volume 47 no. 3 fall 2016
TODAY’S
CHRISTIAN DOCTOR The Journal of the Christian Medical & Dental Associations
Steury Scholarship IN THIS ISSUE
The
Learn how to pray with your patients
CMDA releases ethics statement on transgender identification
Combating burnout to reclaim your passion for healthcare
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A Ring—A Sign of Commitment In 1974, I purchased a special gold ring that happened to look just like the ring in The Lord of the Rings. In the books, this fictional ring was imbued with evil powers and represented a commitment to evil and destruction. It could not be melted in an ordinary fire nor be destroyed by hammer and anvil. It exerted a magical attraction toward any who would look at it.
from the CMDA
Countless factors play into the generalized lack of commitment. And they all boil down to sin. Selfishness, a me-first attitude (what’s in it for me?), unforgiveness and sheer laziness all contribute to us breaking our commitments. The solution? Repentance, humility and a promise to grow and become more like Christ. HE is faithful. HE keeps his word. He is committed to us and can enable us to be committed to Him. The characteristic of commitment can flow from Him to us and on to those around us. That gold wedding ring represents a commitment to my wife and my God in the presence of, and with the affirmation of, my family and community. It was a commitment I intended NOT to break or even allow to be compromised. Note the difference between “not intending to…” and “intending not to….” Commitment requires intentional acts of the will and proactive choices to maintain and even deepen that initial choice that led us to make a commitment in the first place. May we examine ourselves and renew our commitment to the Lord of All (rings, relationships and endeavors).
James Hines, MD
president
I was attracted to my ring because I wanted a ring that would last a lifetime—one that would show my commitment, one that would be noticed by all and one that would make a silent statement of fidelity, love, devotion and a “for better or for worse” faithfulness in marriage. At the time of my marriage to Martha Ann, now 41 years ago, I was an extremely poor teenager. The jeweler, somewhat reluctantly, agreed to my payment schedule for both of our wedding rings. He saw two teenagers who were in love and committed to paying his bill! For the first seven years of our marriage, the ring fit well and was comfortable. When I noticed it getting tight, I would take it to a jeweler to have it resized. The ring would fit fairly well for a period of time, but then it would again need to be enlarged. The last time it was stretched, the jeweler informed me it could no longer be expanded. I suppose that is what eating well and gaining weight does to your fingers! Unable to wear the gold wedding ring, I found a prominent position for it on my dresser. After several years the ring moved to a gold chain around my neck, under my shirt. Whether the ring was on my finger, on the dresser or around my neck, my commitment has never wavered. I know to whom I belong. It is a lifelong commitment. A sense of commitment also applies to other relationships. Throughout the last 36 years of
medical practice, I have seen a distinct and progressive lack of long-term commitment to marriage, the local church, mission service, financial institutions, the family doctor and God and His word. Is the evident lack of commitment a problem? What is the cause of this diminished commitment, and is there a solution? Without a doubt, lack of commitment leads to instability of all kinds—unstable marriages, unstable congregations, unstable strategies, financial instability, unstable relationships and spiritual instability.
Christian Medical & Dental Associations www.cmda.org 3
contents Today’s Christian Doctor
I VOLUME 47, NO. 3 I Fall 2016
The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.
5 Transformations
26 Transgender Identification
STORY 12 COVER Ripple Effects: The
Steury Scholarship
by David Stevens, MD, MA (Ethics)
CMDA Ethics Statement
Recently approved by CMDA’s House of Representatives
ombat Burnout and 30 CReclaim Your Calling
by Errin Weisman, DO
Seeing the effect of this scholarship around the world
How to keep burnout from stealing your joy
raying With Our 18 PPatients
34 Classifieds
by Walt Larimore, MD
Putting spirituality into practice in your practice
INTER ACTIVE Visit www.cmda.org/classifieds to find more online classifieds.
REGIONAL MINISTRIES
Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community
Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-522-1950 west@cmda.org
Midwest Region Allan J. Harmer, ThM 951 East 86th Street, Suite 200A Indianapolis, IN 46240 Office: 317-257-5885 cmdamw@cmda.org
Northeast Region Scott Boyles, MDiv P.O. Box 7500 Bristol, TN 37621 Office: 423-844-1092 scott.boyles@cmda.org
Southern Region William D. Gunnels, MDiv 106 Fern Dr. Covington, LA 70433 Office: 985-502-7490 south@cmda.org
Interested in getting involved? Contact your regional director today!
transformations
TODAY’S CHRISTIAN DOCTOR®
EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD John Crouch, MD Autumn Dawn Galbreath, MD Curtis E. Harris, MD, JD Van Haywood, DMD Rebecca Klint-Townsend, MD Robert D. Orr, MD Debby Read, RN VP FOR COMMUNICATIONS Margie Shealy AD SALES Margie Shealy 423-844-1000 DESIGN Ahaa! Design + Production PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). TODAY’S CHRISTIAN DOCTOR®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Fall 2016, Volume XLVII, No. 3. 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© 2016, 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. Undesignated Scripture references are taken from the Holy Bible, New International Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Scripture references marked (KJV) are taken from the King James Version. Scripture references marked (MSG) are taken from The Message. Copyright© 1993, 1994, 1995, 1996, 2000, 2001, 2002. Used by permission of NavPress Publishing Group. Scripture references marked (NASB) are taken from the New American Standard Bible®, Copyright© 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977, 1995 by The Lockman Foundation. Used by permission. Scripture references marked (NIV 2011) are taken from the Holy Bible, New International Version®, NIV® Copyright© 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission. All rights reserved worldwide. Scripture references marked (NKJV) are taken from the New King James Version. Copyright© 1982 by Thomas Nelson, Inc. Used by permission. All rights reserved. Other versions are noted in the text. Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.
CMDA Files Lawsuit in California On June 8, 2016, the American Academy of Medical Ethics, a DBA (doing business as) of Christian Medical & Dental Associations, filed a lawsuit challenging California’s physicianassisted suicide law, the “End of Life Option Act.” “As the battle to stop physician-assisted suicide became more intense and Compassion & Choices challenged the role religion has in the debate, it became imperative that we needed another entity to be able to get into legislator’s offices and the media,” stated CMDA’s CEO Dr. David Stevens. “In 2004, CMDA member Dr. Curtis Harris gave us ownership of the American Academy of Medical Ethics (AAME), and the journey began.” For several years, the AAME was used as needed in stopping physician-assisted suicide bills in Hawaii, California, Washington and Vermont. But when Brittany Maynard became Compassion & Choices’ poster child, we needed to expand our reach and develop a different strategy. Initially focusing on high risk states, we enlisted CMDA members to become AAME state directors, with a goal for us to have at least one in every state. The state directors are working with coalitions in their specific states to stop physician-assisted suicide, develop relationships with legislators, communicate with CMDA members and strategize on how to stop physician-assisted suicide. As a CMDA member, you are also a member of CMDA’s public policy arm, the American Academy of Medical Ethics. Dr. David Stevens serves as the Executive Director, but with a growing need to develop resources and communication, we hope to be able to fund a position for someone to focus solely on AAME issues. If you are interested in getting involved in the AAME, contact CMDA’s Communications Department at communications@cmda.org.
INTER ACTIVE Visit www.ethicalethicalhealthcare.org to read the lawsuit filed in California.
New Ethics Statements During the 2016 CMDA National Convention held in Ridgecrest, North Carolina earlier this spring, the Board of Trustees and House of Representatives unanimously approved one new ethics statement and two expanded statements. Those statements were: • Transgender Identification • Homosexuality • Artificially-Administered Nutrition and Hydration The full Transgender Identification statement is printed on page 26 of this edition of Today’s Christian Doctor, and the other two statements are available online. These statements are designed to provide you with biblical, ethical, social and scientific understanding of these issues through concise statements articulated in a compassionate and caring manner. They are needed for the religious freedom battles we are currently facing, so we encourage you to share them with your colleagues, pastors, church leaders and others.
INTER ACTIVE Visit www.cmda.org/ethics for more information about CMDA’s Ethics Statements and to review these new statements. Christian Medical & Dental Associations www.cmda.org 5
Transforming Lives AT THE PREMIER CONVENTION FOR CHRISTIAN HEALTHCARE PROFESSIONALS
MAY 4-7, 2017 RIDGECREST, NORTH CAROLINA WWW.CMDA.ORG/NATIONALCONVENTION
transformations
Leaders Wanted to Transform Doctors, to Transform the World House of Representatives Are you interested in serving CMDA as a volunteer leader in the House of Representatives? They meet once a year to approve bylaw changes, receive reports and approve the ethical positions of the organization. During the year, they also serve as two-way channels of communication between CMDA and its members. There is one representative from each state and from many of our local ministries. For more information, visit www.cmda.org/hor.
and pay all their own expenses. The board meets three times a year to set policies, approve the budget, oversee finances and provide supervision to the CEO. For more information, visit www.cmda.org/trustees.
Board of Trustees New trustees to CMDA’s Board of Trustees are nominated by a joint committee of the House of Representatives and the Board of Trustees. They look at the service record of potential nominees to CMDA, their leadership capabilities, expertise and Christian testimony. The nominees are then approved by both the house and the board. Trustees may serve up to two consecutive four-year terms
In His Image encourages and provides great opportunities for international rotations during residency. I explored the option of long-term medical missions while spending a month overseas during my second year of residency at IHI. The faculty physicians and many of the program’s graduates have extensive experience in international medicine and were enthusiastic in helping to provide me with training and counsel for my future.
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After graduating from IHI, my family and I moved to Malawi, Africa. My husband teaches at a village school and I work at a hospital in the capital, treating patients and training Malawian family medicine residents. We are so incredibly thankful for the guidance and experiences God gave us through IHI as we prepared for service in Malawi!
Christian Medical & Dental Associations www.cmda.org 7
transformations
CMDA Member Award CMDA Member John Mellinger, MD, recently received the J. Kevin Dorsey Outstanding Educator Award from Southern Illinois University (SIU) School of Medicine. This award, which is given to one faculty member each year, was given to Dr. Mellinger in recognition of his contributions to educational enrichment, leadership, scholarship and teaching. He was recognized for his selfless drive for serving others and his passion for medical education. He is professor and chief of SIU’s division of general surgery and program director for general surgery residency. Dr. Mellinger is a member of CMDA’s Board of Trustees and is actively involved in the CMDE Commission and the Pan-African Academy of Christian Surgeons.
In Memoriam Dr. John Elsen, a lifetime member of CMDA who was integral in the organization’s growth in the 1950s and served as President in 1948, died peacefully on Thursday, June 2, 2016 at the age of 94. He was born in Chicago, Illinois on February 2, 1922. John and his wife Virginia were married in 1944. He received his medical degree from Northwestern University in 1945. “Dr. John,” as he was known by many, had a heart for serving others and was a man of many talents. He provided leadership to CMDA in the 1940s and 1950s, a time during which the organization saw a great amount of national growth. He was also instrumental in founding the free medical clinic at the Pacific Garden Mission in Chicago and for decades delivered baked goods to the mission, treated patients and occasionally preached at the mission services. Throughout their 71 years of marriage, John and Virginia’s ministry was to offer the gift of hospitality and share the love of Jesus with others. In addition to their own 10 children, they took in numerous foster children, missionaries, international students and others. Prior to his death, Dr. Elsen was one of CMDA’s oldest living members, and he leaves behind a wonderful legacy of what it means to be a servant of Christ. INTER ACTIVE Visit www.cmda.org/cdd to listen to an interview with Dr. Elsen. Visit www.cmda.org/tcd to read an article about his work with CMDA.
c Memoriam and Honorarium Gifts d Gifts received April through June 2016 Mr. and Mrs. Harvey Doorenbos in memory of Ms. Betty Veldhuis
Mrs. Bridget Crabtree and family in memory of Dr. Eric Crabtree
Mr. and Mrs. Bill Scott in memory of Mrs. Mary Dudley
Journey North Community Church in memory of Dr. Eric Crabtree
Dr. and Mrs. Thomas Garigan, Jr. in memory of Mr. Leonard Rose
Mr. and Mrs. Kenneth Klamm in memory of Dr. John Elsen
Dr. Heather K. Bright in memory of Dr. Martin Salia
Mr. Thomas Barmore in memory of Dr. John Elsen
Drs. Gloria & Paul Halverson in memory of Ms. Esther Rudd Nease
Drs. Richard and Constance Turner in memory of Dr. John Elsen
Mr. and Mrs. David Rice in memory of Ms. Esther Rudd Nease
Mr. and Mrs. Dean F. Miller in memory of Dr. John Elsen
Mr. and Mrs. Jack Pike in memory of Ms. Esther Rudd Nease
Ms. Eloise M. Quick in memory of Dr. John Elsen
Mr. and Mrs. Marvin Turner in memory of Ms. Esther Rudd Nease
Mr. Matt Olson in memory of Dr. John Elsen
Ms. Joyce M. Shaw in memory of Ms. Esther Rudd Nease
Ms. Jay Ann Sivits in memory of Dr. John Elsen
Mr. and Mrs. James C. Nease in memory of Ms. Esther Rudd Nease
Mr. and Mrs. Mike Reinders in memory of Dr. John Elsen
The Hart Family in memory of Ms. Esther Rudd Nease
Mr. J. Mark Vanderbeck in honor of Dr. and Mrs. John Esterhai
Mr. and Mrs. Jeff Combs in memory of Ms. Esther Rudd Nease
Mr. and Mrs. George Gunn, Jr. in honor of Dr. and Mrs. John Esterhai
Dr. and Mrs. Peter Dawson in memory of Ms. Esther Rudd Nease
Ms. Fran Owen in honor of Dr. Randall Owen and Dr. Tioluwa Olokunde
Ms. Sherry Boulay in memory of Ms. Esther Rudd Nease
Mr. Charlie Westfall & Dr. Helen Kim in honor of Dr. Randall Owen and Dr. Tioluwa Olokunde
For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.
8 Today’s Christian Doctor Fall 16
transformations
Event Calendar
For more information, visit www.cmda.org/events. Global Missions Health Conference November 10-12, 2016 Louisville, Kentucky www.medicalmissions.com
Marriage Enrichment Weekends February 3-5, 2017 • Healdsburg, California March 24-26, 2017 • Healdsburg, California www.cmda.org/marriage
Northeast Winter Conference January 13-15, 2017 Harvey Cedars, New Jersey www.cmda.org/events
New Medical Missionary Training March 9-12, 2017 Abingdon, Virginia www.cmda.org/events
West Coast Winter Conference January 27-29, 2017 Cannon Beach, Oregon www.cmda.org/events
2017 CMDA National Convention May 4-7, 2017 Ridgecrest, North Carolina www.cmda.org/nationalconvention
Oxford Graduate School
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Stress, conflicts, problems; they are present too frequently in our personal life, family life, and workplace. The doctoral program at Oxford Graduate School grounds the students in the fundamentals of conflict resolution and problem solving. The scholarly program inculcates a disciplined approach, enabling the student to use Christian beliefs to effect change locally and globally. The masters program uses Christian beliefs to train the student in Organizational Leadership or Family Life Education. Spending two weeks per year on campus allows the missionary, the dentist, or physician to prepare for a career change or continue current pursuits without interruption.
For more information visit
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Loren Humphrey, MD, PhD Member CMDA Chairman, Board of Regents Oxford Graduate School Christian Medical & Dental Associations www.cmda.org 9
transformations
SEEN & HEARD VOICES OF CMDA
Voices of CMDA in Ministry “It was great getting to meet you this past weekend at CMDA headquarters. I wanted to thank you and the team again for all the hard work put into making this event possible. Having just started working in the clinic at school a few weeks ago, I had been in desperate need of receiving advice from other followers of Christ.” —A dental student at the Emerging Leaders in Dentistry Symposium “Thank you for standing with us in defense of women’s health. As you know, the Supreme Court heard oral argument on challenges to our state’s abortion clinic safety bill (H.B. 2) on March 2. As I listened to the oral argument in Washington, D.C., it was clear to me that the amicus briefs filed in support of the State of Texas, and women everywhere, made a significant impact on the Court. We appreciate your participation in the amicus brief efforts that buttressed our case.” —A CMDA partner in Texas “Our chapter serves as a great support to those students who are involved, especially in dealing with a dental and medical educational environment where Christianity is not well represented.” —A CMDA student leader “Thank you for your statement on artificially administered nutrition and hydration. It fits with my understanding of the Bible, my own ethical sense and my experience as an RN in rehab and long-term care. In the past I’ve seen Christian and politically conservative statements that are obviously not written by anyone who does any patient care, that encourage any and all ANH.” —A CMDA member
Download the CMDA app
10 Today’s Christian Doctor Fall 16
Voices of CMDA in Missions “This lovely lady accepted Jesus while riding the bus with our team. At some point, she was (and conceivably might still be) a communist party member. But this day, she was born again! Without a doubt, our scientific activities, actions, prayers, etc., these showed love in action which is close to being Jesus for our colleagues. She was transformed through the power of the Holy Spirit as he led her through the sinner’s prayer and her tearful acceptance of Christ. I sit here imagining the impact this conversion will have on her family, friends, colleagues, nurses, staff, residents, students, hundreds of patients, maybe thousands counting family members. WHAT IMPACT! In a lifetime, she could touch thousands with the gospel, which is why Jesus chose twelve to teach the world.” —A team leader on a MEI trip to Cuba “I initially struggled with being able to properly help everybody, with not having all equipment I needed or enough time to be able to really solve the problem. But I learned that it was okay to just do the best I could do in the situation I was in, because it was more important to just be able to share and introduce them to Jesus Christ and the medical aspect of the trip was secondary.” —A physical therapist on a GHO trip to Indonesia “Thanks for your encouragement and enduring prayer. When we are constantly homesick, it points us to our true home, which is not here on earth. In some ways it also reflects our hearts, how we always long for something else than where we are at. The grass on the other side is always greener. It reminds us to cease complaining when things get a bit rough but instead be thankful for the moment and season in life He has given us.” —A long-term missionary serving in Papua New Guinea “We did outreach events in a couple of the Cuban churches. There were several physicians—some Christians, some not believers. I was able to share my testimony. We also heard a powerful testimony from a physician who in the early 1980s had worked with the government to rid medical schools of Christians and find incriminating evidence against Christians. She shared that through her own personal battle with ovarian cancer she accepted Christ and how her life and attitude changed!” —A team member on a MEI trip to Cuba “I realized that I had wandered away from God and have rededicated myself to being a better witness and to participate in activities such as Bible studies that will put me in contact with other believers and provide accountability. I learned I was obsessed with being in my comfort zone rather than making myself FULLY available to be placed where I was needed.” —A medical student on a GHO trip to Nicaragua
??? HAVE YOU BEEN
TRANSFORMED? ARE YOU
TRANSFORMING OTHERS?
We want to hear from you Send your transformation story, letter or photos to communications@cmda.org or to P.O. Box 7500, Bristol, TN 37621. Please include an email address for us to contact you.
We want to hear your story It can be a simple comment about a CMDA ministry; it can be an account of your experiences on a missions trip; it can be a profile of a member who has had a huge impact upon you; it can be photos from a campus meeting; it can be statistics showing how your trip served the needy; it can truly be anything— we want to see how your work is making a difference.
We want to hear your ideas Do you have a great idea for Today’s Christian Doctor? Send your ideas to communications@cmda.org.
TRANSFORMATIONS SHOWCASING THE IMPACT OF CMDA ONE STORY AT A TIME
Christian Medical & Dental Associations www.cmda.org 11
cover story
Ripple Effects:
Steury Scholarship The
by David Stevens, MD, MA (Ethics)
Pictured: Steury Scholarship recipients Drs. Benjamin and Katherine Radcliffe and their four children. Photo courtesy of Larisa Radcliffe, White Tree Photography.
INTER ACTIVE Visit www.cmda.org/scholarships to learn more about other scholarship opportunities through CMDA. 12 Today’s Christian Doctor Fall 16
I
n our first million years in heaven, I think we are going to find out all of the things we said or the things we did that impacted people’s lives here on earth—off-handed comments we spoke in passing, events we had no idea happened, actions we never considered to be important that God used for His glory. After our first term on the mission field, I was standing in the foyer of an auditorium with a large group of missionaries from numerous countries. We were waiting to march down the aisle carrying our service country’s flag in great pageantry to illustrate the needs of a lost world. A young woman standing behind me tapped me on the shoulder and said, “You don’t know me, but my husband and I are going to the mission field because of you.” That was a pretty good conversation starter, wasn’t it? She shared that she had attended a service I preached at four years earlier. I remembered the service because many people came to the altar to make commitments that night, but she said, “I wasn’t one of them because I knew my husband and I needed to answer God’s call together. So, I bought the recording of your sermon, took it home and we listened to it together at our kitchen table. Afterward we talked, prayed, cried and committed our hearts to the Lord to serve Him overseas.” Prior to that chance meeting, I had no idea God had done His work in this couple’s lives. I probably won’t see the two of them again until we gather before the throne of God, and I will never meet or know the people who have been transformed through their service. And that doesn’t even begin to consider who those people then impact. That’s how God works. Most of the time, we only get to see small snapshots just like this of how God is using His people to spread the gospel around the world. But sometimes God gives us a more complete picture of the ripple effects. Dr. Ernie Steury was a pioneer healthcare missionary who arrived in Kenya in 1959 to begin turning a small nurse-run clinic with a few patient beds into one of the largest and best-known mission hospitals in the world. For his first 10 years of service in Kenya, though, he was the only physician and was on call 24 hours a day, seven days a week. My parents financially supported Ernie and his wife Sue in their mission efforts, and they had supported them since they left for the mission field. So when God called me into missionary service, my dad encouraged me to spend the summer of 1972 in Kenya working with Ernie because, as he said, “Of all the missionary doctors
I know, Ernie is the finest.” He was right. Little did my dad or I realize Ernie would become my role model and mentor. I spent my time in medical school and residency preparing to return to Kenya and serve with Ernie. After I arrived in Kenya as a career missionary in 1981, the nationals gave me a great honor. They named me “Arap Mosonik,” which means the Son of Mosonik, Ernie’s Kipsigis name. A very heart-felt appreciation from our family goes to the Steury committee, which has enabled us to pursue our God-given call into medical missions. We thank you for your prayers and considering our family as we continue service in Papua New Guinea. —Mark and Esther Crouch Ernie was living in a retirement community many years later when I had the privilege to interview him and share his inspiring story on Christian Doctor’s Digest. He shared his testimony of God’s grace working through him, a poor farm boy of Swiss decent who didn’t learn to speak English until he started school. As Ernie shared, he related how he was so poor he couldn’t afford medical school after college. He learned that World Gospel Mission, a mission sending agency based in Indiana, was looking for a doctor to serve at Tenwek. So he wrote World Gospel Mission to see if Christian Medical & Dental Associations www.cmda.org 13
year they served overseas. Otherwise the loan would need to be paid back with interest to help another student go overseas. The first scholarship recipient in 2001 had to be selected quickly since school was about to start, so I picked CMDA’s former Northeast Regional Director Scott Lawrence who had felt God’s call to long-term missions and was starting medical school a few months later. In the subsequent years since then, CMDA has run an extremely competitive process that includes submitting an application, financial records, recommendations, personal testimony and other supporting documents. Deb Joseph, Ernie and Sue’s daughter, and Dr. Jim Foulkes, Ernie’s friend and retired Through their constant devotion and commitment to God’s call to long-term healthcare missionary physician, joined me missions, Dr. Ernie and Mrs. Sue Steury greatly impacted the lives of each of the families on the selection committee. We profiled in this article. Pictured throughout this article are recipients of the Steury Scholconsidered the selection to be the arship over the years. hardest decision we made each year. We spent hours “grading” 20 they could provide any financial help for a medical to 35 sets of application materials to student who was committed to serving with them in narrow it down to three finalists who came for a day Kenya. They wrote back to say they regretfully had no of interviews with the committee members before our funds but would pray for God to provide. selection was made. And that is exactly what God did. A few months later, they wrote Ernie to tell him an anonymous donor would pay his tuition to go to medical school. Ernie said, “Without that support, I would never have made it to the mission field.” Thousands of healthcare professionals heard that interview with Ernie, and everyone who heard his story was moved. One listener was moved in a way I never expected, a way that is still sending ripples around the world. It was such an extraordinary decision that I about fell out of my chair when I got the phone call. An ER physician who heard the interview called and said God wanted him to give a $100,000 scholarship each year to a student going into full-time missions to help pay their tuition, book costs and fees for medical school. And thus the “Dr. and Mrs. Ernest Steury Medical Student Scholarship Fund” was born. More accurately it should be called the “Loan/Scholarship” fund because 20 percent of the loan turned into a scholarship for every 14 Today’s Christian Doctor Fall 16
One of the biggest blessings at Kudjip Nazarene Hospital has been the staff we work with. There are so many dedicated and compassionate caregivers who provide countless hours of service showing our patients the love of Christ. This year due to political problems in Papua New Guinea, the hospital’s budget for staff and salaries was cut significantly. Many of the staff voluntarily took pay cuts and worked without pay to keep the doors at Kudjip open. What a humbling and aweinspiring example they have set for us. The example of these dear friends and national co-workers has been a profound blessing in our lives. The adventure of walking with Jesus is never boring! We pray that we will continue to be faithful to follow in His steps as we minister to the people of Papua New Guinea. —Benjamin and Katherine Radcliffe We then mentored each recipient as they began their long road of training, up to a dozen years, before they arrived overseas. Let me share about a few of these extraordinary recipients.
Scott and Tina Lawrence— Scott completed his residency and then a fellowship in ophthalmology before becoming an assistant professor at the University of North Carolina. Yes, it was a more circuitous route to the mission field, but he and a colleague felt God’s call to start the Discovery Eye Institute, a treatment and training center in Addis Ababa, Ethiopia. Having academic credentials and experience were a prerequisite to moving their families there in 2015 to, as Scott described it, “demonstrate the love of God through healing the blind, caring for the poor, giving hope to the hopeless and mentoring future leaders in eye care.” They will be doing research, providing in-service training to national ophthalmologists, starting a residency program and sharing the gospel. God is already blessing their efforts. “C”— Many members of this OB/Gyn physician’s extended family are missionaries, starting with her grandparents and most of her uncles and aunts. Their calling had been South America, but she felt God’s call to serve in Muslim countries. She is now in the Middle East providing compassionate and loving care to women. Benjamin and Katherine Radcliffe— This couple is serving the Lord at Kudjip Hospital in Papua New Guinea. They are both physicians, but Katherine is focused on taking care of their rapidly expanding family. Her third pregnancy was a set of twin girls delivered
at 33 weeks back in the U.S. by C-section this year. NICU for the babies and complications for Katherine has delayed their return to Kudjip, but they recently returned to the mission field. Benjamin is a missionary kid and a surgeon. In fact, his parents serve as Kudjip as well, where his dad is a general surgeon. I’m often reminded of the two weeks I spent in Africa in September and how I realized in those two weeks that my life on a day-to-day basis looks very similar to the moms’ lives living there. Trying to raise kids to know the Lord, trying to get together with friends who don’t know Him, trying to live in such a way as to sacrifice and lay down my desires and hopes and schedule to be flexible and available and show the love of Jesus in a way that is understandable. Trying to learn and study and have conversations that make clear the difference of trusting Jesus and His finished work versus trying to live by the law. —Mike and Noelle Lee Mark and Esther Crouch— Speaking of Kudjip, Mark, a family practice physician, and his family are now in their second term at the same hospital with their growing family. Mark is working on his master’s in public health, seeing patients and also supervising their clinical training program. He is the son of Dr. John
Christian Medical & Dental Associations www.cmda.org 15
2016 Steury Scholarship Winner
T
his year’s Steury Scholarship was awarded to Paul and Kathryn “Kate” Abraham. Paul graduated with a bachelor of arts in religious studies from Rice University in Houston, Texas in 2013. Both Paul and Kate are now medical students at UNC Chapel Hill in North Carolina. They welcomed their first child earlier this summer.
Paul and Kate met at a Christian Community Health Fellowship conference and discovered they shared a passion for international ministry. Kate was already in medical school at UNC Chapel Hill, so Paul transferred to the same school and they will both begin clinical rotations in 2017. Paul plans to focus on family medicine, while Kate wants to pursue women’s and children’s health.
Paul grew up in a Christian home and considers it a blessing he was born into a Christian family. He professed his faith in Christ at the age of nine. “I still remember the relief I felt two days later on the morning of September 11, 2001, knowing that even if the safety of my life on this earth was threatened, I would have eternal life with Christ,” he said.
“I believe that Kate and I have been called to healthcare ministry and that God has uniquely gifted us to be able to serve among populations that need to hear about the salvation that Christ offers. From urban Chicago to refugees in North Carolina, it has been a blessing for us to have various opportunities to share Christ’s love here in the United States. These experiences have taught us how to relate to families from different cultures and have begun to prepare us for engaging with communities overseas,” he said.
His parents were missionaries in India for 40 years, and growing up in a tight-knit South Indian Christian community placed heavy emphasis on mission work in India. A trip to India during college reminded him that addressing physical needs is not enough and Jesus’ primary ministry was also about meeting spiritual needs. After college, he was rejuvenated in his desire to serve Him, but was unsure whether to pursue medicine or seminary. He was led to spend a year in Chicago during which he lived with a team in a poor, urban neighborhood on the west side of Chicago. They pursued intentional relationships with their neighbors and served at Christian organizations that were seeking to build up the community physically, spiritually and emotionally. During his time in Chicago, he served as an operations intern at Lawndale Christian Health Center and found that God had blessed him with a mind suited to endure the rigors of medical school.
Crouch, who founded the In His Image family practice residency in Tulsa, Oklahoma. Esther is homeschooling their three children. Jeff and Grace Larson— They have been serving in domestic missions at Lawndale Christian Health Center while raising funds in preparation to move overseas. They plan to leave in January 2017, but like other missionaries where they plan to serve, they are having difficulty acquiring visas. They need your prayers for that aspect of the planning, their young family’s adjustment and language study. Grace delivered a baby girl in August and they also have a son. David and Jana Villanueva— They are getting close to heading overseas. David began an obstet16 Today’s Christian Doctor Fall 16
rics fellowship after his family practice residency completed this summer, while Jana finished her physician assistant’s training and is now practicing. They have two children and are seeking God’s direction on where He wants them to serve overseas. We have been learning as much as we can about providing holistic healthcare within a biblical worldview, as well as how to minister to locals. One of the conferences we had the privilege of attending was the New Medical Missionary Conference with CMDA. This conference was a wonderful time of fellowship with others at the same point in the journey just about to go overseas for the first time. —Jeff and Grace Larson
project is bigger than just them. I would estimate we have averaged 25 applicants a year who have deeply felt God’s call into long-term healthcare missions, which comes out to around 425 applicants in all. I wish we could have given each one of them a scholarship, but that has not deterred them from their purpose to serve Christ cross-culturally. Most are or will be serving overseas after they complete their training.
Paul and Kate Abraham— Paul and Kate are the 2016 recipients of the Steury Scholarship. Kate was a finalist for the scholarship a couple of years ago, and then she met Paul at a Christian Community Health Fellowship conference. They were married last year and had their first child earlier this summer. They live and minister in an apartment building filled with refugees in North Carolina as they finish their medical school training. They are not waiting until they finish training and travel overseas to do missions. Missions is not a place but a state of being. It seems that the farther along in training I get, the more challenging and rewarding each step is. The last several weeks in particular have been trying as I have finished my coursework and am now on the final leg of my pre-clinical years studying for the USMLE Step 1 boards. The study process has felt like a marathon, but I am continually reminded of the encouragement I have received from other doctors and students and the call to persevere with excellence in what Christ has called me to. God has continued to make clear His calling on Ashley and my life and, in particular, the call to demonstrate His love through medicine. And so while the preparation often feels tedious and leaves me drained, the labor has been an act of worship and one which God continues to bless. —Stephen and Ashley Trinidad This is only a sampling of the Steury Scholarship recipients over the last 17 years, but the impact of this
The last of the Steury Scholarship money was committed this year, but that it is not the end. It is just a milestone in the process. Just like you and I don’t know the full impact of our work in His service, the ripple effects of the ministry of those lives touched by this program who will each minister to tens of thousands of patients on far shores and influence their lives for Christ will only be known in eternity. And it all started with the story of one of God’s faithful servants, a story that motivated a faithful donor whose gift then enabled faithful responders to the Great Commission to go! God sends out the ripples of His love through faithful people like you and me who will say to Him what David wrote in Psalm 116:16, “Oh, God, here I am, your servant, your faithful servant: set me free for your service!” (MSG). Then He does great things and lets us be part of it!
About The Author
DAVID STEVENS, MD, MA (ETHICS), serves as the Chief Executive Officer for CMDA. From 1981 to 1991, he served as a missionary doctor in Kenya helping to transform Tenwek Hospital into one of the premier mission healthcare facilities in the world. Subsequently, he served as the Director of World Medical Mission, the medical arm of Samaritan’s Purse. As a leading spokesman for Christian healthcare professionals, Dr. Stevens has conducted hundreds of television, radio and print media interviews. He holds degrees from Asbury University, is an AOA graduate of University of Louisville School of Medicine and is board certified in family practice. Christian Medical & Dental Associations www.cmda.org 17
INTER ACTIVE Visit www.cmda.org/graceprescriptions for more information about learning how to share your faith in your practice.
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Praying With Our Patients by Walt Larimore, MD
“
Not to employ prayer with my patients was the equivalent of deliberately withholding a potent
”
drug or surgical procedure.
—Larry Dossey, MD
Christian Medical & Dental Associations www.cmda.org 19
W
e had completed a full workup for chronic pain for Susan, a patient of mine, and I could not find a physical or emotional etiology. Though she initially resisted discussing her social and spiritual health, she eventually became willing to talk after I questioned her again. She admitted her marriage was on the rocks. And while she was active in her church, she did not know the peace her pastor often spoke about. I asked Susan if she ever prayed about these things. She had not, but she said she was willing to. When I asked if I could pray for her, tears filled her eyes. As I prayed, an emotional floodgate opened in Susan’s heart. More than two years later, Susan’s chronic pain is now much improved. She points back to our time in prayer as the beginning of her healing. What do you think? Do you think it is appropriate for healthcare professionals to pray for or with their patients? Do you pray for or with your patients?
Spirituality in Practice
As we discuss in Grace Prescriptions and two previous articles published in Today’s Christian Doctor on this topic, researchers increasingly report evidence linking positive spirituality with health, calling it the forgotten factor in health and insisting the spiritual care of our patients should not be the exclusive domain of pastoral professionals. 1,2,3,4
In fact, significant evidence indicates all healthcare professionals should incorporate positive spirituality into their practices.5 A spiritual history or assessment is now considered a core clinical competency for quality care for all of our patients, not just for palliative care or end-of-life care.6,7,8,9 In fact, “the ability to identify and address patient spiritual needs has become an important clinical competency.”10 For Christian healthcare professionals in particular, prayer is one of the most potent spiritual interventions we can utilize with our patients, not only because it has been shown by research to provide comfort for patients, but because we understand it is ultimately God who heals (Exodus 15:26).
The Biblical Case for Prayer
As we see in Genesis 20:7, the first time God calls on a man to pray it is for physical healing. Scripture also provides these biblical reasons for our praying with and for our patients:
• God prescribes prayer for Christians (1 Thessalonians 5:16-18).
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• God prescribes prayer for the sick (James 5:14-15). • God prescribes prayer for our time of need (Hebrews 4:16).
• God cares about the physical world and human
bodies (Matthew 14:14; 3 John 1:2; 1 Thessalonians 5:23). • God hears and answers prayer (1 John 5:14-15). • Ultimate healing comes from a relationship with Christ (Isaiah 53:4-5; Revelation 21:3-5; John 6:44).
I Don’t Have Time to Pray1
Charles Hummel’s classic booklet, Tyranny of the Urgent, notes that the urgent and the important are seldom the same. What seems urgent seldom is. And we must refuse the urgent if we would do the important. It is the same with prayer. The busier we are, the more we need God’s strength. I can pick up a book by myself, but I need help to move a bookcase. The more you have to do, the more you need time with the One who can empower you to do it. Martin Luther translated the entire Bible into German, wrote hymns we still sing today and sparked the Protestant Reformation. He once said, “I have so much to do that I shall have to spend the first three hours in prayer.”
The Clinical Case for Prayer Randomized controlled trials are no help Along with these biblical admonitions, the research literature encourages us to pray with our patients. Several randomized controlled trials (RCTs) reported statistically significant effects with intercessory prayer, including a retrospective study completed 10 years after diagnosis.11 However, several RCTs have been negative, including the largest and most rigorous trial.12 (For a full list of these trials, please visit www.cmda.org/graceprescriptions.) Why the mixed results? Simply put, the scientific study of prayer’s efficacy in healing using RCTs is problematic. One group of researchers explained, “God may indeed exist and prayer may indeed heal; however, it appears that, for important theological and scientific reasons, randomized controlled studies cannot be applied to the study of the efficacy of prayer in healing.” They added, “In fact, no form of scientific enquiry presently available can suitably address the subject.”13 Why is this? According to a 2006 article published in Perspectives in Biology and Medicine, all of the published studies fail to meet RCT standards in several criti-
cal respects. Most importantly, each one of them fails “to measure and control exposure to prayer from others.”14 It would be like doing a RCT in Mexico in which we were trying to determine if an antibiotic worked for a particular common bacterial infection. We randomly and in double-blinded fashion give half the patients the active drug and half the patients a placebo. So far, so good. But the problem arises when we realize that antibiotics in Mexico are over the counter. Almost everybody has a supply in their home medicine cabinet. And with no way of knowing which of the patients are taking or being given an over-the-counter antibiotic, our study would be useless. Just like our antibiotic RCT would fail to measure and control for exposure from an over-the-counter antibiotic, the prayer RCTs “fail to measure and control exposure to prayer from others.”15 In their study published in the Indian Journal of Psychiatry, authors Andrade and Radhakrishnan said two important questions remain unanswered. First, if a RCT “on intercessory prayer is positive, does it suggest to us ways and means by which we can manipulate God or make His behavior statistically predictable?” Secondly, “Why would any divine entity be willing to submit to experiments that attempt to validate His existence and constrain His responses?”16
Health Professional’s Prayer
Lord, Great Physician, I kneel before You. Since every good and perfect gift must come from You, I pray give skill to my hand, clear vision to my mind, kindness and sympathy to my heart. Give me singleness of purpose, strength to lift at least a part of the burden of my suffering fellow men, and a true realization of the rare privilege that is mine. Take from my heart all guile and worldliness, that with the simple faith of a child I may rely on You. Patient agreement with a healthcare professional praying for them increases strongly with the severity of the illness setting: 19 percent agree with prayer during routine office visits, 29 percent in hospitalized settings and 50 percent in life-threatening scenarios.20 In addition, research indicates about 75 percent of physicians report that patients sometimes or often mention spiritual issues such as prayer. While two-thirds of U.S. physicians believe the experience of illness often or always increases patients’ awareness of and focus on religious and spiritual issues, about 75 percent of these physicians be-
Non-RCT Data Are Very Helpful
Even though the RCT data are not able to guide us as Christian healthcare professionals when it comes to whether we should or should not pray with patients, we can hang our hats on other significant data. Specifically, studies show that most of our patients draw on prayer and other religious resources to navigate and overcome the challenges that arise in their illnesses.17 Furthermore, religious beliefs and prayer are commonly used to endure the distress caused by health problems, giving meaning to illness, promoting hope for recovery and providing rituals and behaviors that bring individuals together and settle anxiety.18 In some areas of the country, 90 percent of hospitalized patients use religion, especially prayer, to enable them to cope with their illnesses, and more than 40 percent indicate it is their primary coping behavior.19 Christian Medical & Dental Associations www.cmda.org 21
5. The patient is then free to initiate the request for prayer at a later time or future visit, should they desire prayer with the healthcare professional. 6. In most cases, healthcare professionals should not ask patients if they would like to pray with them, but rather leave the initiative to the patient to request prayer. 23 However, CMDA has found that most members are comfortable praying with their patients in at least some clinical situations. Furthermore, after going through CMDA’s Saline Solution or Grace Prescriptions courses, Christian healthcare professionals seem even more willing and able to pray with patients. If you choose to offer to pray with patients, CMDA recommends considering the following prerequisites: 1. You should have taken a spiritual history. 2. The patient must either request or consent to prayer. 3. The situation calls for prayer. lieve prayer is positive in healthcare by helping patients cope and giving them a positive state of mind. In addition, 55 percent believe prayer provides emotional and practical support via the religious community.21 However, primary care physicians are divided about when and if it is appropriate. At least onethird of surveyed doctors sometimes engage in prayer with their patients; however, this number increased to more than 77 percent if the patient requested physician prayer.22
Cautions for Praying with Patients
When it comes to praying with patients, Duke University psychiatrist Harold Koenig, MD, suggests: 1. Contemplating a spiritual intervention (praying with patients) should always be patient centered and patient desired. 2. The healthcare professional should never do anything related to religion or spirituality that involves coercion. 3. The patient must feel in control and free to reveal or not reveal information about their spiritual lives or to engage or not engage in spiritual practices (i.e., prayer, etc.). 4. The healthcare professional, however, may inform religious or spiritual patients (based on the spiritual history) that they are open to praying with patients if that is what the patient wants. 22 Today’s Christian Doctor Fall 16
Discuss with the patient any specific prayer requests and specific people you can share the prayer request with (i.e., colleagues, prayer ministers at your church, etc.). Finally, it is critical you record the patient’s request or consent for prayer in the medical record and, of course, at all times, remember confidentiality.
The Lumberman26
newly-hired lumberjack cut down more trees on his first day than anyone else in the camp. The next day, he fell behind the others. By the third day, his production was so low the foreman asked for an explanation. A
“I don’t understand,” he said. “I’m working as hard as ever.” With a flash of insight, the foreman asked, “When last did you sharpen your axe?” “Sharpen my axe?” the lumberjack replied. “I don’t have time to sharpen my axe.”
Opportunities for Prayer WITH Patients
• Critical care, critical counseling or giving a critical diagnosis
• After the return of test results • During hospice or specialty referrals • Preventive care visits
• Prenatal visits or after the birth of a baby • Preoperative visits and hospital visits • Consider asking a patient pray with or for you (i.e., before a surgery or a procedure you’ll be performing on the patient)
Opportunities for Prayer FOR Patients • During your daily quiet time • While driving to and from work • With other believers at work or at worship • Via an electronic prayer memo
The Obligation
“…pray for each other so that you may be healed. The prayer of a righteous person is powerful and effective.” —James 5:16, NIV 2011 “To be a Christian without prayer is no more possible than to be alive without breathing.” —Martin Luther King, Jr. “Prayer can never be in excess.” —Charles H. Spurgeon “Men may spurn our appeals, reject our message, oppose our arguments, despise our persons, but they are helpless against our prayers.” — J. Sidlow Baxter For Christian healthcare professionals, not praying for and with their patients is as much spiritual malpractice as for pastors failing to pray for their flock. Larry Dossey, MD, wrote, “Not to employ prayer with my patients was the equivalent of deliberately withholding a potent drug or surgical procedure.”24 And for a patient who desires prayer, a Christian healthcare professional’s prayer may be as or more therapeutic than any other intervention we can offer. In a weekly devotion to CMDA members, Al Weir, MD, writes about the power of prayer: Adam sat across from me, two years out from a very severe illness. “You know, I contribute my healing to four things: the grace of God, the miracle of modern medicine, the support of family and friends and the power of prayer.” He then added after a pause, as if to avoid hurting my feelings, “And I sure thank you for what you’ve done.” I answered him, “I just work for the Boss; He’s the One who healed you.”
What We Can Pray for Others (Our Patients and Colleagues)27
• The Father would draw them to Himself (John 6:44) • They would seek to know God (Deuteronomy 4:29; Acts 17:27) and believe the Bible (Romans 10:17; 1 Thessalonians 2:13) • Satan would be restrained from blinding them to the truth (Matthew 13:19; 2 Corinthians 4:4) • The Holy Spirit would convict them of sin, righteousness and judgment (John 16:8-13) • God would send other Christians into their lives to influence them toward Jesus (Matthew 9:37-38) • They would believe in Jesus as their Savior (John 1:12; John 5:24) • They would turn from sin (Acts 3:19; Acts 8:22; Acts 17:30-31) and would confess Jesus as Lord (Romans 10:9-10) • They would yield their lives to follow Jesus (Mark 8:34-37; Romans 12:1-2; 2 Corinthians 5:15; Philippians 3:7-8) • They would take root and grow in Jesus (Colossians 2:6-7) • They would become a positive influence for Jesus in their realm (2 Timothy 2:2)
What We Can Pray for Ourselves
• We would do excellent work (Proverbs 22:29) • We would bring glory to God (Matthew 5:16) • We would treat people fairly (Colossians 4:1) • We would clothe ourselves with compassion, kindness, humility, gentleness and patience (Colossians 3:12) • We would have a good reputation with unbelievers (1 Thessalonians 4:12) • Others would see Jesus in us (Philippians 2:12-16) • Our lives would make our faith attractive (Titus 2:10) • Our conversations would be wise, sensitive, grace-filled and enticing (Colossians 4:5-6) • We would be bold and fearless (Ephesians 6:19) • We would be alert to open doors (Colossians 4:3) • We would be able to clearly explain the gospel (Colossians 4:4) • God would expand our influence (1 Chronicles 4:10)
Christian Medical & Dental Associations www.cmda.org 23
Not a bad quatrain for the wonder of healing. Those who follow the Christ should remember: • The grace of God • The miracle of modern medicine • The support of family and friends • The power of prayer
Summary
Eighteenth century pastor and theologian Samuel Chadwick wrote, “Satan dreads nothing but prayer. His one concern is to keep the saints from praying. He fears nothing from prayerless studies, prayerless work, prayerless religion. He laughs at our toil, he mocks our wisdom, but he trembles when we pray.” As Christian healthcare professionals, we have a powerful healing resource not all healthcare professionals know how to use—prayer. Use it! Intentionally, wisely and prayerfully. Biblography
1C rowther MR, Parker MW, Achenbaum WA, Larimore WL, Koenig HG. Positive spirituality: The forgotten factor. Gerontologist. 2002;42(5):613-20. tinyurl.com/jentnwn 2K oenig, HG. Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry. 2012. Article ID 278730. tinyurl.com/pr4xo7z 3 L arimore WL, Parker M, Crowther M. Should Clinicians Incorporate Positive Spirituality Into Their Practices? What Does the Evidence Say? Ann Behav Med 2002;24(1):69-73. tinyurl. com/ptocd55 4 L arimore WL. Providing Basic Spiritual Care for Patients: Should It Be the Exclusive Domain of Pastoral Professionals? (Medicine and Society) American Family Physician. 2000;63(1):36-40. tinyurl. com/hzcvbnj 5 L arimore WL, Parker M, Crowther M. Should Clinicians Incorporate Positive Spirituality Into Their Practices? What Does the Evidence Say? Ann Behav Med 2002;24(1):69-73. tinyurl. com/ptocd55 6G raham J. IOM Report Calls for Transformation of End-of-Life Care. JAMA. 2014;312(18):1845-1847. tinyurl.com/zhmaag6 7N ational Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 2nd ed. National Consensus Project for Quality Palliative Care. Pittsburgh, PA. 2009. tinyurl.com/nuv9e92 8 Larimore W. Spiritual Assessment in Clinical Care. Part 1—The Basics. Today’s Christian Doctor 2015(Spring):46(1):22-26. tinyurl. com/hkfnsn5 9 Larimore W. Spiritual Assessment in Clinical Care. Part 2—The LORD’s LAP. Today’s Christian Doctor. 2015(Fall);46(3):26-29. tinyurl.com/hkfnsn5 10 Katz PS. Patients and prayer amid medical practice. ACP Internist. 2012(Oct). tinyurl.com/92o5hws 11 Leibovici,L. Effects of remote, retroactive intercessory prayer on outcomes in patients with bloodstream infection: randomised controlled trial. BMJ. 2001;323:1450-1451. tinyurl.com/k96dey7 12 Benson, H, Dusek, JA, Sherwood, JB, et al. Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. American Heart Journal. 2006;151(4):934-942. tinyurl.com/cczxad 13 Andrade, C, Radhakrishnan, R. Prayer and healing: A medical and scientific perspective on randomized controlled trials. Indian Journal of Psychiatry. 2009(Oct-Dec);51(4):247-253. tinyurl.com/pbunadp
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14 Sloan, RP, Ramakrishnan, R. Science, Medicine, and Intercessory Prayer. Perspectives in Biology and Medicine. 2006(Autumn);49(4):504-514. tinyurl.com/q8yqwln 15 Sloan, RP, Ramakrishnan, R. Science, Medicine, and Intercessory Prayer. Perspectives in Biology and Medicine. 2006(Autumn);49(4):504-514. tinyurl.com/q8yqwln 16 Andrade, C, Radhakrishnan, R. Prayer and healing: A medical and scientific perspective on randomized controlled trials. Indian Journal of Psychiatry. 2009(Oct-Dec);51(4):247-253. tinyurl.com/pbunadp 17 Curlin, FA, Sellergren, SA, Lantos, JD, et al. Physicians’ Observations and Interpretations of the Influence of Religion and Spirituality on Health. Archives of Internal Medicine. 2007(Apr);167(7):649-654. tinyurl.com/phln4vg 18 Koenig, HG. Religious beliefs and practices of hospitalized medically ill older adults. International Journal of Geriatric Psychiatry. 1998(13):213–224. tinyurl.com/gn35yy4 19 Koenig, HG. Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry. 2012, Article ID 278730. tinyurl. com/o7ad6mn 20 MacLean, CD, Susi, B, Phifer, N, et al. Patient Preference for Physician Discussion and Practice of Spirituality. Journal of General Internal Medicine. 2003(Jan);18(1):38-43. tinyurl.com/on9v7pz 21 Curlin, FA, Sellergren, SA, Lantos, JD, et al. Physicians’ Observations and Interpretations of the Influence of Religion and Spirituality on Health. Archives of Internal Medicine. 2007(Apr);167(7):649-654. tinyurl.com/phln4vg 22 Monroe, MH, Bynum, D, Susi, B, et al. Primary care physician preferences regarding spiritual behavior in medical practice. Archives of Internal Medicine. 2003(Dec);163(22):2751-2756. tinyurl.com/qj9vhdm 23 Koenig, HG. Religion, Spirituality, and Health: The Research and Clinical Implications. ISRN Psychiatry. 2012, Article ID 278730. tinyurl. com/o7ad6mn 24 Dossey, L. Healing Words: The Power of Prayer and the Practice of Medicine. HarperOne, 1995. tinyurl.com/p4yl9dw 25 Denison, J. I am the bread of life. Denison Forum on Truth and Culture. September 14, 2015. tinyurl.com/j2ew2pn 26 Denison, J. I am the bread of life. Denison Forum on Truth and Culture. September 14, 2015. tinyurl.com/j2ew2pn 27 Adapted from: Hinckley, KC. Living Proof: A Small Group Discussion Guide. CBMC/NavPress, 1990. tinyurl.com/pekfwzd
About The Author
WALT LARIMORE, MD, is a lifetime member of CMDA. He has been named in The Guide to America’s Top Family Doctors, The Best Doctors in America, Who’s Who in Medicine and Healthcare and Who’s Who in America. He and his wife of 40 years, Barb, reside in Colorado and have been named Educators of the Year by CMDA. They are the parents of two adult children, the doting grandparents of two beautiful granddaughters and the adopted parents of Jack the Cat. Walt serves on the adjunct faculty of the In His Image Family Medicine Residency in Tulsa, Oklahoma, and he is the bestselling author of more than 30 books, 700 articles and 25 medical textbook chapters. You can find Walt’s daily health blog and devotions at www.DrWalt.com.
“As a resident member of CMDA, I immensely enjoy the fellowship, teaching, learning, growth, support and spiritual camaraderie in CMDA.” —Sherry-Ann Brown, MD, PhD
Why is CMDA so important? Dr. Sherry-Ann Brown has been a member of CMDA since she was a medical student. She understands the value of staying connected to a local group of Christian healthcare professionals who join together in community and fellowship. The ministry of CMDA helps her grow as a leader in her field, as a physician and as a Christian. Plus, she knows that she stands in unity with others who face persecution in healthcare for their faith.
Are you a CMDA member? There’s never been a better time to become a CMDA member. You can join Dr. Brown and more than 15,000 healthcare professionals across the country who are part of this growing movement to change hearts in healthcare.
Join CMDA today. Visit www.joincmda.org or call 888-230-2637 to join us today. P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.joincmda.org memberservices@cmda.org
Stay Connected During Residency and Fellowship $99 annual fee or $150 one-time resident or fellow payment
With our new membership package just for residents and fellows, you can stay connected with CMDA throughout your entire training program for one low fee. In addition to a reduced membership rate, you will also receive a variety of benefits and discounts while avoiding the hassle of annual renewal. Contact Member Services or visit www.cmda.org/premium for details. Paid Advertisement
Transgender Identification Ethics Statement
CMDA affirms the historic and enduring Christian understanding of humankind as having been created male and female. CMDA has concerns about recent usage of the term “gender” to emphasize an identity other than one’s biological sex, that is, a sense of self based on subjective feelings or desires of identifying more strongly with the opposite sex or with some combination of male and female.1,2,3,4,5 CMDA affirms the obligation of Christian healthcare professionals to care for patients struggling with gender identity with sensitivity and compassion. CMDA holds that attempts to alter gender surgically or hormonally for psychological indications, however, are medically inappropriate, as they repudiate nature, are unsupported by the witness of Scripture, and are inconsistent with Christian thinking on gender in every prior age. Accordingly, CMDA opposes medical assistance with gender transition on the following grounds.
A. Biblical
1. God created humanity as male and female (Genesis 1:27, 5:2; Matthew 19:4; Mark 10:6). God’s directives – to have dominion over the earth and to fulfill his goals of procreation, union, fellowship, and worship – are given to men and women together (Genesis 1:26-28, 2:18-24). 2. Men and women are morally and spiritually equal (Galatians 3:28) and are created to have roles that are in some respects alike and in other respects wonderfully complementary (Ephesians 5). (See CMDA statement on Human Sexuality) 3. All people are loved by God (John 3:16-17). All struggle with moral failure and fall short of God’s standards (Romans 3:10-12) and, therefore, need the forgiveness that God provides through Christ alone (John 3:36; Romans 3:22-24; Colossians 1:15-22; 1 Timothy 2:5-6). 4. We live in a fallen world (Genesis 3), and we are all fallen creatures with a sinful nature (Romans 3:9-12). The fall is expressed in nature and in humanity in many ways, including sexuality. Confusion of gender identity is but one example of the fall, as are also marital breakdown and sexual immorality (Romans 1:24-32; Ephesians 5:3). 5. A lifestyle that is directed by pursuing sexual desires or governed by personal sexual fulfillment6,7,8 misses the divinely ordained purpose of sex, which is for procreation and for facilitating unity in the lifelong commitment of marriage between one man and one woman, which fosters a secure and nurturing 26 Today’s Christian Doctor Fall 16
environment for children and which reflects the unity of Christ and the church (Exodus 20:1-18; Leviticus 20:10-21; Romans 1; Ephesians 5:23-33).
B. Biological
1. Sex is an objective biological fact that is determined genetically at conception by the allocation of X and Y chromosomes to one’s genome, immutable throughout one’s lifetime, and not a social construct arbitrarily assigned at birth or changed at will. 2. Human beings are sexually dimorphic. Male and female phenotypes are the outworking of sex gene expression, which shapes sex anatomy, determines patterns of sex hormone secretion, and influences sex differences in the development of the central nervous system and other organs. 3. Procreation requires genetic contributions from both one man and one woman. 4. Anomalies of human biological sex are an outcome of the fall and do not invalidate God’s design in creation.
C. Social
1. CMDA recognizes that gender identity issues are complex, and inclination to identify with the opposite gender may have biological, familial, and social origins that are not of the making of particular individuals.9 2. In our current social context there is a prevailing view that removing traditional definitions and boundaries is a requirement for self-actualization. Thus, Christian healthcare professionals find themselves in the position of being at variance with evolving views of gender identity in which patients seek validation by the medical community of transsexual desires and choices that may be socially approved but which are contrary to a Christian worldview. 3. In contrast to the current culture, CMDA believes that finding one’s identity within God’s design will result in a more healthy and fulfilled life. CMDA believes, moreover, that social movements which contend that gender is decided by choice are mistaken in defining gender, not by nature, but according to desire. Authentic personal identity consists in social gender expression that is congruent with one’s natural biological sex. CMDA recognizes that this traditional view has become counter-cultural; however, CMDA affirms that God’s design transcends culture. 4. CMDA is concerned that efforts to impose transgender ideology on all society by excluding, suppressing, marginalizing, intimidating, or portraying as hateful
those individuals and organizations which, on scientific, moral, or religious grounds, reasonably disagree, are contrary to the freedoms of speech and religious liberty that lie at the very foundation of a just and democratic society.10,11 5. CMDA is concerned that efforts to compel healthcare professionals to affirm transgender ideology, provide medical legitimization for transgender psychology, or cooperate with requests for medical or surgical sex reassignment threaten professional integrity.
D. Medical
1. Among individuals who identify as transgender, use cross-sex hormones, and undergo sex reassignment surgery, there is well-documented increased incidence of depression, anxiety, suicidal ideation, substance abuse, and risky sexual behaviors.12,13,14,15,16,17,18,19,20,21 Patients’ gender-altering and sexual encounter choices are among the factors relevant to these health disparities in transgender patients as compared to the general population.22,23,24 2. Hormones prescribed to a previously biologically healthy child for the purpose of blocking puberty inhibit normal growth and fertility.25 Continuation of cross-sex hormones, such as estrogen and testosterone, during adolescence is associated with increased health risks including, but not limited to, high blood pressure, blood clots, stroke, and some types of cancer.26,27,28,29 3. Although current medical evidence is incomplete and open to various interpretations, some studies suggest that surgical alteration of sex characteristics has uncertain and potentially harmful psychological effects and can mask or exacerbate deeper psychological problems.30,31,32 4. Transient gender questioning can occur during childhood. There is evidence that gender identity has some degree of malleability and is influenced by psychosocial experiences, including therapeutic interventions.33,34,35,36,37,38 5. CMDA recognizes that exceedingly rare abnormalities exist in which chromosomal and phenotypic sex characteristics are in discord. These disorders of sex development include congenital adrenal hyperplasia, ambiguous genitalia, and androgen insensitivity syndrome. Treatment of these disorders differs categorically from transgender interventions, which are performed on persons whose sex phenotype is in agreement with their chromosomal sex designation.
E. Ethical
1. Medicine rests on science and should not be held captive to desires or demands that contradict biological reality. Sex reassignment operations are
physically harmful because they disregard normal human anatomy and function. Normal anatomy is not a disease; dissatisfaction with natural anatomical and genetic sexual makeup is not a condition that can be successfully remedied medically or surgically. 2. The medical status of gender identity disorder as a mental or psychosocial disorder should not be discarded on the basis of social activism. 3. For Christians struggling with transgender inclinations, spiritual, psychological, and social support are needed, as attempts to change gender through hormonal or surgical interventions only lead to further spiritual turmoil and distress. 4. CMDA is especially concerned about the increasing phenomenon of parents of children who question their gender intervening hormonally to inhibit normal adolescent development.25,39,40,41,42,43 Children lack the developmental cognitive capacity to assent or request such interventions, which have lifelong physical, psychological, and social consequences.44 5. The purpose of medicine is to heal the sick, not to collaborate with psychosocial disorders. Whereas treatment of anatomically anomalous sexual phenotypes is restorative, interventions to alter normal sexual anatomy to conform to transgender desires are disruptive to health.45 6. The inability of men, including men who identify as women, to bear children is not an illness to be remedied by medical or surgical means, such as uterus transplantation. 7. Many diseases affect men and women differently, according to biological sex phenotype. Transgender designations may conceal biological sex differences relevant to medical risk factors, recognition of which is important for effective healthcare and disease prevention. As accurate documentation is necessary for good patient care, healthcare professionals should document patients’ biological sex and any alterations of gender characteristics factually in the medical record.
CMDA Recommendations for the Christian Community
1. A person struggling with gender identity should evoke neither scorn nor enmity, but rather our concern, compassion, help, and understanding. Christians must respond to the complex issues surrounding gender identity with grace, civility, and love. 2. The Christian community must help society understand that gender complementarity and fixity are both good and a part of the natural order. CMDA is concerned that attempting to reconstruct gender as something that is fluid and changeable through technical means would have grave spiritual, emotional, cultural, and medical repercussions. Christian Medical & Dental Associations www.cmda.org 27
3. The Christian community and especially the family must resist stereotyping or rejecting individuals who do not fit the popular norms of masculinity and femininity. Parents should guide their children in appropriate gender identity development. For children who are experiencing gender identity confusion, the Christian community should provide appropriate role models and informed guidance. 4. The Christian community must condemn hatred and violence directed against those struggling with gender identity. Love for the person does not equate with support of the decision to change sex anatomy or gender identity. 5. For the sake of the common good, Christians should welcome inclusion of transgender individuals but oppose claims to grant special rights based solely on transgender identification. 6. The Christian community is to be a refuge of love for all who are broken – including sexually broken – not to affirm their sin, nor to condemn or castigate, but to shepherd them to Jesus, who alone can forgive, heal, restore, and redirect to a Godly, honorable, and virtuous way of life. God provides the remedy for all moral failure through faith in Jesus Christ and the life-changing power of the Holy Spirit.
CMDA Recommendations for Christian Healthcare Professionals
1. CMDA advocates culturally competent medical care of patients who identify as transgender. Such care requires our compassion, an open and trusting dialogue, a genuine effort to understand and respond to the patient’s psychological distress, and acceptance of the person without necessarily agreeing with the person’s ideology or providing a requested sex-altering intervention. 2. CMDA believes that the appropriate medical response to patients with gender confusion should be to support and encourage them in areas we can affirm and to help them understand themselves as people God loves and who are made in his image, even when we cannot validate their choices. We should validate their right as individuals in a free society to make decisions for themselves, while explaining that their right does not extend to obligating the healthcare professional to prescribe medication or perform surgical procedures that we believe to be harmful, such as interventions that deface, disfigure, or mutilate the patient’s biological sex. 3. CMDA believes that Christian physicians should not engage in hormonal and surgical interventions that alter natural sex phenotypes, as 28 Today’s Christian Doctor Fall 16
this contradicts the basic principles of Christian medical ethics, which regards medical treatment as intended to heal and not to harm. 4. CMDA believes that prescribing hormonal treatments to children or adolescents to disrupt normal sexual development for the purpose of gender reassignment is ethically impermissible, whether requested by the child or the parent. (See CMDA statements on Limits to Parental Authority in Medical Decision-Making, and Abuse of Human Life)
CMDA Recommendations Regarding Nondiscrimination
1. Mutual respect and civil discourse are cornerstones of a free society. The Christian healthcare professional should respect how a patient wishes to be addressed. 2. Christian healthcare professionals, in particular, must care for their patients with gender identity disorders in a non-judgmental and compassionate manner, consistent with the humility Jesus modeled and the love Jesus commanded us to show all people. 3. Those who hold to a biblical or traditional view of human sexuality should be permitted to question transgender dogma free from exclusion, oppression, or unjust discrimination. Healthcare professionals who hold the position that transgender identification is harmful and inconsistent with the will of God should not be stigmatized or accused of being bigoted, phobic, unprofessional, or discriminatory because of this sincerely held and widely shared belief. 4. To decline to provide a requested gender-altering treatment that is harmful or is not medically indicated does not constitute unjust discrimination against persons. CMDA affirms that healthcare professionals should not be coerced or mandated to provide or refer for services that they believe to be morally wrong or harmful to patients. (See CMDA statement on Healthcare Right of Conscience) 5. Healthcare professionals must not be prevented from providing counseling and support to patients who are experiencing confusion in regard to gender orientation and who request assistance with accepting and maintaining their biologic sex and gender identity.
Unanimously approved by the House of Representatives April 21, 2016 Ridgecrest, North Carolina
Bibliography 1 Stoller RJ. A contribution to the study of Gender Identity. Int J Psychoanal 1964; 45: 220-226. 2 Buchholz L. Transgender care moves into the mainstream. JAMA 2015; 314(17): 1785-1787. 3 Drescher J. Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD. Int Rev Psychiatry 2015; 27(5): 386-395. 4 Diamond M. Sex, gender, and identity over the years: a changing perspective. Child Adolesc Psychiatric Clin N Am 2004; 13(3): 591-607. 5 Green R, Money J. Incongruous gender role: nongenital manifestations in prepubertal boys. J Nerv Ment Dis 1960; 131: 160-168. 6 Lawrence AA. Autogynephilia: an underappreciated paraphilia. Adv Psychosom Med 2011; 31: 135-148. 7 Hsu KJ, Rosenthal AM, Miller DI, Bailey JM. Who are gynandromorphophilic men? Characterizing men with sexual interest in transgender women. Psychol Med 2015 Oct 26: 1-9. 8 Blanchard R. Varieties of autogynephilia and their relationship to gender dysphoria. Arch Sex Behav 1993; 22(3): 241-251. 9 Rosenthal SM. Approach to the patient: transgender youth: endocrine considerations. J Clin Endocrinol Metabol 2014; 99(12): 4379-4389. 10 First Amendment to the United States Constitution; Article 18 of the United Nations Universal Declaration of Human Rights. 11 Morabito S. The transgender war against human rights, science, and consent. The Federalist, February 23, 2016. Accessed at: http://thefederalist. com/2016/02/23/the-transgender-war-againsthuman-rights-science-and-consent/ 12 Bariola E, Lyons A, Leonard W, et al. Demographic and psychosocial factors associated with psychological distress and resilience among transgender individuals. Am J Public Health 2015; 105(10): 2108-2116. 13 Bauer GR, Scheim AI, Pyne J, et al. Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada. BMC Public Health 2015; 15: 525. DOI 10.1186/s12889-015-1867-2 14 Budge SL, Adelson JL, Howard KA. Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping. J Consult Clin Psychol 2013; 81(3): 545-557. 15 Dhejne C, Lichtenstein P, Boman M, et al. Longterm follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLoS One 2011 Feb 22; 6(2): e16885. doi: 10.1371/journal.pone.0016885. 16 Krehely J. How to close the LGBT Health Disparities Gap. Center for American Progress, December 21, 2009. “LGBT people are at a higher risk for cancer, mental illnesses, and other diseases, and are more likely to smoke, drink alcohol, use drugs, and engage in other risky behaviors.” Accessed at: https://www.americanprogress.org/wpcontent/uploads/issues/2009/12/pdf/lgbt_health_ disparities.pdf 17 Levine SB, Solomon A. Meanings and political implications of “psychopathology” in a gender identity clinic: a report of 10 cases. J Sex Marital Ther 2009; 35(1): 40-57. 18 Rajkumar RP. Gender identity disorder and schizophrenia: neurodevelopmental disorders with common causal mechanisms? Schizophr Res Treatment 2014; 2014:463757. doi: 10.1155/2014/463757. 19 Reisner SL, Vetters R, Leclerc M, et al. Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. J Adolesc Health 2015; 56(3): 274-279.
20 Rowe C, Santos GM, McFarland W, Wilson EC. Prevalence and correlates of substance use among trans female youth ages 16-24 years in the San Francisco Bay Area. Drug Alcohol Depend 2015; 147: 160-166. 21 Haas AP, Rodgers PL, Herman JL. Suicide attempts among transgender and gender non-conforming adults. The Williams Institute, January 2014. Accessed at: http://williamsinstitute.law.ucla.edu/ wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf 22 Centers for Disease Control and Prevention, About LGBT Health, March 25, 2014. “Differences in sexual behavior account for some of these disparities.” Accessed at: http://www.cdc. gov/lgbthealth/about.htm 23 Clements-Nolle K, Marx R, Guzman R, Katz M. HIV Prevalence, Risk Behaviors, Health Care Use, and Mental Health Status of Transgender Persons: Implications for Public Health Intervention. J Public Health 2001; 91: 915-921. “Many engage in behaviors that put them at risk for HIV.” 24 Bauer GR, Travers R, Scanlon K, Coleman TA. High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey. BMC Public Health 2012; 12: 292. “Several small- to moderate-size studies report high proportions of FTMs engaging in high-risk sex.” Accessed at: http://www.biomedcentral.com/14712458/12/292 25 Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal A, et al. Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2009; 94(9): 3132-3154. 26 Olson-Kennedy J, Forcier M. Overview of the management of gender nonconformity in children and adolescents. UpToDate November 4, 2015. Accessed March 20, 2016 at www.uptodate.com. 27 Moore E, Wisniewski A, Dobs A. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects. J Clin Endocrinol Metab 2003; 88(8): 3467-3473. 28 FDA Drug Safety Communication issued for testosterone products. Http://www.fda.gov/Drugs/ DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm161874.htm. 29 World Health Organization Classification of Estrogen as a Class I Carcinogen. Http://www.who. int/reproductivehealth/topics/ageing/cocs_hrt_ statement.pdf. 30 McHugh PR. Transgender surgery isn’t the solution. The Wall Street Journal, June 12, 2014. Accessed at: http://www.wsj.com/articles/ paul-mchugh-transgender-surgery-isnt-the-solution-1402615120 31 McHugh PR. Surgical sex: why we stopped doing sex change operations. First Things November 2004, pp. 34-38. Accessed at: http://www.firstthings.com/article/2004/11/surgical-sex 32 Köhler B, Kleinemeier E, Lux A, et al. Satisfaction with genital surgery and sexual life of adults with XY disorders of sex development: results from the German clinical evaluation study. J Clin Endocrinol Metab 2012; 97(2): 577-588. 33 Zucker KJ. Gender identity development and issues. Child Adolesc Psychiatr Clin N Am 2004; 13(3): 551-568. “... because GID seems to desist in most children, it seems that gender identity has some degree of malleability that likely is influenced by psychosocial experiences, including therapeutic interventions.” 34 Zucker KJ, Wood H, Singh D, Bradley SJ. A developmental, biopsychosocial model for the treatment of children with gender identity disorder. J
Homosex 2012; 59(3): 369-397. 35 Bradley SJ, Steiner B, Zucker K, et al. Gender identity problems of children and adolescents: the establishment of a special clinic. Can Psychiatr Assoc J 1978; 23(3): 175-183. 36 Zucker KJ. On the “natural history” of gender identity disorder in children. J Am Acad Child Adolesc Psychiatry 2008; 47(12): 1361-1363. 37 Zucker KJ, Bradley SJ, Doering RW, Lozinski JA. Sex-typed behavior in cross-gender-identified children: stability and change at a one-year follow-up. J Am Acad Child Psychiatry 1985; 24(6): 710-719. 38 Zucker KJ, Bradley SJ, Kuksis M, et al. Gender constancy judgments in children with gender identity disorder: evidence for a developmental lag. Arch Sex Behav 1999; 28(6): 475-502. 39 Adelson SL, American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter on gay, lesbian, or bisexual orientation, gender nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry 2012; 51(9): 957-974. 40 Khatchadourian K, Amed S, Metzger DL. Clinical management of youth with gender dysphoria in Vancouver. J Pediatr 2014; 164(4): 906-911. 41 Vrouenraets LJJJ, Fredriks AM, Hannema SE, et al. Early medical treatment of children and adolescents with gender dysphoria: an empirical ethical study. J Adolesc Health 2015; 57(4): 367-373. 42 Wiesemann C, Ude-Koeller S, Sinnecker GHG, Thyen U. Ethical principles and recommendations for the medical management of differences of sex development (DSD)/intersex in children and adolescents. Eur J Pediatr 2010; 169: 671679. 43 Smith WJ. Sex change treatment for 7 year olds! First Things blog, May 19, 2008. Accessed at: http://www.firstthings.com/blogs/ firstthoughts/2008/05/sex-change-treatment-for7-year-olds 44 Diamong M, Garland J. Evidence regarding cosmetic and medically unnecessary surgery on infants. J Pediatr Urol 2014; 10(1): 2-6. 45 Daly TTW. Gender dysphoria and the ethics of transsexual (i.e., gender reassignment) surgery. Ethics & Medicine 2016; 32(1): 39-53.
CMDA’S The POINT A weekly blog keeping you updated on emerging topics relevant to today’s issues in healthcare. Comment and join the discussion on a wide variety of issues. Plus, you’ll get a monthly recap email covering all the topics from the last month. Subscribe today at www.cmda.org/thepoint
Christian Medical & Dental Associations www.cmda.org 29
Combat
BURNOUT and Reclaim Your Calling by Errin Weisman, DO
30 Today’s Christian Doctor Fall 16
I
quit medicine. I was only five months out of residency and I was leaving medicine. I was finally a full-fledged physician with the big paycheck but absolutely no fulfillment. Not only did I leave the office night after night completely frustrated, hopeless and exhausted, I showed up each morning in the same state, if not slightly worse. The personal accomplishment of healing—gone. The enthusiasm of service—gone. The love of humankind—gone. I was drained and running on empty. I developed physical symptoms of headaches, palpitations and anxiety. But, honestly, the scariest part was I quit caring. It just became about ending the day, finishing one more chart, seeing one more patient now so at least it was one less tomorrow. No amount of incentives was going to bring me back. I had dedicated my heart, my soul and several years of my life to this honorable profession. I had even missed my children’s first words because I was at work. It was never supposed to “just be” my job. It was supposed to be my calling, and it had betrayed me. Does my story sound familiar to you? If you haven’t experienced burnout yourself, chances are pretty high you know a colleague, friend or family member who is going through it right now. As Christians in healthcare, we feel tremendous responsibility toward fulfilling our God-given calling of healing. We are determined to complete our work, no matter the cost at times. But somewhere in the hustle and bustle, we are letting our servants’ hearts and best of intentions become our greatest downfall. Our selfcare is forgotten in the effort to take care of “just one more.” We get busy, tired and stressed, and then we let our love of healing and joy of service become depleted by unending demands. Our cup runs dry. The light of our life literally burns out. Burnout is a buzzword in the healthcare world because our community is struggling. An increasing number of healthcare professionals are professionally, personally and spiritually trying to survive against daily demands while experiencing chronic fatigue, depression, anxiety, career and life dissatisfaction brought on by prolonged stress mixed with overworking. Sleepless nights, increased requirements, new stresses, full schedules and practically never-ending 24-hour patient access have left many totally incapacitated and ready to give up. Add on more clinical issues (like larger patient panels, electronic medical records and
patient satisfaction scores) along with family responsibilities, financial constraints and other obligations, it’s no wonder burnout is an epidemic sweeping through healthcare. Some blame system-wide issues like long work hours, bureaucracy, over-burdening of clerical work with increased patient care demands, etc. Others blame the inherit stressful nature of healthcare as a whole. No matter what the underlying diagnosis is, there is a widespread plague of premature career deaths of excellent healthcare professionals. Meager attempts are being made to “reduce dissatisfaction” or provide “a stress reduction approach.” Institutions and hospital systems are scrambling to find a solution to address burnout through resilience or wellness workshops, employer-provided counseling, stress management training or financial incentive programs. But burnout is not the disease; it is the symptom of an underlying pathology. And reducing stress is treating the symptom, like lowering hypertensive emergency to a less critical level. Lower stress takes a situation from terrible to just bad, from critical to manageable. But it’s not cured. To help with the problem, money is thrown at healthcare professionals like gauze piled on a gaping wound. However, just as gauze will not return blood back into circulation, I argue money will never increase or return fulfillment. Treating the burned-out physician with more money, breathing exercises to reduce stress or required attendance at another in-service is missing the mark. Most of us did not enter into this career for the money. No amount of dollar signs can be placed on the art of healing and human life. Degrading our art to a paycheck feels cheap, like being a prostitute to the health system. Christian Medical & Dental Associations www.cmda.org 31
So, some physicians leave. They amputate themselves from the situation, cutting their losses. By removing the gangrenous foot, the rest of the body is spared. However, there is a net overall effect: loss to themselves, their current patients and any future patients. Others see no end, resorting to suicide. An estimated 400 U.S. doctors kill themselves every year, and the numbers are climbing even among healthcare students who have yet to start careers. And I understand why. During my “dark days,” an older colleague said, “We would hope to keep you, Dr. Weisman, for the length of your long 30+ year career.” My thoughts, “30 years of this hell? How am I supposed to suffer through!?” For a brief moment, death seemed like the only way out. Perhaps it is time to approach burnout on an individual basis, allowing for the healthcare professional battling burnout to take an extremely personal approach to address the exact issues pertaining to them. For me, I did what any good physician would do and started searching for answers because, at my core, I knew my career wasn’t over. I never have been and never will be a quitter. In my searching, I found others just like me, and through
Proverbs 27:23
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32 Today’s Christian Doctor Fall 16
continued exploration, I discovered help through professional coaching. Coaching is a partnership that focuses on developing specific, meaningful changes in the life of the person being coached. In essence, coaching is a process that helps individuals get from where they are to where they want to be. Coaches in CMDA’s Life & Leadership Coaching ministry help healthcare professionals focus on the future, changes they wish to make, goals they want to accomplish and the specific ways to achieve those results. To do this, they use powerful questions like those below to generate solutions. •W here in my current circumstances am I living out my beliefs or purpose? Where am I not? • I n what ways has my work life slowly encroached into areas I hold sacred? •H ow do I know if I am living in the middle of God’s will, dwelling in His power, abiding in His presence? Am I there now? What are some steps I can take to achieve this? •W here might God be calling me to reclaim my priorities? What boundaries have I let become compromised and slip that need to be reinstated? •W hat changes am I willing to make to realign my current life with one that fulfills my purpose? If you are experiencing something similar, let me share a few truths to encourage and support you. •O nly the Great Physician can be on-call 24 hours every day. •G et back to the basics. Love, trust and abide in God first, then love others (Matthew 22:37-40). •R emember that God sometimes gives us exactly what we want just to show us it’s not at all what we need (Philippians 4:11). •W e were never created to live defeated, depressed, condemned, guilty, stressed or unworthy. We were made with a purpose to be victorious through Christ (Romans 8:37; 2 Corinthians 12:10). • E ach of us has a calling, but not all of us have a job that is our calling (Psalms 143:8). •D on’t get busy making a living and forget to make a life (Proverbs 16:3). •Y ou can’t effectively serve if you have nothing left to give (Isaiah 41:13). •D o not lose heart if you are experiencing hopelessness, brokenness, feelings of emptiness or inadequacy. God is with you (Matthew 11:28-30). •G od can use even the smallest amount of faith (Matthew 17:20). Through coaching, I refocused, redefined and clarified. My life is not perfect now, but it’s certainly a long way
from what it was. It’s a daily process to remain balanced and focused on my true purpose. By the grace of God, working with a professional coach and intentionally changing my practice, I’m still practicing, but I’m practicing differently. I lived through burnout, and I’m better. If any of this rang true with you, I encourage you to take an introspective look by asking yourself some clarifying questions. Then, determine what you can do to help yourself. Maybe you can seek out help by reconnecting with your local church or CMDA group. Perhaps it’s time you participate in a healthcare mission trip or local service project. Consider taking some days off or changing your current schedule. Maybe just simply turning off your cell for a few silent minutes can be helpful. Whatever you believe can help, try it. You do not have to remain stuck; burnout does not have to define you. And remember, you are not alone. Psalm 34:18 says, “The Lord is near to the brokenhearted and saves the crushed in spirit” (ESV). Zephaniah 3:17
tells us God is always in our midst, He is the mighty one who will save us. He is near, ready to strengthen you, help you and hold you up with His righteous right hand (Isaiah 41:10). So don’t give up. Don’t let burnout steal your passion and your joy. Trust in Him, and start taking steps to combat the burnout and rediscover your calling to serve Christ in healthcare.
About The Author
ERRIN WEISMAN, DO, is a family physician and fierce advocate for better health and wellness among healthcare professionals and working moms. She lives and practices in rural Southwestern Indiana and loves her roles as farmer’s wife and mother of three. She can be visited at Truth Prescriptions at www.truthrxs.com, Facebook or Instagram.
How Can Coaching Help? by Ken Jones, PCC Professional Certified Coach • CMDA Director of Coach Training CMDA’s Life & Leadership Coaching ministry has certified Christian coaches who are trained to coach Christian healthcare professionals. Here are some specific ways our CMDA coaches help you address the challenges of burnout: 1. Address the difference between what can be changed and what can’t be changed. In his book Man’s Search for Meaning, Victor Frankl said that when we aren’t able to change our situation, the challenge is to change ourselves. Working with a coach helps you examine your own life, looking at areas that need to be addressed and exploring ideas for change within. 2. Move from where you are to where God wants you to be. A coach works with you in producing specific and actionable steps for seeing real change that can be measured, producing accountability for results. 3. See things from a new and different perspective. The psalmist David wrote, “I have calmed and quieted myself…” (Psalm 131:2, NIV 2011). Coaches help reframe and shift the focus on life situations. Many times, it’s difficult to see “the forest for the trees.” Working with a coach is a great tool for sorting issues out. 4. Deal with personal issues confidentially in a non-judgmental atmosphere. Few healthcare professionals experiencing burnout have any avenue for processing life issues, without fear of being graded, evaluated or having to protect themselves from criticism. Coaching is a non-judgmental and strictly confidential relationship in which you can transparently address issues like depersonalization, loss of influence or purpose and meaning.
5. F ocus on a new path, not re-hashing old wounds. Coaching helps address burnout because its focus is movement forward. Coaching is not therapy. The role of the coach is to come alongside you to explore and develop new paths for leading a fulfilled and balanced life. 6. H elp design margin. Achieving margin in the lives of healthcare professionals who are experiencing burnout is a real challenge. Coaching can help you develop a sense of mindfulness and broaden your view of yourself and your world, looking for specific avenues for change in perspective, ways of living and creating margin. 7. O ur coaches pray. Most healthcare professionals don’t have someone who faithfully prays for them. One of the great privileges of Christian coaching is that our CMDA coaches pray for their clients. The apostle Paul knew a secret. He wrote to the Philippians, “…I have learned the secret of being content…” (Philippians 4:12, NIV 2011). But the source for what he learned flowed from his inner man and the spiritual reservoir that is Jesus. “I can do all this through him who gives me strength,” he writes (Philippians 4:13, NIV 2011). The praying makes all the difference.
INTER ACTIVE Visit www.cmda.org/coaching for more information about working with a CMDA coach.
Christian Medical & Dental Associations www.cmda.org 33
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34 Today’s Christian Doctor Fall 16
Family Practice — Family practice physician needed in rural Northeast Oregon. Wallowa Memorial Hospital / Mountain View Medical Group is looking for a family practice or FP/OB physician to provide care in our RHC, ER and hospital. Within Wallowa County community there are 12 providers. Our medical group has three family practice physicians (FP and FP/OB), a family nurse practitioner and a general surgeon. Loan repayment option. Great compensation and benefits! WMH is a highly recognized rural/critical access hospital. Our mission is to provide premier healthcare for Wallowa County. Contact Larry Davy at 541-426-5301, email larry.davy@wchcd. org and website www.wchcd.org. Gastroenterology — Christian gastroenterology specialist group with two MDs, two NPs seeking a third gastroenterologist. Call 1:3 or 1:4. Ambulatory center and practice partnership in one year. BC/BE desired. Space Coast of Florida location. Available now. Reply to jessiemccoskey@yahoo.com. Infectious Diseases — Christian medical school seeking infectious diseases physicians — Loma Linda University Faculty Medical Group in Loma Linda, California is offering positions for full-time BE/ BC infectious diseases faculty and hospital epidemiologist. We welcome the application of fellows and experienced physicians. Our faith-based multi-specialty group is affiliated with Loma Linda University School of Medicine, which is dedicated to the formation of Christian physicians. The school is affiliated with mission hospitals worldwide. The campus houses a Center for Spiritual Life and Wholeness and a Global Health Institute. Our mission is to make man whole by continuing the healing ministry of Jesus Christ. The candidate will participate in hospital consultation, clinic and medical education. Basic science teaching is an option. The ID Division manages electives and pathways in tropical medicine, global service and HIV medicine. See full ad on our job board. Darren Thomas, Physician Recruitment Coordinator, recruitmd@llu.edu.
Pediatrics — BE/BC pediatrician needed for busy practice in Southeast Mississippi — Hattiesburg Clinic, one of the largest physician-owned and directed multi-specialty groups in the Southeast, is seeking a Christian, family-oriented, BE/BC pediatrician with a desire to join a well-established pediatric practice with 9 physicians. Weekday and weekend call is currently 1:7. Hattiesburg Clinic offers pediatric care, as well as 45 different specialty services provided by 265 physicians, to over 525,000 patients in our community and the surrounding counties. Excellent compensation and benefits package offered, including relocation expenses. For more information, contact Glenda Sharp, Physician Recruiter, at 601579-5008 or 601-606-5941, or via email at glenda.sharp@hattiesburgclinic.com. Psychiatric Nurse Practitioner or Psychiatrist - Doorways is a faith-based outpatient counseling clinic focused exclusively on treating 13 to 25 year olds in Phoenix, Arizona. We are seeking a PMHNP or psychiatrist to provide psychiatric care. More: DoorwaysArizona.com/pmhnp
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HEALING THE HURTING, BUILDING HEALTHY COMMUNITIES AND TRANSFORMING LIVES SINCE 1981
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Family Medicine — Family medicine physician needed in Minnesota — Have a great career and family time too in this quaint community with lots of character. Full spectrum family medicine 4 MDs, 1 CNM, 4 APPs, new hospital and clinic under construction, MDs all do OB, C/S needed, Call 1:5, HPSA score of 14, loan repayment options, sign on bonus, residency stipend, loyal and growing patient population, part of CentraCare Health, EMR is EPIC. Long Prairie, Minnesota is a community in Central Minnesota, 60 minutes from St. Cloud and 120 minutes from Minneapolis. Private and public school options. Lake, country or city living for a balanced lifestyle. Contact: Cassie Tinius, Physician Recruiter, CentraCare St. Cloud Hospital, 320-6567085, tiniusc@centracare.com.
Family Practice — LifeCare Family Medicine, a busy, well-established family practice in the heart of the Great Plains, Bellevue, Nebraska. Our mission is to give quality care to the whole family. Seeking a full-time family practice physician for outpatient and inpatient care. We are 100% physician owned, located in the Nebraska Medicine of Bellevue hospital. If interested, email your resume to pam@lifecarefm. com or call 402-779-7207. See our website http://bellevue-doctors.nebraskamed.com.
MEDICINES FOR MISSIONS
Family Medicine — Family medicine physician interested in OB and inpatient care in Montana — The Bozeman Clinic is a wellestablished independent family medicine clinic located in Southwest Montana in the beautiful Gallatin Valley. We are a group of seven board certified Christian family physicians whose mission is to provide our patients with compassionate, comprehensive healthcare throughout every stage of life. We are seeking a new physician to join our practice who is interested in obstetrics and in-hospital patient care. Call rotation would be 1:8 weekends and about 4 to 5 weekdays per month. Many of us are involved in short-term mission opportunities that take us around the world including places like Mexico, Iraq, Ethiopia, Kenya and Turkey. The Bozeman community and Gallatin Valley offer the finest in outdoor experiences for individuals and families including world class skiing, hiking, fishing, cycling and hunting. In addition, Bozeman is a key community in Montana to experience excellent theater, dance, opera, art, music and has a highly acclaimed school system. www.bozemanclinic.com Contact the clinic administrator Judy Douglas at bozemanclinic@yahoo.com or by calling 406-587-4242.
To place a classified advertisement, contact communications@cmda.org.
CMDA PLACEMENT SERVICES
BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other providers and practices. We have an established network consisting of hundreds of opportunities in various specialties. You will benefit from our experience and guidance. Every placement carries its own set of challenges. We want to get to know you on a personal basis to help find the perfect fit for you and your practice. P.O. Box 7500 •Bristol, TN 37621 888-690-9054 www.cmda.org/placement placement@cmda.org
RELYING ON CMDA “For more than 15 years, we’ve relied on CMDA Placement Services to introduce us to mission-minded physicians, physician assistants and nurse practitioners. Many of our most fruitful domestic and international missionaries— those who’ve worked for years in the inner city and among unreached people groups— came to us through CMDA.” —Rick Donlon, MD Resurrection Health Paid Advertisement
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With a Charitable Gift Annuity,
you can have a fixed income for life, while you also support the ministry of CMDA. This planning tool allows you to see first-hand how giving can change lives, starting with your own. ■ Income tax deduction ■ Fixed income payments partially free from income tax ■ Fixed payments depending on age, such as 5.1% at age 70 ■ Issued by the National Christian Foundation
GIVE WHILE You Receive through a CHARITABLE GIFT ANNUITY CMDA’S STEWARDSHIP DEPARTMENT P.O. Box 7500 • Bristol, TN 37621 www.cmdagift.org • 888-230-2637