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Editorial
by David Stevens, MD, MA (Ethics) – Chief Executive Officer
Help For When Life Hurts
P
ain decontaminates or it destroys. The thought came to my mind as I listened to my dental hygienist this morning as she cleaned my teeth. She is two years into a severe post herpetic pain syndrome with no end in sight. It has radically changed her lifestyle. More importantly, it has radically changed her and her husband. She commented, “I use to go to church regularly, but now I can’t wait to get into God’s word and claim His promises. My problem has driven my husband and I closer together and both of us closer to God.” She then bubbled over telling me how people had ministered to her, the thrilling experience of a healing service six months ago and how God’s presence was so real to her in the midst of her suffering. Pain never leaves us where we are. A friend described how her father-in-law who had lost his wife last year was angry, lashing out and making everyone around him miserable. Hurt either makes us or breaks us. It moves us toward God or causes us to angrily run away from Him. It draws people to comfort and minister to us or causes us to chase them away and drown in our own bitterness. The latter response is a tragedy because if we ever need help, it is when we are hurting. Doctors relieve suffering all day (and sometimes all night) long. You give and give and are idolized as a model of caring and compassion. The trouble is when your own hurt comes, it is hard to get down off your pedestal and let people care for you. Instead, you tend to internalize your pain, deny it, or believe that if you just suck it up, you can triumph over it. I know, because as a doctor I have the same tendency. We are fools to believe our own propaganda and think we are super humans. Pain needs soothing, a healing balm. We need someone who understands, who has lived through a malpractice suit, struggled with their marriage, agonized over financial difficulties, or burned out from overcommitment . . . someone who will encourage, advise, pray, and point us to God, whose grace is sufficient. We need someone who will stick with us through the soul surgery that suffering always demands.
I believe that CMDA and its members should be that “someone” to you and me when our pain comes. Often it is someone who has been through healthcare training and has experienced the stresses of practice who can fully understand our suffering and the issues we deal with. One of the highlights of our CMDA Trustee meetings three times a year is our Thursday night prayer and share time. We journey together as we deal with malpractice suits, practice difficulties, our children’s misbehaviors, burnout, and health problems. Ministering to each other during our suffering is one of the unheralded benefits of being part of the CMDA family. It is also one of the prime reasons to encourage your colleagues to become CMDA members instead of suffering in silence behind their mask. Our new membership initiative is built around providing you a free copy of Practice by the Book to use as a ministry tool. It is full of advice on dealing with the issues Christian doctors struggle with and provides you a tool to minister to your colleagues. Attached to the book is an attractive fifty-page color booklet, a DVD about CMDA, and a CD with some of the best interviews from Christian Doctors Digest. When you provide these resources, you not only minister to your hurting friend, but you tell them where they can go to be encouraged, prayed for, and to find other helpful resources throughout their career. We are hearing story after story of how members are using these tools to be a blessing and encourage others to join this fellowship. To get your copies of this free resource for distribution go to: www.joincmda.org, e-mail: memberservices@cmda.org, or call toll-free: 1-888-230-2637. This issue of Today’s Christian Doctor focuses on the hurting doctor. I trust you will be inspired, encouraged, and equipped as I have been as you read the stories and learn from others’ journeys. God’s grace is so evident and you will get wise counsel to help you and those you love. No matter what your need, all of us at CMDA stand ready to pray, encourage, and provide you with good resources to help ease your pain. Don’t hesitate to give us a call. ✝
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table of
CONTENTS
V OLUME 3 8 , N O. 3
Fall 2007
( T C D ’s 5 8 t h Y e a r )
The Christian Medical & Dental Associations —Changing Hearts in Healthcare—since 1931. SM
Features
14 Malpractice Pain
by Curtis E. Harris, MD, JD Expert witness shares personal lessons and practical advice about the pain of a malpractice suit
18 Medical Martyrdom?
by David L. Stevens, MD, MA (Ethics) How to fight back when your right of conscience is attacked
22 When Mental Illness Strikes Your Family
by a Christian doctor (and his wife) who wish to remain anonymous Sometimes life’s greatest pain comes through our children
27 I Danced With Death by Caroline Hedges, MS4
Excerpts from a student’s journal
29 The Doctor Who Wanted to Die [Third in a Series] by Robert Cranston, MD Is there such a thing as “rational suicide?”
Departments 7 31 6
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Progress Notes Advertising Section
Editor: David B. Biebel, DMin Editorial Committee: Gregg Albers, MD, Elizabeth Buchinsky, MD, John Crouch, MD, William C. Forbes, DDS, Curtis E. Harris, MD, JD, Rebecca Klint, MD, Bruce MacFadyen, MD, Samuel E. Molind, DMD, Robert D. Orr, MD, Matthew L. Rice, ThM, DO, Richard A. Swenson, MD Vice President for Communications: Margie Shealy Classified Ad Sales: Gloria Gentry 423-844-1000 Display Ad Sales: Gloria Gentry 423-844-1000 Design & Pre-press: B&B Printing 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 2007, Volume 38, 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 © 2007, Christian Medical & Dental Associations . All Rights Reserved. Distributed free to CMDA members. Non-members (U.S.) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tenn. SM
SM
Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Scripture references marked (NASB) are taken from the New American Standard Bible. Copyright © 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977 by the Lockman Foundation. Used by permission. Scripture references marked (KJV) are taken from King James Version. Scripture references marked Living Bible are from The Living Bible © 1971, Tyndale House Publishers. All rights reserved. Undesignated biblical references are from the Holy Bible, New International Version ®. Copyright © 1973, 1978, 1984 by the International Bible Society. Used by permission. All rights reserved. Other versions used are noted in the text.
National Conference Awards Editor’s note: The following awards are presented annually by CMDA. The award summaries are based on the actual statements involved, which can be accessed at: www.cmda.org. Award presentation photos include Dr. Ruth Bolton, outgoing President.
Servant of Christ Dr. Haddon Robinson and his wife, Bonnie, have a relationship with CMDA spanning four decades. In 1966, Dr. Robinson served as the part-time CMDA Dallas Director, and was subsequently promoted to Southwestern Regional Director. He eventually was selected as the General Director of CMDA (then called Christian Medical Society) which he served from 1971-1979. Members noted his disciplined habits, as he was able to fulfill multiple roles. Dr. Robinson also served as editor of CMDA’s Journal. Dr. Robinson served as President of Denver Seminary and taught homiletics at Dallas Theological Seminary. At the time of this award, he was Interim President of Gordon-Conwell Theological Seminary, where he is the Harold John Ockenga Distinguished Professor of Preaching. In a 1996 Baylor University poll, Dr. Robinson was named one of the twelve most effective preachers in the English speaking world. In 2006, he was recognized by Preaching Today as one of the “25 Most Influential Preachers of the Past 50 Years.” Dr. and Mrs. Robinson were heavily involved with CMDA’s family conferences, imparting the love of Christ and the truth of God’s Word into the lives of the hundreds in attendance throughout the years.
Missionary of the Year Dr. Bob Merki and his wife, Beth, went as missionaries to South Africa in
For membership information, contact the Christian Medical & Dental Associations at: PO Box 7500, Bristol, TN 37621-7500; Telephone: 423-844-1000, or toll -free, 1-888-230-2637; Fax: 423-844-1005; E-mail: memberservices@cmda.org; Website: http://www.joincmda.org. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product, or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice, or instruction.
1960, to Ethel Lucas Memorial Hospital, which later was renamed Tintswalo Hospital. During the twenty years they spent in that 250-bed hospital, Dr. Merki (initially one of only three doctors) was “trained on the spot” – learning specialties, how to pull teeth, perform surgery, and administer anesthesia. Trained surgeons eventually relieved major surgery duties. Dr. Merki said, “The Lord always made up for the deficit.” After the South African government took over all the mission hospitals, the Merkis returned to the United States in 1979 for nearly ten years. During this time Bob entered an Internal Medicine residency in Canton, Ohio. After his residency, they returned to the mission field. In 1989 Dr. Merki served at the Raleigh Fitkin Memorial Hospital in Swaziland until 1993. After a year in the States, the Merkis were then sent to Kudjip Hospital in the Western Highlands of Papua New Guinea, where they retired in 2001. - Continued on Next Page Internet website: cmda.org
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Educator of the Year Dr. Warren Heffron and his wife, Rosalee, currently reside in New Mexico where he serves as Chairman of the Department of Family and Community Medicine at the University of New Mexico. His current passion is developing, consulting, and teaching in family medicine residencies in Christian missionary settings. Dr. Heffron has been a visiting professor in many institutions around the world. He has had
multiple teaching and consultation visits in Ecuador, Mexico, Venezuela, Saudi Arabia, Kyrgyzstan, Mongolia, Kenya, and Guatemala. Long-term missions include serving at the Hospital Castaner in Puerto Rico and the Christian Medical College in Ludhiana, India. A CMDA member since 1988, Dr. Heffron is a Student Advisor for the University of New Mexico chapter. He has been active in CMDA’s Medical Education International (MEI) since 1991 and served as President of the Christian Medical & Dental Associations in 2003-2005. Dr. Heffron comments, “Years of sharing with students, residents, and practicing physicians has reconfirmed the vision of CMDA as a vehicle for carrying the Great Commission into the professional lives of Christian doctors.”
President’s Heritage Award
~ REMINDER ~
Si es tas an d F ies tas – R e s t an d J o y in t h e Ch r i s t i an L i f e Women in Medicine and Dentistry Annual Conference 2007 September 20-23, 2007 The St. Anthony Hotel - San Antonio, TX Speakers include: Margaret Brand, MD; Cindi McMenamin; Patsy Sulak, MD; Linda Flower, MD; Al Weir, MD For information or to register, go to: www.cmda.org > Ministry Groups > Women in Medicine & Dentistry > WIMD Annual Conference
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surrounding countries. Dr. Johnson also served in Central and South America, as well as in the South Pacific. At the end of the Cold War, Dr. Johnson was invited to visit and survey the deplorable medical conditions in Albania. Through his efforts, and those of the teams he established, the impoverished country began receiving healthcare training, supplies, and funding that was desperately needed. The name of “Beel Yonson” continues to be well-known and honored by the people of Albania.
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Dr. William A. Johnson has made numerous contributions to the ministry of CMDA. He was the first editor of the Christian Medical Society’s Journal. In 1960-61, he served as President of CMDA (then known as the Christian Medical Society). Bill also established a CMDA Scholarship program to financially assist and encourage interns and residents to take short-term mission trips. Dr. Johnson and his wife, Bobbie, began serving shortterm medical missions in the 1960s, first to Bolivia, then Rhodesia (which is now Zimbabwe), Thailand, and other places. Mrs. Johnson assisted and encouraged her husband along the way. In order to better help Bill with their medical mission work, Bobbie completed training as a nurse, while raising their four daughters. They served together with African Inland Mission in 1970-71 and again in 1975-76 at Kijabe, Kenya—with additional assignments in
Steury Scholarship Recipients Announced The purpose of the “Dr. and Mrs. Ernest Steury Medical Student Scholarship Fund” is to assist with the tuition of medical students who are committed to a career in foreign or domestic missions. Applications are evaluated on the basis of academic record, spiritual maturity, cross-culture experience, leadership ability, the student’s sense of call, references, and extracurricular activities/talents. This year the Steury Scholarship was awarded to Mark and Esther Crouch. Mark is now in his third year at the University of Oklahoma College of Medicine; Esther is a nursing student. They met when they were serving with the MercyShips ministry. “When I accepted Christ,” Mark wrote, “God burdened me to consider [the] less fortunate. I wanted to be of service to them, but didn’t understand exactly how I might do that. Through my experience with MercyShips and my time in Ethiopia [on a prior short-term mission] I realized that medicine provided a very unique tool in ministry. Medicine enabled people to reach countries and areas that were otherwise resistant to the gospel, and the practice of
medicine involved reaching people in some of their most vulnerable times of need. Medicine was a way to meet people’s physical needs, but it also provided a segue into addressing people’s inner needs for a relationship with God. Other areas of service are also essential, but only medicine allows someone to step into a person’s most intimate areas of need and provide both health and hope. When people see that their physical needs are a mere reflection of what their hearts desire, they are more open to discussing where those desires came from, and who can meet them.” Mark and Esther hope to serve somewhere in the “10/40 Window.” “Esther has family in India and Nepal,” Mark wrote, “and we have visited Muslim Africa on several occasions. We are also considering central Asia or the Far East. We will probably combine both clinical and educational medicine in our ministry.” For information regarding the Steury Scholarship, contact the office of the Chief Executive Officer, or download the application at: www.cmda.org.
The Exciting, Inspirational Biography of Ernie Steury is now available!
I n t e r n e t w e b s i t e : w w w. c m d a . o r g
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A world of life and death surrounded him as he rushed from patient to patient, prescribing for body, soul, and spirit all at once. Dr. Ernie Steury spent most of his adult life in Kenya, in the small village of Tenwek, as that area’s first doctor, improving the health of the Kipsigis people and introducing them to Jesus Christ. Dr. Steury never began a surgery without praying with the patient, and though it took time for the local people to get beyond their superstitions and begin to trust him, the difference he made there has impacted the world. This small-town farm boy overcame personal and cultural obstacles to build a small hospital that has become one of the premier mission hospitals in the world. You will see that even though he felt inadequate to fulfill the great plans God had for him, he stepped out of the way and let God work. The results testify that, truly, all things are possible with God! Miracle at Tenwick is sure to be on your list of best-loved books. Buy it today for $14.99 by calling toll-free: 1-888-231-2637, or purchase it online at www.shopcmda.org. For bulk orders, please phone. •
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When Troubles Come Bruce MacFadyen, MD President - CMDA
In Philippians 1:21 the apostle Paul wrote, “For to me, to live is Christ. . . . ” Paul wrote this verse in the present tense because, despite his significant hardships, persecution, trials, and misunderstandings he had learned that the key to facing difficulties faithfully is to stay focused on Christ, pressing on to fulfill His calling and following Him in every circumstance. This kind of faith is the anchor for our souls when troubles come (see Hebrews 6:16-20). Some of the problems that medical or dental professionals face include practice problems such as malpractice; health issues of our own, our family, or our friends; financial challenges; relationship issues; discouragement; or, dissatisfaction with where we are spiritually.
A key to weathering such storms is to seek wisdom, counsel, and support from appropriate sources, including our brothers and sisters in Christ. This is one way that Christ works to bring His presence and will into our lives during times of decision or hardship, providing spiritual and emotional support. We must not attempt to walk through complex issues alone. We must also be aware of colleagues who are facing similar difficulties, and be willing to take time and walk with them through their problems. God wants to use us. If they are already believers, we need to offer spiritual insight, genuine friendship, support, and practical help when appropriate, following the example of Jesus. If our hurting colleague is not a believer, we should still offer support and practical help. We know that true peace in life can never exist apart from Christ. We must first commit to pray, be a genuine friend, and when possible bring other believers or appropriate resources into that person’s life. Even a small gesture of friendship can have a significant long-term effect, for as Paul wrote in Ephesians 3:20: “Now to
him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us. . . . ” His power works in us and through us when we are in His will. In reality, this is the only safe place, the only place of security in this world. When we personally know His call and that those around us confirm our call, we can be assured that our lives are completely in His control, He will either deliver us from difficulties, or He will use them for a greater purpose in our lives or in the lives of others. God will not waste our experiences, for “. . . we are God’s workmanship, created in Christ Jesus to do good works, which God [has already] prepared in advance for us to do” (Ephesians 2:10).
President, CMDA
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Regional Ministries Midwest Region CMDA Midwest Attn: Allan J. Harmer, ThM 9595 Whitley Dr., Suite 200 Indianapolis, IN 46240 Office: 317-566-9040 • Fax: 317-566-9042 cmdamw@sbcglobal.net
Western Region Michael J. McLaughlin, MDiv PO Box 2169 Clackamas, OR 97015 Office/Cell: 503-522-1950 michaelm@cmdawest.com
Northeast Region Scott Boyles, MDiv P.O. Box 7500 • Bristol, TN 37621 Office: 423-844-1092 Cell: 609-502-2078 Fax: 423-844-1017 scott.boyles@cmda.org
Central Region Douglas S. Hornok, ThM 13402 S 123rd East Place Broken Arrow, OK 74011 Office/Cell: 918-625-3827 cmdacentral@cs.com
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Southeast Region William D. Gunnels, MDiv 106 Fern Drive • Covington, LA 70433 Office/Cell: 985-502-4645 wdgunnels@charter.net
~ NEWS NOTES OF INTEREST ~ Self-Referral for Consideration for Board of Trustees Get Involved in CMDA Leadership! In order to give eligible CMDA members an opportunity for consideration of service on the Board of Trustees, we have established a self-referral option. We would be honored if you would notify us of your interests for serving as a volunteer leader in the House of Representatives, on a council or commission and through those ultimately on the CMDA Board of Trustees. The House of Representatives meets once a year to approve Bylaws changes, receive reports, and approve the budget and the ethical positions of the organization. During the year, they 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. New trustees are now 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. Their nominees then are approved by both the House and the Board. Trustees, who may serve up to two consecutive four-year terms, pay all their own expenses. The Board meets three times a year to set policies, oversee finances, and provide supervision to the CEO. Referrals should be directed to Debra Deyton at: debra@cmda.org; Phone: 423-844-1000, Fax: (423) 844-1017. Three Ethics Statements Ratified The CMDA House of Representatives passed three ethics statements at its most recent national meeting in Orlando, including: Human Stem Cell Research and Use; Abuse of Human Life; Human Life: Its Moral Worth. These statements can be viewed at: www.cmda.org > Issues > CMDA Ethics & Position Statements
Global Health Outreach (GHO) Two Way Blessings When we served the people of Zambia, particularly those of Kitwe, Mulenga compound, we heard an interesting comment from a little lady who had waited all day in the heat and in huge lines to be seen on the last day we were there. When she saw the clinic door close before she made it inside, she told one of the team members, through the window, “Even if I have not gotten seen or received any medicines, you people are God’s people. You left
your country just to come and do this generous work to us. God bless you.” Not only do GHO teams bless those we go to serve, but often GHO participants receive a blessing in return! Sometimes it is just a matter of perspective. Here are excerpts from how one team member remembers the same trip: “The churches we worked with were awesome partners in our mission work at the clinic. It was a blessing to have our Zambian brothers and sisters
in Christ to usher and translate for the patients we saw. What was even more encouraging, however, was that after a patient had visited the pharmacy, they were escorted to a prayer and counseling room where Zambian believers would share the gospel with non-believers and pray with believers. Names and addresses of the patients were written down, so that the Zambians could minister long after our medical team had left. It is so reassuring to know that our ministry there wasn’t short-term; that it will continue, thanks to the churches we partnered with. “The Zambian church was very glad that we were there, and I was very humbled by the way they served us. Three different times they cooked all day to serve our team a meal that cost them far more than it would ever cost us. Their servant attitudes definitely taught me a lesson.” Contributors include Bishop Enocent Silwamba, Zambia, and SaraBeth Van Wyk, Iowa
FOR INFORMATION ABOUT GHO OPPORTUNITIES SEE WWW .CMDA.ORG/GO/GHO
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Medical Education International (MEI)
Reaching Internationals with the Love of Christ by Shari Falkenheimer, MD Director, MEI To this day I remember a speaker at an Urbana mission conference cautioning that if we are not able to share the gospel in our own language and culture, we shouldn’t expect to be able to do it in another language and culture. It was a fitting reminder that crossing an international border does not in itself make us effective in reaching others for the kingdom. Acts 17:26-27 reminds us that, “From one man he [God] made every nation of men . . . and he determined the times set for them and the exact places where they should live. God did this so that men would seek him
and perhaps reach out for him and find him. . . .” Today, God is putting the nations all around us. Who does not work with, live near, or in some way come into contact with people of other nations living, studying, and working in the US? Internationals in the US are often very lonely and easy to befriend. But do we reach out to them? Do we see them as people God sent to us to share the gospel? Do we take advantage of the opportunity to share with them in our own language while we are still in our own culture? If we are sensitive to God’s leading, we should have many such opportunities to reach out to them. I had such an opportunity during the MEI reception at the CMDA National Conference in Orlando, when I noticed that the waiter’s name tag listed a North African nation. Having made my first mission trip to Arabia as a medical student, I had fallen in love with Arab people. I greeted the waiter in Arabic and spoke briefly of my relationships with Arabic-speaking people
in the US and the Arab world. As Dr. Jim Smith and I gave presentations on MEI’s ministry, the waiter seemed to be listening closely. At the end of the reception, I thanked him for his excellent service. Feeling a prompting from the Spirit, I asked him if he had ever read the Injil (New Testament). He said he hadn’t. I asked him if he would like to, and he said yes! I told him I would gladly give him a copy. He asked if it was in Arabic. I told him I didn’t have a copy with me in Arabic, but would gladly send him one. He asked if I could give him the whole Bible and he gave me his mailing information. All this happened because God nudged me to reach out to an international in my path! When you see an international at school, work, in the market, in the lab, or in the hospital, I hope you will remember that God has brought them here for a reason—maybe just so you could reach out to them here!
FOR INFORMATION ABOUT MEI OPPORTUNITIES SEE WWW .CMDA.ORG/GO/MEI
2007 Global Missions Health Conference Southeast Christian Church - Louisville, KY November 8-10, 2007
2007 PLENARY SPEAKERS • Dr. David Stevens, CEO of CMDA • Dr. Peter Okaalet of MAP International • Yvette Maher, V.P. of Sanctity of Human Life at Focus on the Family • Steve Saint, missionary, author of “End of the Spear,” and founder of I-TEC WHO SHOULD ATTEND? • Healthcare professionals in medicine, dentistry, nursing, pharmacy, PA, public health, allied health care, psychology, and social work • Students in all medical/nonmedical disciplines, regardless of level of training • Nonmedical individuals with interests in evangelism, ethics, apologetics, missions, church leadership, caring for the poor, or caring for people with HIV/AIDS • Career missionaries CONTACT: Global Missions Health Conference; 920 Blankenbaker Pkwy; Louisville, KY 40243. Phone: 502.253.8158; E-mail: info@medicalmissions.com; Website: www.medicalmissions.com.
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The Global Missions Health Conference informs, trains, and equips healthcare professionals and students to use their skills to further God’s kingdom by sharing the gospel with those in need on both international and domestic mission fields. From its first gathering of a couple hundred people in 1996, the conference has grown to become the largest of its kind in the world, drawing more than 2,000 each year.
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im* was a friend of mine. I say “was” for reasons that will become obvious in a moment. We first met when I was a senior resident in Internal Medicine. Jim was the head of the Emergency Department at the largest hospital in a small town. He was young, well-trained, sensitive, progressive, and hard-working. I liked Jim a lot. In addition to being a father of two young girls, he was an artist. He painted landscapes and nature in both oils and watercolors, and had displayed his work at a local gallery. Jim gave me a small oil painting of geese in flight that I still have. I wanted to be like Jim after I finished my training.
The pain of a malpractice suit can test your limits, threatening all you hold dear. For some, this experience is devasating—personally, relationally, professionally—regardless how the case is resolved. Some have testified, however, that being sued was an opportunity for growth, in disguise, and a pathway to deeper faith. The end result depends, to some degree, on the support you have while making this journey.
Malpractice Pain by Curtis E. Harris, MD, JD
Geese in Flight — by “Jim”
When I finished my residency, I lost track of Jim, and did not see him again until I had completed my Fellowship. In the interim, the following had happened: Late one Saturday evening the popular town Sheriff came to the ED complaining of chest pain. He had eaten his usual dinner at Taco Mayo and was convinced he had bad heartburn. The EKG was normal, as were his enzymes. Jim prescribed Prevacid, and dismissed the Sheriff with the admonition to see his family physician on Monday if things did not get better. The Sheriff stopped by the local 7-Eleven, bought some 14
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Maalox tablets, and continued his evening patrol. An hour later, while making a traffic stop, the Sheriff suffered a major heart attack and died, crashing his car into a light pole. The Sheriff’s family brought a malpractice suit against Jim, which did not go well. Discovery had determined that Jim had missed a minor change on the EKG, and that the enzymes he had reviewed were those of a patient he had seen earlier in the evening, not the Sheriff’s, which showed an acute injury pattern. It was never determined why Jim looked at the wrong lab, but he was blamed nonetheless. Jim lost the case. The Sheriff’s widow got a judgment of $2 million; Jim only had $1 million in insurance. As the appeals process dragged on, Jim developed uncertainty about his competence, and he began to drink heavily. It became increasingly difficult for him to do his work in the ED well. His church was of little help. The Sheriff had been a Deacon there, so the sympathies went to his widow, not to Jim. Many believed that Jim’s “carelessness” had “killed” the Sheriff. A year after the malpractice judgment, Jim’s wife filed for divorce to avoid the financial consequences of the judgment . . . or in her words, “To protect the children.” Abandoned by his church, blamed by everyone for the death, Jim became disconsolate. On the day of the final hearing for his divorce, Jim shot and killed himself. No note was left.
Malpractice Suits Can Bring more Questions than Answers Jim’s case was my first experience with malpractice. Since then, I have counseled numerous physicians who have been sued for various
I have a great relationship with that patient. She wouldn’t sue me. As can happen with grief from other sources, sometimes, without realizing it, Christian physicians attempt to make a deal with God that runs something like: “God, if I dedicate my life to service, work hard, sincerely care about my patients, balance my life between work and family, pray, tithe, love my spouse, volunteer for missions, make my hands your hands, then I can expect that you will surely protect me. Right?” Passages from the Psalms seem to support the bargain struck.
When a physician is sued, he or she is almost always surprised. Common thoughts include: You don’t understand! I didn’t do anything wrong. Besides, I have a great relationship with that patient. She wouldn’t sue me. After the shock ends, denial begins, including a false hope that the case will be dismissed as soon as everyone “comes to their senses.” All of the stages of grief and loss tend to occur as the litigation proceeds – denial, anger, bargaining, depression, and acceptance – though not in any particular order. However, one important difference in dealing with malpractice litigation (versus the loss occasioned by disease or death) is the prolonged sense of despair and isolation many physicians feel as legal actions drag out over time, often years, without any clear resolution . . . and without any available source of comfort or counsel. During this process, physicians may feel embarrassed, wonder if they did the wrong thing, believe they did the wrong thing even when they did not, and feel isolated because they are advised not to talk about the case with anyone for fear that anything they say can and will be “used against them in a court of law.” Even faith can be a double-edged sword: On the one hand, it is a comfort and buttress against the loss of hope; on the other, a simple belief in right and wrong can create excessive self-condemnation, when compared to the relativistic views of a secular progressive values system. Satan, as the Great Accuser, can turn us against ourselves.
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reasons. I have helped others dealing with difficult issues of medical licensure board reviews, and still others accused of Medicare Fraud and Abuse. With only a few exceptions, I have been impressed with the honesty, decency, and general moral character of those I have helped. I have also been impressed by their dedication and professionalism. For many of them, these questions arise: How did all of this happen? Why did it happen? I work hard, avoid mistakes, and have never intentionally hurt anyone . . . and this is what I get? Life seems suddenly unfair, and it hurts more than they imagined it could.
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When you are sued: ❖
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Don’t read all of the accusations in the petition. Just read enough to know you have been sued and by whom. The accusations have little to do with truth, are very inflammatory and hurtful, and are really there just to convince a judge the plaintiff has a case. Call your malpractice carrier as soon as possible. DO NOT CALL THE PATIENT. Do not talk to the patient or the family about the case. The time for that is after the case is resolved.
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Take the advice of your attorney. Be very open and honest with your attorney. Review your files carefully, but do not change anything in them in any way, even if they are on a computer. Altering records is viewed as an admission of liability.
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Remember that it is normal and common to feel angry, guilty, incompetent, depressed, tired, and even suicidal. Take each emotion as a helpful warning sign, like a stop sign or a yield sign on the highway. Take each day one day at a time, and do not borrow from tomorrow’s woes. Jesus said that each day has enough trouble of its own.
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Think hard about what happened, what you recall. Most of us start out by blaming ourselves by saying “if only I had done that.” All that matters
is what you knew and what you did at the time, not what, in hindsight, you might have done. ❖
Remember that you are not alone. Ask for help from your attorney, from your medical association, or from the CMDA Medical Malpractice Ministry, at: www.cmda.org > Ministry Outreaches > Medical Malpractice; 1-888-230-2637; e-mail: sandy.huron@cmda.org.
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Long and drawn-out court proceedings can take a devastating toll on you and your family. You will hear nothing from your attorney for a year, then suddenly the case is back into your life. Don’t get lazy and don’t imagine the case has just “gone away.” Take the time between the various legal steps to strengthen your faith and your understanding of suffering.
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Involve your spouse and children in the case to the extent they need to understand your concerns and emotions. Fear of the unknown and an active imagination can hurt children more than openended conversations about what is and might happen. Children will tend to think it is somehow about them. Make certain they know it is not about them. Keep communication open with your spouse; seek counseling if needed in order to prevent the stress from hurting your relationship.
If You are Being Sued As a believer it is good to remember, if you are being sued, that God never leaves your side, and that suffering is as much a part of life as is joy. Suffering seasons us. Shakespeare wrote, “He jests at scars who never felt a wound.” This kind of suffering may be a gift in disguise from a loving God, the kind of gift we would refuse, but cannot. The second thing to remember in this situation is, “Never pay back evil for evil to anyone. . . . If possible, so far as it depends on you, be at peace with all men. . . . Do not be overcome by evil, but overcome evil with good” (Romans 12:17-21, excerpted, NASB). The pain that accompanies a malpractice suit may be about us, about something God wants us to know about ourselves. In that case, our openness to the lesson is a key to the speed with which we learn it and its ultimate effect in our lives. Or the net result of the experience may be about what He wants someone else to see in us: His love, His grace, His forgiveness. Either way, when sued we do best when we pray: “Hallowed be Thy name; Thy will be done.”
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If you have a friend or colleague being sued, you can help by first validating that physician (and his or her family). I recall one physician who told me how deeply grateful he was to have had a Christian friend who had asked if he could come to his trial to sit in the back of the courtroom, not to listen, but to pray for him. Each day, he felt a profound relief to have someone there to give him spiritual support. When I heard the story, I wished I could have been that friend. My prayer since has been “Lord, give me the insight to see the needs around me.” I still have the oil painting of the geese in flight Jim gave me. It hangs behind my desk and it’s printed here with this article. It helps me remember him at his best. I will always do so. His story has motivated me over the years to remember to open my eyes to what is going on around me, and not just the good, but the bad, and the very ugly, which a malpractice suit can be. That is his epitaph, one he could not have known to write. Funny how that works. . . . Finally, if you know someone who has been sued, the three most important things you need to do are: listen, listen, listen. Then pray with them and for them. Take great care not to add to their feelings of guilt by commenting on how you would have done things, even if asked. You were not there. Don’t judge. Even a small amount of loving compassion feels like huge support to anyone in this situation. ✝ *This story is true, with certain facts disguised to protect confidentiality.
Curtis E. Harris, MD, JD,
is the Chief of Endocrinology for the Chickasaw Indian Nation and Director of the Chickasaw Nation Diabetes Care Center. Prior to his current position, he was in private practice as an Endocrinologist in Oklahoma City, Oklahoma for more than twenty-five years. Dr. Harris received a Juris Doctorate from the Oklahoma City University School of Law in 1994. He is Adjunct Professor of Law at the Oklahoma City University School of Law, and a specialist in medical law. Dr. Harris founded the CMDA Medical Malpractice Ministry in 1995, and in that role trained nearly thirty physicians as counselors. He has personally counseled over 400 physicians and dentists who have been sued for malpractice or have had other practice-related legal problems. He has served as a Trustee of CMDA, and is a member of the editorial committee of Today’s Christian Doctor.
CMDA MEDICAL MALPRACTICE MINISTRY CMDA’s Medical Malpractice Ministry is looking for members to minister to other CMDA members during one of the most devastating times of their lives––a medical malpractice lawsuit. It can wreak havoc on a doctor’s family, career, and emotional and spiritual well-being. For many years CMDA’s Medical Malpractice Ministry has intervened with prayer, educational resources, and a commission of doctors who have faced malpractice suits themselves. If you are interested in participating in this ministry, contact Dr. Robert Agnew at: BobCVS@mac.com.
Malpractice Pain
If a Colleague is Being Sued
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f some have their way, you may soon have to either amputate your conscience or fall on your professional sword and abandon your career. The Washington State Pharmacy Board, after Governor Chris Gregoire threatened to replace them, unanimously ruled in April 2007 that pharmacists must stock and dispense all legally prescribed medications regardless of any moral or religious objections they may have. The regulation states that the patient’s “right to a prescription” supersedes their individual right of conscience. If you don’t comply – you lose your license. In April, 2005, Governor Rod Blagojevich issued an executive order stripping Illinois pharmacists of their right of conscience protection in dispensing potential abortafacients. In California, a Christian physicians group is being sued for discrimination for refusing to perform in vitro fertilization on a lesbian even though they disclosed, before she was accepted as a patient, that they did not perform IVF on unmarried women. CMDA has filed an amicus brief with the Christian Legal Society in this case that is headed for the California Supreme Court. NARAL, Planned Parenthood, the ACLU and other groups have mounted an all out, take no prisoners assault on the right of conscience, which they in disdain refer to as the “right of refusal.” Planned Parenthood’s 18
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Medical Martyrdom? How to Defend Your Right of Conscience by David Stevens, M.D., M.A. (Ethics)
An age-old principle of human rights is under attack, and medical practice is the battlefield. Our right of conscience could be lost unless we stand together and stand our ground.
That is not just my conclusion. Recently, I was debating one of Planned Parenthood’s lawyers on an hour-long coastto-coast NPR radio show when she stated, “If a doctor is not willing to do a legal procedure, they shouldn’t be in healthcare!” Right of conscience issues involve much more than just the ones surrounding abortion. They include contraception, sterilization, physician-assisted suicide, and participating in executions. Many more loom on the horizon – human cloning, therapies derived from human embryonic stem cells, genetic enhancement, euthanasia, trait selection, trans-humanism, and others. This is not a new issue. The right of conscience was a moral debate over 2,500 years ago when a group of physicians decided there were certain things which, even though permitted, they would not do. They agreed, among other things, that it was a violation of their conscience to give a deadly drug to anybody if asked for it or to give to a woman an abortive remedy. Before Hippocrates, patients did not know if their physician would cure them or kill them, heal them or take sexual advantage of them or would share the intimate details of their medical history with others. He and his followers started a dramatically different form of medicine based on their consciences and patients voted with their feet.
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website claims, “Health-related decisions made between a provider and patient should be made on the personal welfare and health-care needs of the patient - not the morals or beliefs of the caregivers. . . . While we firmly believe that all people have a right to their own opinions and moral beliefs, it is unethical for health care providers to stand in the way of a woman’s access to safe, effective, legal, and professional health care.” The ACLU publishes an advocacy kit teaching members how to coerce hospitals, including Catholic ones, to provide abortion services. The Pro-Choice Resource Center’s “Spotlight Project’s” goal is to build a network of opposition to “conscience” or patient abandonment clauses that allow doctors, pharmacists, and entire hospital systems to deny women access to services like abortion. These and other efforts are racking up success after success – forcing a private community hospital to do late term abortions, preventing mergers, requiring Catholic insurance companies to cover contraceptives, and much more. Of all the issues Christian doctor’s face, this is the one I’m most concerned about. If we do not have the freedom to practice healthcare in accordance with our deeply held religious and moral convictions, all the other ethical issues we face will be lost for the simple reason there will be no Christians in healthcare.
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So how do you and I defend our right of conscience? Here are the key points I make: ✒The right of conscience is one of the most fundamental and precious rights that our country was founded upon. The First Amendment to the Bill of Rights says, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.” It is informative to look at the different versions of the First Amendment to understand the intent of the Congress as they polished and shortened it to its final version on September 24, 1789. James Madison’s first draft on June 7th: “The Civil Rights of none shall be abridged on account of religious belief or worship, nor shall any national religion be established, nor shall the full and equal rights of conscience be in any manner, nor on any pretext infringed. No state shall violate the equal rights of conscience or the freedom of the press, or the trial by jury in criminal cases.” The House Select Committee’s revision, July 28th: “No religion shall be established by law, nor shall the equal rights of conscience be infringed.” Thomas Jefferson later said, “The rights of conscience we never submitted, we could not submit. We are answerable for them to our God.” ✒There are already clearly established rights that govern the doctor-patient relationship. Patients have the right to autonomy, to choose what will be done to their body, but they can’t compel a doctor to do something outside their training or established norms. The doctor may prospectively limit the extent and scope of his or her obligation to treat or even refuse to enter into a doctor-patient relationship in a
non-emergent situation. Doctors are not healthcare vending machines, but professionals who understand the difference between negative rights such as the right to refuse treatment or be left alone and positive rights, including entitlement to treatment. In terms of the latter, the physician holds the “trump card” in that he or she can decline to provide requested treatment that he or she feels is not medically indicated or may be outside the standard of care. ✒The AMA, which is on record advocating that pharmacists be required to dispense potential abortafacients, states that neither physician, hospital, nor hospital personnel shall
Doctors are not healthcare vending machines be required to perform any act violative of personally held moral principles. In these circumstances, good medical practice requires only that the physician or other professional withdraw from the case, so long as the withdrawal is consistent with good medical practice. ✒The Health Services, Medicare and Medicaid Acts all have protections to prevent physicians from being compelled to do sterilizations or abortions. The Weldon Amendment of 2001 provides that no federal, state, or local government agency or program that receives federal health and human services funds may discriminate against healthcare professionals because they refuse to provide, pay for,
SOUND BITES YOU CAN USE WHEN DISCUSSING THIS ISSUE: ●
Is our healthcare system in need of more consciencedriven doctors or more “ethically neutered” doctors?
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Do we want medical schools to systematically strip our future doctors from any and all religious and ethical convictions that have not been approved?
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Your doctor’s conscience may some day be the last line of protection between you and those who would profit from your early death.
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Some pharmacists don’t want to dispense the morning after pill for the same reason they don’t want to drive drunk — they don’t want to kill another human being.
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I’m not trying to mandate Planned Parenthood staff to work in a crisis pregnancy center in violation of their conscience.
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Denying the constitutional freedoms of one group is a threat to the constitutional freedoms of every one of us.
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The irony of trampling individual liberties and conscience rights while marching under the banner of “choice” will not be lost on the American public. FOR
TALKING POINTS AND UPDATES ON THIS VITAL ISSUE, GO TO: WWW.CMDA.ORG
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With all this protection, what is the problem? Most conscience protection deals with performing abortions and mainly covers doctors and nurses. Therapeutic modalities, such as Plan B, that inflict a postfertilization effect before implantation, destroy human life, but since that is not defined as an abortion, there is no protection of the right of conscience. There is spotty protection on issues like sterilization and contraception. There is little or no protection from being forced to participate in or refer for present or future morally objectionable therapies including embryonic stem cell therapies, preimplantation genetic diagnosis, genetic enhancements, euthanasia, or other interventions that could become the “standard of care.” Laws are needed to insure that no healthcare professional is forced to violate his or her conscience and become complicit in an immoral act. In some situations, like referring for an abortion, it comes down to the issue of moral complicity, which is (as described in CMDA’s statement on moral complicity): “. . . a culpable association with or participation in wrongful acts by - use of information, technology, or materials obtained through immoral means. - using, rewarding, profiting, perpetuating, justifying, or ignoring past or present evil. - enabling or facilitating future immoral acts. We must strive to never commit evil ourselves, nor should we participate in or encourage evil by others.” (See CMDA Ethics Statement on moral complicity at: www.cmda.org.)
Medical Martyrdom?
provide coverage of, or refer for abortion. This federal law has been repeatedly challenged in court by pro-abortion groups and by the Attorney General of California in his state. CMDA has filed amicus curiae briefs in each of these cases. Forty-five states have some sort of conscience laws on abortion. (See your state’s laws at: www.consciencelaws.org.) ✒There is also international right of conscience protection. Article 9 of the European Convention on Human Rights states that everyone has the right to “. . . freedom of thought, conscience and religion. This includes . . . freedom . . . to manifest his religion or belief in worship, teaching, practice and observance. . . .”
Linda Rankin, a bioethicist at the University of Tennessee summed it up well in a 2004 Christian Science Monitor article when she said, “If we don’t protect personal integrity, we would go down a dangerous avenue. By taking a professional license, you do not in fact step out of your personal morality. You have taken on an additional responsibility, but that does not mean you have given up your integrity as a person.” I encourage you to get into this fight. We dare not lose this war. ✝
David Stevens, MD, MA (Ethics), is the Chief Executive Officer for the Christian Medical & Dental Associations. From 1981 to 1991, Dr. Stevens served as a missionary doctor in Kenya, helping to transform Tenwek Hospital into one of the premier mission healthcare facilities in that country. Subsequently, he served as the Director of World Medical Mission, the medical arm of Samaritan’s Purse, assisting mission hospitals and leading medical relief teams into war and disaster zones. As a leading spokesman for Christian doctors in America, Dr. Stevens has conducted hundreds of television, radio, and print media interviews. Dr. Stevens holds degrees from Asbury College and the University of Louisville School of Medicine. He is board certified in Family Practice. He earned a master’s degree in bioethics from Trinity International University in 2002.
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was way behind schedule on a rainy Friday afternoon, hurrying to the next exam room when our office manager approached me. The concerned look on her face told me we had a problem, but I was totally unprepared for her words. “Your daughter’s principal is on the phone and must speak to you immediately.” My stomach tightened as I reached for the phone. “Jessica was found smoking marijuana and has been suspended. You need to come pick her up immediately.” I felt a stab to my heart and my head reeled as I explained to the staff that I had an urgent situation and the remaining patients had to be rescheduled. Weaving through traffic, I tried to clear my mind and make sense of what was happening. We were so full of joy when we adopted Jessica as an infant, the longed for addition to our family of two sons, an answer to years of heartfelt prayer. Yes, she was labeled a “difficult to place” baby due to her bi-racial heritage and complicated birth, followed by weeks in the NICU. We had been warned that she may have difficulties, but we brushed it off believing she would thrive as we provided a warm and loving home. We were so thankful when she reached all her developmental milestones and put the concerns out of our mind. She had been a delight to raise but recently seemed moody and distant. My wife and I suspected it was normal early adolescent ups and downs and had attempted to spend more individual time with her. We were to leave on a family vacation the next week at the beach she
When Mental Illness Strikes Your Family by a Christian doctor (and his wife) who wish to remain anonymous Photos are representative, not of the actual persons involved
Sometimes Life’s Greatest Pain Comes Through Our Children Mental illness, when it strikes home, can be very hard to discern, and even harder to treat. Faith, hope, and love . . . and support from a coalition of friends and colleagues are keys to a successful long-term outcome. 22
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When Mental Illness Strikes Your Family
loved. Now this; a serious problem that would affect us all. Entering the school office the bitter reality hit me when I saw the look of confusion and pain on my wife’s face as Jessica sat defiantly with arms folded, exuding anger. Little did we know that this was the harbinger of years of future anguish. That afternoon at home, my wife, Amy, and I calmly tried to open up communication with Jessica, expecting to be able to identify the problem and begin working toward a solution. I said, “Jessica I know you are very confused and angry right now, but Mom and I want to help you work this out. Whatever is wrong can be fixed. We need you to talk to us.” Jessica stormed upstairs and slammed the door, leaving us frayed and speechless, staring at one another. Later that night we agonized for hours about what to do. Drugs had never been a problem in our family and we were totally blindsided. I was hurt and angry and blurted out, “Why is she doing this to us? I have tried to be a good father and have given her every advantage.” Through her tears Amy replied, “Maybe you were too lenient. Remember I was worried about her going to the mall with that new friend, but you insisted she could go!” Before I could stop myself I replied, “You are too overprotective; you can’t keep her in a glass cage!” Before we knew it we had lost our perspective and were blaming each other in ways that could erode our close relationship. I was mysti-
fied; always able to talk with my patients and their teens working out counseling and support for the family. Feelings of failure and helplessness engulfed me over the next few days as I fought to stay focused and not over react. We knew we needed to get some objective help and quickly. Jessica initially refused to come with us to a counselor, but we went ourselves and were able to begin to build some safeguards around Jessica. She was not cooperative, but when faced with grounding, she relented. We breathed a sign of relief as we settled back into normal routine, naively believing the crisis was over, but the respite was short-lived. Over the next several years we sank into a nightmare scenario involving cycles of acting out and high risk behavior. Jessica was skipping school and drinking with friends and had been in two potentially serious car accidents. She was angry, reclusive, and manipulative, blaming us for everything, and constantly attempting to draw my wife or me into a stand off against the other. Her brothers, who loved her dearly, were shocked and saddened, but were powerless to intervene. We were heartbroken when Jessica was raped after leaving the mall with a boy she had never seen, who promised to take her to a party. My wife and I sank deeper into despair as we struggled to help her, monitoring her activities and friends and praying for God’s wisdom. Jessica finally agreed to get help and we were all seeing a respected Christian counselor, but nothing seemed to stop the emotional rollercoaster and serious acting out. We were more and more isolated as some of our friends backed away, not wanting their children to associate with Jessica. Our pastor was horrified and, although initially supportive, was convinced we had failed as parents. When Jessica was younger we had even taught marriage and family classes together, increasing our present shame. We were asked to resign from our leadership positions; and the church, where our little girl was baptized and raised, became a source of pain for all of us.
I felt a stab to my heart, and my head reeled . . . In the midst of all this, Amy and I struggled to keep ourselves and our relationship afloat. Gone were the days of carefree family outings, Jessica’s acting out was touching every aspect of our family life. Our sons were struggling as they faced their teachers and friends each day in view of Jessica’s deviant behavior. Many days Jessica’s manipulation would have them at odds with each other or with us as they were drawn into her triangulation attempts. The counselor tried valiantly to keep Amy and I centered on maintaining our relationship and taking care of ourselves. We realized we had to make a strong commitment to each other and not be drawn into the desire to rescue Jessica at all cost. Practicing ongoing forgiveness was a vital part of our ability to cope with all the events that swirled around
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our family. Maintaining communication with each other was vital and we continued our practice of a weekly date all through the dark days, struggling to follow our “rule” of not discussing problems or children during our alone time. We had been runners for years, and I always looked forward to my daily run as a stress reliever, but now I was emotionally drained and exercise was often just too much of an effort. I found peace as I listened to Christian radio whenever possible. Amy teetered on the edge of major depression, but found solace in prayer and daily journaling. Our sons could not understand why Jessica had become so out of control and were angry that her behavior was affecting their lives. We made every effort to continue some level of normalcy in our home so our sons would not get caught in a vortex of chaos. We continued going to their sports events even though it was so painful to see families we used to fellowship with enjoying each other in normal relationships . . . and always the question: What is wrong with Jessica? With the counselor’s help we began to see a pattern emerging in Jessica’s struggles, and by the time she was fifteen, the counselor believed identity issues were behind a lot of the problems. Jessica began to insist that we help her to find her birth parents. The normal identity issues that come with adoption were magnified for Jessica by her biracial roots. As she matured, our sandy-haired, blue-eyed child had taken on facial features that were identified by black society as African American and she gravitated toward the blacks in our community. To make matters
T o d a y ’s C h r i s t i a n D o c t o r
more difficult she had grown into a strikingly beautiful teenager. She had been raised as white but was more and more identifying with the black race; not viewed as acceptable in our Carolina town. We were willing to do whatever was necessary to help her to heal, and after days of agonizing prayer, began the search for her birth mother. It was the early ’80s so it was not as easy a process as it is today, due to the sealing of the birth records. We were terrified about what we might find, but believed we had to try. After several months the adoption agency was successful in locating her birth mother and she had agreed to meet Jessica. The three of us traveled cross country to the agency and Jessica jubilantly went off to spend the day with her “real mother.” Although painful, we were relieved to see the reunion going well and prayed that it would be the missing piece Jessica needed. From our vantage point today however, we can see why this new relationship slowly began to erode. The experience did not fill the void for Jessica and in fact she ended up feeling “abandoned” all over again as the birth mother was not intent on making Jessica the center of her life. She then turned to the idea of meeting her African American birth father, who after much consternation, refused to acknowledge that she was his daughter. In the end what came out of this monumental effort was more pain and an obsession with the black culture, especially men. After a particularly difficult summer we knew we just could not continue on the way we were. We felt like Jessica’s jailors in our attempts to keep her safe, but could
•Don’t expect your pastor or Christian friends to necessarily understand •Realize many people will assume you are a doctor and shouldn’t need support •Maintain a close walk with the Lord, remembering He is in control of all things •Practice ongoing forgiveness for yourself as well as others •Get help from a professional early, you can not handle mental illness alone •Keep communication open with your family as much as possible •Be careful to emphasize that the behavior is unacceptable not the child •Realize your child’s safety is at stake and take precautions •Be on the alert for interactions with your child that pit you against your spouse •Know that mental illness may not be “fixable” but you can adjust and cope •Keep your marriage healthy and avoid the blame game at all cost •Take care of yourself or you cannot help any body •Don’t automatically dismiss a suggestion of medication for the child •Keep an open mind about a good boarding school as a potential safety net •Experiencing a grief reaction often occurs as you face the loss as a normal family •It is impossible to expect that you can control and monitor your child’s every action •Trust God to work and listen for His guidance each step of the way
When Mental Illness Strikes Your Family
Suggestions for those experiencing a similar situation:
not watch her every second. She had a good volunteering job at our science museum but unknown to us, was leaving often with a new boyfriend and was soon fired. She would tell us she was going for a bike ride, but we would find she was meeting up with friends on the other side of the town. She was losing weight and eating only junk food, refusing to go for a checkup. There were small moments of hope when we would see glimpses of the daughter we used to know, but then she would quickly revert back to deviant behavior. We grieved for the daughter we once had. Jessica’s grandparents were equally affected as they watched her sink further into a dangerous lifestyle. While visiting them one weekend they discovered she was sneaking out and spending hours at a local nightspot. Unbelievably, we also discovered she was having nighttime visitors who would come to our house and climb in her window. Our home was no longer safe and we were desperate. It had been suggested before that we enroll her in boarding school to try to contain her dangerous behavior and provide limits that were impossible at home. We always dismissed the idea believing she would be better off with us, but now faced the fact that having a chance to think and start a new direction away from her destructive friendships might be necessary. So we enrolled her in a good school not far away where she could come home on weekends, praying this would be an answer. The school called three weeks later and told us she was getting into fights with the other girls and was impossible to handle. Through much prayer and perseverance we finally found a school able to deal with her acting out so she could graduate from high school.
We begged God to heal Jessica, convinced that, otherwise, she might not reach age 35. As the years passed, the stress was taking a toll. We were riddled with guilt and were constantly going back over Jessica’s childhood, looking for clues as to what we could have done wrong. Most days we struggled just to get through the day. I lost much of the joy of practicing medicine. My energy and excitement about working with patients began to wane. The staff was concerned and asked often if I was getting enough sleep, eating properly? I felt I had failed God, my family, and profession and I agonized over why God was not listening. My wife and I struggled to keep our close walk with the Lord alive, knowing He was our only hope. All our human attempts had totally failed and we were out of options. Thankfully, we drew strength from each other and our marriage remained unscathed. A few of our Christian friends stood beside us and offered much needed solace and prayer. Deep down we believed
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experienced in treating BPD. We asked for prayer as we carefully put the treatment plan into effect. Jessica was placed on Fluoxetine which did help her better control her behavior and we learned ways to help her to balance her severe emotional reactions. We read everything we could find on the subject. The Lord sent us a couple who were dealing with the same situation and we were finally able to pour out our hopes and fears to someone who did not judge us, pity us, or abandon us. Very gradually we began to see an improvement. Now our daughter is 35 and is married to a wonderful Christian man who understands her diagnosis and supports her totally. The child she had out of wedlock is the light of our life. Gone is the horrific anger at us, replaced most days by a congenial, respectful relationship. We are able to enjoy each other’s company and our family spends holidays together laughing and enjoying each other like old times. We are blessed. God has answered our prayers . . . not by instantly healing her, but by standing with us in our pain, sending us compassionate friends, surrounding Jessica with His love and the love of her family. We have learned first hand that doctor’s families have deep struggles too and we are not immune to life’s tragedies. Our experience with mental illness has given us a depth of compassion for those facing its heartbreaking challenges. I am a better physician. In my practice of medicine, I have become much more wholistic, having eyes to see the depth of emotional and spiritual suffering, as well as the physical. We need to celebrate with those physicians whose children are happy and successful, but we must also come alongside our colleagues whose children are struggling. ✝ *Note: Borderline Personality Disorder has recently been termed EmotionImpulse Regulation Disorder (ERD).
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When Mental Illness Strikes Your Family 26
God was faithful and would, one day, somehow restore our daughter to us. We continued to pray moment by moment for His wisdom and strength. By Jessica’s twentieth birthday, she had had two miscarriages and was unable to hold down a job. We were forced to seriously look at the possibility of mental illness. One of my colleagues had mentioned the possibility that Jessica could be suffering from Borderline Personality Disorder (BPD), a disorder that usually cannot be diagnosed until early adulthood. I remember that day vividly. I went to the hospital library and began to read about BPD: hostility, manipulation, impulsivity, self-destructive behaviors, demanding, dependent, entitlemen. It sounded like a description of the person my daughter had become. I was stunned and angry that someone had not suggested it before. Scanning rapidly down the pages I searched for the treatment section. That is when I really hit rock bottom. Tears welled up in my eyes as I read: therapy and medication may help but BPD is a chronic, debilitating disorder of the limbic system. Most patients will not attain greater stability until their 30s and 40s. It went on to discuss the discouragement for those treating BPD because by that time of life most patients have disrupted marriages and multiple personal problems; their lives in shambles. It almost felt like a death sentence for my only daughter. It was a frightening diagnosis that few understand and brought with it continued blame and alienation for our entire family. Had it been cancer we were dealing with, we would have had support and love from every direction; but with mental illness a cloud of suspicion and fear surrounds the diagnosis. People may keep their distance, but we learned that the Lord draws us closer. As Christians, we begged God to heal Jessica, convinced that if she continued the way she was she might not even survive until age 35 or 40. We were desperate to get her help and finally were led to a gifted and compassionate Christian counselor
I Danced With Death by Caroline Hedges, MS4
Editor’s Note: The following journal entry was written by a doctor in training the night she first experienced death on her internal medicine rotation.
I
I danced with death today . . . Death led. I had to follow. Tonight I held the hand of a man I never knew as his heart stopped beating, his lungs stopped breathing . . . his eyes wide open, staring at the unseen. All I know of him is that his name is Bill. Initially, he didn’t want us to tell his family he was in the hospital, even the ICU. But this week he asked for postcards to write them. To me, he didn’t look like a “Bill,” he looked like Kris Kringle with his white hair and long beard. He died almost alone, even with twenty people around his bed. I know that to those who dance with death every day, I must seem silly or naive — misty-eyed, holding the hand of a naked man on a bed as they all pack up their tools for giving life. But what kind of life can you give without holding someone as they journey from life through death to the life beyond? Brian came to the other side of the bed as the patient’s heart rate dropped to forty, thirty, ten, nothing. He, too, felt the sadness, and held the shoulder of Kris Kringle as the world moved on. As I type those last few lines at home, I hear from Death again. “Roy is gone.” My patient, diagnosed with pancreatic cancer three days earlier, unexpectedly went into renal failure today. And now he’s gone. I hang up the phone, put my scrubs back on, and get in the car with wet hair to go cry more tears. I hold more hands. This time with one already dead and with those left behind — left with the shock and emptiness; left with an empty pillow tonight as she sleeps; left without Grandpa’s knee to play on; left without the father so dearly loved. I n t e r n e t w e b s i t e : w w w. c m d a . o r g
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I Danced With Death
I had fallen in love with Roy these past few days. Not in living, but in dying. Musician, tender heart, lover of green chili and tortillas, father, brother. Rough around the edges, known and loved. I had to go back to the hospital for myself as much as for the family. I could cry here by myself, or cry with them. I had to say goodbye. To Roy, to these intimate strangers. I had to say hello to death. Again. So how do you learn to dance these steps? What do you do when someone dies? I cried. I asked a stranger for a hug. She said she doesn’t “do hugs,” but that she’d make an exception today. I ate a piece of chocolate. Two. I told my husband, Jeremy, that we needed to have some chocolate around the house since these latter days have been hard ones. Good thing. I needed a little chocolate love tonight. I’m finding myself showering all the time just like my surgeon husband. Now I get it. It’s a literal washing off of the hospital film, but also a spiritual symbol. There’s something to cleansing your soul in that hot water. Tonight it’s two showers. But there’s not enough heat, not enough water to wash off these tears. I search for the fuzziest pajamas I might own. I even put on my big cozy slippers, seeking some comfort. This is new. And of course, not enough. I’m thinking tomorrow of asking the doctors how to dance with death. But I don’t know if they can tell me. It’s hard enough to show someone how to dance with life. Roy’s wife held my hand and told me to stay soft. To keep compassion. I will fight for it. I will fight too for life. I will fight in pregnant patience as I wait for the day death will die. Someday we will dance upon death. We will lead. Death will follow. ✝
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From the author: I grew up in Colorado Springs, the daughter of an OB/Gyn and a flight attendant (Roy and Carolyn Stringfellow), which led to my love for international medicine. I received my BA in International Studies from Taylor University, am completing my MA in Intercultural Studies at Fuller Theological Seminary, and completed my first two years of medical school at the Medical School for International Health (a collaboration program with Columbia University in NY) in Beer Sheva, Israel. I transferred to the University of Colorado to complete medical school after meeting and marrying my wonderful husband, Jeremy, who is a third year General Surgery resident. Following in the footsteps of my father, I am pursuing a residency in Obstetrics and Gynecology. My husband and I plan to spend our careers in subSaharan Africa, serving as medical missionaries in medically underserved communities. These reflections were written at 3 a.m. during my Internal Medicine rotation, on a call night when two patients died on our service. A code was called for Bill, a man who had been in the ICU for some time, but whom I did not know. Roy was a patient that I admitted, who had sought care for back pain, and we gave him the diagnosis of pancreatic cancer. We became close—Roy, his family, and I—in the few short days that I spent with them. My heart still aches and tears come to my eyes as I think about that night when I danced with death . . . . These events led me to think about death and my role as a Christian physician in the lives of my dying patients. I want to walk through the process of dying with my patients, keeping a tender heart, without despairing. I am slowly learning what this means. But I will never stop waiting and yearning for that day when death will die—when there will be no more death, no more suffering, when Christ will bring His kingdom in its fullness. This is the hope we have, and hope does not disappoint us (Rom. 5:5). –Caroline Hedges, MS4
CLINICAL ETHICS The Doctor Who Wanted To DieT
HIRD IN A
by Robert Cranston, MD The following consultation report is based on a real clinical dilemma that led to a request for an ethics consultation. Some details have been changed to preserve patient privacy. The goal of this series of case presentations is to address ethical dilemmas faced by patients, families, and healthcare professionals, offering careful analysis and recommendations that are consistent with biblical standards. The format and length are intended to simulate an actual consultation report that might appear in a clinical record and are not intended to be an exhaustive discussion of the issues raised.
QUESTION: What are the ethically permissible treatment options for this physician who has made a serious attempt to end his life? Philip is a 72-year-old retired Dermatologist with multiple health problems, including chronic back pain, diabetes (not insulin-dependent), glaucoma, and congestive heart failure; he also has a cardiac pacemaker in place. He has lived in a small apartment on the 12th floor of a high-rise in a large city for many decades. His wife died of a stroke several months ago. Following her death, Philip gradually withdrew from most contact with their former social circles, and he stopped going to church. According to his only daughter, Susan, who is a Cardiologist, he has been threatening to commit suicide for many years because of worsening chronic back pain which has not been responsive to several medications. Yesterday, the patient acted on those threats. He first rubbed a magnet over the area in his chest where his pacemaker sits in an attempt to cause it to malfunction. When this was unsuccessful, he ingested thirty-eight digoxin tablets (a medication to control his heart rate; it has a high toxic and lethal potential, manifested primarily by vomiting and abnormal cardiac rhythms). Three to four hours later he started vomiting repeatedly. When Susan stopped by for her daily visit this morning, she saw the empty digoxin bottle and asked if he had taken an overdose. He reluctantly admitted that he had. Over his objection, Susan called 911 and he was taken to the Emergency Department at the nearest hospital. Though she responded quickly to this emergency, Susan is quite ambivalent. She respects her father’s right to free choice; she recognizes that he has been in moderate to severe pain for several years; she knows he feels his life is over now that his wife has died; she wonders if his choice could be considered a “rational suicide.”
SERIES
In the ED, Philip’s serum digoxin level was found to be markedly elevated into the severely toxic range (patient’s level = 8.9 nanograms per milliliter; therapeutic level is 1.01.5; toxic level is greater than 2.0) and his EKG showed a markedly abnormal rhythm. He was immediately treated with a drug that binds the digoxin to render it inert until it can be cleared from his system. It is not yet clear if the patient has also suffered a myocardial infarction (heart attack) or whether his arrhythmias are all attributable to his digoxin toxicity. The patient is unkempt, garrulous and demanding, upset that his suicide attempt was not successful, and angry that he is now being treated against his will. Susan is torn. She would like to see her father survive, but wonders if this serious suicide attempt should be accepted in light of his physical and social situation. She requests an ethics consultation.
DISCUSSION: The concept of “rational suicide” primarily involves the principle of autonomy. In contemporary medical ethics, rightly or wrongly, autonomy has been accorded trumping weight over the other accepted principles (non-maleficence, first of all, do no harm; beneficence, always seek the patient’s best interests; justice, treat patients without discrimination). In spite of this preeminence, there are limitations to autonomy. In this case, Philip's’ autonomy is limited by at least four considerations: (1) the precept of protection of vulnerable persons; (2) the irreversibility of specific decisions; (3) the long history of societal condemnation of suicide; and (4) the effect of an individual’s actions on the larger society. (1) Protection of Vulnerable Persons - This has been a key element of the common morality throughout history. In this case, Susan should protect her lonely, pained, frustrated, fatigued father from himself. It is interesting to note that Philip left the digoxin bottle in plain sight, and (reluctantly) admitted his actions to Susan. This suggests his action represents a cry for help. This also brings up a more basic question. Is Philip’s problem primarily pain, bereavement, depression, or in light of his behavioral changes, does he have an organic dementia or neurodegenerative process? Each of these problems would be approached differently, but all are addressable. (2) Irreversibility of Decisions - Philip’s current pain may seem to him to be insurmountable. However, with modern pain control, the vast majority of physical pain today can be greatly relieved. It is not clear that adequate measures have been pursued. Palliative medicine I n t e r n e t w e b s i t e : w w w. c m d a . o r g
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focuses not only on physical symptoms, but also on the spiritual, social and psychological aspects of patient care. What changes could improve his spiritual or social world? Has anything been done to address his bereavement issues? Suicide would irreversibly prevent any gains in these areas. (3) History of Societal Condemnation of Suicide Western medicine and society have condemned suicide at least since the time of Hippocrates (~450 BC), both to protect individuals and to protect the greater society. The Roman Catholic church has had a similar stance since the time of Augustine, though some denominations have softened their view on this issue over the past few decades. Prior to Hippocrates, the role of healer was often blurred with that of killer. As the shaman approached the suffering patient, the patient did not know whether his intentions were to prolong or shorten his life. The line in the sand that Hippocrates helped draw was that the physician was never to contribute to a suicidal act. As a physician and family member, Susan has this obligation. (4) Damage to Society - Philip’s decision to kill himself will affect others. As John Donne has said “No man is an island, entire of itself; every man is a piece of the continent, a part of the main . . . any man’s death diminishes me, because I am involved in mankind and therefore never send to know for whom the bell tolls, it tolls for thee.” We know little of Philip’s social network, but the possible implications are devastating. The pain he will cause Susan, his former patients, his friends and extended family is immeasurable. The example he would provide for others may encourage imitation of his actions and lead to others’ untimely deaths.
RECOMMENDATIONS: (1) It is not ethically permissible to withhold treatment and allow this man to die from a reversible condition. (2) The patient should have a complete medical workup including a psychiatric evaluation. (3) The patient should also have consultation about pain management, perhaps from the Pain Service or the Palliative Medicine team. (4) Efforts should be made to help the patient re-establish meaningful social and spiritual relationships.
FOLLOW-UP: The patient survived the life-threatening overdosage. A psychiatry consultant felt he was not at risk for suicide while under medical supervision, but recommended close followup. He was transferred to a convalescent home under the
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Suggestions for Addressing this Patient’s Social and Spiritual Needs Philip’s continuing care provides a Christian physician with a unique opportunity to minister to the whole patient – body, mind, and soul – while not ignoring the patient’s sociological needs, either. In addition to providing better symptom control and ongoing monitoring of Philip’s mental health, the Christian doctor can offer social support in the form of personal friendship, while trying to reconnect Philip with his former friends (or to help him find new friends) and his church family, as well. The Christian doctor could offer spiritual support, with the patient’s consent, in the form of prayer, the provision of devotional materials, and even sharing regarding his or her personal faith should the patient have an interest in that arena. If the patient expresses guilt or remorse related to the suicide attempt, the Christian doctor can function as an agent of grace, expressing God’s forgiveness as appropriate, and pointing Philip toward the hope that comes from faith in Christ. The doctor could try to help Philip embrace and a sense of purpose that might include learning to use his own experience with pain, loneliness, depression, and even despair to comfort and help others with similar experiences or feelings. —David B. Biebel, DMin; Editor, Today’s Christian Doctor
care of a palliative care physician, with the expectation that he would go home when able. He was angry and uncooperative at the time of transfer. Within 72 hours, his new physician was able to bring his pain under adequate control. The nurses caring for him remarked that Philip had a personality change. He smiled, interacted with staff and other residents, ate well, and seemed quite content. The dramatic improvement persisted, and psychiatric re-evaluation felt he was not suicidal nor in need of anti-depressant medication. About 10 days later, he was discharged to his daughter’s home with outpatient follow-up. ✝
Robert Cranston, MD, MA (Ethics) is a Fellow of the Center for Bioethics and Human Dignity in Bannockburn, IL. He currently serves with the CMDA Bioethics Commission. He completed a clinical medical ethics fellowship at University of Chicago in 2003, under Dr. Mark Siegler. Bob has been at Carle Clinic Association in Urbana, IL, since 1991, where he serves as neurology chair, and chairs the Ethics Committee at Carle Foundation Hospital.
CLASSIFIEDS Overseas Missions Ghana - Year round opportunities for medical service, most specialties, ST/LT. Baptist Medical Center in "bush" of NE Ghana with 3 full-time MDs on staff. Busy clinic & surgical service. E-mail: Mamprusi_HMT@yahoo.com; Earl Hewitt, MD. 381/0645/2457
Haiti - Radiologist/sonographer needed in Haiti. Outpatient clinic outside Port-au-Prince. Digital radiography and ultrasonography. Low volume. Active evangelism and health care to poor, underserved. No lawsuits. No on-call or weekend work. E-mail: jim-sandy@wilkins.net or see: www.haitihealthministries.org. 383/0753/2499
India - Looking for a retired/available doctor to serve at a missionary hospital in South India. Term: 1-5 years. Please contact Dr. Susan Kendall-Bell, Psy.D. 818-632-0090 or e-mail: dr.susan@hope-for-people.org. More information: www.Hope-for-people.org.
Excellent salary, incentive and benefits. E-mail CV/cover to: Entegrity@cox.net. 383/0720/2494
FP/NP – Ministry opportunity to underserved community in beautiful Neah Bay, WA. Threeprovider tribal clinic with fantastic staff. No OB/Inpt. Pager call 1/3 weekdays, 1/4 weekends. Malpractice covered by Federal Tort. Housing available. Contact: Inzune@centurytel.net or call: 360-640-9081. 383/0748/2486
General Surgery - Prescott, AZ: Join two Christian surgeons in a thriving bread and butter practice in central Arizona; mile high elevation and pine forests with mild four seasons make Prescott a highly desirable location; income potential in top decile; ER call one in seven; minimal trauma as most trauma is flown to Phoenix; opportunities for missions; contact: drbrian@northlink.com for further information. 383/0504/2500
383/0702/2487
Mexico - Pediatrician - Mexico Medical Missions operates a mission hospital in the Copper Canyon area of Mexico working among the Tarahumara Indians. According to WHO data, our area has the highest infant and maternal mortality rates in Mexico and the fifth highest in the world. We are seeking missionary pediatrician to work with our hospital as well as in our community health evangelism program. For more information, please contact Michael Berkeley, MD at: mike@mexicomedical.org. 383/0750/2489
Pakistan - Christian physicians urgently needed for ST/LT in rural Shikarpur Christian Hospital: female (GP/FP, OB/GYN, GS) for OB/general; male/female pediatrician, OB/GYN for ST teaching GYN surgery. Contact: Bill Bowman, MD; 714-963-2620; e-mail: drbillbow@aol.com. 383/0361/2428
Positions Open Dermatologist - North Carolina. Exceptional opportunity in beautiful Asheville, NC. Busy solo derm in well-established practice recruiting for BE/BC general dermatologist as well as cosmetic. Moh's would be a plus. Great area to raise a family with many outdoor opportunities. Competitive compensation package including salary guarantee and incentive and benefits. E-mail CV/cover to: ehorner@charter.net. 383/0567/2497
Emergicare of Waynesboro - Looking for fulltime or part-time MD or experienced Physicians Assistant. Please send CV to 2611 W. Main St., Waynesboro, VA 22980, attn: Ana Mata, or email: ANAMATA0326@yahoo.com. 383/0752/2498
ENT - Arizona. Exceptional opportunity in beautiful Scottsdale, Arizona. Rewarding and busy 3physician ENT practice in a single state-of-the-art office seeking BC/BE general ENT candidate.
General Surgery - Indiana. Join 5 Christian surgeons in a big 10 community 60 miles from Indianapolis. Opportunities for medical missions. Please call 765-446-5065 or E-mail: jfrancis@insightbb.com. 383/0428/2501
General Surgery/Western PA - Busy practice seeks 4th partner. Hospital assistance with cost of malpractice. Reputation for high-quality, compassionate care; we never turn away patients regardless of ability to pay. Partners begin each week with Bible study and prayer. We make less than the average general surgeon, but more than 99% of the people in the world. Call: 724-8433800, Evenings: 724-495-6144, Fax: 724-8434799, or E-mail: paburkes@msn.com. 383/0740/2504
Internal Medicine - San Diego. Retiring colleague in small private practice opens unique opportunity for PT or FT. Prime location in beautiful medical office directly across from a tertiary care hospital with trauma center and IM residency program. Incredible potential for a new colleague to establish and grow an independent and personally directed private practice. Competitive salary, benefits and partnership track available. Contact: Paul D. Wagner, MD, FACP at 858-560-8890 or: docpaul@covad.net. 383/0337/2485
Neurologist – Sandhills Neurologist, PA is seeking two BC/BE Neurologist, exclusively outpatient practice. This practice is interested in the physical and spiritual needs of the patient. Located in south central NC. World-renowned golfing resort, family-oriented community with large draw area. Approx. 2.5 hrs from beaches and mountains. Contact: sandhillsneuro@earthlink.net. 383/0581/2491
Ophthalmology - Midwestern ophthalmology practice desires an additional anterior segment
surgeon due to rapidly increasing surgery volumes. A fellowship in glaucoma or oculoplastics is desired. Candidate must be able to perform 300+ cataracts in first year and display a servant attitude toward patients. Practice has been recognized as “best in region” for several years: beautiful office, excellent staff, well-equipped with technology. Located in rapidly growing suburb of a metropolitan community. Practice is committed to performing surgical care at the NW Haiti Christian Mission. Please send info to Karen at: kkennedy@moyeseye.com. Fax: 816-587-3555. 383/0725/2502
Orthopedists - Nebraska. Well-established practice of three Orthopedists committed to providing orthopedic care with compassion as well as excellence. Time off for short-term missions. Would like to talk with general and subspecialty Orthopedists about the possibility of joining us in practice. On-site surgery center; local hospital within walking distance. Located in a family-oriented city where many recreational and cultural activities are available. Less than a 10-minute commute from any area of the city. Low malpractice rates and cost of living. Vacation at the mountains and the beach; live here and enjoy all four seasons. Please contact our Medical Director, Dr. Chris Wilkinson at: 308-865-1403 or cwilkinson@kearneyortho.com. Our clinic manager, Vicki Aten, can be reached at: 308-865-2512, or: vaten@kearneyortho.com. 383/0467/2492
Pediatrician - North Carolina – Burlington. Private practice seeking BC/BE pediatrician proficient in Spanish. Full service practice. Call 1:4. Competitive salary and benefits. 2 hours from coast/mountains. Accepting H1B visa. Contact: Dr. Stein: 336-570-0010, Fax: 336-570-0012, E-mail: INFAMCLIN@Bellsouth.net. 383/0551/2490
Social Worker - LCSW needed for Family Christian Health Center (FCHC), a Federally Qualified Christian Health Center. FCHC's model of counseling and social work integrates clinical therapy and Biblical counseling. E-mail resume to Dr. Tom Rose, CEO at: drtom@familychc.org. 383/0744/2484
Positions Wanted Certified Pediatric Nurse Practitioner - available for locums 1-3 months at a time anywhere in the US. I have 3 years primary care/medicaid experience. Available starting January 2008. For more information please E-mail: ckschwabcpnp@hotmail.com. 383/0751/2493
Practice for Sale Internal Medicine Practice For Sale - Planning ahead? Busy IM practice serving two physicians in Central NJ. Turn-key opportunity to manage your own instead of negotiating salary and buyin. Available July 2008. E-mail: therightpersonlag@gmail.com. 383/0743/2495
I n t e r n e t w e b s i t e : w w w. c m d a . o r g
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Toll Free: 1-888-690-9054 Fax: 423-844-1005 E-mail: Placement@cmda.org Website: www.cmda.org
Placement Services Orthopaedic Surgery Allen Vicars Family Medicine allen.vicars@cmda.org
Donna Fitzgerald Cardiology Dermatology Emergency Medicine Endocrinology Gastroenterology Hematology/Oncology Internal Medicine donna.fitzgerald@cmda.org
Rose Courtney Med/Peds Nurse Practitioner OB/GYN Ophthalmology Pediatrics rose@placedocs.com
Cathy Morefield General Surgery Anesthesia Orthopaedic Vascular Surgery Cardio-Thoracic Dentistry cathy.morefield@cmda.org
This section represents a small portion of our opportunities. To view a complete listing, go to the Placement Section on our website: www.cmda.org
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CO – OS-157 Western Colorado. A solo Christian Orthopaedic Surgeon is seeking another surgeon to join his practice. The solo physician is a servant first who happens to perform orthopaedic surgery. He uses his profession to minister to the community and patients. Call 1:6. IL – OS-189 Nestled in the scenic Fox River Valley & just 45 minutes west of Chicago, is an established independent, SS, Orthopaedic & Sports Medicine practice. Current physician specialized in general orthopaedics & sports medicine. Any other orthopaedic specialty is welcome, i.e. hand, foot/ankle, etc. Procedures performed in office and skills desired for new position are evaluation and management, closed reduction of fractures, injections, irrigation and debridement, incision & drainage, sutures.
Radiation Oncology OH – RO-102 Position available in SS group in beautiful, state of the art, freestanding cancer center. Single Site. No competition. Central OH.
Plastic Surgery NC – PG-106 Twenty-nine-year-old, independent, SS, inpatient & outpatient practice is seeking a Plastic Surgery Physician to replace retiring surgeon. Practice is located in the beautiful Piedmont Triad of North Carolina. The practice has all modern equipment and the staff is well trained. The practice office suites are certified by the AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities, Inc.) Class C-M. Their goal is to provide the finest possible patient care. Geographically, practice is about two hours to the Blue Ridge Mountains & about 3 hours to the coast. You will find the finest Continental cuisine, Southern home cooking or International delights. The people of this city take pride in the community, but are not boastful of themselves. This city has never lost its small town values. The practice philosophy is to Serve Christ Always!
General Surgery IA – SG-269 Independent owned or hospital based – your preference. Currently two General Surgeons. Call schedule 1:3 weekdays and weekends. Responsibilities: strictly clinical & they admit to 5 hospitals to provide service to their rural population. This community is located 45 miles from South Dakota & a short distance from Sioux City, IA. IN – SG-266 Located 50 minutes from Indianapolis & 2 hrs from Chicago. Independent, MS, inpatient/outpatient practice is seeking a General Surgeon. Skills desired are laparoscopy & gastroenterology. Currently 5 physicians are on staff with call 1:5 for weekdays/weekends. MI – SG-169 Busy independent Christian; SS surgical group is seeking a BE/BC General Surgeon. Currently they have five surgeons with need to spread out to the rural areas to help a larger market of patients. They admit to 2 hospitals. NC – MS-359 Practice in western North Carolina would like to add one General Surgeon now & another in the near future. Call 1:3 with two long term current General Surgeons – both retiring in a few years. New surgeon can be independent or employed by the hospital. Admitting not-for-profit hospital has 65-licensed beds. OR – MS-413 Hospital owned, 10-year-old, inpatient/outpatient practice is seeking to add a Bread & Butter General Surgeon to their group. Currently they have 2 general surgeons. Call 1:3 for weekends/weekdays. The admitting hospital has 21 licensed beds. TN – MS-154 Clinic located between Memphis & Nashville. Additional physician required due to increase in patient load. Currently 7 surgeons on staff. Call 1:7. BE/BC. Prefer fellowship trained in vascular and endovascular. Must have completed a university residency program, as opposed to hospital program.
Toll Free: 1-888-690-9054 Fax: 423-844-1005 E-mail: Placement@cmda.org Website: www.cmda.org
Pediatrics
Dentistry
Placement Services
Family Medicine
ME – DT-260 An independent, 3-year-old dental practice is seeking another dentist to join them. Currently one dentist, 4 dental assistants and 4 dental hygienists (3 are part-time). Number of patients seen per day varies depending on the complexity and length of appointments. They have 5 operatories. Practice is located in Mid-Coast Maine and a mostly rural area with natural beauty.
CO – 1106 Outpatient only practice in Denver suburbs. Call schedule is phone only for 2 days a week and 1-2 weekends a month. Providers average 25 patients daily. Goal is to provide exceptional care from a team of qualified professionals who appreciate patients and truly care about patients — both physically and spiritually.
Other Dental opportunities: GA–3; IA–2; IN–2; KS–1; LA–1; MI–1; MN–1; MO–1; MS–1; NC–2; NH–1; OH–1; PA–5; VA–2; WA–1; WI–1
TX – MS-520 Wonderful opportunity for FP, OB optional, to join 4 other FPs in the Panhandle area. Inpatient/outpatient required. Only 75 miles from Amarillo, community is a HPSA and eligible for loan repayment. Excellent compensation and benefits.
AZ – PD-232 Practice consisting of one Pediatrician and one Pediatric Nurse Practitioner searching for another Pediatrician to join group. KY – PD-245 Independent, pediatric inpatient/outpatient practice seeking a Pediatrician. Currently 2 other physicians in practice. Shared call coverage 1:5. WA – PD-237 Independent, single specialty group seeking another Pediatrician. Inpatient and outpatient with call of 1:10. Admitting hospital has a level II Nursery and 250 beds.
Oncology PA – ON-108 Acquire ownership of a premier, innovative, solo oncology practice. Established in 1989, owned and operated by the founding physician, who desires to step down and wants to apprentice, disciple and establish the right person to continue the ministry. Experienced staff. Southern PA. NC – MS-466 Established, Christian, hospital based oncology practice. Must be BC/BE and have a desire to give patients compassionate, quality care. Western NC.
Internal Medicine OH – IM-251 Independent SS group of 2 Christian Internists. Inpatient/outpatient. Northcentral OH.
WA – MS-470 3 physician group in SW Washington needing FP, no OB. Outpatient only with inpatient referred to hospitalist group. Only minutes from Olympia and Tacoma with easy access to Seattle. Faith is integral to the practice and how they treat patients, staff and coworkers.
NV – FP-1119 Practice located in northern Nevada searching for FP with OB and C-section experience. Call is 1 in 3 OB and 1 in 6 for ER hospital admissions. Income guarantee of $300K with $15K for moving expenses and loan repayment if needed. Practice extends compassion and dignity to the people of their local and global community with the hope that ultimately everyone will experience the love of Jesus Christ. MD – FP-1115 Independent practice in beautiful western Maryland seeking FP, OB optional. Practice consists of 2 FPs and 2 PAs. Inpatient/outpatient required. Willing to consider either full or part-time physicians. Their foundation is upon the infallible Word of God from which excellence, humility, compassion, service, financial excellence, and giving become paramount in caring for patients. TN – FP-1090 Single specialty practice in Tri-Cities area of east TN seeking FP, no OB. Practice consists of 3 FPs and 1 PA. Each provider averages 20-25 patients daily. Call schedule is every 3rd week and weekend. Desire to expand group to 5 or 6 where physicians can also rotate on and off the mission field.
Physical Medicine & Rehab WA – PM-102 Join an independent SS practice. FT or PT. This is a Christian based clinic that serves the Lord first. Tri-City area of southern WA.
Dermatology MO – DM-115 Vibrant opportunity to join a fellow Christian in an established practice. General Dermatology, adult and pediatric. Kansas City Metro area.
Otolaryngology SC – OT-127 Christian, independent, SS practice of 7 physicians. In/Outpatient. Call 1:7. FT or PT. Located in the capital of SC. OR – OT-135 Independent SS group of 3 ENT physicians is seeking an associate. Patients average 30 per day. ER call 10 days per month. Southwest OR.
OB/Gyn IL – OB-296 OB/Gyn practice seeking another provider. Currently one physician staffs the facility. Call schedule 1:4 weekdays and 1:7 weekends. Their mission is to provide the love of Christ through healthcare. OH – OB-297 Practice seeking to add an OB/Gyn provider. Currently 3 other physicians and 1 CRNP. Call schedule is 1:4. VA – MS-473 Join the largest not-for-profit health system in southwest Virginia. Opportunity to join two physicians in a very busy practice. I n t e r n e t w e b s i t e : w w w. c m d a . o r g
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CHRISTIAN MEDICAL & DENTAL ASSOCIATIONS P.O. Box 7500 Bristol, TN 37621-7500
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