in solo practice for 3 years and business was steady. I loved my job, my office and my patients but wanted some time for myself, some time with my wife and some time to write (my book, Life Medicine, was in the planning stages.) I wanted to take a half-day off in the middle of the week but did not have anyone to cover me. A regular day off would just make the rest of the week terrible as I tried to catch up. I could arrange coverage with other physicians for the occasional day off or vacation coverage but a regular day off seemed out of reach.

I thought about hiring a Nurse Practitioner or a Physician Assistant but I did not have either the business to pay someone a full-time salary or the space for someone to work in the office along side of me. I thought about trying to hire someone part-time but the same problems remained. Who would want to work only one half-day a week? Desperate, I reached out to a colleague to see if the Physician Assistant they employed might be available to cover one morning or afternoon a week. I received a sympathetic “No” as a response.

“I do know someone though,” my colleague said, “I have a neighbor who is a PA who has been out of work for a while. She might be interested.”

I figured I had nothing to lose so I made the call. The woman who answered the phone was very pleasant when I called. She had taken time off when her children were born and now that they were school-aged she was thinking about reentering the work force. She was a little leery about her skills after being out of work for 5 years but wanted to reestablish herself. I invited her in for an interview.

The day of the interview she called to cancel. One of her sons was sick with the stomach flu and she had no child care. “You can bring him with you to the interview if you like,” I told her, “I don’t mind.” She was pleasantly surprised at the offer and agreed to come in.

A few hours later she sat across from me in my office. Her 6 year-old son sat quietly on a blanket she had laid out on the floor, playing with toys while we talked about the job. She was interested in the opportunity but nervous about how everything would work out. “What do we have to lose?” I said,” if it doesn’t work out, we shake hands and part friends.” She liked that logic and accepted the position.

That was 11 years ago. Brandie Walton, the PA I hired is still with me. I remodeled the office two years ago and she now works full time. She has been the perfect PA, kind, gracious and knowledgeable. She has also become a friend, colleague and source of stability and encouragement to me and all of the employees. We share similar views on life, faith, and service to patients. We cannot imagine ever working with anyone else.

Since she started full time in January we have found ourselves reflecting back on how our journey together started and the path that we have walked these last 11 years. At the time I hired her neither one of us could have imagined how the practice and our professional relationship would grow. The initial decision we both made to trust one another and work together has been one of the smartest decisions we ever made. We have been truly blessed.

Bart

PS: An update on the little boy on the blanket- He left for college last week! His big step is a reminder of how much time has passed and the source of this reflection.