Editorial
by David Stevens, MD, MA (Ethics) – Chief Executive Officer
Are You Committed? Devotion and dedication to a cause, person, or relationship is increasingly out of vogue, especially among “Millennials” – those born between approximately 1980 and 2000. Studies predict that they will hold eight jobs before they get to age 40. In their consumer-saturated upbringing, their greatest concern is “making the right choice.” This compulsion to choose “the best” causes them to keep loose ties with everything in case something better comes along – something better in cell phone carrier, coffee brand, or car, for example. Unfortunately, this same lack of commitment leads to superficiality in a multitude of relationships. They are socially networked like never before through “Facebook” and other similar Internet options, but deeply concerned that they don’t have a deep knowledge of their own self or others. They are compelled to put on an act, a persona, in front of others so they will be others’ “best choice.” Their picture may be taken at any time and put on the Web by their friends, causing pressure to always look good, to always look like they are having a great time. Behind the facade, they long for real relationships. Lest you think I’m picking on the Millennial generation, these same attitudes and priorities increasingly saturate GenX’rs and Baby Boomers in more important things than brand loyalty. Increasingly, one’s “vocation” is not a calling, but a complex choice based on the individual’s view of personal fulfillment. Marriage is not a vow “till death do us part,” but a preference for now and a “maybe” for later. Church is a combination of spiritualtainment and group therapy. If the music is not their penchant or the pastor tramples on their toes, it is time for church “shopping” to find a better choice after seeing who is marketing their ministry better. At an even deeper level, right and wrong, if they exist at all, are determined by analyzing complex circumstances and then weighing the facts on the scale of an often seared conscience, sometimes so seared that two diametrically opposed beliefs can both be accepted at the same time. This lack of commitment and limp loyalty to biblical standards and timeless truths is eroding the framework of medicine – the ideas, principles, agreements, and rules – that have made Western medicine flourish. It is exsanguinating professionalism like a slow bleeding ulcer. It is corroding medicine’s covenant that once put the patient’s well-being above the doctor’s finan-
cial, emotional, and even physical needs. The foundation of trust that must exist between the doctor and the patient is crumbling. This disease is destroying our profession and turning it into a bureaucracy whose success is measured by production rather than competency and compassion. No wonder so many doctors are dissatisfied. Abortion on demand, physician-assisted suicide, human cloning, embryonic stem cell research, and the concerted effort to strip healthcare professionals of their right of conscience are just symptoms of the underlying pathology. Those who are committed to nothing will stand for anything. Don’t despair or run to get some Prozac. God is still in control. He always has been, is now, and will be faithful. The crisis we find ourselves in is a unique opportunity for our lights as Christians to shine and to create a counterculture cure for the disease that plagues our profession. We have a best choice, but it is going to take a real commitment to bring this fact to the attention of those who currently insist on keeping their options open. First, we must commit to the biblical principles in our personal lives and then be committed beyond lip service to living these principles in our relationships with our patients, our colleagues, and our culture. Second, we must commit to work together. This is one disease that we can’t cure alone. We need mutual support and prayer – iron sharpening iron. The necessity for an organization like CMDA to motivate, train, and equip us has never been greater and will continue to grow. We need each other more than ever before, and we need to draw others to join with us. Third, we must commit to the future by raising up students and residents who are committed to the covenant and calling of Christian medicine. Strategically, our most important investment is influencing the next generations. If not, Christian medicine and even Christians in medicine may soon be a thing of the past. In this issue of Today’s Christian Doctor, we are going to examine the doctor-patient covenant. As one of the writers says, “We did not go to provider school; we went to medical school.” My prayer is that as you read the articles, you will be challenged to renew your commitments. I was. ✝ I n t e r n e t W e b s i t e : w w w. c m d a . o r g
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table of
CONTENTS
V OLUME 4 0 , N O. 1
Spring 2009
The Christian Medical & Dental Associations®–Changing Hearts in Healthcare–since 1931.
Features
14 A Christian Practice – Contract or Covenant? by James McKinney, DDS Why everything you do really matters
19 Professional Oaths History, Usage, Content, Changes by Robert D. Orr, MD, CM The Hippocratic Oath has been revised to such a degree that its value has diminished
23 Our Tradition, Our Professionalism, and Our Charge! by Thomas Eppes Jr., MD How a long-time CMDA member communicated spiritual truths to his peers in a secular setting
26 Reflections on Hippocratic Medicine in Practice – Three Perspectives Commissioned to Care by Teresa Tseng, MSIII
Oaths for Liars
by Jennifer Holmes, MSIV
The Soul’s Dark Cottage, Batter’d: A Lifetime of Hippocratic Practice
Departments 7 32
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Progress Notes Advertising Section
T o d a y ’s C h r i s t i a n D o c t o r
by Curtis E. Harris, MS, MD, JD, FCLM
30 Macroevolution – Fact or Fiction? (Seventh in our Apologetics Series) by Robert W. Martin III, MD, MAR
Editor: David B. Biebel, DMin Editorial Committee: Gregg Albers, MD, Elizabeth Buchinsky, MD, John Crouch, MD, William C. Forbes, DDS, Curtis E. Harris, MD, JD, Rebecca Klint-Townsend, MD, Bruce MacFadyen, MD, Samuel E. Molind, DMD, Robert D. Orr, MD, Richard A. Swenson, MD Vice President for Communications: Margie Shealy Classified Ad Sales: Margie Shealy 423-844-1000 Display Ad Sales: Margie Shealy 423-844-1000 Design: Judy Johnson Printing: Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). TODAY’S CHRISTIAN DOCTOR ®, registered with the US Patent and Trademark Office. ISSN 0009546X, Spring 2009 Volume XL, No. 1. 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© 2008, 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, Tenn.
David B. Larson Fellowship The Library of Congress invites qualified scholars to apply for a postdoctoral fellowship in the field of health and spirituality. Made possible by a generous endowment from the International Center for the Integration of Health and Spirituality (ICIHS), the fellowship is named in honor of the Center’s founder, David B. Larson, an epidemiologist and psychiatrist, who focused on potentially relevant but understudied factors which might help in prevention, coping, and recovering from illness. The fellowship is designed to continue Dr. Larson’s legacy of promoting meaningful, scholarly study of these two important and increasingly interrelated fields. It seeks to encourage the pursuit of scholarly excellence in the scientific study of the relation of religiousness and spirituality to physical, mental, and social health. The fellowship provides an opportunity for a period of six to twelve months of concentrated use of the collections of the Library of Congress, through full-time residency in the Library’s John W. Kluge Center. For more information about the David B. Larson Fellowship in Health and Spirituality, visit: http://www.loc.gov/loc/kluge/fellowships/ larson.html.
Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Scripture references marked (NASB) are taken from the New American Standard Bible. Copyright© 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977 by the Lockman Foundation. Used by permission. Scripture references marked (KJV) are taken from King James Version. Scripture references marked Living Bible are from The Living Bible© 1971, Tyndale House Publishers. All rights reserved. Undesignated biblical references are from the Holy Bible, New International Version®. Copyright© 1973, 1978, 1984 by the International Bible Society. Used by permission. All rights reserved. Other versions used are noted in the text.
For membership information, contact the Christian Medical & Dental Associations at: PO Box 7500, Bristol, TN 37621-7500; Telephone: 423-844-1000, or toll-free, 1-888-230-2637; Fax: 423-844-1005; E-mail: memberservices@cmda.org; Website: http://www.joincmda.org. 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.
ICMDA XIV World Congress held in the beautiful city of Punta del Este, Uruguay, South America for the first time, July 4-11, 2010. “Priorities in Professional Practice – Who are you working for?” is the theme for 2010’s conference addressing questions like: • Which place has God in our plans? • Which are our priorities regarding our family, husband/wife relationship, and parent/children relationship? • Do we aim at excellence and commitment in our task? • Who are we serving in our profession? Plenaries and workshops will address various scientific issues from a Christian-ethical perspective concerning our profession. For more information go to: www.icmda2010.org.
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Human Trafficking Update “Every country in the world has human trafficking, including the US. Some are worse than others.” – Jeff Barrows, DO, MA
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Human Trafficking is defined as any form of extreme exploitation of one human being by another for financial gain. It comes in different forms: sex trafficking, labor trafficking, recruiting child soldier or war brides, and trafficking in human organs. The most common form is sex trafficking, which involves selling girls under the age of eighteen in prostitution, or coercing adult women to work in prostitution. The average age of entering prostitution in the US is twelve. Twelve to twenty-seven million people are enslaved across the world. One university study estimated that up to 300,000 children in the US are either victimized by commercial sexual exploitation or at grave risk of being exploited. Jeff Barrows, DO, MA, is CMDA’s Health Consultant for Human Trafficking and is addressing this issue at international, national, and local levels. He is working with CMDA’s Global Health Outreach to provide education to team leaders. This past year he led a GHO team to Managua, Nicaragua to study human trafficking in that city, and to reach out to trafficking victims in Nicaragua, a source country for women and children, according to the US State Department. The most prevalent form of internal trafficking in Nicaragua is believed to be the exploitation of minors in prostitution. Their team worked through the House of Hope where they learned about nine-year-old Maria and eleven-year-old Anna.* Because their mother was a prostitute, their grandmother brought them to the House of Hope to keep them from being drawn into prostitution. However, their mother found them and took them out of the House of Hope into the child brothels of Managua to make money off of them, a common practice in many countries. Even now, at age eleven, Anna is still being forced to work in a child brothel. Maria went with her sister, since she had no place to go, and had a “John” get angry with her and break her leg. The last word was that Maria was in the hospital, but still at risk of being taken back into the child brothels.
CMA lobbied for years to encourage US federal government authorities to address the health implications of human trafficking. In September 2008, the US Department of Health and Human Services hosted the first-ever federal symposium on health and human trafficking. Dr. Barrows gave a presentation at the meeting. In December 2008, the White House held a symposium on international best practices for human trafficking victims. On the local front in northwest Ohio, Dr. Barrows is building a shelter called “Gracehaven” to rehabilitate and restore young girls who have been involved in commercial sexual exploitation. There are currently only thirtynine beds in the entire US with this specific purpose. Dr. Barrows’ shelter will provide an additional ten beds. The FBI calls northwest Ohio one of the top recruiting locations for underage prostitution. Federal investigators recently charged thirty-one men and women with herding teens, including at least nine girls, from northwest Ohio across state lines as sex slaves. For more information on Gracehaven go to: www.gracehavenhouse.org. For information on human trafficking, go to: www.cmda.org>issues & ethics>other. *Identities disguised.
CMDA Member Awards/Recognitions Dr. Shari Falkenheimer, Clinical Assistant Professor in the Department of Preventative Medicine and Community Health at The University of Texas Medical Branch at Galveston and Fellow of the Center for Bioethics and Human Dignity, was recognized by the Uniformed Services University (USU) of the Health Sciences in Bethesda, Maryland. She received the University’s Distinguished Service Medal for her contributions as a Member of the USU Board of Regents, to which she was appointed by President George W. Bush and on which she served on from 2003-2007. She was also awarded the Distinguished Service Medal of State Medical Academy in Semipalatinsk, Kazakhstan, this fall, in recognition of her two trips to speak at its international conference and to give lectures and practical training on adult learning methods.
leadership, and contributions to their fellow human beings in the field of dentistry through the dedication of extraordinary time and professional skills to improve the oral health of underserved populations within the United States and abroad. Dr. Kinsaul has provided volunteer dental care on every continent except Antarctica and Australia.
Dr. Jeff Kraakevik, Assistant Professor of Neurology and Staff Neurologist at the Parkinson Center of Oregon & Movement Disorders Program of Oregon Health & Science University, was named an Honorary Professor of the State Medical Academy in Semipalatinsk, Kazakhstan, for his service teaching adult learning methods there this year.
Dr. Jim Smith received the 2008 American Academy of Otolaryngology Humanitarian Efforts Award. This award is given to an Academy member who is widely recognized for a consistent, stable character distinguished by honesty, zeal for truth, integrity, love, devotion to humanity, and a self-giving spirit. The awardee is well-known for professional excellence and has demonstrated professional dedication by the giving of professional skills freely, and without desire for personal gain or aggrandizement, to those in this world who cannot otherwise, physically and financially, receive them.
Dr. Robert Kinsaul received the 2008 American Dental Association Humanitarian Award. The ADA Humanitarian Award recognizes dentist members who have distinguished themselves by outstanding, unselfish
Dr. David Singleton, MEI Prayer Team Member and San Antonio Ministry Advisory Council Member, has been awarded the Fellow of the Academy of Dentistry International. The award is given to dentists who are actively involved in providing dental care and education in lesser-developed countries. He has also been recognized in the Texas Monthly magazine as a “SUPER DENTIST,” an award that is selected by peer survey.
How do you feel about taking risks? Have you ever wished that you, like God, could see the end from the beginning so you’d know which path to take in a difficult situation? Is safety-atall-cost always the right decision? Once you’ve made a choice, do you second-guess yourself? Dr. Ben Carson, a preeminent pediatric neurosurgeon, knows a thing or two about risk-taking. Over the years he has developed a simple set of four questions that he calls a “Best/Worst Analysis.” No matter what the subject matter is, run it through this analysis and you will be surprised how much it clarifies your situation. Besides giving many examples from his remarkable personal life and his even more fascinating professional life, Dr. Carson makes the point that we all face risk. What we do with that risk will determine whether we reach our full potential in life – and whether those around us benefit or lose in the situation.
Take The Risk Learning to Identify, Choose, and Live with Accceptable Risk by Ben Carson, MD
The final two chapters are captivating because they deal with finding solutions to some problems that seem insurmountable – like paying for healthcare for those who are uninsured or underinsured. Will Dr. Carson’s idea work? Only time will tell! While the idea of safety vs. risk is on your mind, why not add When All Plans Fail by Dr. Paul R. Williams to your shopping list? Both of these books are available through Life & Health Resources at (888) 231-2637 or www.shopcmda.org.
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Washington Office Update Washington Office Faces New Challenges by Jonathan Imbody, Vice President for Government Relations While CMDA will work with Congress and President Barack Obama on issues of mutual interest such as human trafficking, international health, and combating HIV/AIDS, the outlook for success on pro-life policies and legislation is much more challenging. Pro-abortion groups have jointly submitted to the Obama administration a strategy document that advocates “de-funding abstinence-only programs,” using taxpayers’ dollars to fund abortions, and overturning a number of policies that the Christian Medical Association has played a role in advancing. For example, the abortion groups call for: • Reversing the new HHS regulation protecting the free exercise of conscience rights in healthcare. • Overturning the Mexico City Policy, which forbids funding groups that promote abortion as a method
of family planning. (On January 22, President Obama overturned the policy.) • Striking from federal budget legislation the conscience-protecting Weldon amendment. • Restoring funding to the United Nations Population Fund (UNFPA), which has been found by the US Dept. of State to aid China’s abortion coercion policy. (On January 23, President Obama said, “I look forward to working with Congress to restore US financial support for the UN Population Fund.”) • Passing the misnamed “Freedom of Choice Act” that would overturn most state laws restricting or regulating abortion, including conscience protections for healthcare professionals. As you pray for your CMDA representatives addressing these issues, consider how God might use you in advancing biblical principles in healthcare and building a culture of life in our nation. Photo by Jonathan Imbody, taken at the March for Life on January 22, 2009, the anniversary of Roe v. Wade
CMA Attends President’s Departure Ceremony On January 20, 2009, the CMA Washington Office joined President Bush’s staff and other well-wishers at Andrews Air Force Base to bid President Bush and his family farewell. During his tenure, President Bush promoted a culture of life on issues related to abortion, stem cell research, and human cloning. He advanced international health through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative. He protected the rights of healthcare professionals to practice medicine in accordance with lifeaffirming ethical codes. President Bush also launched international and domestic efforts to abolish the modern-day slavery known as human trafficking. CMA was privileged to work with his administration on each of these issues.
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T o d a y ’s C h r i s t i a n D o c t o r
Commitment to Our Patients Bruce MacFadyen, MD President – CMDA
The Christian physician/dentist’s commitment to the patient – wherever the practice and circumstances – is to be both spiritually and professionally prepared to give the very best care to that patient at that time and in that place. In many different situations, there are major roadblocks making this difficult to achieve; nevertheless, this is the goal to which we aspire. In our attempts to reach this goal, we may give both assistance and receive help from others. There are often many people involved in the doctor’s delivery of optimal care to each patient, and each one should be encouraged in whatever they do. The foundation of the Christian physician/dentist’s life and his or her ability to provide such care has to be his or her spiritual life – starting with his or her relationship to Christ, and this needs to be continually strengthened on a daily basis. Every medical/dental
environment has its own issues and pressures, which can derail one’s professional life and ministry if these become the primary focus or preoccupation. The only way to proceed successfully in the midst of these challenges is to daily focus on Christ. This requires the commitment of time for personal study of the Word and prayer for our patients, other doctors, nurses, and paramedical personnel. If the hospital is Christian, such as a mission hospital, mutual spiritual support of all the personnel must be a high priority in all daily activities. In a secular community or university hospital, spiritual support needs to be developed. The patients will be the recipients of the blessing that comes from an environment in which there is fellowship among Christian hospital personnel. The doctor’s life can be a witness to all. But Christian patients can have the assurance that their doctor is praying for them and relying on God. Our commitment to our patients also involves our professional growth. We
must be committed to be continually learning and to facilitate each other’s professional development. As we consider the subject of medical/dental information, we must also communicate well with our patients and be sure they understand their own health issues. Most patients value our willingness to communicate medical information, compassion, concern, and understanding related to their medical/dental situation. Even though physicians and dentists work under an extreme time pressure, it is very important that pertinent medical information and explanations be given in such a way that our patients understand the issues. Our commitment to our patients and their treatment is a serious obligation, in which we must rely on Christ’s strength. As Philippians 4:13 says, “I can do all things through Him who strengthens me” (NASB).
Regional Ministries Midwest Region CMDA Midwest Attn: Allan J. Harmer, ThM 9595 Whitley Dr., Suite 200 Indianapolis, IN 46240 Office: 317-566-9040 • Fax: 317-566-9042 cmdamw@sbcglobal.net
Western Region Michael J. McLaughlin, MDiv PO Box 2169 Clackamas, OR 97015 Office/Cell: 503-522-1950 michaelm@cmdawest.com
Northeast Region Scott Boyles, MDiv P.O. Box 7500 • Bristol, TN 37621 Office: 423-844-1092 Cell: 609-502-2078 Fax: 423-844-1017 scott.boyles@cmda.org
Central Region Douglas S. Hornok, ThM 13402 S 123rd East Place Broken Arrow, OK 74011 Office/Cell: 918-625-3827 cmdacentral@cs.com
Southeast Region William D. Gunnels, MDiv 106 Fern Drive • Covington, LA 70433 Office/Cell: 985-502-4645 wdgunnels@charter.net
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Medical Education International (MEI) God Still Works Miracles!
Last fall, MEI sent its first team to teach repair and rehabilititation of cleft palate defects in a Muslim country. The team consisted of an ENT specialist, a maxillofacial surgeon, and a speech pathologist.
Oral-Maxillofacial Surgeon, Dr. Brett Ueech, left, teaches new techniques for cleft palate repair
They consulted on ten very difficult cleft cases, all with complications, which host physicians were unsure how to manage. In addition to daily lectures by team members, the surgeons taught new surgical techniques as they assisted in surgery of these ten patients with cleft palates. The hosts were pleased to learn four new techniques. The speech pathologist evaluated patients pre- and post-op and gave recommendations to their parents. God also used her in a special way: “I had the opportunity to work with and develop a relationship with the speech pathologist at the hospital,” she said. “Although it was difficult to deal with her smoking, God was at work in her life. She opened up and shared . . . personal pains she was dealing with. This is not typical of [this nationality], so I know God was at work.”
FOR INFORMATION ABOUT MEI OPPORTUNITIES, VISIT:
She added, “One of the patients . . . was a blind 6-year-old with autism who had stopped talking about seven months prior. I had no answers to give the mom except, ‘Don’t give up’ and ‘Have hope.’ I did not have any contact with the child after this, but throughout the week we prayed as a group for all the patients and I believe God heard. The child said his first two words two days after I met him, and he has been speaking more ever since. To God be the glory in this miracle! The [local] speech pathologist was so excited she emailed [me] a recording of the child’s voice!” Plans are underway for the oral maxillofacial surgeon and the speech pathologist to return in 2009. They would like to have an orthodontist and audiologist join them this year. Might it be you?
WWW .CMDA.ORG/MEI
Every time you use this card to make a purchase, you support CMDA's Medical Education International and Women in Medicine & Dentistry – at no additional cost to you. 12
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Global Health Outreach (GHO) What to Share with Ethiopian Pastors? by Ron Brown, GHO Associate Director
Photo courtesy GHO files
As our GHO team prepares to serve the unreached people groups in southern Ethiopia, I have been preparing, reading, and studying for the pastor’s conference our GHO pastoral team will lead. We anticipate some 300 local pastors, most of whom have had little or no formal Bible or pastoral training. Marriage and family topics are my areas to address during various sessions. I will be drawing on thirtyfive years of marriage and raising four children, three of whom are now married, two grandchildren, and a 16-year-old daughter still at home. As I prepare, I wonder: What do I really know about the challenges of living a life in Ethiopia, with its raging HIV/AIDS devastation and
vast orphan population, raising a family as a nomad, droughts that have led to food wars, military often seen as foe not friend, or dealing with the African urban challenges of modernity and its fierce temptations? While I may doubt my own competence, I know I can count on the transcendent, eternal, and unchanging truths of God’s Word and His principles that have withstood the challenges of centuries, cultures, languages, and world views. Following these truths guarantees anyone the blessings of joy, peace, and hope in spite of circumstances, weather, war, politics, and suffering. The book, AIDS is Real and It’s in our Church, by C. Jean Garland is a primer on HIV/AIDS in Africa
FOR INFORMATION ABOUT GHO OPPORTUNITIES, VISIT:
and its ongoing devastation. Ms. Garland gives some very thorough counsel on how to deal with this pandemic in and outside the church. Though a very complicated issue, the keys to its prevention are the biblical principles of moral purity, chastity before marriage, and fidelity in marriage. Matthew Parris, writing for the Times in the article “As an atheist, I truly believe Africa needs God” states, “Now a confirmed atheist, I’ve become convinced of the enormous contribution that Christian evangelism makes in Africa: sharply distinct from the work of secular NGO’s, government projects, and international aid efforts. These alone will not do. Education and training alone will not do. In Africa, Christianity changes people’s hearts. It brings a spiritual transformation. The rebirth is real. The change is good.” Praise God that His Word has transforming power that does in fact change hearts and behavior to a degree that even unbelievers cannot deny it. My prayer, as our GHO team goes to Ethiopia, is that we can learn from our pastors in Ethiopia, build on their rich Christian tradition dating back to biblical times, and combat the huge infusion of Muslim money to build many new mosques and spread Islam. How can we accomplish these things? By declaring the ageless truth of God’s Word and embracing the heart-transforming power of the blood of Jesus, which still cleanses, forgives, heals, reconciles, and keeps us from falling!
WWW .CMDA.ORG/GHO
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A Christian Practice – Contract or Covenant? by James McKinney, DDS
Understanding that we participate in the story of redemption gives everything we do each day tremendous significance and meaning
Linda was sitting in my hygienist’s chair even though she should have cancelled or been a “no show” for her appointment. When we had called to confirm Linda’s appointment, we had learned that her husband had just died that morning and had assumed that she would not be coming in today. I sat down beside her, held her hand, and expressed my sadness at her husband’s death. I asked her what in the world she was doing in the dental chair in the midst of something like this. Her response reminded me once again of the awesome opportunity we are given to walk with folks through life. “Doctor,” she said, “this experience has been hard, but I knew if came here today I would be loved, and I wanted to come.” What does it mean to manage your practice from a Christian perspective? Is there more to practicing as a Christian than just treating people nicely, being honest, and playing Christian music on the radio? Are we “providers” of healthcare, with a more or less contractual relationship with our patients, or are we participants in a covenant? We are told in Scripture that we are created in the image of God for His glory and have been given a special task, to have dominion over His creation.
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Understanding what it means to be created in His image and to have dominion sheds some interesting light on what it means to practice dentistry or medicine from a Christian perspective. What does it mean to be created in the image of God? Our God is a relational being: Father, Son, and Holy Spirit. In all other religions, God must create in order to have relationships, but in Christianity God is a relationship between the Father, Son, and the Holy Spirit. The life of God takes place in the community that exists within the Trinity. Out of the overflow of love within that community came the desire to create others with whom this great love could be shared. So God created man in His image. At a bare minimum, to be created in the image of God means that we are made for relationships; in fact, needing to be in relationship to be whole. Because all relationships take place within the context of a community, it follows that community must be a defining characteristic of who we are. Communities, even a dental or medical practice, provide the structure within which we can love and be loved as God intended. The practice can create a community where folks like Linda can go when life becomes difficult.
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A Christian Practice – Contract or Covenant?
3. Separation from his community: His wife, Eve, As image bearers of God, we too, are Trinitarian was given to him so that he might not be beings, created to be in relationship with God and othalone. When God asked Adam if he had eaten ers. We are incomplete if separated from God or our of the forbidden fruit, Adam’s first response community. By definition, to belong to God is to be a was to blame Eve, thus creating a separation part of His body, the Church. This is not an option, but between himself and his community. Today, is a part of who we are created to be. Life for us requires we experience this separation in ruptured community. Community takes different forms in each relationships with spouses, children, team area of our lives: family, neighborhood, worship, play, members, patients, and neighbors, local and and work. All of these areas provide a structure for relaglobal. tionships, and life lived rightly within these communities should exhibit healthy relationships. Jesus said, “Love God and love others,” whatever the context may be. The impact of imaging God in this way becomes clearer when we see the impact of the “fall” on man in Genesis 3. In his book, Genesis in Space and Time, Dr. Francis Schaeffer describes four separations that happened to man when Adam sinned. The first three separations described by Dr. Schaeffer deal with “The Temptation and Fall” (Sistine Chapel) by Michaelangelo Buonarroti Adam’s relationships; the fourth deals with Adam’s These first three separations are relational, related physical dominion. directly to our Trinitarian nature: God, self, and others. Adam was created to be a relational being in the 1. Separation from God: God came to the garden image of the Trinity. Before the fall, he was confident, to walk with Adam, as was His custom, in the transparent, open, and without fear in an intimate cool of the day, and we hear the very sad relationship with God. He was clear about who he words, “Adam, where are you?” We hear was as a child of the Father and in an intimate relaAdam’s equally sad response, “I was afraid, so tionship with his wife. After the fall, Adam became a I hid.” Contrary to what He had intended, relational wreck, desperately in need of restoration God finds Adam not open, transparent, and and reconnection in all three areas. welcoming, but hiding. His sin and his fear Yet the Bible recounts how God, the relational have come between him and God. One, refused to allow humanity to remain discon2. Separation within himself: Adam sinned when nected. It describes His relentless pursuit of humanihe listened to Satan’s lie that a larger, fuller identity could be found if he went outside the ty in order to provide a means for reconnection to boundaries given him by God by eating the Him and a restoration of our flawed selves to the forbidden fruit. Likewise, our own search for original image in which we were made. It speaks of identity tempts us all to seek identity in things the opportunity extended to believers to participate other than in bearing the image of God; for in this restoration. example, in the creation (see Romans 1) or in Understanding the first three separations described our spouse, our kids, our profession, our by Dr. Schaeffer raises some significant questions for wealth, busyness, our name, or any number us to consider as we practice dentistry or medicine: of other idols that are not the image of the • What is the nature of my relationship with God? Do I spend time with Him? Does isolation from One who made us.
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where they will experience connectedness in each area of separation we have described? 4. Loss of dominion: When Adam “fell,” he lost the dominion over the earth that was given to humanity by God at creation.
God leave me feeling alone, unimportant, fearful, and hollow? When all is quiet, dark, and I am alone, whose voice do I hear? In what do I seek to find my identity and significance? From whom do I feel disconnected and at odds? What will I do about this? • How is God a part of this Trinitarian community I call my practice? • Since relationships require time, is my practice structured and do my systems allow time to build relationships with my team and with my patients? For example, does my new patient process just gather information, or does it help create a relationship? Are our team meetings structured for lecture or relationship? • How can I be intentional about growing my team as people? • Are the people on my team a means to an end (e.g. to fulfill a job description, create production, help me be more efficient, etc.) or do I see them as persons created in the image of God and a part of this particular community of which I am the “pastor”? • Do I see my patients as members again of this particular community, my practice, of which I am the “pastor”? Do I listen for where they are disconnected from God, themselves, and others and seek to facilitate reconnection in whatever creative ways God may lead? • Do I serve (love) my patients or take from them? Do I see them as persons, made in the image of God, or as a means to an end, including the meeting of my needs? • How do I intentionally create a community into which I can invite team members and patients
T o d a y ’s C h r i s t i a n D o c t o r
Another patient, Jennifer, said, “Doctor, you gave me back my smile and I want to thank you.” As I listened to her gratitude for the changes we made in her smile, I remembered how she had presented months before. She covered her mouth when she spoke in order to hide the missing teeth and black decay that embarrassed her if she dared to smile. The condition of her teeth made her reluctant to be seen in public with her husband. Jennifer begged us to help her, adding one requirement: “I don’t want to lose any more teeth.” Genesis 1 describes how God created the world and then Adam and Eve. He commanded them to be fruitful and multiply and to have dominion over the earth. In essence, they were given the keys to the kingdom with the directive to watch over it, care for it, and use it to bring Him glory. The most vivid picture of this dominion was demonstrated when God asked Adam to name the animals, much as God allows parents to name their children as an expression of their love, care, provision, and responsibility for them. To name something is to have dominion over it. Under the dominion of Adam and Eve, creation was a beautiful, ordered, and alive place where every detail had been pronounced “good” by God. Adam and Eve were enjoying paradise, perfectly related to God, themselves, and each other, until paradise was foiled by their sin. Genesis 3 describes how Satan, whose purpose is to find every way he can to undo all that is beautiful, ordered, alive, and God-glorifying, moved against God’s people in paradise. Satan suggested to Adam and Eve that God might be holding out on them, keeping them from being all they could be. When Adam and Eve fell for the deception, not only were their relationships jeopardized, but God’s judgment was that their dominion, which had once come easily as a natural order of things, would now come only with sweat and pain. The result of this physical loss of dominion is described clearly in Romans 8:19-22. Physical creation, through no choice of its own, still suffers the ravages of the evil one; physical chaos where there had been order, ugliness where there had been beauty, decay and disease where there had been health, death where there had been life, and a creation-permeating sense of futility, with which we as healthcare professionals often come face to face.
be allowed to participate now in what Dr. Schaeffer calls “substantial healing.” We will not bring in the new heaven and new earth as described in Revelation 21; God will do that. But we can participate in the substantial healing of our current world, now, in this present age. The story of Jennifer illustrates the opportunity we are given on a regular basis in our practices. Jennifer was experiencing the ravages of lost dominion, a world at odds with what had been intended by its Creator. Yes, there were spiritual issues and a battle for Jennifer’s heart that was our concern. But there was more, also. Periodontal disease, decay, tooth loss, and even the loss of beauty and shame that goes with the tooth loss are all ravages of the evil one and an intentional affront to God. When I restore decaying teeth, provide healing for disease, restore beauty, and create order, I participate, to a small degree, in the restoration that is to come. God is glorified in what I do as I exercise with authority the dominion He intended from the beginning. Physicians, likewise, have many opportunities for exercising a similar authority.
A Christian Practice – Contract or Covenant?
Thankfully, for Adam and Eve (and for us), God provided hope, not through some blaze of Almighty power, but a promise (covenant) of redemption through one who would be born of a woman, laid in a manger, and remain unnoticed by most of the world until He made His appearance at the Jordan River and was baptized by John. After His baptism, Jesus confronted Satan in the wilderness, and then began His ministry by taking on one of Satan’s henchmen (Luke 4:31-37), a demon that He cast out. Throughout the gospels, we see Jesus systematically exert His dominion and authority in one arena after another. He healed the sick, turned water into wine, controlled the winds/storms, walked on water, multiplied loaves and fish, threw the money changers out of His house of prayer, raised the dead, forgave sin, and, in the ultimate exertion of dominion, overcame death itself (1 Corinthians 15:54-55). After His resurrection, Jesus told His disciples that they would do greater things than He had done (John 14:12). They had already experienced a taste of what new authority would look and feel like when Jesus had sent them out with authority over the demons (Luke 10:17). In fact, as His disciples recounted stories of exercising their authority, Jesus described the fall of Satan with the words, “I saw Satan fall like lightning from heaven” (Luke 10:18). In His final words to His disciples in Matthew 28, Jesus assured them that all authority had been given to Him. Then, despite humanity’s history of giving authority away to the enemy, Jesus did a startling thing – He gave authority to us again. He said, “Go and make disciples.” Jesus told His disciples (including us) that all power and authority would be given to them by His Spirit to continue what He had begun – the redemption of the earth, a restoration that will culminate in Christ’s return. Indeed, all creation eagerly awaits the redemption that is to come through the children of God (Romans 8). Our commission is to return to the King what is rightfully His, not just in the spiritual realm, but also in all of creation, because under the new covenant, all things in heaven and earth come together in Christ (Col. 1:15-20). Therefore, where there is chaos, restore order; where there is ugliness, restore beauty; where there is war, restore peace; where there is a need for forgiveness, forgive; where there is separation, reconciliation; where there is thirst, a cup of cold water; where there is disease, healing; where there is decay, restoration (pun intended); and, where there is fear, love. Although the Scriptures make it clear that we will not see full restoration in this life, our privilege is to
If we truly have been given dominion and the responsibility to care for and protect God’s creation, in the face of an enemy bent on its misuse and destruction, what are some of the questions we should be asking • What is my dominion? (My circle of influence?) • Where do I see chaos, ugliness, disease, decay, and separation? What is my response to it? Do I see this as evidence of the ravages of the evil one, and what is my responsibility in addressing it?
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• In any given situation, what does “substantial healing” look like? • Have I received power, and do I exercise authority within my circle of influence? • What connections do I see between the physical well-being and circumstances of my patients and the conditions of their hearts and souls? • How do I participate in “bringing all things together in Christ?” • Does participating in the restoration of order, beauty, health, and life give me joy? Where do I see this happening within my circle of influence?
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As believers, we get to participate in the story of redemption. It is a story of dominion given, lost, regained, and given again. It is a story of promise and hope and the glory that is coming. The end of this story is what the prophets called “consummation,” the making of all things, both physical and spiritual, new. Relationships and dominion will be restored because we will be “with” the One who has promised to make all things new. If we understand this story, then every part of everything we do each day has tremendous significance and meaning. What a privilege it is to participate in the reconciliation of the relational separations that plague
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human souls, while we also participate in the restoration of the physical world that is marred by the evil intent of the one who is not only the enemy of our souls, but of the creation that should glorify our God, of which we, and our patients, are a part. ✝
James McKinney, DDS, FAGD, practiced general dentistry for twenty-eight years, first as a solo practitioner and then as the managing partner in a large group practice. In both settings he wrestled with how, in daily practice, he could honor God in all things, develop people, pursue excellence, and operate profitably. He retired from dentistry in 2001 and served for six years as the director of student ministries in a large church. He currently works with “Transformation3,” a practice consulting firm that seeks to create space for personal and professional transformation. Dr. McKinney lives in Knoxville, TN, with his wife and black Lab. They enjoy their three married children and two grandchildren. He can be reached through www.transformation3.com or by e-mail at: jim@transformation3.com.
Professional Oaths HistoryUsageContentChanges by Robert D. Orr, MD, CM While the practice of medical oath-taking in North America has steadily increased, the content has been steadily diluted and secularized
History of Medical Oaths When a new ethical dilemma is discussed today, either in a professional forum or in the public square, someone often asks, “What does the Hippocratic Oath have to say about this issue?” This ancient document is truly regarded as a standard with contemporary relevance and application. The Oath of Hippocrates, likely dating from a few centuries before Christ’s birth,1 defines a watershed in the history of western medicine. Most ancient Greek physicians were tradesmen who were looking out for themselves; e.g., treating the rich, ignoring the poor. Those who took this Oath, on the other hand, swore to instead seek first the patient’s best interests. This defining feature – seeking the patient’s best interest – was the beginning of medicine as a profession rather than merely a trade. It is interesting to note that at that time the Oath was administered to the novice at the beginning of training to be a physician, not at its completion as is the common practice today. Even more important, what began as a badge of non-conformity to the medical practices of the day has become the standard to which society often refers in analyzing issues in current practice. The text of the revolutionary Oath includes pledges about teaching, dedication to patient’s welfare, and decorum. Of equal importance, it is not a code of ethics, i.e., sworn to peers, but an oath, sworn to divinity. The exact wording of the Hippocratic Oath has been the subject of much scholarly debate. The most frequently used translation was done by Ludwig Edelstein in 1943 (see sidebar, page 20). Perhaps more important than the exact words, however, is an
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Professional Oaths: History, Usage, Content, Changes
understanding of its intent. Of the many analyses and commentaries on the Oath, that done by Leon Kass2 is, in my estimate, the most insightful and applicable to today’s medicine (see sidebar, page 22). Usage of Medical Oaths The Hippocratic Oath is the oldest and best known of the several medical professional oaths used in the past and present. However, in the past 100 years, many individuals have declared the Oath to be archaic, and some have proposed revisions or even have developed entirely new oaths (or codes). Thus, while society looks to the classical Hippocratic Oath as the standard, most graduating medical students do not actually swear this particular oath.
In 1993, colleagues and I reviewed the literature and undertook a survey of all 157 allopathic and osteopathic schools of medicine in North America to learn what oaths were being used at that time.3 We learned from the literature that oath-taking increased dramatically in the 20th century: in 1928, 24 percent of schools administered an oath; in 1958, 72 percent; in 1977, 90 percent; and by 1989, 100 percent of US schools administered an oath to their graduating physicians. We were able to obtain the name and text of most of the oaths used. Interestingly, seventy-four schools labeled the oath they used “The Hippocratic Oath,” but in fact, when we looked at the text, we found that only one so labeled used the ancient words (State University of New York at Syracuse). Thus, the term
Hippocratic Oath – Classical Version I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant: To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it – without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else. I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot. Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.
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Oaths used in 1993 Oath of Hippocrates - classical version - modern version - modified version** - unknown version Declaration of Geneva - 1948 version - 1983 version The Osteopathic Oath The Oath of Louis Lasagna The Prayer of Maimonides Other No oath administered Total
Number
%
1 45 22 1
1 30 15 1
10 24 15 5 4 20 3
7 16 10 3 3 13 2
euthanasia (14 percent), and agreement to be accountable for keeping the oath (43 percent).
150 schools
*does not add up to 100% due to rounding **some portions of the original oath with substantial changes, each one unique
Content of Oaths Used in 1993 We were able to analyze the content of 146 oaths using a modification of Kass’ analysis (see sidebar, page 22). The classical Hippocratic Oath contains fourteen identifiable content items. The Modern Hippocratic Oath includes ten of them; the Osteopathic Oath has nine; the 1948 Declaration of Geneva has seven; the 1983 Declaration of Geneva has six; the Oath of Louis Lasagna has six; and the Prayer of Maimonides has five. Except for the Prayer of Maimonides (which is really a prayer, not an oath), the fall-off in content items is directly related to the age of the oath – the newer the oath, the fewer of the original content items. To be fair, many of the newer oaths have added new items such as prevention of disease, commitments to science and learning, avoidance of greed, humility, care of the whole person, autonomy of patients, assistance with decision-making, gender-inclusive language, and wording suggesting that taking a patient’s life may be acceptable. The items most often deleted from newer oaths are: proscription of sexual contact with patients (retained in only 3 percent), covenant with deity (11 percent), foreswearing abortion (8 percent), foreswearing
Changes: What and Why?
Professional Oaths: History, Usage, Content, Changes
“Hippocratic Oath” is often used as a generic term meaning a medical professional oath. Seven schools volunteered that they allowed their students to either choose from a selection of oaths, or even write their own oath.
Why have there been such dramatic changes in the practice of oath administration and the content of the oaths used? Clearly, the practice of medicine has changed immeasurably in the past 2,500 years. And of course, the Oath is not Holy Writ. The question then becomes whether the Oath is foundational, whether it set the stage for the practice of medicine – for all time. Albert Jonsen, a medical historian, maintains that the thrust of the Hippocratic Oath focused on the competence of the physician and the best interests of the patient.4 He goes on to conclude that this revolutionary focus subsequently combined with the compassion taught and modeled by Jesus to develop the ethos of modern medicine. Nigel Cameron, theoloI n t e r n e t W e b s i t e : w w w. c m d a . o r g
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Professional Oaths: History, Usage, Content, Changes 22
a. using appropriate means
One other finding from our 1993 survey may shed some light on these changes. Allowing graduating medical students to write their own oath seems antithetical. This postmodern approach is like saying to the students, “Okay, you are doctors now. What does that mean to you?” If there is an ethic in medicine, if there are foundational standards, it seems self-evident that the practitioners of the art should articulate those standards rather than asking new inductees to choose their own standards and boundaries.
b. with appropriate ends
Conclusions
Traditional Hippocratic Oath content items (modified from Kass) 1. Covenant with Deity 2. Covenant with Teachers 3. Commitment to Students 4. Covenant with Patients
c. limit on the ends i. no abortion ii. no euthanasia iii. limit on means d. justice e. chastity f. confidentiality
The practice of medical oath-taking in North America has steadily increased in the past 100 years, but the content has been steadily diluted and secularized, seriously diminishing the core values of the profession. As Cameron has suggested, when we can no longer agree on the content, we have focused instead on the process. This departure from the Hippocratic tradition is very troubling. Very troubling, indeed. ✝
5. Accountability The author of the Oath is unknown. Various scholars have dated its origin between 600 BC and 100 AD; the most commonly cited date is about 450 BC. 1
gian and ethicist, concurs and laments that this historic combination of skill and moral commitment has devolved in recent years to a lesser concept, that medicine is all about technique, ignoring the moral commitment. He concludes that the current practice of medical professional oath-taking focuses more on the process rather than the content.5 It is important in looking at the changes to understand the original intent of the writer of the Oath. For example, Kass points out that the proscription against operating on a patient with kidney stones was not because such surgery was immoral. The intent was to focus on the welfare of the patient, i.e., if surgery was not done, the stone might pass; but if surgery was attempted by the untrained physician, there was a high likelihood that the patient would die of infection. Many of the changes can be attributed to the societal changes of the 1960s and ’70s. During that period of time in western culture, patient rights and autonomy came to the fore (along with consumer rights, minority rights, women’s rights, etc.). I would not for a moment suggest that we return to the pre-1960 age of medical paternalism where physicians decided what to do without patient input or consent. But, I believe the pendulum has swung too far, that physicians have ceded their moral authority and been unwilling to assert the traditional boundaries of medical practice. Nowhere is this more evident than in the acceptance of abortion and the clamor for physician-assisted suicide or even euthanasia. T o d a y ’s C h r i s t i a n D o c t o r
“Is There a Medical Ethic? The Hippocratic Oath and the Sources of Ethical Medicine.” Chapter 9 in Toward a More Natural Science, by LR Kass; New York: The Free Press, 1985. 2
Orr RD, Pang N, Pellegrino ED, Siegler M. “Use of the Hippocratic Oath: A review of twentieth century practice and a content analysis of oaths administered in medical schools in the U.S. and Canada in 1993.” Journal of Clinical Ethics 1997; 8 (4): 377-88. 3
Jonsen AR. The New Medicine & the Old Ethics. Cambridge, MA: Harvard University Press, 1990. 4
Cameron, NMdeS. The New Medicine: Life and Death after Hippocrates. Wheaton, IL: Crossway Books, 1991. 5
Robert D. Orr, MD, CM, is a family physician and ethics consultant who currently teaches clinical ethics to graduate students at The Graduate College of Union University (Schenectady, NY), Trinity International University (Deerfield, IL), and Loma Linda University (Loma Linda, CA). He has been a member of CMDA for over forty years, has chaired its Ethics Committee, and currently serves on the editorial committee of Today’s Christian Doctor.
Our Tradition, Our Professionalism, and Our Charge!
“We did not go to provider school; we went to medical school.”
by Thomas Eppes Jr., MD
An essential element of getting heard in the public arena is learning to communicate truth with the kind of creativity long-time CMDA member Dr. Eppes used in his inauguration speech as president of the Medical Society of Virginia (excerpted below). To learn more about how to communicate in a similar fashion, attend one of our media training programs. – CEO of CMDA David Stevens, MD, MA (Ethics)
this into my head? I believe that most of us in here could not name one of our great-grandfathers, certainly not all four of them. Even in Virginia the farther back into our family tree we go, the fuzzier the history becomes. I know that just saying this disturbs greatly the genealogyresearching, graveyard-tromping, and historical-record-gathering woman who is my mother. But it leads me to the question, “Who will remember us, much less anything that we do?” Unless we step up to the plate of history and hit a home run that has a lasting effect that carries on for generations, the answer will be, “Who cares?” Thomas Aquinas gave us a hint about where we can leave our mark. He asked three questions that we all must answer: Thomas Eppes Jr., MD, is sworn in as president of the Medical Society of Virginia “What can I know? What may I believe? And what should I do?” To answer these As I get started I readily acknowledge that what I do the next requires a brief history lesson, followed by some thoughts on twelve months will in many ways be dictated to me by the our role as physicians – and what the fact that we are profesevents of the General Assembly, the US Congress, and whatsionals entails. Finally, I would like to share with you what I ever the medical news story of the day may be. This evening believe to be our charge. I will take a moment to talk about a stream of thoughts regarding what is near and dear to my heart as a physician, Our tradition with the goal of providing a taste of the perspective from which I will approach issues as they arise this year and next. Western medicine is our tradition. It has been enriched by Being a Virginian from a heritage starting in 1622 or so, I many sources, but two major influences have withstood the have pondered what could be said that ties our long-standtest of time. The first occurred in ancient Greece. About ing heritage of the Commonwealth together with the 182 2,500 years ago, medicine was a scary proposition. If you years of MSV’s importance to the physicians of this state. For were sick and went to a physician for a cure, you never were a year I have had the recurring question pop into my head, quite sure of what you would get. At that time if you paid “Who is your great-granddad?” What in the world brought enough you might get the cure, but if you did not and your I n t e r n e t W e b s i t e : w w w. c m d a . o r g
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Our Tradition, Our Professionalism, and Our Charge!
enemy paid more, the physician might take the payment to do you in while pocketing your money, too. It took the followers of Hippocrates to craft and follow the oath that he created to change the way patients viewed and eventually trusted their physician. Why was this oath so revolutionary at that time? Several characteristics bear mentioning now, because in today’s culture we are beginning to forget this cornerstone, in which his followers swore to: • The transcendence of a higher power. I thought I was going to give a eulogy for Aesculapius tonight, but his image lives on. Not that anyone here swears to Apollo or him, but that we all must live to a level of accountability that is above us and not what we individually make up. • A commitment to the sanctity of life. We are healers, not life-takers. • A commitment to the relief of pain. • An obligation to teach the healing arts to the next generation. • A preservation of proper boundaries with those who entrust their health to us. Patients undress physically and spiritually before us. This we never should violate. • The critical role of confidentiality in the patientphysician relationship. What Hippocrates put down would have meant nothing unless it was what the people/patients valued and wanted. They voted with their feet, by going to those doctors who swore to this level of conduct. I believe that they still would today. Patients crave that level of confidence in their physician – who he or she is, how competent he or she is, and what each of them stand for. The second great influence on our tradition was born in an obscure corner of Palestine 2,000 years ago. The logical extension of this carpenter’s teachings brought us hospitals that are places of healing. They are not places where intentional death is the reason for admission. The combination of this emphasis on caring for the weak, frail, and ill, coupled with the commitment to Hippocratic ethics is the formula that through the centuries has led to the evolution of what we would call Western Medicine. We must make sure that this foundation is our solid rock, not the shifting sand that society increasingly perceives us as standing upon. Physicians need to know this foundation and society must see that we know it. Our professionalism Aquinas’s question “What may I believe?” was conceived, birthed, and nurtured as professionalism. Edmund Pelligrino, the father of medical bioethics, most eloquently defines a professional “a person dedicated to the care of
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Byzantine manuscript of the Oath, rendered in the form of a cross
another human being who needs help, is dependent, and is vulnerable.” He further explains that “the essence of professionalism is that we declare aloud and publicly our dedication of our lives and our work to something other than our own self-interest. Our knowledge and our power do not endow upon us excessive privileges, but instead impose on us greater responsibilities.” This is tough as we try to balance the role of businessman with the roles of patient advocate and caregiver. Historically, physicians are professionals. We must believe, and our patients need to see, that our role in society is to be the professional who is there for our patient, now and for generations to come. Our charge “What should we do?” was Aquinas’s third question. In the book of Genesis, which is the starting point for three great religions, God promised His blessing to Abram if he would follow Him as He instructed. But this blessing was coupled with the purpose that Abram would be a blessing to others. Are we skeptical of our ability to find the right and the good, or are we going to take the easy way out, compromising for what is workable?
Our Tradition, Our Professionalism, and Our Charge!
Personal preferences are the order of the day. We did not go to provider school; we went to medical school. We don’t care for clients; we care for patients. As physicians we are blessed with a position unlike any other in society. We are entrusted with the health and lives of those who are our patients and all that that sacred trust means. As professionals we should be a blessing to our patients, their families, and our communities. We should live in the finest traditions of our foundations as we grapple with all the new, fancy, incredible, and frankly amazing things we do today that will themselves be mundane in twenty years. People will forget what we could do, but they will remember who we were, how much we cared, how we lived our professional lives, and how we passed it on. Those who follow us might not know our name as they know Hippocrates (just as we have forgotten the names of our great-grandfathers), but the tradition of caring for those entrusted to our care will live on in our legacy. “What should we do?” Just as the Medical Society of Virginia has created a new banner to lead the troops into action, each and every one of you who carries the title of physician needs to carry that banner of a true professional physician in the richest sense. When we do this, we will reclaim and maintain the respect of not only our individual patients, but also the citizens of the Commonwealth as well. We are physicians – we have a hallowed position of
trust that has grown over the centuries. We are physicians – no one can do what we do. We are physicians – we are blessed with oh, so much. We are physicians – our charge is to be a blessing to all for whom we care. This is our challenge as our patients and the state watch. Let us never let them down. Let us carry the banner high. Our legacy cannot be the same as any other “provider” of services or even of healthcare, for we are physicians. ✝ This address was delivered at the Presidential Inauguration ceremonies for Dr. Eppes’ incoming presidency of the Medical Society of Virginia, on October 11, 2008.
Thomas Eppes Jr., MD In 1995 the new president of CMDA stated that Christians should be salt in their local, state, and national societies. Years of work after hearing that call positioned Dr. Thomas Eppes Jr., a family practitioner from Forest, Virginia, to be elected by his peers to lead the Medical Society of Virginia 2008-2009. He craves your prayers as he balances his faith with the secular needs of leading and representing a pluralistic organization.
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Reflections on Hippocratic Medicine in Practice
Commissioned to Care by Teresa Tseng, MSIII
“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being.” – Hippocratic Oath (adapted) I vividly remember a terminal cancer patient I interviewed on my first history and physical assignment of second year. There were tumors in both his lungs and extensively throughout his colon. Even before stepping into his room, a hospital staff member warned me that this patient would unexpectedly leave his room each day to smoke cigarettes outside. When I met him, he was grumpy and in severe pain, and he let everyone know about his misery. I watched my frail patient struggle to face me from his bed, careful not to disturb his colostomy bag. At first, he did not want to answer my standard questions, but as the encounter continued, his replies grew more descriptive as he shared his rich past with me. He talked about everything from his childhood and his combat in Vietnam to his current condition and his hope for a better future with the Lord. I became genuinely interested about his personal history, and the interview slowly transformed into a pleasant conversation, culminating in the patient thanking me for my medical explanations and my patience to listen to his stories. Sadly, my patient was all alone at the end of his life. To make things worse, his attitude and behavior were shunning even the healthcare workers. He was an outcast in a busy hospital: a malodorous, complaining, terminal patient without family or friends to care that he was dying. The patient’s demeanor combined with the pressures of the hospital environment led the staff to half-heartedly focus on patient care for this man. Even I was guilty of just wanting to finish my assignment and get home for dinner at one point early in my interview. It was actually a month later, after I had heard that
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this patient had passed away, when I drew the connection between this patient and an outcast to whom Jesus would minister. My experience made me brutally aware of how today’s healthcare setting makes it easy for one to lose a Christ-like approach to any patient encounter. My encounter with this terminal cancer patient reminds me of the Hippocratic Oath (adapted): “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being.” Our patients are whole persons whom God created and loves. I look back on my patient’s experience and realize that he was treated as if he were a list of symptoms instead of a human being near the end of his life. In a busy hospital, this man’s physical health was already a hassle enough to manage in the eyes of the staff. His emotional health was all but ignored. As a compassionate student, I was able to listen to his concerns and frustrations. But as a Christian student-doctor I felt moved to inquire about the patient’s spiritual health after noticing a weathered Bible next his hospital bed. I asked him what role his religious beliefs played in how he viewed his illness. I was encouraged to hear that he was at peace with his situation because God was in control. He was not scared of dying because he knew he was redeemed through Christ’s sacrifice and would be eternally relieved of his suffering. The encounter was a learning lesson for myself to view this patient not as a complaining outcast with a laundry list of problems, but as a suffering child of God. His body was important to the God who created him, just as were his mind, his emotions, and his eternal spirit – all a part of being a human, all a part of our responsibility as Christian doctors. ✝
Teresa Tseng, MSIII, is a third year medical student at UC Davis School of Medicine and plans on pursuing a career in pediatric endocrinolgy. She is an avid sports fan and word game player. Her other hobbies include photography and playing the guitar. She tries to enjoy the journey of life, knowing she is blessed with an opportunity to pursue a career path of service.
Three Perspectives
Oaths for Liars by Jennifer Holmes, MSIV
As medical school graduation approaches, I am of course filled with excitement. No more multiple choice tests, no more flashcards, and most of all, no more debt accumulation. But along with the relief comes a looming apprehension: real responsibility. To reinforce this sense of responsibility, most medical schools across the country administer some sort of oath in the ancient tradition of Hippocrates. Anticipating this has caused me to confront my greatest fear as a product of my generation – commitment. The idea of commitment has taken a beating in the last few decades in both the public and private spheres. Marriages fall apart at the first crisis, church members jump ship for flashier youth groups, and companies oust long-time employees to avoid paying costly benefits. The result for people like me is a deep-seated doubt of mankind’s ability (myself included) to keep any promise, no matter how small. More and more people indefinitely postpone marriage, church membership, or having children because of this fear of failure. In short, my generation suffers from a lack of trust in other human beings. Abundant evidence exists that oath-taking does not guarantee oath-keeping or make a waverer a loyal adherent. From Luther, I learned that I can’t even want to want to keep any of my promises unless my desires are kindled and transformed by God. Why should I bind myself to an oath I know I, a sinful person, cannot keep? My self-doubt was reinforced while I was on a rotation this past fall. Our consult team was following a complicated HIV patient who was admitted for recurrent diarrhea and profound wasting. In the midst of all the testing and therapy aimed at his main problem, I overlooked a urinary tract infection that was present on admission. On hospital day five, the patient rapidly deteriorated and died of urosepsis. Guilt flooded over me because I had missed the most important thing and had inadvertently caused
harm to a patient, violating the most basic aim of medicine. The team rushed to both share and shift the blame. The upper levels were in charge, ultimately, they noted. And even if we had treated the infection earlier, the patient was so weakened by HIV that he probably would not have survived despite our best efforts. We had done everything we could. His underlying condition was irreversible. While I accepted this incident as another testament to the limitations of medicine, I also resolved to never again breeze over a urinalysis. What was this I was making, could it be a . . . commitment? It was indeed. This case helped me understand what led ancient physicians to bind themselves before the gods. The graver the consequence of error, the stronger must be the commitment in avoiding it. It has to be the case that life’s most important events are “hedged about” with oaths. God’s covenant with Israel, the vows of marriage, and the rite of baptism are just a few that come to mind for the Christian. In all of these cases, it is the importance of the task and not the integrity of the oath-taker that prompts the oath.
Why should I bind myself to an oath I know I, a sinful person, cannot keep?
As I was contemplating this idea, I heard a country song on the radio that solidified for me the rightness of making strong promises. The song is called “I’ll Try,” by Alan Jackson. Instead of swearing to the lady he loves that he will be true, he says simply, “I’ll try to love only you. I’ll try my best to be true, oh darlin,’ I’ll try.” All he is doing is being honest and acknowledging his weakness as a man. I understand the self-doubt that is forcing him to avoid the possibility of a broken promise. But on the other hand, if the man I love tried to woo me with such “I’ll try” nonsense, I would be outraged. “Come back when you get a backbone!” I’d say. In the final analysis, medicine is a fearful and terrible task that calls for fierce and gut-wrenching commitment. So how do we, the skeptical and fash-
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Reflections on Hippocratic Medicine in Practice ionably “broken” postmodern crowd, embark on such a task in our utter weakness? Oaths from Hippocrates onward have acknowledged some degree of human limitation with phrasing like “I will carry out, according to my ability and judgment, this oath. . . .” However, the blessings and curses at the end of the oath are still strong consequences that do not admit second chances or excuses. In a more merciful tone, the revised “Physician’s Oath” by CMDA inserts, “With the help of God, I will. . . .” This addition expresses the human need for grace in all our undertakings. The God whose grace provides me with every breath also is actively working within my resurrected soul to strengthen me in all goodness. While my own strength constantly fails, His life in me is unending provision. God does not allow us to collapse into apathy, paralyzed by moral and intellectual failure. He calls us to have enough courage to embark on impossible journeys, like marriage or medicine, armed with all the solemnity of Hippocrates. Only through making, breaking, and renewing big promises can we make arduous progress toward true fidelity and integrity. The Oath itself forges a community of imperfect healers striving for greater perfection, not for themselves but for their patients. For example, a patient
going for surgery needs to hear more than, “I’ll try not to kill you.” He deserves a promise through which the doctor risks as much of his honor on the table as the patient risks of his life and well-being. Living under oath adds urgency and weight to the familiar disciplines of confession and forgiveness. The transition from liar to oath-keeper is marked, as is the entire Christian life, by innumerable deaths and surprising resurrections. ✝
Jennifer Holmes, MSIV, is a fourth year medical student at University of Texas Southwestern in Dallas, currently applying for residency in Internal Medicine. She took last year off from school to attend Augustine College in Ottawa with Dr. John Patrick, who helped broaden her perspective on medicine. The school offers a one-year classical curriculum that includes the history of ideas in the West as well as the origins of science and medicine. She enjoys discussions on medical ethics and how Christians can better integrate their faith with medical practice.
The Soul’s Dark Cottage, Batter’d: A Lifetime of Hippocratic Practice by Curtis E. Harris, MS, MD, JD, FCLM
I began practice in 1978, a time when medicine did not doubt its traditions or place in society. By 1990, the world had changed. The “Brave New World” of managed care was ushered in with a fanfare . . . as the way to improve access to care, improve fairness, remove greed, and control costs. By 2005, the
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experiment was over, and the failure of managed care to solve the difficulties of healthcare delivery was obvious to everyone. I began my career dedicated to the principles of the Hippocratic tradition, watched in fascination as those principles were eroded by outside business
Three Perspectives and governmental forces, only to see them discussed seriously once again, thirty years later. In the interim, I have seen healthcare systems in every continent of the world, and from that experience have recognized a truth: the problems of caring for the ill are universal to every society, and are never solved by plans and schemes outside the privacy of the exam room or outside who we are as individuals. I read an ancient verse by Edmund Waller (16061687) recently that says it well: The seas are quiet when the winds give o’er; So calm are we when passions are no more. For then we know how vain it was to boast Of fleeting things, so certain to be lost. Clouds of affections from our younger eyes Conceal that emptiness which age descries. The soul’s dark cottage, batter’d and decay’d, Lets in new light through chinks that Time has made; Stronger by weakness, wiser, men become As they draw near to their eternal home. Leaving the old, both worlds at once they view That stand upon the threshold of the new. The history of the Hippocratic Oath and tradition is complex, and is the subject of books. Without meaning to demean scholarship, it is the biblical tradition focused in the few words of the Oath that give it modern meaning. Giving one’s self to the care of others in transparency, putting the interests of the patient in our care ahead of those of society at large, avoiding our own sinful nature, valuing each human life as made in His Image, sacred: these are biblical ideals often imputed to the Hippocratic Oath. In these forty years, I have faced conflicts, large and small, over and again with those around me over issues of money, caring for the poor, quality of care, abortion, euthanasia, the right of conscience . . . and I have faced personal failures, those times when I have failed myself. The art of medicine is the same as the art of life: to be in the world but not of the world. This I promise you: There is nothing you will face that someone else has not faced before, for as Solomon said, there is “nothing new under the sun.” What is new is your reaction to the moral and
ethical dilemmas you encounter today. The Hippocratic Oath provides a proven focus for even more eternal values, worthy of your daily attention. You must “stand for something or you will fall for anything.” I also promise you this: The Hippocratic tradition is not a light for the “soul’s dark cottage,” but rather the means by which we are “batter’d” to attain that light. Four decades as a physician have taught me that standing on principle will cause opposition, both outside and inside my soul. Willingly let time and circumstance cause the “chinks” that let light in, and do so without fear. In the wilds of Africa, lions hunt and kill. One of their most effective strategies for capturing their prey is for the old, toothless males to sit at one end of a field and roar, driving the grazing animals to the far side where the young lionesses crouch for the kill. This is the basis of the African saying, “Safety is running into the roar of the lion.” Facing the problems we have with faith in our Lord is far better than avoidance or compromise. One tool for physicians that helps focus our thinking is the Hippocratic tradition. Run into the roar of the Lion, where the safety is. And as you run, let your soul be flooded with His light. ✝
Curtis E. Harris, MS, MD, JD, FCLM, is the Chief of Endocrinology for the Chickasaw Indian Nation and Director of the Chickasaw Nation Diabetes Care Center. Prior to his current position, he was in private practice as an Endocrinologist in Oklahoma City, Oklahoma for more twenty-five years, with a specialty of Diabetology. He has been President of the Oklahoma Chapter of the American Diabetes Association; and in 1998, was the first physician in Oklahoma to receive the American Diabetes Association Physician Excellence Award, with Distinction. In May 2007, he was elected to the Federation of State Medical Boards, which is the oversight organization for all of the Medical Licensure Boards in the United States and the Protectorates.
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APOLOGETICS SERIES
Macroevolution – Fact or Fiction? by Robert W. Martin III, MD, MAR Note: This is the seventh article in this series. The pages are designed for ease in copying for personal study, discussion in a group setting, or distribution to colleagues and staff. The views expressed in this article are the author’s. CMDA has taken no position on this subject. Installment eight is scheduled to appear in the Fall 2009 issue.
I. Introduction Evolution is not just one theory, but it is comprised of microevolution, macroevolution, cosmic evolution, biologic evolution, and chemical evolution. The different forms of evolution are investigated using different principles of empiric/operation science or origin/ forensic science. Operation science is an empirical science that investigates observable repeatable events. Origin science is forensic science that evaluates past singularities such as the origin of the universe and life forms. Microevolution employs empiric science. Macroevolution employs origin or forensic science.
II. Are we debating macroevolution or microevolution? When debating with evolutionists, clearly articulate which form of evolution is being addressed. Macroevolution deals with singular events while microevolution deals with repeatable/observable events. For example, the scientific principles utilized in studying the operation of the cosmos (empiric/operation science) called cosmology are different from the principles of origin science used to investigate the origin of the cosmos or cosmogony. The empirical/operational science of biology does not properly deal with the beginning of life, but with its continuing functioning. How life began (biogeny) uses principles of forensic/origin science. Creationists accept the validity of empiric science in microevolution (for example in the area of genetics) but oppose the unfounded extrapolation/application of operation/empiric science to support the veracity of macroevolution. Macroevolution consists of unrepeatable, unobservable singularities such as the beginning of the universe (cosmic evolution), first life (chemical evolution), and first man (biological evolution). Since there is no direct way to test a theory or model of origin/forensic science, it must be judged to be plausible or implausible based on how consistently and comprehensively it reconstructs the unobserved past in conformity with the available evidence using the principles of analogy and causality. This is quite different from empiric/operation science based on principles of observation and repetition that occur in microevolution (for example, genetics). Such observations can be made with the unaided eye or with the aid of sensitive instruments, but observation of some sort is crucial. Likewise, there must be some repetition or recurring pattern. No empiric scientific analysis can be made on the
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basis of a singular event, for operation science involves not only present regularities but future ones that can be projected.
A. “But science has shown the universe does not need God!” The origin of the universe/cosmos can only be explained in four ways. Either the universe came from nothing (impossible!), was selfcaused (ontologically illogical), is infinitely old (mathematically/ scientifically/philosophically impossible), or was created by another. There are no other choices. Cosmic evolution is wrong!
B. “But science has proven evolution!” There are only two possible causes for the origin of first life or man. Either these were created by intelligent (primary) causes (i.e., creation) or they occurred through natural (secondary) causes (i.e., chemical and biological evolution). Theories of both evolution and creation must be evaluated using principles of forensic/origin science, since they are singular, not repeatable events. Macroevolutionists believe that the universe was self-generated out of nothing; life began spontaneously from nonliving chemicals by purely natural processes (chemical evolution); and variation and natural selection worked together to form all living things from the first simple life form (biological evolution). All the steps in macroevolution were gradual and all variations were spontaneous and random. Neo-Darwinian Theory (NDT) revised Darwinism in the 1940s, retaining the basic concepts of variation and natural selection, but specifying that variation is both spontaneous and random. When Stanley Miller and Harold Urey’s experiment in 1953 (reanalyzed in 2008) produced several amino acids used in the genetic process, it was heralded as finally proving chemical evolution. However, Norman Geisler points out several errors with this interpretation. The conditions of early earth necessary to produce life were just as likely to destroy it. The early earth was rich in oxygen but low in nitrogen–the opposite of what their experiment needed. Each amino acid took a separate set-up and dissolved in water. There was also the intelligent interference of the scientists who selectively and intelligently controlled every aspect of the experiment. Even if the right chemicals could be produced, there is no answer for how they could have been arranged properly and enclosed in a cell wall. The principle of causation demands that an effect cannot be greater than its cause or, put simply, non-life cannot produce life. Although there may have been enough energy available to do the work, only living or intelligent systems could have harnessed the energy to do this kind of work; but, according to evolutionists, neither existed before life. An amino acid is only a chemical and not alive. Finally, there is one crucial missing ingredient – DNA. Chemical evolution is wrong!
C. But do creationists have any scientific evidence for their position? Creationists can show evidence of intelligent cause of first life. The principal of analogy (uniformity) used in origin science is the key to knowing which kind of cause is involved in the various “questions of origins.” By observing repeatedly what kinds of effects are produced by causes, we can determine which kind of cause is needed to produce life. Life contains specified complexity. The only kind of cause known to produce specified complexity is an intelligent cause; therefore, according to the “principal of uniformity” (analogy), intelligence must be responsible for the sudden appearance of life and the informational organization of living matter! Since it is not possible that we are speaking of human intelligence or even living beings in the natural sphere (anachronistic considering the issue is “first life”); the cause had to be a supernatural intelligence.
D. Doesn’t natural selection prove evolution? Don’t confuse microevolution with macroevolution! Microevolution (small scale) is legitimate empirical/operation science. Natural selection, breeding, and genetic drift add diversity within a species but do not add substantive characteristics to the gene pool. “Dogs stay dogs” and “cats stay cats.” Darwin’s theory of macroevolution (large scale) proposes that variation and diversity arise in nature by the agency of natural selection adding substantive characteristics in a gene pool to create new, more complex organisms. Darwin claimed that the appearance of all life on earth (after the first instance) is explained by natural selection, coupled with random mutations, through undirected natural forces. Creationists respond that Darwin’s analogy of “natural selection” is misleading. His example of selective breeding of animals is not analogous to, but directly opposite undirected “natural selection.” Breeders manipulate according to an intelligent plan to produce specific developments. If Darwin’s analogy proves anything, it shows the need for intelligent intervention to produce new life forms!
E. Is there other evidence against macroevolution? Macroevolution also fails as a theory because of irreducible complexity of complex organisms and the lack of intermediate mechanisms in the macroevolutionary process. According to Michael Behe, there is no credible evidence for intermediate mechanisms in over 50,000 articles in Journal of Molecular Evolution or Proceedings of the National Academy of Sciences. None of these articles ever detailed a model by which a complex biochemical system might have been produced in a gradual, step-by-step Darwinian fashion. Surveys of other biochemistry journals show the same results. In fact, the opposite is suggested. Second, irreducible complexity disproves evolution. An irreducibly complex system is composed of several well-matched, interacting parts that contribute to the basic function, wherein the removal of any one of the parts causes the system to effectively cease functioning. By analogy, the human cell needs all of its complex parts to function at the same time in the right order to survive. If any part is missing or not functioning properly the cell dies. Nature shows multiple examples of irreducibly complex systems including the bombardier beetle, cilium, vision, DNA reduplication, telomere synthesis, photosynthesis, transcription regulation and electron transport, and human blood clotting mechanism.
F. Doesn’t fossil evidence prove macroevolution? Over 250 million documented fossils with 87 percent of extant vertebrates (excluding birds) have been found. No intermediate forms have been found. The fossil evidence is incompatible with the gradualism of macroevolution. Instead, two features typify fossil evidence: stasis – i.e. species exhibit no directional change. They appear in the fossil record looking much the same as when they disappear. Morphological change is usually limited and directionless. Second, there is the sudden appearance of species. In any local area, a species does not arise gradually by the steady transformation of its ancestors. It appears all at once and “fully formed.”
G. What about “punctuated equilibrium?” To deal with the lack of fossil evidence, macroevolutionists have proposed punctuated equilibrium. Evolution is not gradual, but punctuated by sudden leaps from one stage to the next. Punctuated equilibrium is a troubled theory since there is no evidence for a mechanism of secondary causes that makes these sudden advances possible. This theory is an example of interpreting data from one’s worldview. Their theory is necessitated by the absence of transitional fossils and their resolute denial of a Creator. In fact, Creationists can make a better case that the sudden appearance of life forms strengthens the case for supernatural intelligence at work. Biological evolution is wrong!
III. Summary: Evolution assumes antisupernaturalistic presuppositions of atheism and/or agnosticism. Only theism truly believes in supernatural acts from a God who is beyond the universe and who occasionally intervenes in it. Non-intelligent natural laws do not have the ability to bring life or new life forms into existence. There are only two possible causes for the origins of the universe, first life or man. Either they were created by an intelligent cause or they occurred through natural causes. The evidence overwhelmingly supports the former. Bibliography Geisler, Norman L. Bakers Encyclopedia of Apologetics. Grand Rapids: Baker, 1999.
Robert W. Martin III, MD, MAR, lives in Lafayette, Indiana, where he practices Dermatology and Dermato-pathology. He is married, with four children. He has served on the faculty of Johns Hopkins, Case Western Reserve, and now Indiana University and Purdue Pharmacy School. He has a Masters in Religion from Southern Evangelical Seminary. His Just Add Water (Volume 3.1: Apologetics for the Health Professional), available via CMDA’s Website, utilizes Norman Geisler’s twelve-point “Classical Apologetic” approach fashioned after Paul’s apologetic in Acts 17. Dr. Martin may be reached by e-mail at: martinr@arnett.com.
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CLASSIFIEDS Educational Opportunity Clinical Tropical Medicine & Parasitology Course – ASTMH accredited. June 9-July 31, 2009. Sponsored by West Virginia University School of Medicine Office of CME and Global Health Program. Contact: Nancy Sanders (304) 2935916; nsanders@hsc.wvu.edu.
Oversees Missions London – Christian Medical Fellowship is looking for a head of student ministries to start by early February 2009. Job description and application forms can be found on the CMF website at http://www.cmf.org.uk/ fellowship/doctors/vacancies/?id-172.
Pakistan – Christian physicians urgently needed for ST/LT in rural Shikarpur Christian Hospital: female (GP/FP, OB/Gyn, GS) for OB/general; male/female pediatrician, OB/Gyn for ST teaching GYN surgery. Contact: Bill Bowman, MD (714) 963-2620; drbillbow@aol.com.
competitive salary and excellent benefits which include a year-end productivity bonus. Contact: Cindy Sowinski, Pediatrix Medical Group, 1301 Concord Terrace, Sunrise, FL 33323; 800-243-3839 ext. 5210; Fax: (954) 851-1838; cindy_sowinski@pediatrix.com.
Positions Open
Orthopedic – Well-established practice of three orthopedists committed to providing orthopedic care with compassion as well as excellence. Time off for short-term missions. Would like to talk with general and subspecialty orthopedists about the possibility of joining us in practice. On-site surgery center; local hospital within walking distance. Located in a family-oriented city where many recreational and cultural activities are available. Less than a ten minute commute from any area of the city. Low malpractice rates and cost of living. Vacation at the mountains and the beach; live here and enjoy all four seasons. Please contact our Medical Director, Dr. Chris Wilkinson at (308) 865-1403 or cwilkinson@kearneyortho.com. Our clinic manager, Vicki Aten, can be reached at (308) 865-2512 or vaten@kearneyortho.com.
Family Practice – Cedar Falls, Iowa. Step into a busy practice with a wellrespected Christian group of seven FPs. The need for an additional practitioner was created by the steady growth in a neighborhood of young families. Salary guarantee with a bonus structure. Living in a university town with excellent schools, a four season climate, and a supportive group of colleagues who live their Christian values makes this an outstanding opportunity. Contact: Janice Yagla 888-780-0390; CV to Janice.Yagla@wfhc.org.
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Neurologist – North Carolina. Sandhills Neurologist, PA is seeking two BC/BE Neurologists, exclusively out-patient practice. This practice is interested in the physical and spiritual needs of the patient. Located in south central NC. World-renowned golfing resort, family-oriented community with large draw area. Approx. 2.5 hrs from beaches and mountains. Contact: voss.sandhillsneuro@gmail.com. Newborn Hospitalist – Fort Worth, TX. Established pediatric practice serving three hospitals in Tarrant County. Responsibilities include daytime in-house shifts, out-ofhospital night pager call, caring for well newborns (including circumcisions), and consulting with parents and referring physicians. Call is 1:3 weekends. Established Neonatology group provides 24-hour coverage for delivery attendance, stabilization, and NICU patients. We offer a 32
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Otolaryngologist – Beautiful North Cascades area of Washington State. Located between Seattle, Washington and Vancouver, B.C. The area offers quick access to the San Juan Islands or the Cascade Mountains for hiking, fishing, and kayaking, to name just a few of the exceptional outdoor recreational opportunities available. An excellent partnership opportunity to join a well established five-man physician practice in Washington State. We are seeking a board eligible or board certified physician. Please contact: Human Resources Department, Brooke Herzberg, Director, Cascade Medical Group (360) 336-2178; brookeh@cascademedicalgroup.com.
CLASSIFIEDS Pediatrician – Montgomery, AL. Seeking a BC/BE pediatrician to join a group of four Christian pediatricians. Competitive salary and benefits; call 1:4. High priority on family life. Position available July 2010. Please contact Bonita Lancaster at (866) 507-3385, or e-mail your CV to blancaster@baptistfirst.org.
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Pediatric Pulmonologist, Pediatric Intensivist, Allergist/ Immunologist, Immunologist, and General Pediatrician with a heart to treat the whole person; body, soul, and spirit and a heart for God. Emphasis on evidence-based management combined with a strong physician-patient relationship. Excellence in both specialty and primary care is stressed. Providers are encouraged to integrate faith and medicine in patient care. Would become part of a small physician owned group with four providers. Practice located in Tulsa, OK. Good city to raise children and have a family. Fax resume to (918) 451-6707. Podiatric Medicine and Surgery – Associate wanted in North Central Pennsylvania. Excellent associate practice opportunity leading to a buy out in 5-7 years. Well established practice (sixteen years). Ethical, academic, successful solo with need to expand. Need diabetic limb salvage, strong surgical and orthopedic mind with expansion capabilities. Present doctor is chief of podiatry. Need certification, three letters of recommendation and CV. E-mail to fgsddpm@verizon.net.
Staying In Touch Electronically CMDA has a Facebook Site
Membership Updates Available Online
CMDA now has a Facebook site. Do you? Currently, 150 million people are using Facebook, many of them every day. It’s a great way to keep up with family and friends, share photos, videos, and much more. Considered to be one of the main communication tools used by the Millennials (those born between approximately 1980 and 2000), go there to see what everyone is talking about. Sign up for an account at: www.facebook.com, and then search for CMDA and “join” us to stay in touch with CMDA in general as well as specific CMDA ministries such as Side By Side, CMDA Uniformed Services Section, and CMDA’s Field Staff.
CMDA members can go to our website at: www.cmda.org and log in to view and update their information. Login is typically your e-mail address. If you have any problems, please be sure to contact our Member Services Department, toll-free at 888-230-2637, or by e-mail at: memberservices@ cmda.org.
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