Editorial
by David Stevens, MD, MA (Ethics) – Chief Executive Officer
This is Mission Control I was in Camp Happyland that night in 1969. No, that was not a residential psychiatric facility! It was a Salvation Army kids camp outside of Washington, DC, where I was a counselor the summer after I graduated from high school. If you are over 50 you probably remember where you were that same night when the Apollo 11 attempted to land the first men on the moon. The world held its breath as the Eagle separated from the mother ship. The first phase of the firing of the lunar module engine went well as the descent started; and then, approximately five minutes after ignition, the first of a series of computer alarms was received via telemetry in the Mission Control Center and was displayed to the crew onboard the Eagle. The flight controller responsible for assessing the problem, 27-year-old Steve Bales, was faced with an immediate decision: Should the descent be aborted? An abort meant there would be no landing for Apollo 11- millions of dollars lost, reputations damaged. Was it just a software issue or a life-threatening mechanical problem that could kill the astronauts? Young Mr. Bales’ eyes scanned the readouts, his mind working many times faster than any computer, and without hesitation loudly announced to the apprehensive landing team, “This is mission control. You are still a ‘Go!’” The rest is history. In a few minutes, through the static we heard, “The Eagle has landed,” and cheers and clapping circled the globe. That safe landing never would have happened without mission control. There was no way they could put all the brilliant minds and equipment needed into the Apollo spacecraft to get it to the moon and back. As trained and as smart as each astronaut was, unless they surrendered ultimate control of their destiny to their command center, they would not succeed. As the years pass, I’m more and more convinced that the key to a victorious Christian life is complete surrender to God’s “mission control.” In some ways, accepting God’s salvation is the easy part. What’s hard is getting out of the
driver’s seat and letting God direct our lives every day. It’s almost like Christ asking as you start your day, “Are you going to drive or are you going to let Me have the wheel?” It is an even greater challenge, because God often asks for the keys before He tells you where you’re going! So we want to either hang onto the keys or at least, like a driving instructor, have an emergency brake on our side of the car. Foolish, isn’t it, that we think we can do a better job of controlling our lives than the God who created the universe? He said, “Anyone who intends to come with me has to let me lead. You’re not in the driver’s seat; I am” (Matt. 16:24; The Message). I remember the morning in college at a chapel service where I went forward to surrender control. As I’ve matured, God, like He asked Abraham to sacrifice Isaac, continued to ask me to put new areas of my life on the altar – my children, my financial independence, my desire to be a medical missionary in Kenya my whole life, daily practicing medicine, and more. I’ve learned that submitting to God involves simply two things: continually seeking and accepting God’s mission, His purpose for me, and then giving Him control of every aspect of my life. Proverbs 3:5, 6 says, “Trust God from the bottom of your heart; don’t try to figure out everything on your own. Listen for God’s voice in everything you do, everywhere you go; he’s the one who will keep you on track” (The Message). What does the Bible promise as the result? It says, “You’re blessed when you follow his directions, doing your best to find him” (Psalm 119:1; The Message). Want that blessing? You and I aren’t brilliant enough. We don’t have the equipment to successfully accomplish God’s purpose for our lives alone. We need to be tuned in and daily listening for God’s voice, saying, “This is mission control.” Want to better know how to do that? Read on. Learn. Apply. Then some day, when you complete the mission He has laid out for your life, you will hear God cheer! ✝ 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
•
Summer 2009
3
table of
CONTENTS
V OLUME 4 0 , N O. 2
Summer 2009
The Christian Medical & Dental Associations® – Changing Hearts in Healthcare – since 1931.
Features 12 Medical Education International Ministry Update Over 1,500 East African medical professionals trained in advanced life support
14 Understanding Your Mission by John Crouch, MD How knowing your mission affects your life’s goals and objectives
18 Living a Missional Life by Jennifer Matkin Grant, DDS Since she was a teenager, this doctor’s life has been mission-controlled
20 Ten Reasons to Go on a Short-Term Missions Trip by William T. Griffin, DDS There may be more reasons to go than not. Are you ready?
24 Washing Feet in Kibera by Lawrence P. Frick, MD Lessons in servanthood in unlikely places
27 Professionalism in Peril First in a Five-Part Series by Gene Rudd, MD Liabilities and limits of autonomy
30 CMDA Missions Overview Cover photo courtesy of Paul Stevens Photography
Departments 5 34
4
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
Summary of CMDA’s current missions emphases
32 Clinical Ethics Case Consultation What is the role of the ethics consultant in peer review? by Gregory W. Rutecki, MD
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 0009-546X, Summer 2009 Volume XL, No. 2. 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 © 2009, 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. 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: P.O. 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.
CMDA Members Converge on Washington, DC, to Advance Conscience Rights Gathering in Washington, DC, on April 8, 2009, members of the CMDA spoke to national media to warn that the Obama administration’s plan to scrap a conscience-protecting healthcare regulation is very unpopular and threatens to cut off patient access to healthcare professionals and institutions nationwide, especially imperiling the poor and medically underserved populations. Speaking at the National Press Club, CMDA CEO Dr. David Stevens unveiled a new national poll, commissioned by CMDA and conducted by The Polling Company, Inc., that shows that 63 percent of American adults surveyed support the existing conscience protection regulation and 62 percent oppose the Obama administration’s proposal to get rid of it. A new online poll of CMDA members and other faith-based healthcare professionals, also conducted by The Polling Company, Inc., found that 95 percent of physicians agreed, “I would rather stop practicing medicine altogether than be forced to violate my conscience.” Dr. Stevens noted, “These regulations put teeth into the law and insure patients have the doctors and nurses they need. Removing them sends a clear message, ‘It is open season on healthcare professionals of conscience. Discriminate at will.’” CMDA members Drs. Sandy Christiansen and Donald Thompson also spoke at the press conference. Following the press conference, which CNN streamed live on its website and FOX News covered throughout the day, CMDA members visited legislators to educate them on conscience rights. CMDA also hosted a briefing of congressional staffers, under the banner of the Freedom2Care coalition. CMDA has organized Freedom2Care (www.Freedom2Care.org), a coalition of thirty-five organizations representing over five million constituents, to advance conscience protections. Individuals have used the Freedom2Care website to send nearly 50,000 comments to the US Department of Health and Human Services. Individuals can now use the website to send a message to the President.
Dr. David Stevens speaking at the National Press Club, April 8, 2009
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
•
Summer 2009
5
John R. Crouch Jr., MD, is the New President-Elect The CMDA membership elects a new President-Elect every two years. This spring, members selected Dr. John R. Crouch Jr. as the new CMDA PresidentElect. His term begins during the National Convention meeting September 24-27, 2009 at Ridgecrest, NC. At that time outgoing President, Bruce MacFadyen Jr., MD, will hand the gavel to incoming President, George Gonzalez, MD. Dr. John Crouch is a Founding Member of Family Medicine Education International and currently serves as the President of In His Image International, Inc., which offers international medical missions, a family medicine residency, and mobile medical missions. A member of CMDA since 1990, Dr. Crouch’s first ministry role was in 1997 as he was asked to serve on the then COIMEA Commission, now known as Medical Education International. He represented his district in the 2000 House of Delegates and only two years later was elected to the Board of Trustees where he continues to serve. Dr. Crouch was honored with CMDA’s Educator of the Year award in 2001. His organization continues to incorporate CMDA members and leaders to speak at their retreats and sponsored events.
In his vision statement (posted online and adapted here), Dr. Crouch said, “There are so many factors that impact each and every one of us that, in my opinion, mandate us joining together to preserve and advance quality Christian healthcare. The demands of the busyness of our practices, the need to know there are others out there dealing with these challenges, our call to serve in some way, and our need to have a strong public voice for our values, all underscore the reason for us to be equipped, have community, find avenues to serve, and to have our voices heard in a very secular oriented society. I very strongly believe that CMDA is the vehicle for all of those things to happen. These are very critical ministry activities that I believe in and want to support as much as possible. I also have a real heart for medical missions with a focus on medical education and the ‘10/40 Window.’ My belief is that all of these are very parallel to some of the ministries of CMDA. “I am convinced that CMDA has excellent leadership and staff and that the President is to simply compliment that in any way possible. I would like to see our organization grow because it would mean that we are serving more of our fellow physicians and having a stronger voice in the public square. Though I have no grand scheme or plan for this job, I believe that working hard to serve our multiple constituencies (our doctors, residents, students, patients, and those we serve in ministry – the underserved around the world) is the best way to assist our leaders.”
Do you know what a young person most likely means if they say they’ve been “hooking up” with someone? Ever heard the term “friends with benefits”? Both phrases refer to having casual sexual encounters with no strings attached, and it’s happening more and more in our culture – to the detriment of this and future generations. Today, thanks to breakthroughs in neuroscience research techniques, scientists have been able to view the activity of the brain as it functions. With state-of-the-art mapping and imaging tools, researchers have unlocked a new world of data on what happens between your ears each day. In addition, new methods of tracking brain chemicals have allowed scientists to understand when and how much of these chemicals are released and how they influence behavior. We now have scientific studies about brain function and sexual thoughts and behavior that are not only fascinating but are true advances in our understanding of ourselves and the intriguing part of our behavior called sex. Drs. McIlhaney and Bush, from The Medical Institute for Sexual Health, provide a very readable book culled from many sources, including research and medical journals. You’ll find twenty-one pages of footnotes in the back - but that doesn’t mean it’s boring! It’s filled with intriguing information you may not have heard before. It could help you influence your patients, your colleagues, or even your own children. Hardcover. 175 pages. Available from CMDA Life & Health Resources: (888) 231-2637 or www.shopcmda.org for $17.99. Other new resources to reinforce the message of purity: Dating, Finding, and Keeping “The One” written for teens and young adults $12.95; Apples of Gold: A Parable of Purity written for ’tween girls $10.99. Age-appropriate information for kids of all ages – Questions Kids Ask About Sex: Honest Answers for Every Age $14.99.
6
T o d a y ’s C h r i s t i a n D o c t o r
Hooked: New Science on How Casual Sex is Affecting Our Children by Joe S. McIlhaney, Jr., MD and Freda McKissic Bush, MD
2009 National CMDA Convention Joint meeting with Women In Medicine & Dentistry
September 24-27, 2009 Ridgecrest Conference Center – Ridgecrest, NC (Asheville area) To register, go to www.cmda.org/nationalconvention
National Convention Plenary Speakers A CMDA member since her first year in medical school, Dr. Cynthia B. Hale served for twenty-five years as a medical missionary in the country of Nepal, alongside her husband, Dr. Thomas Hale Jr. Initially, her medical practice was in a rural mission hospital; later, she trained and supervised community health workers in one of the districts of Nepal. Her final assignment was as a Visiting Professor of Community Medicine in the government medical school in Kathmandu. Most recently, Cynthia has headed up an international outreach team from her local church to the Nepali-speaking refugees being resettled in Albany, NY. Her husband Tom’s books on missionary life in Nepal have long been highly acclaimed. Cynthia’s piano performances have been recorded on three CDs.
Mark Earley, former State Senator and Attorney General of Virginia, became president of Prison Fellowship on February 1, 2002. Mr. Earley practiced law for fifteen years in Norfolk, VA, and then served in the Virginia State Senate for ten years before being elected Attorney General of the Commonwealth of Virginia. He also served on the staff of the Navigators, an international evangelical ministry active on college campuses, military bases, and other settings. Speaking Schedule: Thursday Evening Plenary
Dr. J. P. Moreland is Distinguished Professor of philosophy at Talbot School of Theology, Biola University in La Mirada, CA. He has authored, edited, or contributed papers to thirty-five books, including Does God Exist? (Prometheus), Universals (McGillQueen’s), Consciousness and the Existence of God (Routledge), and Blackwell Companion to Natural Theology (Blackwell). He has also published over sixty articles in journals such as Philosophy and Phenomenological Research, American Philosophical Quarterly, Australasian Journal of Philosophy, Philosophia Christi, Religious Studies, and Faith and Philosophy.
Ken Myers is the host and producer of the MARS HILL AUDIO Journal, a bimonthly audio magazine that examines issues in contemporary culture from a framework shaped by Christian conviction. He was formerly the editor of This World: A Journal of Religion and Public Life, a quarterly journal whose editor-in-chief was Richard John Neuhaus. Prior to his tenure at This World, he was executive editor of Eternity, the Evangelical monthly magazine. For eight years, he was a producer and editor for National Public Radio, working for much of that time as arts and humanities editor for the two news programs, “Morning Edition” and “All Things Considered.” He has served on the Arts on Radio and Television Panel for the National Endowment for the Arts, and he lectures frequently at colleges, universities, and churches around the country.
Speaking Schedule: Friday Evening and Saturday Midday Plenaries
Speaking Schedule: Friday and Saturday Morning Plenaries and Sunday’s Worship Service
Speaking Schedule: Friday Midday Plenary
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
•
Summer 2009
7
CMDA Member Awards/Recognitions Hall of Fame Honoree Bruce C. Steffes, MD, MBA, FACS, FWACS, FCS (ECSA) has been inducted into the University of Toledo College of Medicine’s Medical Mission Hall of Fame. A surgeon and educator, the Fayetteville, NC based Dr. Steffes serves as Chief Executive Officer of the Pan-African Academy of Christian Surgeons. His organization uses rural mission hospitals, volunteer surgeons, and missionaries to teach the best practices of surgery. The Medical Mission Hall of Fame honors those individuals and/or organizations that have made significant and substantial contributions to advancing the medical well-being of people throughout the world.
Aviation Medicine Award MAJ Susan R. E. Fondy, MD, was awarded the Army Aviation Association of America’s Aviation Medicine Award for 2008 for her outstanding contribution to aviation medicine during her most recent deployment to Forward Operating Base (FOB) Salerno, Afghanistan. MAJ Fondy’s achievements included over 100 lives saved on MEDEVAC missions, running a trauma table at the Combat Support Hospital during nearly fifty mass casualty events on the FOB, over 230 hours flown, participation in four medical missions to impoverished Afghan villages resulting in over 1,200 patients seen, teaching six Afghan physicians at a local national clinic, and providing medical care for over 500 members of her battalion.
8
T o d a y ’s C h r i s t i a n D o c t o r
Distinguished Service Medal Scott Middleton, MD, retired Clinical Professor of Surgery at University of Texas Southwestern, Dallas, was named an Honorary Professor of the State Medical Academy in Semey, Kazakhstan, last year and received its Distinguished Service Medal this year for his service in leading medical teaching teams there.
Freedom Award Dr. Neal Smith, medical missionary, of Bridgman Family Dental Care, in Bridgman, MI, received the 2009 Freedom Award at the Martin Luther King Jr. Convocation at Andrews University. Over the last three decades, in addition to personally providing free dental care for thousands of individuals overseas, Dr. Smith has established seven self-sustaining dental clinics, significantly improved many other clinics, mentored fifteen Christian dentists in the former western Soviet Union states, and lectured to hundreds of dentists in Moscow and St. Petersburg.
(l. to r.) Dr. Joseph Warren (chair of the Dr. Martin Luther King Jr. Planning Committee), Dr. Neal Smith, Niels-Erik Andreasen (president of Andrews University, Berrien Springs, MI)
What and Where is Your Mission
Bruce MacFadyen, MD President – CMDA
The question for all of us is, “What has God called me to do?” Everything we do should be according to God’s call. This calling may be as a medical student, a resident, a physician in community practice, a faculty member in a medical school, a medical or dental missionary, a mentor of students and residents, a trainer of nationals, or a visionary leader of a missions agency. The Bible is full of examples of God preparing individuals and
groups for both what He is going to do and for what He wants them to do. When we look at our own lives, we can see how God has been preparing us for our mission. He wants us to listen to His call. God has given all of us relationships, experiences, and training. Through times of prayer and commitment, by reflecting on how God has been working around us, and through the wise counsel of other believers, we can respond to His specific call for us. Those seeking to discern their call may wish to consider the extremely wide range of opportunities available through CMDA. Many have found meaningful fellowship and ministry opportunities through their local CMDA chapter. Others have been called to encourage and mentor medical or dental students. Many have been blessed by serving though Global Health Outreach
(GHO). Those who are called to teach may have participated in Medical Education International (MEI) or The Pan-African Academy of Christian Surgeons (PAACS). God has led many doctors to contact mission boards for long-term or short-term service. If we consider our whole life to be a ministry, we must also think about what God is calling us to in our families, offices, hospitals, and communities, and in our relationships with other healthcare professionals. Wherever we are, we must pray for God to show us where He is working and then we must get involved, for as Paul wrote in Ephesians 2:10, “. . . we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.”
Announcement Reduction in Field Ministries
Paid Advertisement
Due to economic conditions, CMDA is reorganizing its field ministries, reducing from five to four regions across the country. The various CMDA ministries within the current Central Region will be distributed into the four remaining regions. Consequently, Doug Hornok, ThM, will be leaving his position as Director of the Central Region effective May 31, 2009. CMDA released this statement, “Doug has graciously and effectively ministered with CMDA for more than a decade, influencing many in the Way. His departure will create a challenging void for CMDA. Doug’s dynamic personality, kindness, and talents will be missed. But of greater concern is the challenge created for Doug and Connie. They must now step out in faith in a new direction. We covenant to pray that God will direct and make provision for their future.” 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
•
Summer 2009
9
Global Health Outreach (GHO) Not for the Faint of Heart by Michael O’Callaghan, DDS
Mike and Thomas with Ptatl of Abridge, Liberia
About a year ago I was praying through the GHO trip calendar. I’d read the description of the January 2009 Liberia trip. “Not for the faint of heart” was what impressed me. I was lying in bed one night praying that God would build His team for His glory in Liberia. Just then I felt a
prompting that shocked me, “What about YOU?” I almost answered aloud, “No way!” I was already signed up for several trips and as a solo GP dentist I thought I was already pushing the limit. I vividly recall pondering this. I prayed to God affirming my commitment to Him to do anything He asked me to do. Yet I needed to be sure if this prompting was my own imagination or a clear leading from His Spirit. I asked Him to lead me by the desires of my heart, to give me an irrepressible desire to serve on the Liberia team IF that was what He wanted me to do. Shortly thereafter, I was tremendously excited about the trip to Liberia. I signed up and God allowed me to go and serve with a wonderful
For InFormatIon about GHo opportunItIes, VIsIt:
group of tireless servants. The photo is of a young boy from Mecca, a village in the bush of Liberia. Among other things, our team was able to come alongside pastors working to build a church in that impoverished sub-Saharan nation. I am thankful I heard and answered His call to service. There is no better place to be than in the center of His will!
Boy in Mecca, Liberia
www .cmda.orG/GHo
SPECIAL REPORT Medical Education International Ministry Update “Teaching to Transform” is the motto and goal of Medical Education International (MEI). MEI’s short-term mission team members provide state-of-the art academic and clinical teaching to increase the capabilities of healthcare professional colleagues and students in other nations and share the love and message of Christ with them in word and deed. Each team is tailored to the needs and requests of MEI’s in-country partners. These range from sister Christian medical fellowships to government leaders, medical schools, and hospitals in some of the most medically-needy parts of the world. Once a team is planned, MEI’s team leader largely takes over. The team leader has the final word on team members and coordinates team arrangements with team members and the in-country host. MEI has taught in over thirty countries. Its spring and fall teams to Mongolia are in their eleventh year, and Dr. George Mikhail, who led the Mongolia Project for its first
Dr. Bill Cayley teaching Kenyan colleagues
12
T o d a y ’s C h r i s t i a n D o c t o r
ten years, was recently named CMDA Teacher of the Year. Recent teams have taught everything from cleft palate repair and cardiovascular surgery to medical ethics, teaching methods for adult learners, and treatment of depression and post-traumatic stress with donated electroconvulsive shock machines, in a war-torn area where psychiatric drugs are not affordable or widely available. Team members have been drawn from numerous institutions, including some of North America’s most prestigious, such as the Cleveland and Mayo Clinics and Johns Hopkins, George Washington and McMaster Universities. MEI teams are small – usually five or less – but can have a spiritual and medical impact out of proportion to their size and the resources invested. Kenya Christian Medical Fellowship/MEI Partnership A great example of this kind of impact is the partnership between MEI and the Kenyan Christian Medical Fellowship (KCMF). Five MEI teams in the last six years have spent a week each year training Kenyans in advanced life support principles for trauma and cardiac care. Dr. Jim Smith, Emeritus Professor of ENT at Oregon Health Sciences University in Portland, led the first and third team, Dr. Scott Middleton, General Surgeon from Texas led the second, and Dr. Bill Cayley, a Family Medicine Physician from Wisconsin, led the two most recent. (The 2008 team had to be cancelled due to postelection unrest in Kenya.) There was almost no training available in the country on advanced trauma or cardiac life support before MEI responded to the KCMF’s request to provide them as a means of providing CME to local physicians. The training has led to more recognition of and respect for the KCMF in the local community. These courses have become widely-sought-out and the standard of care for emergency room doctors in Nairobi. They have provided the KCMF higher visibility and enhanced their opportunities to share their faith. Roles and Responsibilities The KCMF does all of the local preparations and administration-information generation and dissemination, coordination with MEI, recruiting local faculty, students, and support staff, course marketing and arrangements,
accommodations and transportation for the MEI team, and project administration before, during, and after training. MEI recruits and sends US instructors, provides the course directors and some equipment, and works with the KCMF to select and provide instructor training for the best students from previous courses. In addition, Dr. Jim Ritchie, an Emergency Room physician in Norfolk, VA, who has served on MEI’s Kenya teams developed and has provided the KCMF with a practical hemodynamic simulator, which effectively demonstrates physiologic principles and can be made with simple, widely available, low cost components. To allow adaptation of North American advanced life support courses to East Africa, the courses have been accredited by the Resuscitation Council of Kenya.
2009 joint KCMF/MEI teaching team
Building Local Capacity Since the fourth year, this effort has equipped a local faculty of advanced life support instructors by selecting the best students for instructor training. This sustainable approach has built a local capacity to teach the courses without MEI involvement. The trauma course, for instance, has been taught by Kenyan instructors in Nairobi as well as three additional Kenyan cities, under the directorship of Dr. Bill Bevins (2006 MEI team member and now long-term missionary doctor in Kenya). The program has also trained Kenyan instructors in adult education theory and practice and brought the additional benefit of increasing opportunities for them to teach and demonstrate Christ’s love. Response to Emergency Kenya has been experiencing ethnic violence and traumatic accidents. Both public and private hospitals have benefited from the contributions these courses have made
in helping develop a systematic response to emergencies and, at some locations, the development emergency response teams. These hospitals include Nairobi Hospital, Mombasa Hospital, Gertrude’s Garden Children Hospital, and Kenyatta National Hospital, Kenya’s main referral and teaching hospital. Benson Omondi, KCMF CEO, attributes his uncle’s survival last year, after he was the victim of post-election violence, to the teamwork and knowledge of professionals trained in these courses. Holistic Approach and Benefits Courses provide a holistic package that addresses both the spiritual and professional needs of the participants. Daily devotions at the beginning of each training day have been a powerful tool to reach out to unbelievers and seekers, some of whom show great interest in these devotions. In addition to practical educational training, there are several other benefits of the courses. Faculty model Christian behavior as physicians and teachers of medicine and are often able to share the role their faith plays in their motivation to provide healthcare and to give of their time and resources to serve others. Other benefits of the courses include individual mentoring of participants, their experiences using a team approach to emergency care, and the networking which occurs between healthcare providers from different locations and facilities. The fellowship that arises from partnering between African and American believers is also invaluable and creates longterm ministry opportunities. Over 1,500 Kenyans have been trained via MEI and the KCMF to date. MEI has catalyzed and fueled a learning process that is profoundly changing the health system in its care of the critically ill. Some MEI team members, like Dr. Bill Bevins of the 2006 Kenya team decided to return long-term. Dr. Bevins has played an important role in coordinating between the KCMF and MEI and in setting up courses in multiple Kenyan cities after the MEI team has left Kenya. A 2009 team member is also considering returning to teach emergency care in Kenya long-term and to provide coordination for teachers in other specialties. The Impact Multiplies The KCMF now plans to reach out to neighboring countries like Ethiopia, Tanzania, Rwanda, Uganda, and Sudan in the same way MEI has assisted them. This will even further multiply MEI’s small investment in teaching days! Additionally, the two organizations hope to give a conference for East Africans on oncology in Kenya in 2010. After the 2009 courses, the Director of MEI received this message from Mr. Omondi: “The task is done. People are inspired and lives are obviously changed for eternity. The training was, is, and will always be a treasured gift to us from MEI. Long live MEI . . . for His name’s sake!”
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
•
Summer 2009
13
Understanding Your Mission (Adapted from Practice by the Book – see ad, end of article)
by John Crouch, MD
Understanding your mission controls your missions
Dr. Crouch greets patients outside the Good Samaritan Health Services Mobile Medical Unit
God has given all Christians a universal mission to work with Him as Lord to redeem the world. “All authority in heaven and on earth has been given to me. Go therefore and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, teaching them to observe all that I have commanded you; and lo, I am with you always, to the close of the age” (Matt. 28:18-20, Revised Standard Version [RSV]). Once we have accepted Christ as Lord, we come under this command and this mission as part of our lives. God has also created each of us with an individual mission for our lives. Each of us must seek that mission and live it out if our lives are to be fulfilled. “For we are His workmanship, created in Christ Jesus for good works, which God prepared beforehand, that we should walk in them” (Eph. 2:10, RSV). God has a special plan for each of our lives. We must long for it, seek it, and carry it out to its completion. One minister put it this way, “I’ve got my own spiritual DNA.” God may call us out from our everyday life of mission to special missions that may be short-term or lifelong. Such missions may require a disruption of our routine lives in order to accomplish His special purpose. “For if
14
T o d a y ’s C h r i s t i a n D o c t o r
you keep silence at such a time as this, relief and deliverance will rise for the Jews from another quarter, but you and your father’s house will perish. And who knows whether you have not come to the kingdom for such a time as this?” (Esther 4:14, RSV). Many doctors can remember a night by a soda machine, a campfire service, a tap on the shoulder, or a cry from the pulpit that was God’s way of calling them to some special work that changed their life’s routine for God’s purpose. Any missions God calls us to may be a large or a small part of the life mission for which He created us. Only God knows how the whole plan fits together. Oswald Chambers’ greatest legacy for the Kingdom was not his mission to North Africa during the First World War, but the sermons his wife collected into the book, My Utmost for His Highest, after his death in North Africa. Your Vision and Your Mission Bruce Wilkinson, in his video series “The Vision of the Leader,” describes principles related to the birth and development of a vision. A great vision begins, he says, with seeking for the need and developing, through prayer, an intentional sympathy with those in need. With cultivation, that sympathy intensifies until the passion for something to be done becomes your burden from God. God reveals to you your part in meeting that need, using your resources, skills, and talents by His grace and power. Yet you must choose to accept responsibility for that need, or not: you can answer God’s call on your life, or not. Wilkinson describes how the power for the vision comes from the closeness of our relationship with God. This requires forgiveness of our sins and obedience to Scripture. Additionally, that power becomes more effective as we claim God’s promises to accomplish His mission. God may be whispering a great mission for your life, but you may be too far away to hear Him, or your sin may be
Three Questions to Ask Yourself 1. Am I living fully the mission for which God created me? 2. What dream of service has God placed on my heart?
Eight guidelines for finding and fulfilling your mission 1. Realize that we all have a significant mission in kingdom work – we need only be open to receiving it and obedient in following it. Sometimes it may seem that some folks have been given a great and clear vision from God as if such people are special in God’s plan. But God has planned and promised a mission for each of us (Eph. 2:20). Christian doctors need to explore their great dreams and hopes and desires and ask God if they are not a wonderful vision from our Father to be pursued through faith (Heb. 11:1-3). 2. Wanting God’s will is 99 percent of what is required to find God’s will. “You will seek me and find me when you seek me with all your heart” (Jer. 29:13, RSV). It is our business to seek God’s will with our whole heart. It is God’s business to show us clearly what that is. 3. Our call or mission becomes most clear when we are involved in kingdom work where we are right now. “Well done, good and faithful servant; you have been faithful over a little, I will set you over much” (Matt. 25:21, RSV). God most often comes to us with a new, vital mission if we have proven to Him through our everyday life of mission that we can be trusted. 4. God will more likely call us to missions if we trust Him to the point of obedience. When God’s call comes, the first challenge is to obey what we know to do first. God seldom reveals our whole life mission all at once. It unfolds one step at a time and our challenge is to confirm the next step as God’s call and obey one step at a time. Obedience is at the heart of each step. 5. God will likely place you in circumstances outside your comfort zone. God likes it when
3. What personal goals must I set aside in order to radically change my direction from “seeking temporary success” to “finding eternal significance?”
Understanding Your Mission
stuffing your ears like wet cotton. If you want a sense of mission in your life, lay your sins at the foot of the Cross and leave them there; then spend time with the One who desires to call your life into significance. And then . . . don’t sit back and wait for some grand “call” to come in some supernatural form, but as Elizabeth Elliot once said, begin by realizing that God knows where He has placed us and we are to do His work in that place. She observed that God’s call to missions usually comes while Christians are already active in ministry. Each time He calls, He may show us only a part of the whole vision. She admonished us not to wait for the big call, but to do the next thing, take the next step He has placed before us, whether big or small.
we are not able to rely on our own capabilities. In missions He often keeps us off balance so we have to depend on Him. 6. Our failures may be stepping stones to God’s successes. Only God knows what He plans to accomplish with the mission He has called us to and how this will happen. “For as the rain and snow come down from heaven, and return not thither but water the earth, making it bring forth and sprout, giving seed to the sower and bread to the eater, so shall my word be that goes forth from my mouth; it shall not return to me empty, but it shall accomplish that which I purpose, and prosper in the thing for which I have sent it” (Is. 55:10-11, RSV). 7. God will provide the power necessary to accomplish His mission and will most visibly demonstrate His power in our weakness. It is our business to obey; it is God’s business to accomplish. “But he said to me ‘My grace is sufficient for you, for my power is made perfect in weakness.’ I will all the more gladly boast of my weaknesses, that the power of Christ may rest on me” (2 Cor. 12:9, RSV).
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
•
Summer 2009
15
Understanding Your Mission
Ten Actions to Consider 1. Honestly seek God and ask Him if you are accomplishing all that He wants you to do in your lifetime. 2. Deepen your relationship with God and ask Him to share with you His heart for kingdom work that needs to be done. 3. Be involved in kingdom work/ministry right where you are now. 4. As you pray, think of the needs in your community and around the world – outside of yourself, your spouse, your kids. 5. As you identify needs that touch your heart and as you dream of what could be, answer the question, “What tool of my trade has God placed in my hand?” (Note: In Moses’ case, it was his shepherd’s rod.) 6. As God lays it on your heart to do something, be quick to obey and take the next step – whether it is only a small one, or even if it is such a great one that it will disrupt your life. 7. Trust God to confirm His call to the degree you need it. 8. Always be prepared to give “your” ministry to God. Do His work, and don’t possess it. 9. Trust God to care for those you love as you follow His call. 10. Explore CMDA missions opportunities.
16
T o d a y ’s C h r i s t i a n D o c t o r
John R. Crouch Jr., MD, helped
Resident physician exams international patient
8. God’s plan demands personal sacrifice. Whether or not we are called to drop our comfortable lives and go overseas, we will not follow Christ fully without letting go of something we hold dear. German martyr Dietrich Bonhoeffer wrote, “When Jesus calls a man, He bids him come to die.” Accept your loss on the front end, and then follow the call.
form the In His Image Family Medicine Residency Program in Tulsa, Oklahoma, in 1989. He has served on numerous committees and boards for Family Medicine and other healthcare and community concerns at the local and state level. Dr. Crouch was named the Oklahoma Family Physician of the Year in 2001. For over ten years, Dr. Crouch’s vision has been to enable resident physicians in training to travel overseas on shortterm international medical trips and to encourage long-term overseas service to multiple countries. Twenty graduates of his residency are serving, longterm, in locations around the world. He continues to work on establishing residency programs overseas in several countries.
Understanding Your Mission
Those of us who are older can look back on our lives and realize that much of our time on Earth has been spent doing good things that don’t really matter in the long run. We have accumulated nice things that satisfy only temporarily and fall apart with the sands of time. We have used our skills to help people live a few years longer. We long for our lives to matter in an important and lasting way. A life that matters is exactly what God has planned for each of us and He has woven mission into the tapestry of our lives even before we were born. God has created us for mission and He is calling us to follow. ✝
Ever wonder if your practice is making an eternal difference? Do the pieces of your life still fit together? Are you neglecting important areas of your life? Are you a workaholic or perhaps already burned out? Practice By the Book is just what the doctor ordered! In addition to their own contributions, Drs. Al Weir and Gene Rudd have compiled content from more than a dozen Christian colleagues into a compendium that teaches doctors how to live a life guided by biblical principles. Suitable for both individual and group study. 263 pages/paperback/$16.95 Call 888-231-2637 to order.
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
•
Summer 2009
17
Living a Missional Life by Jennifer Matkin Grant, DDS “Jenn, It has always been a privilege to be your dad, and I am glad that what I have done with my life had a part in your doing what you are doing with yours. With love and affection, Dad” Anyone with a beating heart would probably get choked up with those amazing words, but they were especially meaningful to me. My friend who works with college students had asked me to write my testimony for a talk she was preparing about living a missional life. I had asked my dad to read it and this was his response. As is often the case, my friend had asked me for the favor to contribute to her talk, but I was the one to reap the most rewards as I put down on paper a culmination of my childhood, upbringing, education, and calling. I became a dentist as a result of going on mission trips as a child and teenager. My father has been a minister to college, medical, and dental students for forty years. Literally every year of my life my father has led five to ten
mission trips along the border and in the interior of Mexico. We began going as a family on these trips and participating as we were able early on in my childhood. It was on one of these trips as a 13-year-old girl that I worked with the dentist holding the flashlight and spit bucket and fell in love with dentistry. The very fact that I use the word “love” in reference to blood and spit tells me that God has put all of us in this world with different gifts and passions. How many other people can say that they love extracting teeth and doing root canals? As I assisted the dentist as a young teenager, I watched hurting people come to him to have their pain relieved, smiles restored, and anxiety dissolved. Dentistry is a very tangible science and creative art, so my friend and I watched as the dentists drained abscesses, fixed broken teeth, and gave people a reason to smile. I was intrigued and hooked from the beginning, while the teenage girl next to me had to go sit down before she passed out or threw up! I eventually went to dental school in San Antonio where my parents live and fully expected to continue going on these trips with my father as one of the dentists, like the people who were my mentors growing up. However my husband, Jonathan, was attending Truett Seminary when we married, so we moved to Waco after I graduated from dental school and completed my residency. It soon became obvious to me that going on mission trips (more than seven hours away) was not going to be quite as “easy” as it had been when I lived three hours from the Texas-Mexico borJennifer and her dental assistant, Alex, on a recent trip to Mexico der, was a single student, and didn’t
18
T o d a y ’s C h r i s t i a n D o c t o r
Living a Missional Life
have a full-time job. Then add growing debt, as I began my own practice, and starting a family to the equation. As all this was happening, I had this cloud of guilt and regret following me that I should be going on trips to Mexico like those that had brought me to this point. I have always lived my life with two basic mantras: “To whom much has been given, much is required” and “If there, not but for the grace of God, go I.” I don’t believe that God determines whose life is blessed and whose is not – and I think all of that is beyond human comprehension as Ecclesiastes 3:11 states. What I do believe, though, is that God created Jennifer’s daughter, Libby, likes to help clean on the mission trips each one of us with the desire to know Him and fully experience the life He has given us. I just happen to to be addressed. Certainly, the homeless and poor have been born to upper middle class Christian parents deserve a chance to get out of pain. But how can we (at who valued education and dreaming dreams. I had the my dental office) help them to get beyond just survivopportunity to become absolutely anything I wanted to. ing, to a life marked by independence, pride, and joy? Many do not have that option in life. We look at the whole person and help them to achieve And my seven-year-old daughter, Libby, seems intent health and improve their self-esteem with a nice smile. on becoming a dentist like her mommy. She is at the Going to school or applying for a job is a lot harder office at every opportunity and loves to put on pink with a mouth full of rotten or missing teeth. gloves and clean the operatories. And so it has become my privilege to take on several So how lucky am I to be able to do what I love and patients a month and help them better themselves. It to help people? It has become increasingly obvious to almost seems too easy to be able to incorporate this me how much dental need surrounds me right here in missional opportunity into my practice. I had always Waco. Mission Waco, the Family Practice Clinic, and envisioned doing dental missions on an occasional Christian Women’s Job Corp send patients to my dental weekend trip out of town, but God has dropped it right office on a regular basis. In some cases, the work is free. into my lap so that I can do what I love every day. This However, sometimes for the sake of a patient’s pride past year it was my privilege to give away to those needand personal responsibility we charge a small fee. ing help in my community approximately 10 percent of I have found that once a person’s physical pain or illmy gross annual income in pro bono services. ✝ ness is treated, there are other equally important needs
Jennifer Matkin Grant, DDS,
(l. to r.) Jonathan Grant, Kelsey Conine, Dr. Jennifer Grant, Brittney Conine, and Alex Moya in Mexico
and her husband, Jonathan, live in Waco, Texas with their two children, Libby Kate and Luke. Jennifer graduated from The University of Texas at San Antonio Dental School in 1997. After completing a General Practice residency at the Carolinas Medical Center in Charlotte, NC, she completed a fellowship in Hospital Dentistry. Jennifer’s father, Roger Matkin, DMin, currently is the Executive Director for the San Antonio Area CMDA ministry.
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
•
Summer 2009
19
10
Reasons
to go on a
Short-Term Mission Trip
by William T. Griffin, DDS Many see short-term missions as a way to help others, which it is. But in the process, the Lord often helps the helpers, too. mately more rewarding when the Lord works through one’s efforts to bring a person to faith in Christ. Jesus calls His people to “Love one another. As I have loved you, so you must love one another” (John 13:34), and free health care for the needy is among the most powerful manifestations of God’s love for the lost. 2. Evangelistic opportunities back home
Dr. Bill Griffin on a recent mission trip to Nigeria
Despite our society’s widespread mentality of seeking one’s own comfort above all else, there are many members of CMDA who intentionally make themselves uncomfortable, and they do so on a regular basis. They purposely put themselves into situations with inferior food and housing, difficult working conditions, and they receive no financial compensation for their labors. What is it that they find so appealing about medical mission trips? Based on my personal experience, here are ten motivating factors, though this is by no means an exhaustive list: 1. Evangelistic Opportunities “in the field” “Which is easier: to say, ‘Your sins are forgiven,’ or to say, ‘Get up and walk’?” (Luke 5:23). For many CMDA members, this is the reason for that first trip, and it continues to be a primary motivator throughout one’s medical missions endeavors. Jesus often connected His physical healings with the ultimate spiritual healing of forgiveness of sins and reconciliation of man with his Creator. As much of a privilege as it is to be used by the Lord to improve a person’s health, it becomes ulti20
T o d a y ’s C h r i s t i a n D o c t o r
“. . . let your light shine before men, that they may see your good deeds and praise your Father in heaven” (Matt. 5:16). When you get back home to private practice, discussing your mission trips is a vary natural way to move patient conversations in the direction of the gospel. Prior to the trip, a doctor can inform patients of his upcoming absence from the office, and explain the reason for the trip, in detail, appropriate to the situation. After returning from a trip, a photo album can be compiled and placed in the waiting room for patients to see, thereby creating more opportunities to speak to patients about the reality of the Christian message. As patients express admiration for a doctor’s willingness to donate time on the mission field, the door is wide open to redirect the praise to the One who gave far more of Himself than we ever will. 3. Showing love to believers “Therefore, as we have opportunity, let us do good to all people, especially to those who belong to the family of believers” (Gal. 6:10). My first mission trip, to Belize in 1998, started out as a real bummer. My expectations were that I would change the world, or at least this particular corner of it. To my chagrin, the area in which I served was predominantly
4. Increased appreciation for what you have “Give thanks in all circumstances, for this is God’s will for you in Christ Jesus” (1 Thess. 5:18). Man’s need for salvation in Jesus Christ is well-illustrated by the fact that, no matter how much we have, we never lose the capacity to desire “just a little more.” Whatever level of comfort we attain becomes the norm, and anything less makes us feel unfairly deprived. Spending time among the poor around the world, however, will bring us back to the reality that we in America don’t know what real poverty is. I remember coming home after a recent trip to Nigeria, deeply grateful for the simple convenience of a hot shower. My next fast food burger tasted really good, as well. 5. Decreased dependence on material things “I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want” (Phil. 4:12).
In addition to becoming more grateful for all that the Lord has given us in this country, mission trips are also a stark reminder that we don’t really need as much as we think we need. My time in the mountains of Jamaica allowed me to meet brothers and sisters who work eight hours a day at a coffee factory, sorting through coffee beans by hand, barely making enough to keep food on the table. When it came time to worship the Lord, however, there was a joy and sincerity of heart that most Americans would envy. Perhaps a lot of the “stuff” that we accumulate actually serves as an obstacle to recognizing the Lord as our provider. I am reminded of Jesus’ parable of the Sower and the Seed, in which some of the seed fell among the thorns. Jesus explained: “The seed that fell among thorns stands for those who hear, but as they go on their way they are choked by life’s worries, riches and pleasures, and they do not mature” (Luke 8:14). If we are to bear fruit that lasts for the kingdom of Christ, then we need to heed this stark warning from our Savior, and mission trips help greatly in this regard. 6. Freedom from the Western pace of life “Who of you by worrying can add a single hour to his life?” (Matt. 6:27). One of the many ironies that becomes apparent on the mission field is the fact people who have less are often more laid back about life. While we are working overtime to fund that retirement plan account, those we treat around the world are more concerned with enjoying their families and getting to know their neighbors. Most of us have much to learn in this regard from those we serve on the mission field, and each trip I take is therapeutic in this regard.
10 Reasons to go on a Short-Term Mission Trip
Christian already, with well-established churches that were physically needy but spiritually well-endowed. The Holy Spirit convicted me of the inappropriateness of my attitude through several passages that speak clearly to our calling to minister to fellow believers. Among the more applicable verses is Ephesians 4:12, where Paul refers to abilities given to men by the Lord “. . . to prepare God’s people for works of service, so that the body of Christ may be built up . . . .” For us to ignore the needs of other Christians, so that we can add a few evangelistic notches to our belts, is in direct contrast to the Christ-centered gospel that we seek to proclaim. Not surprisingly, as Acts 2 shows, love between Christians can also be a very effective testimony to the unbelieving world of the truth of the gospel.
7. Teaching medical/dental students “And the things you have heard me say in the presence of many witnesses entrust to reliable men who will also be qualified to teach others” (2 Tim. 2:2).
Dental students Kevin Howarth and Nicole Reynolds, from the University of Oklahoma, sharing and expanding their skills in Jamaica
A physician or dentist who has been practicing for awhile has much to offer those still in medical or dental school. The mission field is a perfect teaching environment in many respects. First, there are normally plenty of patients, and not nearly as much record-keeping required as back in the states. Secondly, students will often have the opportunity to provide more handson treatment, and yet will still have seasoned professionals nearby for back-up if the situation extends beyond the student’s comfort zone. Thirdly, because of the desperate need for care in most parts of the world, 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
•
Summer 2009
21
10 Reasons to go on a Short-Term Mission Trip 22
patients will be as grateful for the opportunity to see a student as they would a licensed doctor. Medical and dental school represent very difficult times in the lives of most people. The quantity of information that must be learned, and the hours of classroom and clinical time required have a profoundly humbling effect on most students. The Lord has used these difficult years to open many students’ eyes, including my own, to faith in Jesus Christ. A Christian physician or dentist who shares his or her expertise with a student in humility and love while on a mission trip can be a powerful force for the gospel in that student’s life. 8. Establishment of profound friendships “A friend loves at all times, and a brother is born for adversity” (Prov. 17:17). I met one of my dearest friends, Dr. Jim Carney, on a mission trip to Jamaica about ten years ago. Since then we have gone on about a dozen trips together, and our families have also enjoyed each other’s company on many occasions. Jim’s love for Christ has inspired in him a deep love for the people of Jamaica, as evidenced by his establishment of six dental clinics throughout Jamaica and over fifty total mission trips. It should be no surprise that our deepest, most meaningful friendships will be with those with whom we serve the Lord. Scriptural examples of friendships forged through faithfulness to the Lord include David and Jonathan, Ruth and Naomi, and Paul and Barnabas.
9. Greater appreciation for the universality of the church “. . . that all of them may be one, Father, just as you are in me and I am in you. May they also be in us so that the world may believe that you have sent me” (John 17:21). In Jesus’ High Priestly Prayer, a portion of which is cited above, He prays for unity among believers, so that the unbelieving world will be able to recognize that Jesus really was from God, that He really was the Messiah. The fellowship that believers enjoy is especially sweet when it crosses ethnic and cultural boundaries. Differences in skin color or language cannot inhibit the unity brought about by the presence of the Holy Spirit in the lives of believers. It still amazes me that I can meet a Christian for the first time in a foreign country, and in less than two minutes we have more in common that I do with an unbelieving neighbor I have known for nearly two decades. Without a doubt, God the Father has answered Jesus’ prayer in a powerful way. 10. The privilege of seeing God at work “Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us, to him be glory in the church and in Christ Jesus throughout all generations, for ever and ever! Amen” (Eph. 3:20, 21) .
The unpredictable nature of mission trips can create some very scary moments. I think back to challenges of getting dental equipment through customs, power outages, treatment needs that sometimes went well beyond my level of experience, and so forth. Just about every repeat medical or dental missionary has a plethora of stories relating how the Lord came through in awesome, sometimes miraculous, ways. Though life is certainly more predictable at home than on the mission field, a doctor’s willingness to venture into uncharted territory creates the privilege of experiencing God’s deliverance in amazing ways. There are certainly many other reasons, along with those listed above, to give up the pleasures of our country to help the needy around the world. Dr. Kathy Dr. Bill Griffin, Dr. Jim Carney, and some of their Jamaican friends O’Connell, an OB/Gyn and
T o d a y ’s C h r i s t i a n D o c t o r
CMDA member from Yorktown, Virginia, who goes to Kenya annually to treat AIDS patients, admits that the satisfaction she receives from these trips almost makes her feel a bit guilty. “I suppose it’s a little selfish on my part,” O’Connell says, “because there is nothing greater than the huge smiles I get from helping the poorest of the poor.” As the Bible says, “It is more blessed to give than receive,” and the amazing thing about missions is that often in giving of our wealth, time, and talents to show Christ’s love to others, we receive in return the immensely more valuable treasures of heaven, and are filled spiritually and emotionally to overflowing. This is the power of the
10 Reasons to go on a Short-Term Mission Trip
Dr. Kathy O’Connell caring for patients in Kenya
gospel, which we seek to spread to others, returning like a boomerang and making our joy more full (John 15:11). If you haven’t yet ventured into the field of missionary dentistry or medicine, I hope this article inspires you to go on that first trip. You don’t have to start with a trip down the Amazon; there are plenty of “safe” destinations to try first. If this is something you know you would like to try, but the time is not right, I encourage you to put it on the schedule at some point in the future. Otherwise, you could wake up someday at 85 years of age, still saying, “Maybe next year . . . .” If you are a veteran of medical-dental mission trips, then I encourage you to invite at least one new doctor to join you every time you go. The worst that could happen is that they might say no, and you have lost nothing. On the other hand, if they accept your invitation, who knows what the Lord might do through your labors together? ✝
William T. Griffin, DDS, has been a member of CMDA since 1982. He is a member of the CDA Dental Advisory Council. He may be reached at: williamgriffindds@gmail.com.
Paid Advertisement
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
•
Summer 2009
23
Washing Feet in Kibera
Sometimes we hear the voice of God through the feet of those He’s called us to serve
by Lawrence P. Frick, MD Photos courtesy of Paul Stevens Photography along the road are full of freshly butchered meat with no sign of refrigeration anywhere. Chickens, dogs, and scavenger birds roam freely, and one can only imagine that all other kinds of rodents are just out of sight. The “road” itself is just a mud footpath, flanked at times by an open sewer ditch which spills over onto the path itself in places. This morning the walk was particularly challenging as it had begun to rain, making the footing treacherous, and the mixture of mud, animal dung, garbage, and sewage running down the middle of the path unavoidable. We looked quite Medical team walking into Kibera humorous with our scrub pants legs rolled up to avoid It had been a long, hard day of seeing patients. My current getting the mixture on our clothes, but despite the fashion patient was complaining of foot pain and I bent down to statement, were still covered in muck. begin to examine his feet. It suddenly occurred to me It was that picture I had in mind as I began to examine my where those feet had been walking and my mind was patient’s feet. It occurred to me that he had spent the day drawn to my own walk earlier that day. walking through those same streets. Unfortunately his We were ministering in Kenya with Global Health footwear was much less sturdy and weatherproof than the Outreach on a short-term medical team. Our site for our hiking shoes I had brought for the occasion. As I began to clinic this week was in Kibera, which is the largest slum in examine him, I could feel myself draw back ever so subtly, Nairobi, and one of the largest in all of Africa. Getting to wondering if I should really touch those feet. Maybe a pair our clinic site each day was no small task. It required a of gloves would be a good idea. twenty minute bus ride to the place where we got out each As I pulled on that latex layer of protection for my hands, I morning and met our friends from the Kibera Transformathought back to this story about Jesus: “Jesus, knowing that tion Development Project. They then guided us through the the Father had given all things into His hands, and that He streets of Kibera which were not passable by vehicle had come forth from God and was going back to God, got up because they were too narrow and crowded. We went in from supper, and laid aside His garments; and taking a towel, on foot for the fifteen minute journey. He girded Himself. Then He poured water into the basin, and The sights and smells are almost unimaginable for those began to wash the disciples’ feet and to wipe them with the of us who live in clean, comfortable America. The shops towel with which He was girded” (John 13:3-5, NASB).
24
T o d a y ’s C h r i s t i a n D o c t o r
The Lord calls us to follow His example today. When we serve in a place like Kibera, we are only following the example that Jesus set for us. Our culture tells us that the measure of greatness is found in who serves us. Jesus tells us that the measure of greatness is found in how we serve others. Our involvement in missions becomes one way we can follow the example of Christ in serving others. Seeing the filth and grime of the streets of Kibera draws me to another truth in this passage of Scripture. “So He came to Simon Peter. He said to Him, ‘Lord, do You wash my feet?’ Jesus answered and said to him, ‘What I do you do not realize now, but you will understand hereafter.’ Peter said to Him, ‘Never shall You wash my feet!’ Jesus answered him, ‘If I do not wash you, you have no part with Me’” (John 13:6-8, NASB). Peter was so humiliated by the fact that Jesus was washing his feet that he objected. Jesus replied that without cleansing we cannot have a relationship with Christ. Whenever I am tempted to minimize my sin, I need only to remember the filth of the streets of Kibera. My sin is just as filthy to Jesus and, praise God, He is willing and able to wash me completely! I am thankful that God, the Holy Spirit, met me that day in Kibera and showed me these truths from His Word. It’s
Washing Feet in Kibera
As I read this, I noticed no hesitation on Jesus’ part to touch the disciples’ dirty feet. There is no reason to believe the streets were any cleaner in ancient Palestine than they were in Kibera. I doubt the disciples’ footwear was any more weatherproof than what my patient had been wearing. And yet, Jesus, the Son of God, washed their feet. If Jesus had no hesitation washing the disciples’ feet, I should have no hesitation examining my patient’s feet, and no hesitation in any other service my Master calls me to perform. It is important to us who follow in Jesus’ footsteps to know not only that He washed the disciples’ feet, but why He did it. He did it as an example to us. “So when He had washed their feet, and taken His garments and reclined at the table again, He said to them, ‘Do you know what I have done to you? You call Me Teacher and Lord; and you are right, for so I am. If I then, the Lord and the Teacher, washed your feet, you also ought to wash one another’s feet. For I gave you an example that you also should do as I did to you. Truly, truly, I say to you, a slave is not greater than his master, nor is one who is sent greater than the one who sent him. If you know these things, you are blessed if you do them’” (John 13:12-16, NASB).
Dr. Frick with a child patient
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
•
Summer 2009
25
Dr. Frick listens to patient describe ailments
amazing that as we give ourselves to serving others in missions, God always ends up blessing us in the process. That’s the final truth from this passage: “If you know these things, you are blessed if you do them” (John 13:17, NASB). Serve others on a medical mission team. You will be blessed if you do. ✝
Paid Advertisement
Washing Feet in Kibera
Lawrence P. Frick, MD, is a grad-
26
T o d a y ’s C h r i s t i a n D o c t o r
uate of the University of Cincinnati College of Medicine and the Grant Medical Center Family Medicine Residency in Columbus, Ohio. He practiced family medicine in Chillicothe, Ohio, for fourteen years. In August, 2008, Larry became Director of Medical Missions for GO InterNational in Wilmore, KY. Larry is responsible for leading short-term medical teams to minister with GO’s partners to the poor of the world who have little access to medical care. He oversees outreach to medical personnel in the US and GO’s partnership with CMDA and GHO. He also volunteers as CMDA Associate Staff for Lexington, KY. Over the past twelve years he has traveled to Honduras, Nicaragua, Peru, Bolivia, Russia, Kenya, and Zambia. He and Marci live in Nicholasville, KY, and have an eight-year-old-daughter, Hannah.
PROFESSIONALISM IN PERIL Part 1 – Liabilities and Limits of Autonomy by Gene Rudd, MD To be autonomous is to be a law to oneself. – Stanford Encyclopedia of Philosophy There are only two kinds of people – those who say “Thy will be done” to God or those to whom God in the end says, “Thy will be done.” – C.S. Lewis, The Problem of Pain
Professionalism in Peril
Editor’s Note: This is the first of a five-part series on the subject “Professionalism in Peril.” The series will examine five paradigm shifts that undermine the tradition of medical professionalism.
There have been moments when I doubted the wisdom of autonomy. Look where it has gotten us. God granted autonomy to Adam and Eve. (The theologians call it free will.) They exercised the privilege poorly, with devastating results that remain with us. While it would be easy to blame our ancestors for the fallen world we live in, similarly, we fall prey to pride and self-reliance – facilitated by autonomy. Had we the same opportunity in the Garden, we would have done the same. Each of us is inclined to presume the place of God – thinking we have enough knowledge, wisdom, and power to find our own way. So, I sometimes wonder if we would have faired better had we not had the capacity to choose. However, that perspective quickly fades when I remember that autonomy was God’s idea. It was His gift to mankind. To accomplish His divine plan for relationship through choice, love, and redemption, He suspended His omnipotence over the volition of men and women, granting us the option to choose our own way. Since autonomy has been exercised since the creation of mankind, it might seem surprising that only in recent history has autonomy played a prominent role in medicine. While beneficence, nonmaleficence, and justice date back to Hippocrates, the concept of autonomy was not part of the Oath that bears his name. For 2000 years healthcare was more paternalistic. Autonomy emerged as a tenet of medical ethics in the 1960s – along with many fundamental shifts 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
•
Summer 2009
27
Professionalism in Peril 28
in Western culture. The emergence of individualism, relativism, and the laying off of cultural norms provided fertile ground for the flourishing of autonomy. Some argue (and advocate) that autonomy has now assumed supremacy over other tenets of medical ethics. The history of abortion during the last generation documents that deference to individual autonomy has allowed the advance of practices once objectionable to a broad consensus of the culture. The loss of a consensus of moral truth (or even that truth exists) predisposed our loss of society’s prerogative to limit many individual choices. Autonomy has advanced its influence. But even Immanuel Kant, who extolled the virtue and necessity of autonomy, recognized that it must not be accepted without limits. For there to be social order, autonomy must operate within the boundaries of cultural norms and laws. But today’s culture blurs those boundaries, often choosing to abandon the norm in deference to individual choice. Some argue that autonomy is the best system we have for ethical decision making. But is it? Do all have the same capacity, or at least a reasonable threshold of competence, for ethical reasoning? The operative platform for autonomy is self. The supremacy of autonomy asserts that self can better determine what is best for itself than can any other entity. But self is limited by one’s experience and cognition. Since most patients have limited knowledge and understanding of medicine, doctors attempt to fill this deficit by offering their knowledge. Throw in a degree of professional judgment (the art of medicine) and we have informed consent (or to be more accurate, partially informed consent). The underlying assumption is that the patient can absorb and understand the information provided – something that studies consistently show is lacking. Consequently, informed consent is limited by the quality of information offered, understood, and/or accepted – all significant obstacles. Autonomy can also foster division. A common end of autonomy is self-interest over common interest. Autonomy does not necessarily seek to embrace the good that most fellow citizens can agree upon or live by. It is subject to the notion that individuals can establish their own reality – their own truth. It allows skepticism and disloyalty to standards. It is antagonis-
T o d a y ’s C h r i s t i a n D o c t o r
tic to the concept of social contract advanced by Rousseau and others – the idea that we each have to give up some of our rights for the good of the whole. Without such, we degenerate into the law of the jungle where the strong take what they will while the weak are left to suffer the consequences. As suggested above, deference to autonomy can allow evil to go unchecked. Scientists guided only by unbridled curiosity may pursue unethical investigation. Specifically in medicine, unchecked autonomy can harm relationships between patients and doctors. It becomes consumer-oriented. Moreover, autonomy creates an environment that fosters contractual relationships – as opposed to a more valued covenant relationship (something we will discuss in a subsequent article in this series). As autonomy becomes tenet-in-chief in medicine, what about those who cannot speak for themselves? Others must fill the void when patients cannot decide. The task typically falls to a family member – again with no assurance of their ability to discern the facts and make a reasoned disposition. And to which family member? The current solution is to encourage living wills and advance directives so that self can be represented when self is not able. Autonomy is bent on serving self-interests, even if by surrogacy or proxy. While it is impossible to measure the economic impact of autonomy, it must be significant. In addition to the time required of healthcare professionals to adequately inform patients of their disease and treatment options (noble efforts), autonomy has its own expectation to be satisfied – even if not evidence-based. A classic example is the dispensing of antibiotics for the common cold in response to expectations by patients.
Professionalism in Peril
cover that I still care for you. And if you come back to Me, I will help you.” We can apply these same principles to our patients: “There are things that you can do that are good for your health (physical, mental, and spiritual), and there are things that are bad for your health. You ought not to make those bad choices. And while you are free to choose, I will not help you make the bad choices. But if you do make a bad choice and suffer the consequences, know that I still care. And I will be here to help you recover and go in a healthy direction.” To preserve the integrity and quality of medicine, we must resist the growing cultural philosophy that doctors be required to assist no matter what decisions their patients make. We must resist professional expectations that we be complicit with practices that are morally objectionable. Because autonomy has liabilities, we must define its limits. ✝
Gene Rudd, MD, co-author of Practice by the Book, serves as Senior Vice President of the Christian Medical & Dental Associations. A specialist in obstetrics/gynecology, Dr. Rudd has experience in maternalfetal, medical education, and rural healthcare. He has garnered numerous awards including the Gorgas Medal. While working with World Medical Mission, he established the Christian Medical Mission of Russia, directed the rehabilitation of the Central Hospital in Kigali, Rwanda, and served in Belarus, Bosnia, and Kazakhstan.
Paid Advertisement
Doctors may also unconsciously view autonomy as a defense mechanism. The process of informed consent and shared decision-making with the patient may lead doctors to a sense of shared responsibility (and blame) for each decision. Autonomy threatens professional integrity. There is growing sentiment in healthcare and in culture that autonomy should extend beyond the patient having dominion over self. Advocates claim that a patient’s desire for a particular service constitutes an obligation by those in healthcare to provide that service. This concept is commonly applied to situations related to reproductive and sexual rights. Unfortunately, little thought is given to how this principle will affect decision making in other areas of medicine. If applied consistently, a patient could claim the right to demand not just an abortion, but a supply of oxycodone HCL. Today’s broadening understanding of autonomy is directly threatening healthcare right of conscience. While there are many liabilities to autonomy, I do not advocate that medicine return to the pre-autonomy days of paternalism. In part, autonomy serves as a protection against the paters in healthcare who are not guided by beneficence, nonmaleficence, justice, integrity, etc. More and more, healthcare systems have economic motives to abandon ethical tenets and the primacy of the patient. Patient participation in decision making provides some level of oversight. More importantly, the benefits of patient participation in understanding their disease and taking ownership in the treatment plan outweigh the liabilities of autonomy. But how much autonomy is too much? Where do we draw the line? Those questions are best answered in the story from which autonomy began. The Garden of Eden account teaches us some important parameters. Consider the scenario: God said, “Yes, you are free to make choices. But I must explain (informed consent) that while there are many good choices, there is also a bad choice. You shouldn’t make the bad choice. There will be harmful consequences if you do. Because I care for you, I do not want you to suffer those consequences. I will not help you if you choose to go in that direction. But if you make the bad choice and suffer the consequences, you will dis-
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
•
Summer 2009
29
A D CM ons i s w s e i i v r e M Ov
Campus Mission Teams – Each year nearly a thousand CMDA students travel abroad to experience medical missions first-hand. For example, students from UC Davis, USC, UAMS, Penn State, U of TN, Mercer School of Medicine, UFL, OSU, UOK, UT Southwestern, and Texas Tech have participated in missions trips to places like Nicaragua, Peru, Bolivia, Mexico, Haiti, El Salvador, and Guatemala. Each year hundreds of others serve the underserved here in the US. For more information, contact Al Weir, MD, at: ccm@cmda.org.
Editor’s note: Since its inception, CMDA has been missioncontrolled. These pages are just an overview and summary of what the organization is doing today in the arena of missions, for your information and also to facilitate your prayers.
c. Medical Mission Management Consultation – Working with medical mission outreaches to evaluate systems, management strategies, ministries, and their strategic plans. d. Mentoring Program for those Preparing for a Medical Mission Career – Includes information on scholarships for international rotations, and a semimonthly e-newsletter, “Your Call,” that mentors those called, during their training years. e. E-Pistle – Free monthly e-newsletter to inspire, educate, and equip those already serving in medical missions. Continuing Medical & Dental Education Commission (CMDE), launched in 1976 by Dr. David Stewart, offers over sixty CME and CDE hours to physicians and dentists in Africa and Asia so they can maintain US licenses. The two-week conference is organized in daily tracks of specialty lectures and hands-on workshops. Opportunities for spiritual and physical renewal are provided, along with counseling and prayer support. An experienced, inspired spiritual life speaker ministers in worship each day. There is a program for spouses and when held in Thailand in alternating years, there is also a program for children. For more information, contact the Commission Chair, Jarrett Richardson, MD, at: richardson.jarrett@mayo.edu. Global Health Outreach (GHO) – is CMDA’s short-term medical/dental and surgical missions outreach into developing countries around the world that has over fifty missions scheduled in 2009. We partner with Go
Annual Medical Missions Executive Summit
Center for Medical Missions (CMM) – The overall goal of CMM is to help develop new personnel, partnerships, resources, strategies to advance the cause of Medical Missions, and to support health care missionaries in their work for Christ. Contact CMM Director Susan Carter at: susan.carter@cmda.org, or call: 423-844-1000. a. Medical Missionary Orientation – Annual conference teaching new medical missionaries how to serve well. b. Medical Mission Executive Summit – Annual two-day conference networking medical mission agencies and establishing partnerships.
30
T o d a y ’s C h r i s t i a n D o c t o r
Dr. Larry Frick with translators in Kibera
InterNational and Downline Ministries to bring pastors’ conferences into developing countries where 98 percent of the pastors have had no form of Bible school or seminary training. Through our Community Health Education Program, we have been able to increase health and wellness while also inviting new friends into the body of Christ. For more information, visit: www.cmda.org/gho or contact GHO by e-mail at: gho@cmda.org. The Global Missions Health Conference (GMHC), cosponsored by CMDA, has connected medical professionals for nearly fifteen years. The annual GMHC offers plenary sessions, breakout sessions, 150-plus exhibitors, events for students, forums, working groups, and much more. The GMHC is for anyone interested in serving people with their medical skill and ability, both domestic and international. For more information, visit: www.medicalmissions.com.
organization striving to serve the poor of Africa, build capacity within the healthcare sector, and help maintain the faith-based healthcare facilities that provide over 40 percent of the continent’s healthcare. PAACS started its first program in Africa and took its first resident in 1997. It has subsequently graduated nine surgeons who are serving in the remote areas of Angola, Kenya, Cameroon, Republic of Congo and Madagascar. Today thirty more are in training. PAACS’s CEO is Dr. Bruce C. Steffes; Director for Africa and founder is Dr. David C. Thompson. For further information, visit: www.paacs.net, or e-mail: admin@paacs.net.
Healthcare for the Poor – CMDA works to motivate and recruit doctors to be involved in domestic missions. It partners with Christian Community Health Fellowship (CCHF) to provide training and networking. Each year, CMDA funds lectures on over fifty medical and dental campuses. Contact Al Weir, MD, at: al.weir@cmda.org. Medical Education International (MEI) – Since 1988, MEI has been sending CMDA members to other countries to teach national physicians, dentists, and students. MEI sends approximately ten teaching teams each year into difficult to access countries. For more information, go to: www.cmda.org/mei, or contact MEI directly at: mei@cmda.org. The Pan-African Academy of Christian Surgeons (PAACS) is a non-denominational, multi-national volunteer service
While formats have changed, the impact continues
the SCAN – since 1986 the SCAN has provided a comprehensive review of important articles in major medical journals for missionary healthcare personnel. It is a rich resource to keep missionaries current in their knowledge. For more information, contact Reneé Hyatt by e-mail at: scan@cmda.org, or by fax at: 972-278-8486. Scholarships 1) Steury scholarship – $100,000 medical school scholarship for a student going into career missions. 2) Westra Scholarship – up to $500 to medical students doing short-term mission trips or rotations overseas. 3) Johnson Scholarship – Up to $1,000 ($2,000 per couple) to residents doing rotations in mission hospitals. 4) Risser Fund – funding orthopedic training for national doctors. 5) Tami Fisk Mission – Up to $1,000 scholarships for those providing medical mission service in East Asia.
Photo courtesy of PAACS, taken in Limuru, Kenya (2009)
For more information, visit: www.cmda.org/scholarships.
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
•
Summer 2009
31
BIOETHICS SERIES
Clinical Ethics Case Consultation What is the role of the ethics consultant in peer review? by Gregory W. Rutecki, MD The following report is based on a real clinical dilemma that led to a request for an opinion from an ethics consultant. Some details have been changed to preserve patient privacy. The goal of this column is to address ethical dilemmas faced by patients, families, and healthcare professionals, offering careful analysis and recommendations that are consistent with biblical standards. Most of these reports published in this column are formal ethics consultations that would appear in the patient’s chart. However, one of the recommendations in this case is to NOT do a formal ethics consultation, but to address this as a peer review issue. – Column editor: Robert D. Orr, MD, CM
QUESTION: How should this primary physician respond when a specialist performs an unnecessary procedure on his patient? NARRATIVE: A Christian physician colleague asks you as the ethics consultant at his hospital how to handle a distressing situation. Millie, a 72-year-old widowed, retired teacher has been his patient for fifteen years. She lives alone, has been generally healthy, and is seen primarily for minor arthritic pain. While he was not on call, she presented to the Emergency Department with crushing chest pain of one hour duration. Of interest, her grandson was seriously injured in a motor vehicle accident a few hours prior to the onset of her pain. She had EKG changes and enzyme elevations consistent with an acute ischemic coronary syndrome. She was treated with aspirin and heparin and transferred to the care of an interventional cardiologist. Catheterization revealed ballooning of her anterior cardiac wall, but she had only a twenty percent non-obstructing lesion in her left anterior descending coronary artery. The clinical picture met the standard criteria for Tako-Tsubo syndrome, an apical-sparing variant of acute ballooning syndrome (ABS).1 The cardiologist performed a percutaneous dilatation of the left coronary artery and placed a drugeluting stent. The catheterization technician and med32
T o d a y ’s C h r i s t i a n D o c t o r
ical resident present suggested the procedure was unnecessary, but the cardiologist ignored them. Millie would almost certainly have improved without this procedure since patients with ABS are symptom-free without sequelae approximately four to six weeks after the acute event. When her primary physician examined her and reviewed her records the following morning, he was disconcerted both that the procedure had been done and that, because of the stent, she will now require prolonged treatment with an expensive anti-platelet medication with some risk of hemorrhagic complications. The technician, Coronary Care Nurses, and medical resident openly expressed dismay at her management, but they were also concerned that the cardiologist might seek retribution if they were implicated in investigation for an unnecessary procedure. Her primary physician wonders whether the cardiologist’s decision was financially motivated, since Medicare reimbursement for placing the stent would be much greater than the catheterization alone. ASSESSMENT: The case presents a patient with a specific acute cardiac syndrome that, though uncommon, should be familiar to interventional cardiologists. Her primary physician believes she was treated unnecessarily with a procedure. Consequently, a chronic medication that slightly increases her risk of serious bleeding will be required. How should he proceed? DISCUSSION: For physicians and other health professionals, “Do no harm” has been the cornerstone of the Hippocratic tradition. It has also been integral to other medical traditions such as Eastern (Shinto, Buddhist, Hindu) and secular practice for centuries. What might be construed as harm in professional contexts warrants the broadest definition. Most would consider performing an unnecessary procedure, especially one that entails both current and future risk, to be harmful. The Dartmouth Atlas of
Medical Care and the Veteran’s Administration experience have clearly demonstrated that higher than needed intensity of subspecialty care can be harmful. Thus, complications consequent to mistakes, errors, or inappropriate procedures should be confronted out of respect to the sanctity of every human life. What should the Christian primary physician do in response? Matthew 18:15-16 gives Jesus’ advice on adjudicating disagreements. Although this approach may be a “dis-analogy,” in that the cardiologist may not be a believer, gently speaking to him/her personally about your concerns is still a good place to begin. However, if he/she is not amenable to correction, further steps may be required. Depending on third party payer agreements, the primary physician might stop referring to this cardiologist. Or, if he chooses to continue referrals, he could request the cardiologist call him or his partners prior to any procedures. Alternatively, he could merely report his concern about an unnecessary procedure to the hospital’s peer review committee. A report to the hospital’s peer review committee can also be initiated by a non-physician. Nurses, technicians, and trainees are not as “empowered” as physicians and might be fearful of retribution, even though most hospital policies attempt to protect them by prohibiting such behavior. Many hospitals have a Potential Error/Event Reporting System (PEERS) which permits confidential, non-punitive reporting of unsafe practices. Even if there are no obvious complications, PEERS can rectify system or individual flaws that might recur – before another patient is harmed. The incident recounted here warrants a PEERS report, either by the physician or a non-physician who was involved. What specifically can be done to avoid repeats of this situation? If the catheterization laboratory had a preprocedure safety checklist, this procedure might have been diplomatically questioned.2 Active membership on quality and safety committees permits Christian healthcare professionals to oversee best practices, protecting patients from harm or procedures not in their best interests. There are two other considerations: First, should the patient be informed that an unnecessary procedure was done? This should not be a first response, and should not be done immediately by the primary physician without further investigation. In general, the patient has a “right to know,” thus the default should be to inform her if a peer review committee confirms the primary physician’s concern. Second, should a formal ethics consultation be requested? This may not be in everyone’s best interests. If an ethics committee is perceived as the “ethics police,” it can lose critical influence. While it would not be inherently wrong to request a formal ethics consultation, it may not be prudent in this case.
RECOMMENDATIONS: 1) It would be professionally appropriate for the primary physician to speak directly with the cardiologist to express his concern. 2) If the response is unrewarding, the primary physician could (a) report the incident to the hospital’s peer review committee, (b) stop referring to this cardiologist, or (c) ask this cardiologist to call him before future procedures on his patients. 3) The primary physician should be a champion for quality and safety initiatives and should support other healthcare professionals who confront unethical or unsafe practices. End of clinical ethics consultant’s report FOLLOW-UP: The primary physician chose to speak to the interventional cardiologist regarding his concerns. He did not feel that the cardiologist was sympathetic. There was no other cardiology group available for interventional technique at the hospital. The primary care physician insisted that he and/or his partners be called any time their patients required intervention. The primary physician also requested appointment to a quality/safety committee to exercise an active role on behalf of patients. Prasad A., Lerman A., Rihal C.S. “Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction.” American Heart Journal 2008; 155:408-417.
1
2 Haynes A.B., Weiser T.G., Barry W.R., et.al. “A short surgery checklist to reduce morbidity and mortality in a global population.” N Engl J Med 2009; 360:491-499.
Gregory W. Rutecki, MD, is Professor of Medicine at the University of South Alabama in Mobile. He has been on the faculty at the Feinberg School of Medicine, Northwestern University as the E. Stephen Kurtides Chair of Medical Education. He was also awarded the designation “Master Teacher” at the Northeastern Ohio Universities College of Medicine. Dr. Rutecki has been listed in the Consumer’s Guide to America’s Top Physicians. He splits his clinical time among Nephrology, General Medicine, and Bioethics.
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
•
Summer 2009
33
CLASSIFIEDS Oversees Missions 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. Positions Open Dentist – Associate for thriving general and prosthodontic dental practice. Christian dentists, in-house lab, no insurance. Great experienced staff, area needs dentists. 2.5 hrs to NYC, safe, beautiful, stable area, low housing costs. Long established practice with excellent reputation. Partnership opportunities. Contact: jboyd13168@gmail.com.
Dentist – Yakima, Washington. Our well-established, Christian group practice is seeking a caring, motivated dentist wanting to locate in the beautiful Pacific Northwest. Excellent opportunity leading to partnership. Call: 509-965-0080. Family Practice – Cedar Falls, Iowa. Step into a busy practice with a wellrespected Christian group of five FPs. The need for two additional family medicine doctors was created by the steady growth in a neighborhood of young families. Generous 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 at: 888-780-0390; or e-mail CV to: Janice.Yagla@wfhc.org. Neurologist – North Carolina. Sandhills Neurologist, PA is seeking two BC/BE Neurologist, 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, familyoriented community with large draw area. Approx. 2.5 hrs from beaches and mountains. Contact: voss.sandhillsneuro@gmail.com.
Paid Advertisement
OB/GYN – Gainesville, GA. Three-man OB/GYN practice looking for one or two associates. Located 60 miles north of Atlanta. New Women & Children’s Center opened in November. Level II Nursery with Perinatologists and Neonatologists. Gainesville is located on Lake Lanier at the foothills of the North Georgia Mountains with many recreational activities. Call James Bauerband, MD, or Lori Stallard at: 770-536-0149; or e-mail to: jbauerband@charter.net or lstallard30542@yahoo.com. Orthopedic – Well-established practice of three orthopedists and one podiatrist committed to providing care with compassion as well as excellence. Time off for short-term missions. Would like to 34
T o d a y ’s C h r i s t i a n D o c t o r
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 10 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 308-627-4664 or cwilkinson@kearneyortho.com. Our clinic manager, Vicki Aten, can be reached at: 308-865-2512; or vaten@kearneyortho.com. Pediatrician – Burlington, North Carolina. Private practice seeking BC/BE pediatrician. Spanish helpful although not necessary. Call 1:5 to 1:6. Good lifestyle. Salary and benefits quite competitive for this sought after area. Contact: Dr. David Stein 336-570-0010; fax 336-570-0012; e-mail: Infamclin@bellsouth.net. 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. Full-Time General Pediatrician – Busy small-town practice on the edge of Appalachia seeks BE/BC Christian pediatrician to fill available position. Call 1:4. Salary negotiable, intangible rewards incomparable. Contact Kim at: 276-783-8183; or forward resume/CV to: Marion Pediatric Associates, 590 Radio Hill Road, Marion, VA 24354.
CHRISTIAN MEDICAL & DENTAL ASSoCIATIoNS P.o. Box 7500 Bristol, TN 37621-7500
Nonprofit Org. U.S. Postage
PAID Bristol, TN Permit No. 1000