Mental Health & The Church CMDA
Entrusted with the Gospel
“My
Masters in Bioethics from TEDS gave me critical knowledge that enabled me to do hundreds of media interviews each year, train healthcare professionals, write for publications, and affect public policy decisions at the state and federal levels.”
DR. DAVID STEVENS
’02
The Master of Arts in Bioethics
How should we think about moral and ethical issues related to healthcare, scientific research, and emerging technology? The Master of Arts in Bioethics from Trinity Evangelical Divinity School (TEDS) will provide you with the ethical and theological understanding you need to approach these questions with skill and care. Our program will equip you to work in healthcare, science, law, advocacy, clergy, and more.
• We offer the MA in Bioethics in several delivery formats and it is designed to be flexible with busy professionals in mind.
• Complete the program in person or online (with one or two weeklong summer courses).
Why Earn a Master of Arts in Bioethics at TEDS?
At TEDS, you’ll not only study bioethics from a rigorous academic perspective but also explore how Christian faith informs and influences the field. We’ll give you the framework and tools to understand and navigate these issues with clarity and compassion.
Get access to The Center for Bioethics & Human Dignity (CBHD), Trinity’s world-class Christian bioethics center
The Center engages in research and cultural-engagement initiatives, and is the only center focused on Bioethics among Evangelical academic institutions. As a student, you’ll be able to attend CBHD events, including their annual conference.
TEDS HAS NEW SCHOLARSHIPS AVAILABLE! Go to www.teds.edu/CMDA to apply today
George C. Gonzalez, MD
Staying in the Game
Sometimes I feel like Moses—content to play it safe and take care of a few sheep after experiencing significant ups and downs of life, yet the burning bush keeps calling me. It’s a call to be an instrument of God and get out of my comfort zone. I can come up with some valid excuses, though. Surely, there are more qualified, articulate and younger people who can do the task needed. In my latter 60s, can’t I just rest and relax a little more? I have worked hard most of my life. No, there is no concept of retirement from God’s work in Scripture! Moses, Joshua and Caleb began at 80! Psalm 90:10-12 reminds us we don’t know how many years we have left, but we are to be wise with the years we have.
I admired a pastor friend of mine, who was also a patient, because he was still active in teaching and discipling, as well as writing several books, into his late 70s. John was always reaching out to people and sharing the gospel with unbelievers, especially Muslims. Though diagnosed with leukemia and chronic anemia, he remained spiritually and physically disciplined, letting me know his utmost concern was to finish well. As Paul stated in 2 Timothy 4:7 to a younger Timothy, “I have fought the good fight. I have finished the race, I have kept the faith.” He was motivated to continue doing what he could and run the race set before him, keeping his eyes on Jesus, lest he be disqualified from the victor’s crown or laurel. The term, after we have worked hard and completed well, is to sit back and rest on our laurels—not for Paul or for my friend John.
What is it to finish well? My friend John expressed the desire to hear from his Lord Jesus, “…‘Well done, good and faithful servant! You have been faithful in a few things; I will put you in charge of many things. Come and share in our master’s happiness’” (Matthew 25:21). I noticed the Master did not say to him, “Well done, now you can retire and rest from your hard work.” Instead, by giving him more responsibility, he was invited to share in his Master’s happiness. In fact, the two servants of the Master who dealt wisely with the Master’s resources by doubling them were commended. The one who did nothing with what he was given was condemned. Luke 12:48 states, “… to whom much was given, of him much will be required….” (ESV).
We in the health professions have been given much in the way of resources and access to the hurt and lost. We are privileged with the Master’s resources to advance His kingdom as good stewards should do. What does that mean on an individual basis? I think it can be different for everyone. To the servants of
the Master in Matthew 25, He gave them resources according to their ability. Not all of us are going to be as impactful as Billy Graham or Mother Teresa, but all of us have a part to play as faithful and wise servants in the Great Commandment and the Great Commission.
It starts with having our lamps full of oil of the Holy Spirit. In the parable preceding the three servants with talents in Matthew 25, 10 virgins were awaiting the coming of the bridegroom. The five foolish ones had no oil, but the five wise ones filled their lamps with oil, representing the working power of the Holy Spirit. To be filled with oil is to desire to know and be with Jesus our Bridegroom. The last parable of Matthew 25 is when the Son of Man will judge all people as a shepherd who separates the sheep from the goats. With what time we have left on earth, we are to be generously giving and compassionate, reaching out to those who are needy and down (Matthew 25:34-36). Healthcare is a perfect platform to do that and even get paid to do so, but I believe God calls us to go beyond any financial incentive and to give our time, talent and resources sacrificially. That’s why I love CMDA’s Global Health Outreach (GHO) and Medical Education International (MEI) mission outreaches where we expect nothing in return, only the pleasure of our Lord and Master.
CMDA is all about bringing healthcare professionals together to more powerfully do the work of God. By our membership and camaraderie, we encourage one another and are educated and equipped to do what God has for us, even in our latter years. I have learned from several mentor leaders at CMDA like Warren Heffron, MD; Al Weir, MD; John Crouch, MD; Gene Rudd, MD; and David Stevens, MD, MA (Ethics), to name a few who, in their fourth quarter of life, continue doing what they can to advance God’s kingdom. Thank you for being part of CMDA and joining in glorifying Christ through your profession and beyond.
George Gonzalez, MD, is a Diplomate of the American Board of Family Medicine and has practiced for over 30 years in Fresno and Clovis, California. Dr. Gonzalez has served as the medical director of Pregnancy Care Center of Fresno for 20 years. He has been the acting president of the local CMDA Fresno/Clovis Chapter for more than 27 years. He is a founding member of Medical Ministries International (MMI) serving 17 years on the MMI Board. Dr. Gonzalez has been the team leader for over 30 international mission trips and 55 local mission outreaches in the Central Valley of California.
EDITOR
Rebeka Honeycutt
EDITORIAL COMMITTEE
Gregg Albers, MD
John Crouch, MD
Autumn Dawn Galbreath, MD
Curtis E. Harris, MD, JD
Van Haywood, DMD
Rebecca Klint-Townsend, MD
Debby Read, RN
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CMDA Today™, registered with the U.S. Patent and Trademark Office. Winter 2024, Volume LV, No. 4. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2024, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tennessee.
Undesignated Scripture references are taken from THE HOLY BIBLE, NEW INTERNATIONAL VERSION®, NIV®
Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.® Used by permission. All rights reserved worldwide. Other versions are noted in the text.
CHRISTIAN MEDICAL & DENTAL ASSOCIATIONS
P.O. Box 7500, Bristol, TN 37621 888-230-2637
main@cmda.org•www.cmda.org
If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction. Organizational financial records, Board of Trustees meeting minutes and House of Representatives meeting minutes are available upon request.
CMDA
10 ON THE COVER
Mental Health & the Church
StephenGrcevich,MD
Ways the Church can help those who struggle with mental health overcome stigma and grow in Christ
Opioid and Substance Use Disorder Identification & Treatment
DougLindberg,MD
How CMDA is helping healthcare professionals satisfy DEA requirements through online training
The Corporatization of Healthcare
GratCorell,MD,FAAFP
How the modern transformation of medicine impacts healthcare professionals and patients
Preach, Teach and Heal: Medical Education as a Mission
WarrenHeffron,MD,and
ChrisJenkins,MD
Lessons learned from international medical missions consultations
The Dr. John Patrick Bioethics Column The Disappearance of Ethics JohnPatrick,MD
The need for godly order in the foundation of ethics
REGIONAL MINISTRIES
Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community
Western Region: Wes Ehrhart, MA • 6204 Green Top Way • Orangevale, CA 95662 • 916-716-7826 • wes.ehrhart@cmda.org
Midwest Region: Connor Ham, MA • 2435 Lincoln Avenue • Cincinnati, OH 45231 • 419-789-3933 • connor.ham@cmda.org
Northeast Region: Tom Grosh, DMin • 1844 Cloverleaf Road • Mount Joy, PA 17552 • 609-502-2078 • northeast@cmda.org
Southern Region: Grant Hewitt, MDiv • P.O. Box 7500 • Bristol, TN 37621 • 402-677-3252 • south@cmda.org
&
Ministry News
MEMBER NEWS
In Memoriam
Our hearts are with the family members of the following CMDA members who have passed in recent months. We thank them for their support of CMDA and their service to Christ.
• Edward Berretta, MD – Port Angeles, Washington Member since 2020
• Thales Bowen, MD – West Norriton, Pennsylvania Member since 1949
• Merlynn Colip, MD – Fort Collins, Colorado Former Trustee
Member since 1960
• Ronald Foltz, MD – Shingle Springs, California Member since 1981
• Frederick MacDowell, MD – Edinburg, Texas Member since 1986
• Ralph B. Martin, MD – Pasadena, California Member since 2000
• Peter E. Nielsen, MD – San Antonio, Texas Member since 1984
• Lyle Nilson, MD – Omaha, Nebraska Member since 1953
• Bill H. Pratt, DDS – Portland, Oregon Member since 1980
• Richard J. Schilling, DDS – Loveland, Colorado Member since 1993
• Arthur D. Thiessen, MD – Federal Way, Washington Member since 1948
Memoriam and Honorarium Gifts
Gifts received April through September 2024
• Shannon Bowers in honor of Janis Davis
• Mary Dachenhausen in honor of Branden Leupold
• Sharon McClellan in honor of Ward McClellan
• Elizabeth Myers in honor of Dr. Michael Knower
• Cindy Pyo in honor of Joshua Atkinson
• Ted Witzig in honor of Dr. Thomas Witzig
• Dr. Philip Mikesell in honor of Dr. Sam Molind
• Dr. Philip Mikesell, in honor of Dr. Al Weir
• Dr. John Peterson in honor of JP Smith
• Dr. John Peterson in honor of Brooke Herndon
• Dr. Mark Gaulke in honor of Rev. Wallace Gaulke
• Dr. Miry Makebish in honor of Caleb Whitaker
• Dr. Pari Ehsanzadeh in honor of Selina Lin
• Amy Maurer, PA-C, in honor of Michael Maurer
• Eva Chalas in memory of Dr. Peter Nielsen
• Deborah Conway in memory of Dr. Peter Nielsen
• Jenny Digiantonio in memory of Daniel Wheeler
• Jimmy and Janice Graham in memory of Janis Davis
• Tracy Lyon in memory of Dr. Peter Nielsen
• Cristin Mount in memory of Dr. Peter Nielsen
• Thomas Nolan in memory of Dr. Peter Nielsen
• Aaron Pettis in memory of Robert Corley Bishop
• Richa Sharma in memory of Awantika Pokharel
• Deon Spearman in memory of Janis Davis
• Elizabeth Stewart in memory of Dr. Peter Nielsen
• Juan Vargas in memory of Dr. Peter Nielsen
• Barbara VerSteeg in memory of David A. Swanson
• John Watkins in memory of Janis Davis
• Christopher Zahn in memory of Dr. Peter Nielsen
• Dr. Charles Marting in memory of Dr. Thomas E. Marting
• Dr. Roger Bitar in memory of Dr. Emmanuel Bitar
• Dr. Cortney Draper in memory of Rosalind Gerber Stoner
• Dr. Leticia Shanley in memory of Dr. Peter Nielsen
• Dr. Peggy Spears in memory of Dr. Jesse C. Hill
• Dr. Jon Sullivan in memory of Dr. Jack Sullivan
• Dr. Robert Wolf in memory of John Lewis Wolf
• Dr. David Schall in memory of Gertrude Schall
For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.
Ministry News
CMDA Announces Victory to Protect Conscience Freedoms
CMDA announced a pivotal victory on October 8, 2024, when the U.S. Supreme Court denied the federal government’s request to hear the case Becerra v. State of Texas. This decision upholds the U.S. Court of Appeals for the 5th Circuit’s ruling, which protects the conscience freedoms of healthcare professionals from being forced to perform abortions.
In State of Texas v. Becerra, CMDA joined the American Association of Pro-life Obstetricians and Gynecologists (AAPLOG) to stop the U.S. Department of Health and Human Services (HHS) from attempting to employ the Emergency Medical Treatment and Labor Act (EMTALA) to force physicians to perform an elective abortion when an actual emergency does not exist. A federal district court issued an order in August and December 2022 that blocked this attempt by HHS in Texas and for all of CMDA’s and AAPLOG’s members, and the appeals court unanimously agreed with
this decision in January 2024. And now, due to the Supreme Court’s decision on October 7, 2024, this permanent order blocks the federal government from illegally using federal law to force doctors to perform abortions.
This permanent ruling applies in the state of Texas and to the members of AAPLOG and CMDA located around the country, strengthening conscience freedoms for thousands of healthcare professionals in countless emergency rooms and hospitals across the United States.
CMDA was represented in this case by Alliance Defending Freedom (ADF), the world’s largest legal organization com mitted to protecting religious freedom, free speech, the sanc tity of life, parental rights and God’s design for marriage and family.
CMDA has a position statement on abortion, which is available at cmda.org/ethics. This statement was developed by CMDA’s Ethics Committee and officially adopted by the or ganization. To learn more about how to get involved with CMDA’s grassroots advocacy efforts, visit
What if
SHARING THE GOSPEL THROUGH HEALTHCARE MISSIONS
CMDA’s Global Health Outreach sends short-term healthcare mission teams around the world to places like Central America, Africa, Western Europe, Middle East and Asia. We serve the poor and needy who have no access to healthcare by offering medical, dental and surgical care.
Our trips are open to anyone interested in serving others through missions, whether you have experience in healthcare or not. Joining a team is easy, so visit cmda.org/gho to find a trip that fits your schedule. Join us today as we bring the HOPE and HEALING of CHRIST to the world through HEALTHCARE .
“This ministry is truly impacting lives, not only of the patients but also of the ones who serve on the trips. It was the experience of a lifetime.”
—Trip Participant
Ministry
VIE Poster Session
Please encourage students, residents and fellows to submit an abstract for CMDA’s eighth annual VIE Poster Session, which will take place during our 2025 CMDA National Convention. Presentations in areas of spirituality, ethics, education, computational biology, mathematical modeling, biophysics, biotechnology, biomedical science, medicine, surgery, dentistry, nursing and medical humanities are all welcome! Visit cmda.org/vie to submit an abstract by January 31, 2025. Cash prizes are awarded!
Upcoming Events
Dates and locations are subject to change. For a full list of upcoming CMDA events, visit cmda.org/events
2025 West Coast Winter Conference
January 16-19, 2025 • Cannon Beach, Oregon
Marriage Enrichment Weekend
January 17-19, 2025 • St. Pete Beach, Florida
CMDA Beaver Creek Winter Conference
February 1-8, 2025 • Beaver Creek, Colorado
Mentoring With A Coach Approach
February 6 – March 6, 2025 • Virtual
CMDA New Zealand Tour
March 22 – April 2, 2025 • New Zealand
CMDA Turkey Tour – Seven Churches of Revelation
April 12-24, 2025 • Turkey
CMDA 2025 National Convention
May 1-4, 2025 • St. Charles, Missouri
RESOURCES The Voice of Advocacy
As Christians in healthcare, we glorify God by serving as a voice for the vulnerable. CMDA Advocacy is pleased to introduce The Voice of Advocacy. This monthly podcast is hosted by Senior Vice President of Bioethics and Public Policy Jeff Barrows, DO, MA (Ethics), and features members of the Advocacy team as well as special guests. Listen to learn more about Advocacy’s grassroots efforts at the state and federal level, legal and legislative victories and how CMDA members can be involved in achieving justice for the vulnerable. To listen to the latest episode, visit cmda.org/advocacy.
Mental Health & The Church
StephenGrcevich,MD
CMDA Matters is the premier audio resource for Christian healthcare professionals. Hosted by CMDA CEO Dr. Mike Chupp, MD, FACS, it is a weekly podcast that includes interviews with experts from Christian healthcare professionals. Topics include bioethics, healthcare missions, financial stewardship, marriage, family and much more. Listen to CMDA Matters on your smartphone, your computer, your tablet…wherever you are and whenever you want. For more information, visit cmda.org/cmdamatters.
This article is an excerpt transcribed from an interview recorded for a CMDA Matters podcast episode released in September 2024 with CMDA CEO Mike Chupp, MD, FACS; CMDA Senior Vice President of Bioethics and Public Policy Jeff Barrows, DO, MA (Ethics); and Stephen Grcevich, MD. During the conversation, they discussed mental health and the church, as well as how mental health relates to gender and identity. To listen to the full episode, visit cmda.org/cmdamatters.
MIKE CHUPP, MD, FACS: We’re discussing the impact of kids with mental health disorders and their families who genuinely want to be involved in their churches, as well as how mental health relates to gender and identity. Let’s talk about the ministry you founded some time ago.
STEPHEN GRCEVICH, MD: Key Ministry has been in existence now for over 20 years, and our focus is working with churches to help them welcome, serve, include and share the gospel with families who have children with disabilities with a unique focus on “hidden disabilities”—any emotional, behavioral, developmental or neurologic conditions where there aren’t outwardly apparent physical symptoms. Part of how this got started was, I was serving on the elder board at our church, and we had a large cohort of families in the mid to late 1990s, after the fall of the Iron Curtain, who went to Russia and Bulgaria and adopted kids with complex medical, neurological, emotional and behavioral issues. These were stalwart families in the church who had been involved in leadership and in serving.
I’m sitting in an elder board one night and the woman who, at the time, was leading our family ministry efforts was talking about some of the challenges these families were having staying involved with church, because the issues they were having with their kids were getting in the way of them being able to attend worship, to stay involved with their small groups or to serve in the capacities they’d been serving. At the time I was running a large multidisciplinary child psychiatry group in suburban Cleveland, Ohio, and I’m thinking, “I wonder how much of an issue this is for the kinds of kids and families who are coming through a practice like ours.”
At the time, the most common things we were dealing with were kids with anxiety, kids with ADHD, kids with mood disorders like depression or bipolar disorder and kids on the high end of the autism spectrum. In an informal way, over the next few months, as families
cycled through our practice for follow up, we asked each of them one question: “Did the problems that led you to come to our practice significantly impact your family’s ability to attend church or your place of worship?”
I was floored by the stories I started hearing from folks. I was spending a lot of time traveling around doing grand rounds or doing other lectures for healthcare professionals, and wherever I would go, I would start talking about some of the work our church was doing trying to support families in situations like these. The church started getting inundated with requests from around the country. That’s how Key Ministry got started. It’s helping churches be able to recognize the needs in terms of sharing the gospel and the imperative need for supporting families in being fully engaged and involved in Bible-believing churches where they can hear the gospel preached, come to faith and grow in faith and use their gifts and talents to serve other people.
JEFFREY BARROWS, DO, MA (ETHICS): You’ve also written a book entitled Mental Health and the Church: A Ministry Handbook for Including Children and Adults with ADHD, Anxiety, Mood Disorders, and Other Common Mental Health Conditions. The title implies you believe the church has not done a good job in addressing mental health problems; is that your perspective? If so, can you talk to us about the premise of the book?
DR. GRCEVICH: It’s not just that I believe the church has a role here, it’s that we have an overwhelming amount of evidence that argues, in my belief, families who are impacted by mental illness may in fact be the largest underserved population by the church in North America. There was a study published about six years ago based upon over a quarter million interviews conducted as part of the National Children’s Health Survey. One of the questions they asked as part of that survey was, “Has your family attended a church or place of worship at any point in the last year?”
Andrew Whitehead, a sociologist and father of two sons with autism, did a deep dive looking at the data and at the relationship between the presence in the home of a child with a disability and family church attempts. To nobody’s surprise who operates in my world, having a child with an autism spectrum disorder decreases the likelihood a family will set foot in church by 84 percent; 73 percent if you have a kid with depression; 55 percent if you have a kid with a disruptive behavior disorder, oppositional defiant disorder or conduct disorder; 45 percent if you have a child with an anxiety disorder; and around 20 percent if you have a child with ADD or ADHD.
Data from the 2011 Baylor Study of Religion suggests when you look at adults who have symptoms of anxiety or depression on any given Sunday, they’re somewhere between 50 to 60 percent less likely than their peers in the community to be at
church. One of the things we’re hearing more of in the church, given the mental health crisis our society is experiencing, is the need to do more to care for and support people who are in the church. Almost the entire thrust of what we’re doing in mental health ministry is associated with care and support of people who are already coming to church. The burden the Lord has given me is to try to help the church recognize the need for the gospel among individuals and families who are impacted by these conditions and aren’t currently attending church.
One of the things Key Ministry is doing on an annual basis is to hold an event called Disability in the Church, which is the largest disability ministry conference in North America. This year we held our first Mental Health in the Church conference in suburban Cleveland, specifically to blend these two ideas to help people in the church integrate the need for better care and support of folks who have these struggles who already identify as Christian with the urgent need for evangelism and outreach to folks who are outside of the church. Part of Mental Health and the Church was an attempt to lay out a model for churches to pursue and develop a mental health outreach and inclusion strategy in the communities they serve.
DR. CHUPP: Are you still seeing a reticence in the church today to get engaged in doing ministry with those who are suffering with mental health?
DR. GRCEVICH: There’s clearly a reticence. When I look at the whole mental health ministry movement, we’re about 15 years behind. Part of where we have struggled is this notion about the extent of some of the struggles people have associated with mental health. Is this something that is neurobiological or is this something that is indicative, for example, of someone’s skin condition or indicative of a lack of faith? One of the struggles we’ve had is that having a mental health condition is very much stigmatized in the church.
A Lifeway study surveyed several unchurched adults. 55 percent of them disagreed with the statement that if they had a mental health issue, they would be welcome at church. In the book, we look at some of the things that get in the way of individuals and families who have struggles being part of church. Part of the model is helping churches think about this in terms of seven different barriers using a cultural model of disability.
Certain attributes about church culture make it more difficult for folks who have some of these mental health struggles to fit in. The first one is stigma. In that same Lifeway survey,
they surveyed adult family members of other adults who had serious mental illness, and when they asked those families what their churches could do that would be most helpful to them, the number one answer was for their pastors to talk about these issues from the pulpit. In doing so, it then gave them permission to share their struggles within the context of their relationships in the church and their small groups. A lot of folks perceive this to be not something people who are in the church are necessarily comfortable talking about with other church members.
DR. BARROWS: We do hear a great deal about the negative impact of social media, especially on our children and adolescents today. I am thinking about a recent book by Dr. Jonathan Haidt called The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness. Do you agree social media is causing an epidemic in our children?
DR. GRCEVICH: Absolutely. I think the evidence is incontrovertible if you look at the United States and Western culture and some of the things Haidt presents in his book. He makes several arguments for why we’ve seen the mental health crisis in kids over the last 10 years, particularly the advent of smartphones. We’ve reached a sort of a tipping point where the majority of teenagers have smartphones. He makes a compelling argument in the book and traces data, again, not just in the U.S. but across all other Western cultures, showing a significant spike in rates of anxiety after smartphones got in the hands of our kids. One of the other arguments he makes is we don’t give kids enough opportunity to take risks and explore the world, and that our society, beginning in about the 1990s, became very overprotective of kids. He’s an advocate for what some folks have described as free-range parenting—we need to let kids have the opportunity to play without adult supervision and to actively encourage kids to be more independent. One of the points I think he made that’s very compelling is many parents are concerned about predators in the world, but our kids are much more likely to encounter predators online than they are in the real world. Part of the argument he makes is in addition to the images kids are bombarded with and the way algorithms some apps use to feed information to kids, is combined with excessively protective attitudes we have about our kids that contributes to why we’ve seen the explosion and rates of anxiety we have in recent years.
DR. CHUPP: Sometimes as a parent, it is hard to avoid hypocrisy because we are so in tune with our smartphones. In terms of your recommendations to parents of children, teens or young adults, tell me what you’re telling these parents.
DR. GRCEVICH: One of the things I tell parents is kids learn how to deal with their anxiety by watching how parents deal with anxiety. I think we have to be conscious of how to model for our kids how to deal with some of the challenges we’re all dealing with. Our kids learn from watching us. If we don’t want them using smartphones at dinner, we can’t be checking our smartphones at dinner ourselves.
Some of the recommendations I thought Haidt made in his book make sense based upon my read of the ever-expanding research literature dealing with this topic. He strongly recommends kids not be given smartphones with internet access until they enter high school and they not be allowed to sign up for social media apps until they’re, at a minimum, 16 years old. This is something folks can think about in our schools and in our churches, is that it’s very hard for individual parents to manage this issue alone. The reality is if their kid doesn’t have a way of connecting and staying in touch with other kids, that in and of itself is going to be a problem. The parents need to come together, and this can happen through a church or a Christian school. One of the arguments Haidt puts forward in the book is schools, regardless of whether they’re public or private, need to take a strong stand in this and eliminate the availability of smartphones and technology where kids can access social media during the school day. They need opportunities to be able to build the kinds of social skills they’re going to need to fully function and to reach their potential as adults. We need networks of parents to come together to be unified in taking a stand about safe and appropriate access of technology
for kids, so then we have a greater opportunity to be successful in terms of setting healthy limits on kids.
DR. BARROWS: In previous conversations, we talked about your concern especially with the American Academy of Pediatrics’ and the American Psychiatric Association’s approach to gender dysphoria. I’d like you to elaborate on what those concerns are as a psychiatrist yourself.
DR. GRCEVICH: Over the last couple of years, I have become so embarrassed and ashamed by some of the trends I see in our profession where we’ve lost the ability to look at data objectively. A lot of folks in leadership positions in our professional societies have essentially been hijacked by the sexual revolution and by a political agenda. This is probably most dramatized in terms of the approach folks are taking to what’s referred to as gender-affirming care in kids. Our colleagues across Europe are looking at the data and questioning our approach to what I would argue is probably one of the most vulnerable subsets of kids we see within the pediatric age group. At the same time they’re slamming the brakes on this and calling attention to the fact the data doesn’t support what we’ve been doing, the professional societies here in the United States are doubling down on these practices.
One of the reasons I recently joined CMDA is it’s important that healthcare professionals who are more evidence based have places to get together, resources and connection with one another to strengthen and support one another in terms of how we deal with issues like this.
DR. CHUPP: Would you talk about the association of mental health problems with those who identify as transgender, as well as neurodevelopmental disorders?
DR. GRCEVICH: Let me start with the mental health disorder issue. One of the things we know is this is an extraordinarily vulnerable population. A 2022 study showed that, of the kids who presented or identified as having gender dysphoria, 70 percent of them met criteria for at least one anxiety disorder, and close to 60 percent of them met criteria for major depression. Nearly half of them met criteria for post-traumatic stress disorder, and 56 percent of these kids were involved in chronic self-injurious types of behavior. A study looked at the variance and mental health outcomes between kids with gender dysphoria and kids who identified as gay and lesbian, and nearly 20 percent of the variance specifically was attributed to the higher incidence of trauma among kids who have gender dysphoria. We’re exposing these kids to particularly risky and unproven treatments with serious long-term consequences in many instances, it appears, without doing the kind of careful diagnostic assessment necessary to separate that out from other neurodevelopmental conditions. This is scandalous.
ways they can be part of a resistance to this onslaught of truth in the area of gender identity?
DR. BARROWS: As a child and adolescent psychiatrist, why do you think it’s important for Christian healthcare professionals like yourself to get connected to organizations like CMDA?
DR. GRCEVICH: Our professional societies have been captured by this ideology. For a number of years now, I don’t feel like I’ve belonged at the child psychiatry meetings. On a day-to-day basis, I’m running into more devoutly Christian colleagues who are afraid to speak up about stuff like this. As healthcare has shifted over time, it’s important for those of us of faith in the profession to network with one another, to be able to encourage one another and to support one another. One of the most important things I can do as a Christian physician is to represent truth. Jesus calls Himself the way, the truth and the life. Truth has been abdicated at the expense of pursuing a certain political agenda. We need to be connected with one another to strengthen and support one another in our faith and to share effective strategies for being able to continue to practice within the system in a way that is consistent with our faith and displays integrity with the teaching of the Bible. If we are going to be a positive force to bring about the change and restore certain things to the practice of healthcare that we’ve lost in the last several decades, we need to be networked together. We need to be collaborating with one another. We need to be encouraging one another, and we need to be platforming one another to amplify some of these voices within the profession. I’m grateful CMDA provides us an opportunity to do that.
DR. CHUPP: Those of us who have had a career behind us, we’re speaking out because we know those who are younger are at high risk. We know we’re in a war here for truth. In a war, we talk about a resistance. For our younger listeners, what are some
DR. GRCEVICH: One of the things we can do is make ourselves available to mentoring our younger colleagues. We have to model and be the change we desire to see in other people. It becomes easier to be brave when you see other people around you demonstrating bravery. When you think about the early church, they saw the leaders of the church being brave and bold and continuing with the power of the Holy Spirit to speak out while they were being persecuted. That was a period of time when the church experienced its most rapid growth. More than anything else, we have to model for our younger colleagues that we can speak out about these things, and we know in the end, Jesus wins. We have to keep all of that in perspective in speaking out and advocating for our patients and advocating for our profession at such a time as this.
Stephen Grcevich, MD (Northeast Ohio Medical University), is a child and adolescent psychiatrist serving as President and Founder of Key Ministry. Dr. Grcevich is the primary spokesperson and vision caster for Key, leads efforts to build collaborations with pastors, leaders and other ministry organizations, represents the ministry as a speaker at major conferences throughout the year and serves as Program Chair for Disability and the Church and Mental Health and the Church, Key’s national conferences. His writing has been featured by the ERLC, D6, Outreach Magazine, the American Association of Christian Counselors and the National Association of Evangelicals. His book, Mental Health and the Church (Zondervan, 2018), presents a strategy for evangelism and outreach with individuals and families impacted by mental illness. In addition to his work on behalf of Key Ministry, Dr. Grcevich is an experienced clinician, researcher and medical school professor with more than 35 presentations at major medical conferences. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI) and was a participant in the 2019 White House Summit on Mental Health.
Opioid and Substance use disorder Identification & Treatment
DougLindberg,MD
LEARN MORE
The CMDA Learning Center exists to provide quality continuing education opportunities to healthcare professionals and encouragement as they glorify God through providing care with excellence and compassion for all people. The Opioid and Substance Use Disorder Identification & Treatment course is now available. To explore this course, visit cmda.org/learning
Addiction has devastated the United States. As a healthcare professional, you’ve almost certainly seen its impact upon your patients and their families. As a community member, parent or friend, you’ve seen it in your town, on your streets and in your schools. The damage crosses geographic, socioeconomic and religious fault lines. Heartache, broken trust, desperation, grief and even death are left in its wake.
Two specific patients opened my eyes to this epidemic. Back in 2007, I was a new attending at a family medicine residency. The practice was filled with kind, well-meaning, compassionate physicians and staff who were a joy to work with. We cared deeply for our patients, and we had very much taken to heart the emphasis on treating non-cancer pain with opiates that was pushed in the early 2000s. As a result, a high number of patients in our practice were taking controlled substances, but we had not yet caught up with the need to do things like pill counts, urine drug screens and other interventions to prevent misuse, diversion and addiction. Additionally, the practice was busy, and it was admittedly easier to just continue medications that seemed to be working without delving into the details, risks and side effects with patients who were not asking to cut back. This is not a justification for how we practiced, just an explanation. We were not alone, as numerous practices did and still do operate with less-than-stringent compliance mechanisms in place for high-risk medications, but we were sitting on a ticking time bomb.
I knew immediately I needed to do something. These tragedies served as a catalyst for me to help spearhead efforts within our program to overhaul our controlled substance prescription patterns and come into better compliance with best practices. It was not easy to change our ways, and it created conflict with patients and even among the staff at times. However, things did get better in our practice and for the community we served.
The scope of this problem can feel overwhelming.
In 2023, over 81,000 people died in the United States from opioid overdose including an average of 22 adolescents per week.
The scope of this problem can feel overwhelming. In 2023, over 81,000 people died in the United States from opioid overdose,1 including an average of 22 adolescents per week.2 Treatment is difficult to come by. Less than half of the facilities offering inpatient addiction rehabilitation have open beds, and the average wait for the others is 28 days. Only about half of these facilities accept Medicaid, and the out-ofpocket treatment cost for those paying privately is over $26,000.3 Finding care within a given practice or community that prescribe medications like suboxone can be challenging for patients, particularly those without insurance or reliable transportation.
Of course, the problem of addiction is not limited to opioid use. Statistics tell us 10.5 percent of Americans who are 12 or older meet criteria for Alcohol Use Disorder.4 Benzodiazepines, illicit drugs and other lifestyle addictions like gambling and pornography rip at the fabric of our families and our society.
One morning, I was notified one of my patients had died that weekend in a car accident. There was a story in the newspaper about the accident. Apparently when his body was found, still in the vehicle, he was clutching a bottle of prescription hydrocodone. While I can’t be certain, there’s a good chance I had prescribed those pills. Less than a week later, one of our residents came to me distraught because they had just seen the toxicology report from one of their patients who died after overdosing on multiple medications, including an opiate and a benzodiazepine prescribed by our clinic. I looked back in the chart and realized I had provided staffing for that patient within the last couple months.
Statistics fail to capture the heartbreak of the individual stories that lie behind these numbers. Perhaps someone you know and love has battled addiction or has even lost their life because of it. NICUs around the country care for newborns struggling through opioid withdrawal. Unintended overdose from increasingly dangerous fentanyl tainted street drugs end the lives of young people every day. The lives of those struggling with addiction and those who love and care for them can be a nightmare of betrayal, broken promises and destroyed relationships. Law enforcement and the criminal justice system struggle to find ways to balance compassion and consequence, without easy answers. Personally, my wife and I experienced the depth of the depravity addiction can cause when my wife’s fentanyl patches prescribed for cancer pain were stolen from our bathroom medicine cabinet by someone we had invited into our
GET INVOLVED
The Addiction Medicine Section of CMDA exists to prevent and treat addiction and transform lives, by God’s grace, love and power. We strive to provide compassionate excellence in all aspects of addiction care, including whole-person prevention and treatment, education, advocacy, empowerment of others, research, church, and community partnerships, and interprofessional collaboration and support. For more information and to get involved, visit cmda.org/ams
home. The scope of the problem can easily engender a sense of hopelessness.
Recognizing the scope and trajectory of the problem, the United States Congress passed the Medication Access and Training Expansion (MATE) Act, which went into effect in June 2023. The MATE Act requires U.S.-based prescribers who hold a Drug Enforcement Administration (DEA) registration to complete eight hours of continuing education on substance use disorder assessment and treatment prior to their next DEA renewal, which will impact all DEA holders over the next three years. Exceptions include those who have recently obtained DEA registrations within the last five years and those with specialized training in addiction.
As Christians, of course, we have resources and guidelines the world lacks. Jesus gives us clear instructions and tangible examples of how to treat the outcast, forgotten and downtrodden. Matthew 25 reminds us whatever we do for the least of these, we do for Jesus. In Luke 5:12-32, we read of Jesus showing love and concern for a leper, a paralytic and a tax collector. A 21st century person struggling with addiction would fit right into this line-up, wouldn’t they? Is there any doubt Jesus would reach out to the addict with compassion and would ask the same of us, His followers?
CMDA has a great deal of concern and compassion for those struggling with addiction, as well as for our members who are providing medical care and support to these individuals and their families. As Jesus ministered to the leper, the paralytic and the tax collector, as Christians we should consider how He might be asking us to use our skills to serve those struggling with addiction.
CMDA is responding in concrete, tangible ways. Our Addiction Medicine Section (AMS) exists to prevent and treat addiction and transform lives, by God’s grace, love and power. The AMS strives to provide compassionate excellence in all aspects of addiction care, including whole-person prevention and treatment, education, advocacy, empowerment of others, research, church and community partnerships, and interprofessional collaboration and support.5 We welcome and encourage any students, trainees or professionals to be part of AMS, even those who don’t have addiction medicine as part of their daily practice.
Pertaining to the MATE Act, in a spirit of collaboration, CMDA joined forces with a long-standing and highly valued partner organization, Christian Community Health Fellowship (CCHF). Together we produced a high-quality course, Opioid and Substance Use Disorder Identification & Treatment,
that meets the MATE Act’s requirements of eight hours of continuing education material. The course equips participants with practical, up-to-date information to apply in clinical practice. The course was developed by subject matter experts from CMDA and CCHF and is available free-of-charge to our members through CMDA’s online Learning Center.
The course is comprised of four modules:
1. Intersection of Faith and Science in Addiction Treatment
2. Safe and Effective Opioid Prescribing & Pain: Historical Context and Current Approaches
3. Identifying and Treating Opioid Use Disorder
4. An Alternative Approach to Alcohol Use Disorder Treatment and Nutritional Repletion in Addiction
Participants will find that this offering is unique among other courses that meet the MATE Act’s requirement. Several for-profit continuing education companies saw this law as a profit opportunity and created courses, of varying quality, that charge up to $500 for access to their material. CMDA and CCHF’s course, in contrast, is different. It stands alone in providing a whole-person care approach that integrates faith and science in approaching and treating addiction. The course includes practical and clinically relevant information along with poignant personal testimony. The lecturers
and quality of their content are outstanding, and the feedback from those who have completed the course has been uniformly positive. The lectures can be viewed with video and are also valuable if you listen to them while on the go.
Additionally, this course serves to highlight the value of CMDA membership. Free continuing education is one of the numerous benefits our members enjoy. By joining and remaining a member of CMDA, you not only support the dozens of ministries that CMDA is involved in, but also enjoy unlimited access to the online Learning Center, including this course. Perhaps this is even a time you’d consider becoming a lifetime member and enjoying both the additional benefits and the absence of an annual membership invoice!
In closing, we all have a part to play in addressing the scourge of addiction that plagues our world. We can start by educating ourselves. Then, we can ask the Holy Spirit to guide us as to what role we might have in helping those in our community struggling with addiction. Remember what we do for the least of these, we do for Jesus.
Endnotes
1 https://www.uclahealth.org/news/release/about-22-high-schoolage-adolescents-died-each-week
2 https://nida.nih.gov/research-topics/trends-statistics/overdosedeath-rates
3 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2023.00777
4 https://americanaddictioncenters.org/addiction-statistics
5 https://cmda.org/specialty-sections/addiction-medicine-section/
Doug Lindberg, MD, has served at CMDA as the Director for the Center for Advancing Healthcare Missions since 2020. He attended Loyola University, Chicago for medical school, completed a family medicine residency at Waukesha Family Practice Residency and then completed a one-year rural health fellowship at East Tennessee State University. The Lindbergs served in South Asia as missionaries from 2009 to 2013, and Doug served as the medical director for a mission hospital there. They returned to the U.S. in 2013 for what was intended to be a one-year furlough. However, a series of unexpected events, including his wife’s life-threatening cancer diagnosis followed by her miraculous healing, led them to relocate back to Wisconsin where they continue to reside. In addition to his work with CMDA, Doug works part-time clinically in urgent care. He and his wife Ruth are both family physicians, and they have two children, Maddie and James. He also enjoys running, hiking and coaching his son’s sports teams.
THE CORPORATIZATION OF HEALTHCARE
Ithink I finally understand the Dilbert comic strip. In 1997, upon graduation from residency, I did something totally countercultural. Instead of opening my own practice, or even joining an existing physician-owned medical group, I took a job in a new practice owned by our local hospital, so I could be free of the administrative demands of running a business. Although rare back then, today that is the norm. According to a study by the Physicians Advocacy Institute, nearly three-quarters of U.S. physicians (74 percent) were employed by hospitals, health systems or corporate entities as of January 1, 2022.1 The numbers are even higher among new graduates. In the last quarter century, we saw the transformation of the healthcare profession into what was termed “the corporatization of healthcare,” as local hospitals are gobbled up by multistate healthcare entities, all jockeying for market domination. Several experts predict this will eventually culminate in the ultimate corporatization of healthcare—socialized healthcare.
At a local level, this pattern played out in my town as our sole hospital became a regional center, then part of a conglomeration of formerly competing hospitals, and now it is fully expected to be integrated into the next larger merger. It certainly seems as if the world of corporate medicine is here to stay, and the day of physician-owned practices is ostensibly over. Even dentists— the one branch of healthcare that somehow dodged the reforms of the last few decades—are now choosing to be employees. Dilbert is now something even healthcare professionals chuckle at because of their familiarity with the inane.
How does this trend impact our profession? For starters, we must remind ourselves of what it means to be a “professional.” Although today the term is (inappropriately) applied to all sorts of trades (i.e. “professional wrestling”), historically there were only three professionals in society: doctors, lawyers and the clergy. The term “professional” began in the first century AD, when the personal physician to the Roman Emperor Claudius (41-54 AD) coined the term “professio,” meaning “commitment with moral obligation.”2 It meant one had such a high internal moral code that they didn’t need to be regulated by an outside entity. One’s own self-imposed conscientiousness exceeded any external standard of morality that could be imposed upon them. Money brings a risk that can change one’s moral commitment, does it not? So, we must tread lightly into the world of corporatized healthcare, with the moral compass of our professional character as a check-and-balance to the world of profit and loss spreadsheets. Medical doctors need to be the filter through which Master of Business Administration understand the world of patient care, not the other way around.
Is business good for the business of healthcare? The word business comes from the Old English word “bisignis,” literally translated as “anxiety.” The word picture is that of a Scrooge-like character nervously counting his coins, fretting if they are enough.
There are two other words whose origins we should be familiar with as well. The word “patient” comes from the Latin “patiens,” meaning “one who bears a suffering.” In contrast, however, “customer” is a word derived from the Latin “custumarius,” meaning “one whom toll is collected from.”3 So, who are those we serve? Are they to be seen as ones who bear a great suffering we should help relieve, or as someone from whom tolls should be collected? In the first, we give, and in the second, we take. Etymology can be an inconvenient truth. Money might be a necessary evil, but it’s still an evil, nonetheless. So, we have to be careful to make it our servant, and not allow profit motive to be our motive.
Is there a better way of doing business? When it comes to how we do business with people, we need to remember the difference between a covenant and a contract. A covenant is an agreement or commitment made in trust. The parties value each other. Limits of responsibility are liberal or are not necessary to define, because the basis is a presumption that each person will do what is in the other’s best interest. Historically, doctors have always related to our patients in a covenantal way. Today, however, that language has changed, and a contract is an agreement or commitment made out of distrust. The parties are suspicious of each other, and so the limits of responsibility are restrictive and clearly defined. Unfortunately, that is how the healthcare industry does business today—just as in the past two warring factions tried to keep the peace. How do you think patients feel about that? Which do you think they would prefer? Do they want to be a patient who enters into a covenant, or a customer who enters into a contract?
A curious phenomenon is afoot: despite being more successful in fighting disease than ever before, pessimism is also at an all-time high. A hundred years ago, we could do little to help patients. No antibiotics, no MRI scanners, no vaccines and no readily available lab tests meant we offered little hope. The death of a child was expected among a typical family of 12. Yet, patients were universally positive about the healthcare system. Today, in contrast, we are the most successful we have ever been in fighting disease. In my 30-year career, for instance, I have only had one child under my care (in the U.S.) to die, and it was from abuse—not disease. Surprisingly, virtually every major indicator in polls show patients to be universally pessimistic about the healthcare system today. The numbers are no better among healthcare professionals. Why the dissociation? I would suggest it is because we have lost the “care” part of “healthcare.” What did doctors do a hundred years ago when their patient had a disease they couldn’t cure? They held their hand, telling them it would be alright. They cried with them. They prayed with them. In brief, they helped them bear an overwhelming suffering, and they were loved for it. What do we do today? Physicians have been transformed into data entry technicians, spending their days clicking little boxes to prove they are providing quality care, rather than actually providing quality care with the patient sitting just beyond the edge of the computer screen, and they are resented for it.
There is a final word origin you should know. The word “doctor” comes from the Latin word “docere,” meaning “teach.”4 It means doctors are not the only ones who have been well taught, but also by the moral virtue of our education we should teach others as well, so they too may enjoy the benefits of such knowledge. Such is my prescription for the world of healthcare that is rapidly changing into a mishmash of corporate entities that use verbiage such as “customer” instead of “patient,” and “provider” instead of “doctor,” without knowing the difference. That is not to say corporate culture can’t help an industry that has been financially malignant for decades. It may be just what the doctor ordered. It’s just that fiscal rectitude is rarely achieved apart from moral responsibility. People are more than the sum of their profit and loss potential. When we lose sight of that, we have lost the heart of healthcare and negated its virtues.
As healthcare professionals, we need to be that moral compass—an advocate for our patients who feel increasingly more alienated from true care. Who will be their ombudsmen in a time when the industry strives to do no more than most efficiently implement bureaucracy? Their healthcare professional— the one whose profession of commitment is covenantal and not contractual. Maybe we should keep a dictionary at hand for the wild ride ahead. Maybe Dilbert should have gone to medical school.
Endnotes
1 https://www.physiciansadvocacyinstitute.org/PAI-Research/ Physician-Employment-Trends-Specialty-Edition-2019-2021
2 https://www.oed.com/dictionary/professional_ adj?tab=factsheet#28087345
3 https://www.oed.com/
4 https://www.oed.com/dictionary/doctor_n?tab=factsheet#6348292
Grat Corell, MD, FAAFP, is a board-certified family physician, a fellow of the American Academy of Family Physicians and a member of Christian Medical & Dental Associations. He has practiced medicine in Bristol, Tennessee since 1997, and he has been awarded “Best Doctor in Bristol” on several occasions. He did his undergraduate work at Furman University, linguistic training at Nebrija University in Madrid, Spain, attended medical school at the University of South Carolina and completed his internship and residency at East Tennesee State University. Today, in addition to private practice, he also serves as a clinical assistant professor at both the Quillen College of Medicine and Emory & Henry University’s School of Health Sciences. Dr. Correll has a special passion for missions and has been on more than two dozen trips throughout Central and South America. He also enjoys public speaking and has lectured from coast to coast in every venue from small churches to national conferences. He is married, has two children and has two Great Danes.
Medical Education as a Mission
WarrenHeffron,MD,andChrisJenkins,MD
Teaching as Part of the Great Commission
Jesus gave His disciples instructions to include preaching, teaching and healing as key parts of their work and mission. Christian mission hospitals are excellent sources of providing witness and healing. While some teaching takes place in mission projects, there have been few reports of formal medical education programs, specifically such as family medicine residencies, in missionary hospitals.
Our experiences over 20 years with several international consultations demonstrated to us the immense value of adding medical education programs to the service and witness components of missionary activities.
This article highlights insights from 66 distinct family medicine education consultations in 23 countries in six areas of the world. These visits assisted in the development and sustenance of family medicine residencies, academic departments and other programs. It reviews the types of consultations provided, organizations involved, typical recommendations and some lessons learned. Although our focus was family medicine, the consultation model can easily be applied to other specialties. Locally trained physicians are beneficial for patient care and improve access to care and physician retention. Local training can be key to preventing “brain drain,” which is when a country’s skilled and educated workers move to another country.
The consultations were performed through In His Image International (IHII), which is a component of the fully accredited In His Image (IHI) family medicine residency program in Tulsa, Oklahoma. Goals of IHII include the training and empowerment of healthcare professionals to impact the world for Christ by improving health and meeting the spiritual needs of the unreached. One of its missions is to train family physicians to work internationally, with an emphasis on serving in missionary settings.
IHI residency graduates working globally recognized a need to develop training efforts for new community-oriented family physicians who were ideally situated to practice family medicine in a bio-psycho-social-spiritual manner. A consulting service was created to help start and sustain excellence in family medicine residencies. The emphasis was on missionary set-
tings in low- and middle-income countries while permitting freedom to explore appropriate methods of education based on local needs, resources and cultures. The programs ranged in size from two residents at program start up to an academic program with more than 60 residents in three years.
We became the first two consultants and worked as a team to provide free consultations and initially paid our own expenses. IHII later developed the capacity to help with travel expenses. The consultants took time off from their regular positions, and most local expenses such as lodging, food and local transportation were provided by the consultees. This arrangement made it possible to provide advice to mission settings that could not afford the usual costs of international consultations.
Varied Opportunities and Synergies for Medical Education
Each of our consultations involved a one- or two-week onsite visit. The consultations were initiated by personal invitation. We utilized pre-visit questionnaires with prospective consultees to learn their desired goals and outcomes for the consultation. Each visit resulted in a formal written report, with follow-up communications such as emails, phone calls, webinars and repeat continuity in-person visits as needed.
Each consultation was as varied as their geographical distribution, in terms of needs, resources, cultural, ethnic and linguistic diversity. They have expanded to include family medicine, activities and organizations. For example, residency consultations included:
· Feasibility studies
· New residency startup (missionary and non)
· Development of an existing residency
· Continuity consultation
· Curriculum and faculty development
Additionally, we had opportunities to work with several other organizations, and consultants were invited to serve in various capacities including visiting professors and continuing education development.
As residency programs evolved, additional areas of need were identified. A sending agency was developed and led by Matt Acker, MD, so new faculty could go to serve the new residencies as teachers. Additionally, a residency network was formed to support communication and mutual help among the new residencies, and this important endeavor is facilitated by Chris Place, MD.
Curriculum and Faculty Development
Medical schools were frequently interested in collaborative relationships with residencies in mission settings. Our consultations involved helping with chair and faculty development, interactions with other specialties, teaching medical students through residency training and providing continuing education to graduates and practicing physicians. Assistance with curriculum development and guidelines was especially important.
Incorporation of spirituality into teaching and the lives of the faculty and residents was another frequent advice request. We encouraged each interested program to develop a curriculum plan to incorporate exploring spirituality among their patients and tailor this to fit the individual needs and interests of patients, residents and faculty. Academic programs particularly sought advice about improving their research capabilities, research methodologies, data collection and analysis, the process of writing for publication and collaborating with international researchers. We observed faculty recruitment, and development was the single greatest need. Hybrid consultations included medical education conferences to facilitate teaching skills for faculty development, including workshops and continuous professional development.
To assist with structure and organization, we helped with written plans, documentation and written job descriptions.
It was unusual to have a well-organized mission statement and a set of goals and objectives, which are necessary for effective evaluation. We assisted in planning for long-term financial sustainability, securing clinical space and training administrators, mentors, community health workers and education and activity coordinators. This led to help in assessing the needs for family physicians in the country and using the resources available and vision statements to develop a formal growth plan.
Partnerships and Collaborations
We frequently found it of value to explore expanding plans and developing relationships beyond the residency itself. Some countries had accreditation and/or certification agencies, and it was imperative for them to be aware of any regulations they needed to comply with before getting too far into development. We also discussed developing organizations to help provide jobs for new graduates of established programs. Hosting cross training for residents with other specialty residents through didactic experiences was an opportunity for innovation and team building with other departments. Interdisciplinary cross training was encouraged where training in areas such as physical therapy, clinical officers and education for faculty development could be utilized.
Collaborative relationships in nearby countries can be of value. For example, during our consultation to a hospital in Papua New Guinea, we realized it would be advantageous to develop the residency along the Australian model of the master’s degree in general practice.
Lessons Learned
1. Sustainability and Leadership: It is imperative sustainability be provided from the beginning of new programs. Dr. Warren Heffron performed our first consultation as part of a sabbatical leave, which he spent studying applications of the new specialty of family medicine at a Christian medical school in Asia. During this year, a fledgling family medicine residency was started. After he returned to the U.S., within two years sustainability proved inadequate as budgets were cut and leadership had not infiltrated the medical school power structure for support and other departments cannibalized the residency positions.
2. Internal Differences of Priorities: It is ideal to have near unanimity of direction and local decision making and leadership to create new programs. Another consultation asked us to evaluate the possibility of starting a family medicine residency. At the end of the evaluation, we concluded this rural hospital was unusually well fitted to meet local needs while training indigenous physicians. There were good can-
didates for residents from the national medical school. The current medical staff were expat physicians and excellent candidates to be faculty, with an interest in training indigenous practitioners and future faculty for the residency. However, initially only about half of the physicians were interested in teaching, while the other half were dedicated to a service model. It took two years to develop the sustainable resources for the residency. The physicians in the hospital used this time to look at the long-term needs; then, by the time the residency opened, they were unified in their interest in adding medical education to their program. They also developed solid leadership in this interval and their decision was locally based.
3. Internal Conflict: Be extremely careful that all participants be given the opportunity to participate in expressing their opinions and establishing agreement on next steps. One consultation was to a program that was a part of a religious, non-governmental organization. They had a history of providing healthcare teams to remote and underserved areas. These were short-term mobile efforts and met a lot of health needs for underserved rural citizens. As a religious organization, they had an interest in providing healthcare services while offering spiritual support and care and an evangelism program. It had grown to be quite large and was successful in these two primary efforts.
We were asked to evaluate the feasibility of adding resident rotations to this program. While continuity of care was not possible in this setting, it was an intriguing idea, and we felt it was a worthy experimental educational program. However, the evangelism and service teams were quite opposed to adding medical education to their mix. We did not discover this until a later rift took place, which resulted in no new educational programs being added and some of the leadership leaving the program.
4. Flexibility: Adversity may contribute to our process over the long haul. The onset of the COVID-19 pandemic affected our ability to travel. Subsequently, we worked through a series of online consultations using the internet. This may permit us to offer follow-up or interval consultations at significant cost savings.
5. Consultant Teams: A team of two or three consultants is much more effective than an individual consultant. In some interviews, they can divide and interview a much larger cohort of local faculty, administrators and other key participants, as well as participate in a larger number of teaching sessions. For group interviews, it is helpful to have one person be the key interviewer while the other observes nonverbal communication and other interactions.
6. Time on Site: We found international consultations were more time consuming than a consultation in the U.S., often one or
two weeks in length. Jet lag was a factor and cross-cultural language and communication took more time. By including educational programs, we were able to address larger audiences. Continuity is important, and follow-up communications can be offered through repeat visits, Zoom, email, phone or letters.
7. Financing Consultations: Such a program can be financially viable if the sponsoring organization permits faculty to be away from the core responsibilities of performing consultations. In our cases, both consultants worked part-time for parts of their careers in order to take additional time to perform consultations. Volunteer donations of time on the part of consultants permits them to work at no cost to mission programs. The sponsoring program can be helpful in underwriting the costs of transportation or raising funds specifically for consultation activities.
Call to Action
For persons interested in improving global health, assisting in the creation and development of family medicine residencies may be a strategic mechanism for working toward equity in healthcare. Locally controlled and led educational programs may contribute more than going and providing healthcare. Missionaries almost universally are excellent educators, and role models and students exposed to this work frequently have a career call to participate in this type of work.
Education programs can be excellent sources for medical education across all medical specialties, for medical student and resident rotations as well as nurses, community health educators, social workers, physical therapists, occupational therapists, counselors, administrators and other members of the healthcare team. Other medical specialties can offer valuable and collaborative parallel education opportunities.
In summary, we feel adding family medicine education, providing consultations and training consultants are valuable additions to mission efforts and help fulfill the Great Commission of Jesus.
Warren Heffron, MD is a professor emeritus at the University of New Mexico School of Medicine and a volunteer faculty at In His Image. He is a past president of CMDA.
Chris Jenkins, MD is a faculty member of the In His Image residency program in Tulsa, Oklahoma.
LIFETIME MEMBE R
“Seeing CMDA come alongside all these different areas as a Christian, as a man of faith, as a healthcare professional, it was something I wanted to commit to for a lifetime. I didn’t want it to be something that I was involved with as a student and dropped off with the intention of picking up when I was more established, when I was more financially secure, when my kids were older, when I felt like I had more time. And so, I committed to be a lifetime member.”
CMDA LIFETIME MEMBERSHIP — A LIFELINE FOR A LIFETIME
When you become a CMDA Lifetime Member, you make a lifetime commitment to the ministry of CMDA. More importantly, you make a lifetime investment in bringing the hope and healing of Christ to the world. It is truly A LIFELINE
FOR A LIFETIME
It also means no annual dues payments. You make a one-time payment, and then you are a member for life! Plus, you gain access to exclusive resources and events just for lifetime members. With new lower rates for Lifetime Members, you could see cost savings up to 60 percent from annual membership dues based on your age and category in healthcare. To learn more about being a Lifetime Member, scan the QR code or visit cmda.org/lifetime
—Blake Westra, DMD
CMDA Lifetime Member
Bioethics
The Dr. John Patrick Bioethics Column
THE DISAPPEARANCE OF
“People say Gen Z follow these new faiths [namely social justice, climate activism and other urgent progressive causes] because we crave belonging and connection, but what if we also crave commandments? What if we are desperate to be delivered from something? To be at the mercy of something? I think we underestimate how hard it is for young people today to feel their way through life without moral guardrails and guidance, to follow the whims and wishes of our own ego and be affirmed by adults every step of the way. I am not sure that’s actual freedom. And if it is, I am not sure freedom is what any of us actually wants.” This is Freya India writing about a world in which no unchallengeable moral foundations are apparent and quoted in First Things. 1
In the same edition of First Things, James Orr begins a glowing review of Oliver O’Donovan’s Gifford Lectures on “The Disappearance of Ethics” with an ironic comment on the most powerful company in the world, Google, which began its existence by declaring a fundamental commitment: “Don’t Be Evil.” Ten years later, they realized it was a recipe for total corporate paralysis and quietly retired it.2 Why? Modern multicultural societies have bought into identity politics with victimhood being the trump card: no agreement on public good is possible between Jews and Christians, and all the others—Muslims, Hindus, Buddhists and secular atheists. Our ruling elites cannot agree on a foundational morality, so they try to pretend it doesn’t matter. More on this in a moment.
First, a little history on medical ethics as a curricular course in medical school. Its history is short, less than 50 years, despite the fact that the most famous foundational medical document, the Hippocratic Oath, begins with the invocation of transcendence (the gods) and proceeds to a statement of moral principles.
When our medical school started an ethics course because of undeniable bad behavior, cheating, etc., I commented to the dean at a cocktail party that such a course might produce some physicians who were amateur ethicists, but I doubted it would improve ethics amongst physicians. The dean was a liberal gentleman committed to the core liberal error—the idea that all problems were ultimately problems of ignorance and therefore correctable by education. He was appalled at my comment but also curious. I pointed out the most trustworthy people I knew would not even be able to define the word ethics, but I knew ethicists who acknowledged they only taught ethics; they did not practice them. (As it happened, the philosopher the dean put in
charge of our course left precipitously when his habit of sleeping with his graduate students became public. He continued to be part of the committee that evaluates the quality of ethics programs in medical schools.) When the dean asked what I would do, I said the students are beyond the reach of ordinary mortals like you and me, but they have not read the great novelists who might stop them in their tracks, like Dostoevsky. I knew no one in that year’s student group had read him, and so I found myself starting a reading group. (The most immediately powerful text was the chapter bearing the same title as the book, Fidelity, by Wendell Berry, and it should be read by every medical student.)
I was soon banished from our school’s ethics course for the usual reasons, even though a group of students followed me out after a lecture, preferring to spend the time arguing with me rather than endure another politically correct lecture.
For most students, if they remember anything from their ethics course, it will be the Georgetown Mantra—autonomy, justice, beneficence and non-maleficence. I have yet to meet a group of students who have been taught these four concepts are not all equally important and certainly not the same in all cultures. Furthermore, the trump card in most cultures, group loyalty, is not even included. Are they all equally important? Commonly, when asked to rank order them, most students used to say autonomy is the most important, which is not logically correct. (I leave you to work out why because you will then remember it.) Today’s educational establishment is thereby trapped in a conundrum.
John Patrick, MD
They want equal outcomes within a multicultural dogma! I hope this paragraph is sufficiently difficult for some of you to write to me.
When God gave the children of Israel the Law, He began by reminding them they were dependent on His grace to get out of Egypt and then He lists 10 practices He will not tolerate. If they keep the law they will flourish; if not, they will lose their land and become slaves. Given our fallen nature, grace turns out to be continuously necessary. The Torah teaches but it does not cleanse our souls; rather, it shows the need for something more—a Savior, because our problem is not moral ignorance but willful denial of the obvious conclusion. The writer of the first paragraph is inching toward this glorious conclusion. Quite a few intellectuals are on or have recently traveled on the same track, e.g. Tom Holland, Jordan Peterson, Paul Kingsnorth and Mary Harrington.
My comment to the dean was more intuitive than thought out, but I recently came across Wittgenstein’s provocative comment that ethics is not a science, and it cannot be taught. It is not reducible to knowledge as we understand it in science. Here is the last paragraph of his lecture on ethics. He wrote,
“…I believe the tendency of all men who ever tried to write or talk ethics or religion was to run against the boundaries of language. This running against the walls of our cage is perfectly, absolutely hopeless. Ethics, so far as it springs from a desire to say something about the ultimate meaning of life, the absolute good, the absolute valuable, can be no science. What it says does not add to our knowledge in any sense. But it is a document of a tendency in the human mind which I personally cannot help respecting deeply and would not for my life ridicule it.”3
Jesus tells us more in John 7:17, “If any man’s will is to do His will, he shall know concerning the doctrine, whether it is from God or whether I speak on my own authority” (NKJV). As all of us hopefully know, when we read the Scripture seeking understanding, God can authenticate them in overwhelming ways for which there is no parallel in our professional lives. He also changes us in ways beyond our merely knowledge-based understanding.
I almost began this essay with the words, “Reach out for some good,” which Aristotle uses in the opening of the Nicomachean Ethics.4 O’Donovan does start from that quote, but he gives the whole quotation, “All action, practice and aspiration reach out for some good.” He points out good must be there, or at least seem to be there, but in Christian ethics the good is often not taken for reality. When we lose the sense of immaterial good, we think of ourselves as just animals, but we are not. We are devastated by gossip, marital infidelity and misrepresentation, not to mention several teenage tantrums, most of which are rooted in the ill-understood developing ego. The fact of the conflict between the unmeasurable, immaterial realities of humanity like kindness, truth speaking and our own self-centeredness becomes apparent in very small children as C.S. Lewis notes in the opening of Mere Christianity. 5 In contrast, the animal world is a world of instinct. Robert Frost commented on the way we were failing to distinguish between humans and all other animals, something he could see would have disastrous consequences. More than 65 years ago, he wrote that our humor, conscientiousness and worship were being lost piecemeal to the animals under the table because of this intellectual error.6 Humor is almost absent from university.
Healthcare today deals with the consequences of behavior all the while, but we have no shared allowed language providing a base for discussion. Good and evil are real and must be acknowledged. Augustine famously said God created all things, and so they are good. Evil is therefore the absence of God, which only man has the freedom to want and pretend he is not dependent on God. The solution to the problem is a new world, which began on the first Easter, and in the Western world the intellectual elite dominantly accepted the gospel as truth until the late Middle Ages. Their intellectual efforts ironically led to reductionistic science beginning in the late 12th century, which allowed human pride to pretend God was not necessary for science and science was all we needed to manufacture a perfect world. The fact that a belief in, and an account of why science worked, required faith was conveniently overlooked. The losses Frost foresaw are all too apparent now, but we should not be entirely without hope because the hard sciences still respect data. For example, in cosmology, (especially the data from the Webb telescope that makes emergence of the cosmos from chaos untenable), in molecular biology, (since the statistical unlikelihood of an evolutionary origin of DNA is undeniable) and in origin of life theory (because Darwin’s imagined warm pool of inorganic chemicals cannot make a single amino acid without the help of a very sophisticated chemist). Thus, theism is at the very least semi-respectable again! It has more explanatory power than purely reductive thought.
Now I have used up my space without dealing with O’Donovan, so that must wait, but here is an appetizer. O’Donovan argues we have lost the recognition that the good is real and comes from God and is recognizable. Sadly, this involved the dismissal of intellectual history which we used to argue God has touched the minds of human beings throughout history. We also need the recognition and appropriate fear that God is the judge of all men. We see the nature of persons is being steadily degraded from a divine gift to a transient reality only ours, while we reach the functional level our politicians deem necessary. Fail the test and we can be aborted or euthanized. We need two practices of healthcare which differ in ethical commitments.
Endnotes
1 https://www.firstthings.com/article/2024/08/empire-under-siege
2 https://www.firstthings.com/article/2024/08/re-enchanting-ethics
3 https://www.wittgensteinproject.org/w/index.php?title=Lecture_ on_Ethics
4 Aristotle, W. D. 1877-1971. Ross and Lesley Brown. 2009. The Nicomachean Ethics. Oxford ; New York, Oxford University Press.
5 Lewis, C. S. 2012. Mere Christianity. C. S. Lewis Signature Classic. London, England: William Collins.
6 Frost, Robert, “The White-Tailed Hornet,” in Complete Poems of Robert Frost. 1979. Henry Holt and Co.
John Patrick, MD, studied medicine at Kings College, London and St. George’s Hospital, London in the United Kingdom. He has held appointments in Britain, the West Indies and Canada. At the University of Ottawa, Dr. Patrick was Associate Professor in Clinical Nutrition in the Department of Biochemistry and Pediatrics for 20 years. Today he is President and Professor at Augustine College and speaks to Christian and secular groups around the world, communicating effectively on medical ethics, culture, public policy and the integration of faith and science. Connect with Dr. Patrick at johnpatrick.ca. You can also learn more about his work with Augustine College at augustinecollege.org
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