Volume 48 No. 3 • Fall 2017
Today’s
Christian Doctor The Journal of the Christian Medical & Dental Associations
EFFICIENT CARE & SPIRITUAL CARE
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CEO EDITORIAL
JOY IN THE MESS
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by David Stevens, MD, MA (Ethics)
he physician teared up as he answered my simple question, “Tell me about your practice.” My question led to a story about the reason for his long commute to his rural practice. Before that move, he practiced for 11 years at a clinic owned by a not-for-profit system in his city. Then one day it was sold to a for-profit entity. Soon after, as he was rushing to see his last two patients before grabbing a quick lunch, an administrator came by and asked if he could have a word with him. They stepped into his office and he was told he was terminated effective immediately. There was no explanation of the reason before he was immediately ushered out the back door of the building, leaving his patients sitting in their exam rooms. He was told to contact the head nurse to set a time to come back that evening to clear out his office. He wasn’t even allowed to say goodbye to his staff of many years. The epilogue to that tragic day was his wife had dropped him off at his office that morning, so he had to walk home. Misconduct? Malpractice? Insubordination? No, it was an “efficiency” decision, and efficiency is the god of 21st century healthcare. Healthcare has increasingly become a brutal business where healthcare professionals are mere “units of production.” They have lost respect, influence and satisfaction. Satisfaction comes from having relationships with your patients, your staff and your family, but there is little time for those relationships these days. You arrive home late only to find an electronic box full of charts still to complete. The mantra is to give us more in less time on the health assembly line, and if we can’t get all the work done, we have to solve that problem. How did we get into this mess? Healthcare costs way too much. To try to solve that, the government and other third party payers created more and more bureaucracy in an attempt to control costs. Endless data collection takes more time, which destroyed professional and patient satisfaction. Healthcare professionals at the peak of their abilities are increasingly dissatisfied, so they are leaving healthcare in droves just as the population bulge of the baby boomers reach the peak of their lifetime health needs. Women, who now make up more than half of new healthcare professionals, are more likely to step away from practice if they have children, which decreases the workforce. We import healthcare professionals from countries around the world creating a brain drain. The list could go on.
Recently, there was a healthcare crisis in Kenya. All the public hospitals in Kenya were closed for 100 days due to a doctor strike. It was the only tool the physicians had left in their nationalized system to deal with chronic low pay, long hours and a poorly functioning bureaucracy. Sadly, patients died and others suffered during the strike. I increasingly see the United States heading down the path to a single payer system. There are not many other options to try before we are only left with that to push down the cost curve. If we do head that way, I hope we can avoid the land mines littering its path. The cover story of this issue of Today’s Christian Doctor focuses on the issue of “efficiency” and contains many practical suggestions that I hope are helpful to you. At the same time, I encourage you to remember why you are in healthcare. You don’t have a job or even a profession; instead, you have a CALLING from God Himself. Take your eyes off your circumstances and look up! Ask God to give you joy, it is contagious. Ask God to help you to be the oil in the machine of healthcare that is not working well. All these problems open the door for ministry every day. Realize even your too brief encounter with each patient is a divine appointment. If you are having a pity party, ponder what it must have been like for the Great Physician. Imagine the mob scene of people desperate to just touch Him. Remember He sees patients with you every day while offering you His experience, wisdom, patience and strength. Lean on Him. Transformed Doctors ➤ Transforming the World www.cmda.org 3
TO DAY ’ S C H R I S T I A N D O C TO R
contents
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VO LU M E 4 8 , N O. 3
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FA L L 2 0 1 7
The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.
26 30
22 14 Cover Story
Efficient Care & Spiritual Care: Can You Do Both?
34
Classifieds
by Walt Larimore, MD
Exploring ways to incorporate spiritual care into your busy schedule
22
The Two Diagnoses
by Wilson Wayne Grant, MD
How the writings of Dr. Paul Tournier can impact your practice today
26
What Are You Training For?
by Jeff Amstutz, DDS, MBA
The importance of committing to spiritual training
30
Where Did My Joy Go...and How Do I Get it Back?
by Betsy Manor, MD
One physician shares how burnout forced her to revaluate her career priorities
4 TODAY'S CHRISTIAN DOCTOR Fall 2017
EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD; John Crouch, MD; Autumn Dawn Galbreath, MD; Curtis E. Harris, MD, JD; Van Haywood, DMD; Rebecca Klint-Townsend, MD; Robert D. Orr, MD; Debby Read, RN AD SALES Margie Shealy 423-8441000 DESIGN Ahaa! Design + Production PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). Today’s Christian Doctor®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Fall 2017, Volume XLVIII, 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© 2017, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tennessee. Undesignated Scripture references are taken from the Holy Bible, New In-
ternational Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Other versions are noted in the text. Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.
TRANSFORMATIONS
A NEW MEDICAL MISSIONS CONFERENCE FROM CMDA REMEDY MEDICAL MISSIONS CONFERENCE March 23-24, 2018 • Orlando, Florida www.cmda.org/remedy
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edical missions brings the remedy for disease. And medical missions brings the remedy for sin. But in order to do this, medical missions needs missionaries. Committed healthcare professionals are the greatest need in closed countries to provide God’s spiritual and physical remedy. Join us at First Baptist Orlando in Orlando, Florida on March 23-24, 2018 for Remedy, a new conference focused on bringing God’s remedy to the world through missions.
LEARN MORE
For more information about Remedy, including the venue, breakout sessions, registration costs and more, visit www.cmda.org/remedy.
PLENARY SPEAKERS
Michael D. Johnson, MD, FACS
Rebekah Naylor, MD, FACS
Val Tramonte, MD
David Stevens, MD, MA (Ethics)
Transformed Doctors ➤ Transforming the World www.cmda.org 5
TRANSFORMATIONS
CONTINUING TRANSFORMATION THROUGH EEG by Gregory R. Lipscomb, MD
In the spring edition of Today’s Christian Doctor, I shared how God is opening doors to use portable EEG machines to help treat and share the gospel with patients in remote locations. God is moving in miraculous ways through this program, as evidenced from the trip to Haiti I returned from in March. We had the portable EEG with us when we saw a 15-year-old boy living in the mountains who has had seizures his entire life. He has never been in school, has no friends, is ridiculed and was untouched by anyone other than his mother. His mother blames herself because about three years ago he had a seizure and fell into a fire while she was not there. With my partner, we performed an EEG to discover he has primary generalized absence epilepsy, which is treatable in 80 percent of patients. We were able to give medication to help with his epilepsy. With this medication, the diagnosis made by the EEG will surely help change his life. We also saw a little girl completely collapsed, who had a normal EEG. She had rhythmic jerking of her right arm, and I would have treated her for epilepsy without the EEG. She is from a voodoo family, and she started fighting simply at the name of Jesus. With prayer, she woke up. In addition, I was able to share my faith with a practitioner of voodoo. We saw God move in an amazing way. When he turned from his dark ways and decided to follow Jesus, his face changed before our eyes, as we felt the evil leave, and the little hut we were in was filled with the presence of the Holy Spirit. We then took his voodoo items and burned them. God is moving in Haiti, and lives are being transformed. Will you pray for these people? Gregory R. Lipscomb, MD, is a board certified neurologist practicing in Montgomery, Alabama. He is also the founder and director of the International Neurology Services. For more information about this project and to get involved, visit www. intlneuro.org.
EVENTS For more information, visit www.cmda.org/events.
Women Physicians in Christ Annual Conference September 21-24, 2017 • Big Sky, Montana Midwest Fall Conference October 13-15, 2017 • Norton Shores, Michigan CMDA Dawson Retreat October 25-29, 2017 • Avon, Colorado Global Missions Health Conference November 9-11, 2017 • Louisville, Kentucky Northeast Winter Conference January 12-14, 2018 • North East, Maryland West Coast Winter Conference January 26-28, 2018 • Cannon Beach, Oregon Voice of Christian Doctor’s Media Training May 18-19, 2018 • Bristol, Tennessee International Christian Medical and Dental Associations World Congress August 21-26, 2018 • Hyderabad, India
MEMORIAM & GIFTS Gifts received April through June 2017
Cottage Garden Club in honor of Dr. Bill Wood Ms. Ruth L. Smith in honor of Dr. Bill Barnett’s 100th birthday Mr. and Mrs. James Lane in honor of Dr. Bill Barnett’s 100th birthday Dr. and Mrs. James D. Barnett in honor of Dr. Bill Barnett’s 100th birthday Ms. Sharon A. Babbitt in honor of Dr. Bill Barnett’s 100th birthday Mr. and Mrs. Daniel G. Macke in honor of Dr. Bill Barnett’s 100th birthday Ms. Jacquelynn Remery in honor of Beth Chrzan for Mother’s Day Dr. and Mrs. Henry Lesesne in honor of Will Gunnels’ retirement Dr. and Mrs. Bruce MacFadyen in memory of Mrs. Kit Sillin Dr. Jennifer Brown in memory of Dr. Donald Graves Health Choice, LLC in memory of Richard Towne Mr. and Mrs. Thomas Titkemeier, RPHs in memory of Ms. Barbara J. Naplerala Pat Oldham in memory of Wanda J. Cowper Isabelle, George and Michael Dewey in memory of Wanda J. Cowper Pat and Gaye Shivers in memory of Wanda J. Cowper Jason and Suzanne Moody in memory of Wanda J. Cowper Dr. Marvin Culbertson, III in memory of Mrs. Pam Goad For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.
6 TODAY'S CHRISTIAN DOCTOR Fall 2017
CENTER FOR MEDICAL MISSIONS
MEMBERSHIP
VOICE IN PUBLIC POLICY
MEDICAL EDUCATION INTERNATIONAL
LIFE & LEADERSHIP COACHING
GLOBAL HEALTH RELIEF GLOBAL HEALTH OUTREACH
COMMISSION ON HUMAN TRAFFICKING
CAMPUS & COMMUNITY MINISTRIES
DENTAL MINISTRIES
MARRIAGE ENRICHMENT
45+ MINISTRIES. 1 MISSION. Changing Hearts in Healthcare. We are a Christ-centered organization dedicated to motivating, educating and equipping you to be the hands of Jesus in your practice, your community and your world. We offer you discipleship, fellowship, mentoring, resources and missions opportunities to share the gospel and serve others. Become a member of CMDA today and join the thousands of Christian healthcare professionals who are changing hearts in healthcare. Visit www.joincmda.org to join today! Paid Advertisement
P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.cmda.org
RENEW
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YOUR MIND
at TRANSFORM: CMDA’s National Convention The premier convention for Christian healthcare professionals
PLENARY SPEAKERS
April 26-29, 2018 Ridgecrest Conference Center Ridgecrest, North Carolina www.cmda.org/nationalconvention
Rev. Jon Barnett
Ellie Lofaro
Hon. Joe Pitts
David Stevens, MD, MA (Ethics)
TRANSFORMATIONS
LEADERS WANTED TO TRANSFORM THE WORLD House of Representatives Are you interested in serving CMDA as a volunteer leader in the House of Representatives? They meet once a year to approve bylaw changes, receive reports and approve the ethical positions of the organization. During the year, they also serve as two-way channels of communication between CMDA and its members. There is one representative from each state and from many of our local ministries. For more information, visit www.cmda.org/hor.
Regional Ministries Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 503-522-1950 west@cmda.org Midwest Region Allan J. Harmer, ThM, DMin 951 East 86th Street, Suite 200A Indianapolis, IN 46240 317-257-5885 cmdamw@cmda.org
Board of Trustees New trustees to CMDA’s Board of Trustees are nominated by a joint committee of the House of Representatives and the Board of Trustees. They look at the service record of potential nominees to CMDA, their leadership capabilities, expertise and Christian testimony. The nominees are then approved by both the house and the board. Trustees may serve up to two consecutive four-year terms and pay all their own expenses. The board meets three times a year to set policies, approve the budget, oversee finances and provide supervision to the CEO. For more information, visit www.cmda.org/trustees.
Northeast Region Scott Boyles, MDiv P.O. Box 7500 Bristol, TN 37621 423-844-1092 scott.boyles@cmda.org Southern Region P.O. Box 7500 Bristol, TN 37621 888-230-2637 ccm@cmda.org
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HOW C AN DEM ENT I A HONOR G OD? Showing us how God can be honored as we respect the inherent dignity of all humans made in his image, Dr. John Dunlop offers biblical and practical principles for appropriate care for dementia patients as we serve them and their families.
“Dunlop’s extensive experience allows him to contribute rich practical and spiritual wisdom for those walking this path. I highly recommend it as a guide.” MEGAN BEST, palliative care practitioner; bioethicist
CROSSWAY.ORG
Transformed Doctors ➤ Transforming the World www.cmda.org 9
TRANSFORMATIONS
VIE POSTER SESSION At the inaugural VIE Poster Session held at the 2017 CMDA National Convention, a total off 11 posters were displayed by CMDA students, residents and fellows as they masterfully described their research for the judges. Some of the topics included human trafficking, international missions, anaphylaxis, neuropathy and more. The idea for this new addition to the convention originated a year prior during a brainstorming session of the National Resident & Fellow Council (NRFC) to consider new ways to encourage more involvement of students, residents and fellows at the convention. The idea quickly blossomed and the name VIE was chosen as an acronym for Vignettes, Initiatives, Innovations and Education, which is also the French word “life.” One participant exclaimed that the VIE Poster Session was the “best new thing at National Convention!” For many of the participants involved, their institution only allowed them to attend the convention because they were present-
ing at the poster session. Many of these institutions even sponsored the presenters, helping make the trip more affordable for students. GET INVOLVED
Preparations are already underway for the 2018 VIE Poster Session, and there are plenty of ways to get involved as a participant, judge or supporter. You can also encourage your colleagues and trainees to submit abstracts and request funding from their institutions. For more information, visit www.cmda.org/vie.
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12 STEPS TO CHRISTIAN DECISION MAKING Finding God’s Direction for Life’s Decisions with Al Weir, MD CMDA President
CMDA NATIONAL WINTER CONFERENCE 10 TODAY'S CHRISTIAN DOCTOR Fall 2017
February 23-25, 2018 Bristol, Tennessee www.cmda.org/events
TRANSFORMATIONS
NEW ETHICS STATEMENTS During the 2017 CMDA National Convention held in Ridgecrest, North Carolina earlier this spring, the Board of Trustees and House of Representatives unanimously approved two new ethics statements. Those statements were: • Three Parent Human Embryos • Imminent Death Organ Donation The full statements, along with detailed references, are available online at www.cmda.org/ethics. These statements are designed to provide you with biblical, ethical, social and scientific understanding of these issues through concise statements articulated in a compassionate and caring manner. They are needed for the religious freedom battles we are currently facing, so we encourage you to share them with your colleagues, pastors, church leaders and others. LEARN MORE
Visit www.cmda.org/ethics for more information about CMDA’s Ethics Statements and to review these new statements.
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TRANSFORMING HEALTHCARE MARRIAGES
oday’s healthcare profession is taking its toll on marriages. Increasing time pressures, fiscal burdens, continuing education requirements and countless demands have made building strong marriage relationships all the more difficult. We see this need and want to help healthcare couples by providing opportunities for you to transform your marital relationship. CMDA’s Marriage Enrichment Weekends offer a comfortable, get-away-from-it-all setting, allowing couples to communicate and experience a deeper appreciation for their marriage partnership.
UPCOMING DATES October 13-15, 2017 • Palm Coast, Florida January 19-21, 2018 • Palm Coast, Florida (for women physicians and their spouses only)
February 23-25, 2018 • Albuquerque, New Mexico October 12-14, 2018 • Bristol, Tennessee REGISTER NOW
To find more information about or register for an upcoming Marriage Enrichment Weekend, visit www.cmda.org/marriage.
A Marriage Enrichment Weekend will help you to: • Have a healthier marriage • Improve communication • Develop spiritual intimacy • Achieve balanced priorities • Rekindle romance The weekend conference offers a three-fold format consisting of brief information sessions, private time for couples to work on assignments to assess their own marital relationship, and small group sharing sessions consisting of four to five couples which address the unique needs and stresses of healthcare marriages.
Transformed Doctors ➤ Transforming the World www.cmda.org 11
TRANSFORMATIONS
There are no great preachers, only a great Christ. —Dr. Haddon W. Robinson 1931-2017
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r. Haddon W. Robinson, one of the foremost experts in biblical preaching, passed away on Saturday, July 22 at the age of 86. Dr. Robinson served as the General Director of CMDA from 1971 to 1979, and he was a member of our Board of Reference until his death. He truly embodied our vision of “Transformed Doctors, Transforming the World” throughout his life.
“Haddon Robinson was a great friend of mine. He was such a tremendous Christian person that he was always a model to me and to many others also. And I thank God for the life of Haddon Robinson. He was a real blessing to me.” —Don Westra, JD, CMDA Executive Director, 1980-1984
Originally from Harlem, New York, Haddon became a Christian as a child and preached his first sermon as a teenager volunteering with prison ministry. He received a bachelor’s degree from Bob Jones University, a master of theology from Dallas Theological Seminary, a master of arts from Southern Methodist University and a doctor of philosophy degree from the University of Illinois. He was also awarded honorary degrees from Gordon College and McMaster Divinity College. His book Biblical Preaching is used in more than 150 seminaries and Bible colleges as the preeminent textbook for preachers in training. In addition, he authored more than a dozen additional books on preaching and regularly taught through radio ministries. Dr. Robinson also taught at Dallas Theological Seminary and was president of Denver Seminary. At the time of his death, he was interim president and professor of teaching at Gordon-Conwell Theological Seminary. In 1996, he was named in a Baylor University poll as one of the “12 Most Effective Preachers in the English Speaking 12 TODAY'S CHRISTIAN DOCTOR Fall 2017
World.” In 2006, he was recognized by Christianity Today in the top 10 of its “25 Most Influential Preachers of the Past 50 Years.” In 2008, he received the E.K. Bailey “Living Legend Award.” And in 2010, Preaching magazine named him among the “25 Most Influential Preachers of the Past 25 Years.” He is survived by his devoted wife of 66 years, Bonnie, two grown children and two grandchildren. During his time as the General Director of CMDA (known at the time as Christian Medical Society) in the 1970s, Dr. Robinson effectively led the ministry through a period of growth, placing a renewed emphasis on evangelism through healthcare. He also served as the editor of the Christian Medical Society Journal (which is now Today’s Christian Doctor). In 2002, he was the keynote speaker at the dedication of CMDA’s new headquarters in Bristol, Tennessee. In lieu of flowers, the Robinson family requests that memorial gifts be given to the Haddon Robinson Chair of Preaching at Denver Seminary in Denver, Colorado or the Haddon Robinson Center for Preaching at Gordon-Conwell Theological Seminary. If you would like to share how Haddon
TRANSFORMATIONS
“I remember one time when [Christian Medical Society] had the annual meeting in Grand Rapids, Michigan. They were going to have a big dinner out of town, and we were staying at a hotel in Grand Rapids. Everyone went to the place we were supposed to go for dinner, but there was no Haddon, and he was supposed to be the main speaker. Someone said, ‘Maybe he was taking a nap and didn’t hear us leave the hotel.’ One of the guys went back to get him and he made it in time for the speech. Haddon said, ‘I woke up and everyone was gone. I looked around and thought the rapture had come.’ Everyone roared in laughter, because if anyone was going to be in the rapture, it would be him. He had such a dry, wonderful sense of humor, as well as being a brilliant man.” —Mae Westra “He had a very gifted mind, so that he could speak of convention truths in unconventional ways that were very thought-provoking. In his writing and in his speaking, that was Haddon Robinson.” —Lew Bird, former CMDA staff
Dr. Haddon Robinson was the guest speaker at the dedication of CMDA’s headquarters in Bristol, Tennessee in 2002, and he assisted in the ribbon cutting ceremony as well.
impacted your life, send your comments to communications@ cmda.org and we will forward them on to his family. Haddon’s legacy lives on through every person he taught, every person he reached through his radio ministry and every person he transformed through his preaching. We are grateful for the impact he had on CMDA during his tenure, and we rejoice in knowing he is walking with our Lord after hearing, “Well done, good and faithful servant” (Matthew 25:23).
“He was a true leader of humans of all ages, proven by his family conference directing of chorale groups of medical and dental professionals’ progeny and his ‘practical theology’ discussion sessions with their parents. The children so looked forward to his directing their performances of the ‘classics’ such as ‘She’ll Be Coming Round the Mountain When She Comes.’ I was so impressed with his management of personal time and of CMS staff time. In addition to his academic responsibilities as Professor of Homiletics and Practical Theology for Dallas Theological Seminary, he authored many outstanding booklets under the CMS publishing banner. His admirable attribute of persistence was demonstrated by his multi-year attempts at our summer family conferences to learn to waterski. His generosity was demonstrated during those conferences through the evening sessions dedicated to teaching us non-clergy the principles of preaching. Haddon Robinson and his whole family were a special gift of God to CMDA.” —Marvin Jewell, CMDA President, 1975-1977
“For the believer in Jesus Christ, for the righteous person, we do not go out into death and into darkness. Instead, we go home to God.” —Dr. Haddon W. Robinson Transformed Doctors ➤ Transforming the World www.cmda.org 13
EFFICIENT CARE & SPIRITUAL CARE Can You Do Both? by Walt Larimore, MD
14 TODAY'S CHRISTIAN DOCTOR Fall 2017
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t was bound to happen. And it did, on a Thursday morning. But let me give you some background first. My best friend and practice partner, John Hartman, MD, and I were seeing patients in our family medicine practice from, as they say, conception to cremation. We had been working to introduce a variety of simple spiritual interventions that allowed us to practice not just as healthcare professionals who were Christians, but as Christians who happened to be healthcare professionals. In other words, our practice was becoming a ministry as we took a spiritual assessment with most patients; utilized faith flags, faith stories and faith prescriptions; and prayed for and with patients when indicated. Christ was central to who we were and what we did professionally. We took great joy in what the Lord was doing in and through each of us. Then came that auspicious Thursday. Paul Brennan (not his real name) was a grouchy senior who continually ignored or resisted anything to do with God, Christ, the Bible or church, and he didn’t mind letting me know about it. During the years I had known him, I had raised countless faith flags and explained the health benefits of faith. He was on my daily prayer list for more than a year. He had even allowed me to pray for him once about a difficult medical decision he needed to make and then once again before a minor procedure in the office. All of these were interventions that took virtually no time. And all were seemingly to no avail.
He stared out the window and then came the unexpected: “Doc, I think I’m going to need that God you’ve been trying to tell me about for this one.”
Then, on the morning of an appointment to hear a biopsy report, something changed. Unfortunately, it was peak flu season and I knew the schedule was double-booked, a patient was waiting for me in the ER and I was already running terribly behind. When I walked into Mr. Brennan’s exam room, instead of receiving the verbal beating I expected from this crabby, cantankerous old fellow, I sensed that my patient’s heart had softened.
On the one hand, I was excited. I sensed we were on the edge of an amazing spiritual breakthrough. 1 Peter 3:15 says, “In your hearts honor Christ the Lord as holy, always being prepared to make a defense to anyone who asks you for a reason for the hope that is in you; yet do it with gentleness and respect” (ESV, emphasis mine). And here was Paul, asking—seriously asking. And I was prepared. But, on the other hand, I was behind for the day—terribly behind.
“What’s the word, Doc?” he asked quietly. I sighed and replied, “Paul, I’ve got bad news. It’s cancer.”
Transformed Doctors ➤ Transforming the World www.cmda.org 15
THE COLD REALITY OF TIME
I was slapped in the face that day with the allto-familiar bucket-of-cold-water realization that Christian healthcare professionals who begin utilizing spiritual interventions quite quickly will find themselves, as I was, being caught in a time crunch by a patient or family member who wants to know more. If I took time to talk with Paul, I knew I’d run even more behind. But if I failed to take time to meet Paul’s spiritual needs, something that is a passion for me, would I put Paul’s spiritual health at risk? Would I risk being disobedient to God and His call for me in healthcare? Would I miss an opportunity to join the Holy Spirit where He was already at work? Did I really believe God was sovereign even over my schedule?
“
[We] have a matchless, wonderful opportunity to meet people at times of their real need when they are ready to open up their hearts and expose their fears and worries and concerns. They will talk about their families and about eternity and the other things that are bottled up inside them. They are broken and afraid when they face a medical situation. They often are very willing to express these things, and this gives us the opportunity to present the grace of our Lord Jesus Christ. In the active practice of our profession, we need to know and have available to us, on call as it were, other people who can participate with us in the great work of witnessing to the love of God. I believe we should know people in our church and in our hospital—nurses, mothers, people who have been bereaved, people who have suffered, people who know how to sympathize and comfort—so that in our busyness, when we cannot give as much time as we ought to give, we can call on someone else to help. It would be wise to have a list of other members of the body of Christ who could help us in this great work. —Paul Brand, MD
Add to this conundrum the pressure-cooker of modern healthcare systems where healthcare professionals are required to do more and more in less and less time. When most of us have less time with patients than ever, it’s no wonder many question how they’ll ever meet the spiritual needs of their patients—and many don’t even try.
What’s the answer? It’s actually stunningly simple. It’s no different for Christian healthcare professionals than it is for the church. We are not designed nor called to do ministry in the workplace alone. There are no lone rangers at the frontline of evangelism. We are designed and called to be part of the body of Christ in worship and work. In fact, I believe our work as followers of Jesus is to be an act of worship. We each know God has called and commissioned us to be competent healthcare professionals who practice with Christ-like compassion while being draped in Christ-honoring character. And most of us in healthcare know God can speak very loudly with His megaphone of pain, disease, disorder or disaster (to use a C. S. Lewis metaphor). But God simply has not given most of us the time or the impossible call to “do it all” ourselves with everyone we see. Rather, He has given each of us the call and commission to “do ministry” with others. But how?
OUR SPIRITUAL CARE TEAM
After having more and more spiritual crises pop up in our day-to-day care and talking to other Christians wrestling with the same issue, we decided to utilize a 16 TODAY'S CHRISTIAN DOCTOR Fall 2017
”
Spiritual Care Team in our practice. Emmer and Brown first described Spiritual Care Teams in healthcare literature in 1984. They defined a Spiritual Care Team as a group of health professionals and staff who seek to integrate spirituality into patient care in a way that enhances their ability to provide “whole-person” healthcare that includes “spiritual care.” For us it meant organizing two of our staff nurses into what we called our Spiritual Care Coordinators. Their role was to be sure spiritual assessments were recorded when indicated. And when spiritual needs arose that the physicians didn’t have the time or training to handle, their role was to coordinate this care with Spiritual Care Providers. In our practice, the Spiritual Care Provider took two forms: 1. We could have used chaplains, but none were based in our town’s hospitals. So we approached pastoral professionals and Christian counselors in our area to see if they’d be available for referrals or consults, and not a single person turned us down. Their biggest complaint over the years was that we didn’t use them enough! 2. The second type came from our patients and close friends—Christians who were mature in their walk with Christ and had successfully wrestled with (or were wrestling with) a specific health crisis or problem. People in this group were more than delighted to join us, and we called them our “lay ministers.”
John and I were now able to utilize spiritual interventions without the worry of a spiritual crisis, for we were now quarterbacking a team—the body of Christ—in providing whole-person care. Practice became a joy. It was not overwork but overflow. We actually became both more fruitful and more efficient.
OTHER FORMS OF SPIRITUAL CARE TEAMS
Dr. Sherry O’Donnell followed a path similar to our practice. She developed a consult and referral network with pastoral professionals in her one-doctor clinic in Southern Michigan, plus she developed a training program for lay ministers and was able to have a lay minister in her clinic every day she was open. Most would serve a half-day at a time. Some would be in the waiting room visiting, while others would stay in the staff lounge praying for and over the clinic. All were available to be called into a patient room at a moment’s notice to listen, to share, to pray. A hospitalist physician worked with one of his administrators to authorize a Christian nurse manager to be his Spir-
itual Care Coordinator. She worked with the doctor to coordinate spiritual needs with the hospital chaplains and several local pastoral professionals as Spiritual Care Providers. A group of Christian anesthesiologists who wanted their work to become a ministry in their academic center worked with administration to have a Christian nurse manager become their Spiritual Care Coordinator, and then they coordinated with local prayer warriors who would be at the hospital chapel each day to pray for folks in surgery who desired prayer and with hospital chaplains who could be called in when indicated. A group of Christian medical students met with a Christian faculty member to brainstorm how to incorporate their faith into their clinical rotations. Two Christian emergency room physicians developed a small Spiritual Care Team in a large inner-city hospital and their personal ministry bore incredible fruit. A Christian dentist worked with her hygienists to add a spiritual assessment to their dental intake form. One of the hygienists volunteered to be the practice Spiritual Care Coordinator, and as a team they began to
Transformed Doctors ➤ Transforming the World www.cmda.org 17
SPIRITUAL CARE TEAM MEMBERS The members of the Spiritual Care Team and their roles will vary depending on whether the setting of care is outpatient or inpatient. For outpatient settings, the Spiritual Care Team is headed by a healthcare professional and a Spiritual Care Coordinator (a nurse or clinic manager assisted by the nursing and administrative staff), as well as chaplains, community pastoral professionals and/or lay ministers. In inpatient settings, the Spiritual Care Team can have the same basic makeup, but could also include a social worker or case manager, behavioral health professionals and even the patient transport, food service, maintenance and cleaning staff.
HEALTHCARE PROFESSIONAL The healthcare professional’s responsibility is to be the coach of the Spiritual Care Team—to help form it and supervise it. The Spiritual Care Team can be as small as the healthcare professional and the Spiritual Care Coordinator. After that, the healthcare professional’s major role, other than undergirding the entire ministry with prayer, is to conduct a brief spiritual assessment with most or all patients in order to identify spiritual needs. The healthcare professional needs to know about factors that could affect the patient’s health and their compliance with the medical care. Thus, it’s highly advantageous to both the healthcare professional and the patient to take this history. Once spiritual needs are identified, the healthcare professional can then work with the Spiritual Care Coordinator to ensure these needs are addressed.
SPIRITUAL CARE COORDINATOR The Spiritual Care Coordinator is most likely to be a nurse or a clinic manager, but it could also be the healthcare pro-
pray for and with patients and developed a small group of Spiritual Care Providers for referral when indicated. She told me, “I never imagined my dental practice could be a thriving ministry—but it is.”
BUT I DON’T HAVE TIME FOR ONE MORE THING!
Why should I take the time to form a Spiritual Care Team to assess and address the spiritual needs of my patients? Shouldn’t this be someone else’s job? The chaplain? A pastoral professional? Someone in administration who has the time? In short, no! This is our job as healthcare professionals, and it allows us to take back our rightful position as the patient’s healthcare advocate and coach. The major goal of the Spiritual Care Team is to help you provide spiritual care to all of your patients who desire it. But I don’t have time to add one more responsibility to my day. I barely have enough time to perform my currently required 18 TODAY'S CHRISTIAN DOCTOR Fall 2017
fessional’s spouse or pastor. If the physician is the coach of the Spiritual Care Team, the Spiritual Care Coordinator is the quarterback of the team. The Spiritual Care Coordinator has a number of roles, and the first duty is to hold the healthcare professional accountable for conducting and recording spiritual assessments. Then, they can review the results of the healthcare professional’s spiritual assessment and identify and prioritize the spiritual needs that require addressing. The Spiritual Care Coordinator does not conduct the assessment. The healthcare professional’s assessment cannot be deferred to the Spiritual Care Coordinator, since the healthcare professional needs to collect this information first hand. Next, the Spiritual Care Coordinator manages each step to ensure the patients’ spiritual needs are addressed, providing resources as needed (for example, information on local faith communities, spiritual reading materials, information on pastoral care services and so forth).
SPIRITUAL CARE PROVIDER Chaplains, pastoral professionals and/or lay ministers are a critical component of any Spiritual Care Team. They are responsible for conducting a more comprehensive spiritual assessment to clarify spiritual needs and develop a spiritual care plan to address them along with the healthcare professional and Spiritual Care Coordinator. If a Spiritual Care Provider is necessary, the Spiritual Care Coordinator can prepare the patient to see the person, explain the reason for the referral, describe the training or qualifications the person has and discuss what the person will do. The Spiritual Care Coordinator can also prepare the Spiritual Care Provider for the patient, informing about the spiritual needs identified and why the patient is being referred.
duties and then document the results. If I open Pandora’s box by taking a spiritual assessment, there’s no way I will have adequate time to address the issues uncovered. I understand completely. In fact, in the 25 years I’ve been teaching CMDA’s Saline Solution and Grace Prescriptions courses with Bill Peel, the major obstacle most healthcare professionals have raised to incorporating faith into their profession was the reality of time. But consider this—isn’t the provision of spiritual care one of the reasons you were called and commissioned into healthcare? By making a short spiritual assessment a cornerstone of your practice’s social history on each patient and also make addressing those needs a priority for the Spiritual Care Team, you will be taking the first steps into providing true wholeperson healthcare. And you will be turning your patient care into a body-of-Christ ministry, whether you are in a solo practice, a multispecialty practice or a healthcare institution.
Dr. Harold G. Koenig, the Director of the Center for Spirituality, Theology, and Health at Duke University, writes, “Doing a brief spiritual assessment must be a priority for the physician and addressing those needs a priority for the spiritual care team. This is not an optional activity, but central to providing ‘whole-person’ medical care. Furthermore, the spiritual assessment can actually save time, improve the relationship with the patient, improve compliance, and make the physician’s work more rewarding.1” After John and I began utilizing a Spiritual Care Team, we found our efficiency, spiritual ministry and satisfaction with practice all increased. In addition, our practice was named “The Most Efficient Medical Practice in America” by Medical Economics.
“You are the salt of the earth. But if the salt loses its saltiness, how can it be made salty again? It is no longer good for anything, except to be thrown out and trampled by men.” —Matthew 5:13 Could working with a Spiritual Care Team potentially increase the quality of your patient care, your personal and professional satisfaction, and your efficiency in caring for patients? Could a Spiritual Care Team allow you as whole person to provide whole-person care—the call and commission the Bible gives each Christian healer—and allow you to bring all of who you are to all of what your patient needs? Could it be within your reach?
can begin recruiting Spiritual Care Providers to be available. I pray this information will allow you to efficiently and effectively begin providing the whole-person and spiritual care to which you have been called and commissioned. Who of us would not want to be able to practice as a healthcare professional, in the power of the Holy Spirit, undergirded with fervent prayer, and leave the results to God? To experience our OTHER RESOURCES • Grace Prescriptions: Incorporating Spiritual Care in Your Practice by Walt Larimore, MD, and William C. Peel, DMin is available at www.cmda. org/graceprescriptions. • Workplace chaplains may be available in your area to help with your practice. Check with Marketplace Chaplains at mchapusa.com or Corporate Chaplains of Americas at chaplain.org. • Helping Hurting People: Lay Minister Training includes 29 one-hour training videos for training lay ministers for your practice. Contact Dr. O’Donnell at saodonnell@rappha.com. • Stephen Ministries equips and empowers lay caregivers—called Stephen Ministers—to provide high-quality, confidential, Christ-centered care to people who are hurting. For more information, visit www.stephenministries.org.
Let me encourage you to prayerfully consider studying more about setting up a Spiritual Care Team (Dr. Koenig’s article explaining exactly how to do this and how to address the many objections you may face can be found at www.cmda.org/koenig.) Begin praying for God to provide a Spiritual Care Coordinator to work alongside you, and then present a proposal to pilot a Spiritual Care Team where you practice. You and your Spiritual Care Coordinator Transformed Doctors ➤ Transforming the World www.cmda.org 19
work as worship? To see healthcare as ministry that involves the body of Christ? To become salt that is flavorful and light that is attractive to the patients we see each day? To see God work in and through us each day in patient care? There can be no higher calling—even in the midst of terribly busy and demanding days—of finding where the Spirit is at work and being able to briefly, but effectively, fan the flame of His work in the hearts of the hurting people He is calling to come into their Father’s eternal embrace.
WHAT ABOUT PAUL?
What in the world did I do with Paul, my patient who was having a spiritual crisis when I didn’t have a Spiritual Care Coordinator to help? I quickly asked the four questions I normally ask in a potential emergency—spiritual, physical, emotional or relational: 1. Is it an actual emergency? Or can the situation actually wait? 20 TODAY'S CHRISTIAN DOCTOR Fall 2017
2. Am I the best one to handle this? Or can I refer this to someone else? 3. How will my decision affect others? Other patients who are waiting? My work colleagues? 4. Is this the best time? Or can I schedule this later?
“For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.” —Ephesians 2:10 In Paul’s case, since we as a practice had prayed for him for so long, and since I felt I was the one who should answer his questions even though we were so behind, I excused myself from the room. My partner John was in the hall talking with two of the nurses. I quickly explained the situation. John gave me permission to take all the time I needed. The nurses would let the patients who were waiting know the
ing for me there. Obviously, God was sovereign, even over my crazy schedule, and He was working in more ways than one—to show me how He would work in and through His body to draw my patients to Himself. What a joy!
“Two are better than one, because they have a good return for their work: If one falls down, his friend can help him up. But pity the man who falls and has no one to help him up! Also, if two lie down together, they will keep warm. But how can one keep warm alone? Though one may be overpowered, two can defend themselves. A cord of three strands is not quickly broken.” —Ecclesiastes 4:9-12 situation. They would give them the option to continue to wait, see John or reschedule. And the front office staff began letting patients who were on their way know we had hit a snag so they could reschedule if they desired. I then had the freedom to spend some quality time with Paul. I answered his questions and then briefly shared the gospel. With tears in his eyes, we held hands and he asked the Lord to become his Lord and Savior. He was changed, but so was I. I left the room and, with Paul’s permission, called Bob, a Christian businessman who had recovered from the same type of cancer. Bob came to pick up Paul, took him to lunch and began discipling him that very day. By the way, it will likely be no surprise to you that the schedule “miraculously” took care of itself. Some folks canceled. Some no showed. Others were happy to reschedule. Another Christian physician “just happened” to be in the ER and was happy to see the patient wait-
THE GOALS OF A SPIRITUAL CARE TEAM 1. Identify the spiritual needs of patients related to illness. 2. Competently address those spiritual needs. 3. Create an atmosphere where patients feel comfortable talking about their spiritual needs with the healthcare professional and other team members. 4. Provide whole-person spiritual care to all patients they serve.
BIBLIOGRAPHY 1 Harold G. Koenig. The Spiritual Care Team: Enabling the Practice of Whole Person Medicine. Religions 2014, 5, 1161– 1174. http://www.mdpi.com/2077-1444/5/4/1161/htm. Also available at www.cmda.org/koenig.
WALT LARIMORE, MD, award-winning family physician, bestselling author and educator, has been called “one of America’s best-known family physicians.” He serves as a visiting professor to the In His Image Family Medicine Residency in Tulsa, Oklahoma. Dr. Larimore is a prolific author, having published 32 books, 30 medical textbook chapters and nearly 800 articles in a variety of medical journals and lay magazines. His books have garnered a number of national awards, including a Book of the Year Award from ECPA. Dr. Larimore and Barb, his sweetheart from childhood, have been married since 1973, and they live in Colorado Springs, Colorado. They have two adult children, two grandchildren and a cat named Jack. Visit his website at www.DrWalt.com. His daily Bible devotional, Morning Glory, Evening Grace, is available at www.Devotional.DrWalt.com.
GRACE PRESCRIPTIONS
Want to learn more about how you can incorporate spiritual care into your daily practice of healthcare? Grace Prescriptions is designed to teach you to share your faith with patients in ways that safeguard the important ethical principles of respect, sensitivity and permission. For more information, visit www.cmda.org/graceprescriptions.
Transformed Doctors ➤ Transforming the World www.cmda.org 21
T
here was a time, a few decades ago, when most everyone interested in bringing together healthcare and the Christian faith was familiar with Dr. Paul Tournier and his work.
Dr. Tournier, a Swiss physician, emerged onto the world stage after World War II as he shared his professional and spiritual journey through a series of popular books. Trained in traditional medicine, he was committed to the day-to-day care of his patients as a family physician. But early in his medical career, he realized psychological and spiritual issues played a significant role in the physical illness and subsequent recovery of his patients. He was intrigued by the tight weaving together of the physical, spiritual and psychological wellbeing of these patients, as well as how all these components affected the health of his patients. He came more and more to practice what he called “Medicine of the Person.” He first outlined his concepts in the popular book The Meaning of Persons, which was published in English in 1957. A later book, A Doctor’s Casebook in the Light of the Bible, expanded on the concept that mind, body and spirit are indelibly linked together influencing each other in dynamic ways. Following the success of The Meaning of Persons, Tournier continued to write, authoring more than 30 popular books during his career.
He wrote on numerous subjects, but his works focused largely on medicine, family life and human relationships. His books were popular with physicians as well as laymen. He went on to be in great demand as a speaker in both Europe and America, before his death in 1986. In 2006, Christianity Today ranked The Meaning of Persons as one of the 50 most influential books that have influenced the way evangelicals think, talk, witness, worship and live—rating it as number 24 on the list.1 In the time since his death, Dr. Tournier’s work appears to have faded out of prominence in healthcare. Perhaps that’s a result of the boom of medical technology and the rise of electronic medical records. However, his message and style of medical practice is increasingly relevant to today’s healthcare professionals because he anticipated the loss of personal touch in the practice of healthcare. His practice, as well as his writing from decades ago, continue to stretch us, reminding us that our patients are persons with hopes, dreams and feeling, not simply bodies with a disease. As defined by Dr. Tournier, “Medicine of the Person” is not just another branch of medicine. It is an all-inclusive approach to patient care that sees the patient as a “whole person” whose life and health are conditioned by family, community, body and spirit. In his view, care to the physical, psychological and spiritual
The Two Diagnoses by Wilson Wayne Grant, MD 22 TODAY'S CHRISTIAN DOCTOR Fall 2017
components of the person are integral to the restoration and maintenance of health. For Dr. Tournier, “Medicine of the Person” is a spirit, an attitude and a way of relating that applies to all areas of healthcare. It is a way of focusing on the integration of the whole person—body, mind and spirit—in the healing process.
We health professionals living in the 21st century, surrounded by our technological marvels, can learn much from Dr. Tournier about how to effectively minster to hurting people. The following excerpt from A Doctor’s Casebook in the Light of the Bible reminds us how Dr. Tournier’s insights continue to be relevant to the effective care of our contemporary patients: Clearly, any kind of illness raises questions of two quite distinct orders: firstly, scientific—questions concerning the nature of the malady and its mechanism: diagnosis, aetiology, pathogensis; secondly, spiritual—questions concerning the deep meaning of the illness, its purpose. We may say, then, that every illness calls for two diagnoses: one scientific, nosological and causal, and the other spiritual, a diagnosis of its meaning and purpose.2 Dr. Tournier then points out that both diagnoses are in play whether the symptoms are mild or serious, the diagnosis minor or life threatening. The first diagnosis is objective. It is we doctors who make it on our patient. Of course we need his collaboration, but it might be termed a passive collaboration. It is much more difficult to tend a brother doctor than any other patient, precisely because the former seeks to take part in the working-out of the diagnosis. All we require of our patient is that he furnish us with the data on which to base our judgment, to tell us what he feels and the diseases he or his forbears have had previously. The second diagnosis, on the other hand, is subjective. It is the patient himself, and never the doctor, who can make it through the impulse of his inmost conscience. We in our turn can help him to establish this diagnosis, but here again passively; that is to say, not by suggesting a diagnosis to him, but through the climate of spiritual fellowship that we offer him. From the point of view of the patient’s eternal destiny, the second diagnosis is much more important than the first. But from the strictly medical point of view they are of equal importance.3 Until a few decades ago, accurate physical diagnosis was primarily intuitive and depended on a thorough dialogue with, and exam of, the patient. Treatment was based on anecdotal experience. Today, healthcare professionals rely on their experience aided by highly sophistiTransformed Doctors ➤ Transforming the World www.cmda.org 23
us to see the sick person as a body with a broken bone to be fixed, a chemical imbalance to be restored or a cancerous part to be removed, rather than a human being of value and worth with feelings, hopes and dreams. The wonderful tools that modern medicine has placed in the hands of healthcare professionals greatly increase their effectiveness. But at the same time, this technology interfaces between the patient and the physician. If we are not careful, the clinician begins to treat lab results and x-ray pictures rather than a person with feelings.
cated technology to make the first diagnosis. They have an array of effective tools to help make the medical diagnosis with speed and accuracy. The second diagnosis is much harder for today’s healthcare professional to make—or even contemplate. In fact, healthcare professionals can become so enraptured with their technological capability that they easily ignore the significance of the second diagnosis all together. Our modern tools allow the clinician to make the medical diagnosis and even perform treatment with minimal touching or talking to the patient. Dr. Tournier’s point that the second diagnosis (the meaning that any malady has for the patient) has equal importance in the patient’s treatment is seldom understood by today’s healthcare professionals. However, the reality of this point continues to be relevant. As healthcare professionals, we must admit that the faithfulness with which the patient submits to the diagnostic tools, or follows our prescriptions (written and otherwise), depends largely on the patient’s understanding of the illness and its meaning. One of the defects of modern healthcare is that we are so preoccupied with the treatment of disease that we often fail to focus on the healing of the sick person in front of us. The technological atmosphere today tempts 24 TODAY'S CHRISTIAN DOCTOR Fall 2017
Unfortunately, one of the major barriers to come between our patients and us today is the computer screen. One of the main pressures on the healthcare professional is the demand to maintain patient volume while creating a comprehensive electronic medical record for each patient. As many of us can attest, it is often hard to maintain good eye contact and communication with patients while completing their electronic records. In the process, the patient can easily feel ignored. Several recent studies have evaluated the effects of novel technologies on interactions between the patient and healthcare professionals. In a 2014 edition of the International Journal of Medical Informatics, Enid Montague, PhD, and Onur Asan, MS, examined eye gaze patterns between
tient. As one of my colleague’s patient lamented, “My doctor hardly ever talks with me anymore. He mostly looks at the computer screen and asks me the same questions from the computer every time I visit. There’s not much time for me to ask my questions.” As healthcare professionals, we must be ready to sit down by the bedside, take the hand of the patient, look them in the eye and communicate with them as a person. The patient needs to know their healthcare professional is thorough and is considering all the available options. And we need to be sure we have heard all the patient’s questions. While speaking at a conference for healthcare professionals that I attended in 1984, Dr. Tournier stated, “All sick people have a question which they hide in their pocket. They will take the question out of their pocket and share it only when they feel they can trust the doctor and that the doctor will truly listen to them.”
patients and healthcare professionals while electronic medical records were used to support patient care.4 Gaze was studied because it provides a more objective indicator of attention and communication. In their study, patient visits were recorded using three high-resolution video cameras placed at different angles. A total of 100 patients and 10 healthcare professionals participated in the study. The results showed the healthcare professional spent on average nearly one-third of the visit’s length gazing at the electronic medical record. When paper medical records were used, healthcare professionals spent approximately 9 percent of the visit’s length gazing at the record. We certainly cannot throw away the technological helps and the precision of diagnosis and treatment these tools provide. But we must realize that one side effect of the gadgets and sophisticated tools is they can become screens between our patients and us. To be effective in dealing with both diagnoses, we need to deliberately look past the instrument or latest test result, and we need to deliberately look past the computer screen in order to focus on the pa-
Making the two diagnoses is important if we are to ever fully understand our patients. In The Meaning of Persons, Dr. Tournier wrote, “Through information I can understand a case; only through communication shall I be able to understand a person.”5 As we use our technology effectively, we are called to remember that our encounter with our patients has meaning above and beyond our diagnosis and therapeutic intervention. Most of all, we are called to listen to our patient’s story and the meaning that story has for the patient as a person. The more we attend to their story, and their interpretation of that story, the more effective we will be as healthcare professionals and as people. BIBLIOGRAPHY 1h ttp://www.christianitytoday.com/ct/2006/october/23.51. html 2 Tournier, P., MD. (1960). A Doctor's Casebook in Light of the Bible. New York: Harper's Brothers. p. 13. 3 Ibid. 4 Montague, E., & Asan, O. (2014). Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor–patient communication and attention. International Journal of Medical Informatics, 83(3), 225-234. doi:10.1016/j.ijmedinf.2013.11.003. 5 Tournier, P., MD. (1957). The Meaning of Persons. San Francisco: Harper and Row. p. 25.
WILSON WAYNE GRANT, MD, has been a member of CMDA since 1965 and continues to be active in the San Antonio, Texas chapter of CMDA. He is a pediatrician who retired in 2015.
Transformed Doctors ➤ Transforming the World www.cmda.org 25
What Are You Training For? by Jeff Amstutz, DDS, MBA
I
, admittedly, am not much of a runner. But each year I encourage those involved with the CMDA Dental Residency [+] program in Memphis, Tennessee and in our local house church to participate in the annual St. Jude Memphis Marathon weekend. People choose to run everything from the one-mile family fun run up to the full marathon. Last year I signed up for the half marathon— much farther than I’ve ever run (visualize more of a plodding as opposed to actually running) at one time.
26 TODAY'S CHRISTIAN DOCTOR Fall 2017
Being of an age where getting injured is becoming more of a concern, I turned toward a half-marathon training program in order to build up the endurance I would need over time, while hopefully not overdoing it. Relying on the advice of experts with a proven record of success in helping people like me prepare to run, I stuck to their program. The training consisted of days of short and moderate length runs throughout the week with interspersed rest days and a longer run each weekend, building up strength and endurance for the race weekend. The training was challenging—not only in increasing the mileage I would run each week, but also in committing to make the time daily to prepare over the course of several months. But by sticking to the training program, I was able to finish the race and achieve my goals. Those involved in our house church here in Memphis know about training. Most are young professionals currently involved in intensive training programs—urban education, family practice residents, surgery, med-peds and dental training programs to list a few.
With no dentists in the southern part of the country where our hospital was located, our program focused on taking committed Christian men with nursing degrees and training them for three years to provide quality, basic dental care to an extremely underserved population.
Most of us in CMDA have been involved to varying degrees with different types of training: training for our specialties, to run a race, to get in shape, to eat healthier, to get better in our areas of interest.
In the first year of training, our dental team was invited to be part of an outreach team. The national church, along with our agency, had a commitment to take the gospel to every village—and they were well on the way to accomplishing that goal. A local pastor and I collaborated to help with the outreach by taking our dental team and portable dental equipment to go to a village where there was not yet a gospel presence.
We put tremendous amounts of time into our professional training. Undergraduate, professional school, residencies, fellowships and continuing education—all specifically designed to help us be the best we can be in our chosen profession of healthcare. Many of us work hard to balance our professional life with time for family and with some type of training program to help us stay physically fit.
Are you taking the time to make a real effort in training to be godly?
We shared the benefits of modern dentistry with the people of the village throughout the day, and on that first evening we planned a service to share the really good news of why we were there. The pastor would share biblical truth and Michel, one of my dental trainees, asked if he could follow the pastor and provide a call to action following the message. So that was the plan. Michel’s grandfather had been born and lived in that village, so it was a proud moment. Not only had he, as a son of the village, been educated—having received a nursing degree and now currently in dental training—but he had returned to bless the village with his skills. I was thrilled. The pastor delivered truth and God’s presence was evident.
Early in my career, following 10 years of private practice, God gave me the opportunity to start a three-year dental training program in the Central African country of Gabon.
As Michel stood up to speak following the message (with what we assumed would be a call to commit to Christ), he instead delivered a most eloquent call to action. It wasn’t
But what about our spiritual training? In his letter to Timothy, the apostle Paul tells this young disciple to “... train yourself to be godly. For physical training is of some value, but godliness has value for all things, holding promise for both the present life and the life to come” (1 Timothy 4:7-8).
Transformed Doctors ➤ Transforming the World www.cmda.org 27
based on the pastor’s just completed message, but on the importance of proper oral hygiene, regular dental checkups and good brushing and flossing techniques. And in that moment, I realized we had done a great job training on the importance of oral health, but that excellence perhaps came at the expense of the things that really matter. That evening, God still moved and people came to faith, and today a body of believers is meeting and serving in that village. But I also learned the importance of perspective and focus. Dental care is of some value—for this time—certainly for those with little or no other access. And we need to be training for excellence. But we also need to integrate training that is of value for all things—both for the present and for the eternal life to come. So we made the adjustment. We began studying God’s Word together, praying with each other and with our patients, sharing our faith journeys with others and helping establish groups of believers in nearby villages. As Christians in healthcare today, simply graduating professional school and being a healthcare professional is not enough. Imagine the intern who doesn’t progress. It is not just time that makes us good clinicians. It is through training and constant use of our skills that we develop, grow and increase our abilities. Hebrews 5:12-14 says, “In fact, though by this time you ought to be teachers, you need someone to teach you the elementary truths of God’s word all over again. You need milk, not solid food! Anyone who lives on milk, being still an infant, is not acquainted with the teaching about righteousness. But solid food is for the mature, who by constant use have trained themselves to distinguish good from evil.” Physical maturity is mostly a matter of time (the longer we live, the more physically mature we become). Spiritual maturity, on the other hand, does not happen as a direct result of time; it requires constant training. At the CMDA Dental Residency [+] program, we are not content with training that is only of some value. Yes, we want to train and prepare to deliver excellent dental care. What we are striving for, both in our personal lives and in our program, is that which has value for all things—both for this present life and the eternal life to come. As followers of Christ, we need to commit to spiritual training so we might better understand God’s righteousness and distinguish between good and evil. We train by: 28 TODAY'S CHRISTIAN DOCTOR Fall 2017
1. Being in God’s Word regularly and spending committed time in prayer. We need to spend time and receive our guidance from the expert. 2. Looking to Jesus, remembering who He is and whose we are. 3. Exercising our faith on a daily basis—stretching ourselves out of our comfort zone—by praying with patients, sharing our faith journey with a co-worker, proclaiming the good news of the gospel and making decisions with our lives that have eternal impact. 4. Persevering. Keeping our eyes on the goal and encouraging each other along the way. Many of the residents and those involved with our house church are signed up to participate again in this year’s St. Jude Memphis Marathon weekend. Soon we will need to begin training in earnest for race day. The young men and women I have the privilege of working with in Memphis are dedicated and committed young professionals, putting in the time necessary to train for their specialties, to train for an annual race and, more importantly, to train for that which matters most. What are you training for? Does your training reflect your true priorities? FIND TRAINING RESOURCES
Are you ready to increase your spiritual training? CMDA has a wide variety of resources and services to help you merge your spiritual beliefs with your professional practice. These resources and services give you the knowledge and tools you need to effectively serve the Lord. To access these resources, visit www.cmda.org/resources.
JEFFREY D. AMSTUTZ, DDS, MBA, is CMDA’s Vice President for Dental Ministries, Peter E. Dawson Chair of Dentistry. He directs the CMDA Dental Residency [+] program in Memphis, Tennessee that trains dentists for domestic and international missions. Dr. Amstutz is a graduate of Case Western Reserve and its School of Dental Medicine. He also completed an MBA at Kent State University. In 1999, he and his wife Carrie were called to the mission field where they opened a dental clinic in Gabon, established a program to train Gabonese dental technicians and launched a mobile ministry to reach remote villages. They also served in Mali and Senegal. He joined CMDA in 2012 and is focusing on expanding CMDA’s ministry, services and resources for dental members, as well as intensifying outreach to dental schools in the U.S.
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Where Did My Joy Go... How Do I Get it Back?
&
by Betsy Manor, MD
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recall the overflowing enthusiasm I had for healthcare during Christmas break of my first year of medical school. I recall the moment during my fourth year when I knew family medicine was a perfect fit for me. Neither of those realizations came quickly for me, but they arrived with such peace they were unmistakably the hand of God. I was excited to ultimately practice and teach in a residency program in an urban underserved community that desperately needed compassion and respect, and I knew it was exactly where He wanted me. Now in my ninth year of practice, the joy I once had seems like a distant memory. I have traded enthusiasm for fatigue. I began questioning the fairness of my workload compared to my colleagues, feeling bothered by patient requests and wondering how many more external pressures were going 30 TODAY'S CHRISTIAN DOCTOR Fall 2017
to dictate patient care. I became extremely discouraged about the threats to our right of conscience and even the overall moral decline in our society. Looking over the edge of burnout, I had to ask myself, “What changed?” Did I make the wrong career choice? Am I at the wrong job? Do I lack proper training or support? Do I care about people less? Is healthcare changing too much for my liking? Do I work too much? Although these are legitimate concerns, I really couldn’t find that answering “yes” to any of those questions satisfied the deepest unrest I was feeling. That’s when I realized the journey back to joy needed to start with a hard look at myself. I had spent the last four years trying to tackle the daily rigor with my own strength.
I cannot really say what changed one day, other than that the Holy Spirit petitioned my heart’s cry for help before I even knew what to pray for—and God answered through the words of a friend. A casual conversation with a friend in ministry was a pivotal point in my journey back to joy. She explained that she and her husband regularly have to ask themselves what God has gifted them to do rather than what others want them to do or what they think they should do. At that moment, I knew I needed to focus on my gifts of caring for patients and teaching residents. But that realization didn’t come with regret or anger for time lost, as I would have expected; instead, it came with a sense of peace and hope. Scripture says, “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” (Ephesians 3:20). And as God often does, He paved the way for me to return to those roles in ways I could not have asked for or imagined.
“Restore to me the joy of your salvation and grant me a willing spirit, to sustain me.” —Psalm 51:12
Due to an unexpected departure of a colleague when I was only a few years out of residency, I assumed a new leadership role as medical director that came with a steep learning curve and a heavy workload. I kept investing more and more of my time and energy to power through personnel changes, electronic health record transitions and healthcare restructuring, while ultimately hoping I could make things better. But rather than feeling as though I was making things better, I just became more tired and more discouraged. I was stretched too thin and not doing anything as well as I would have liked. I did not even realize for most of that time that I was more concerned with my own ambitions and accomplishments than with revealing God’s glory to others. As it says in Philippians 2:3, “Do nothing out of selfish ambition or vain conceit....”
So I had an honest conversation with my boss, a fellow believer and someone who knows my gifting and passions dating back to our time in residency together. Although I have always known her to be supportive and thoughtful, in this instance she truly understood my needs with a depth I hadn’t expected. Her promise to work on transitioning me out of my administrative position over the coming six months was something I was so grateful for. Little did I know that within a few weeks and several conversations, she discovered that one of my colleagues was already interested in the role and was prepared to start immediately. Only the hand of God can orchestrate the perfect timing of such situations. As I saw this remarkable situation unfolding, I knew I did not want to spend one more day toiling without the strength and guidance of the Lord. It seemed empty and unfulfilling, like Solomon wrote in Psalm 127:1-2, “Unless the Lord builds the house, its builders labor in vain. Unless the Lord watches over the city, the watchmen stand guard in vain.” Unfortunately, I didn’t know how I was going to slow my pace down or really make time to be present for people. I began praying I would have just the right amount of time for each patient without feeling hurried or harried. And wouldn’t you know that’s exactly what has happened? Patients who usually took more time had other obligations to get to, while patients who were more reserved began opening up more. The Lord opened doors for conversation and prayer with patients like I have never had before, even Transformed Doctors ➤ Transforming the World www.cmda.org 31
there is an ever-increasing focus on numerical evidence of what we do. While feeding the 5,000 in Mark 6:30-43 was a miracle of numbers, I don’t think Jesus would consider that a greater accomplishment than healing one man’s blindness as in Mark 8:22-26. Only when we seek out God’s will do we start using His accounting system of success.
“Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance.” —James 1:2-3 with some patients I have known for many years. Walking alongside patients in their times of need has become a pleasure and a privilege again. I know this is not the end of my journey. Healthcare is changing. Society is changing. I do work too much. My burnout was not resolved instantaneously, but I now have a hope that comes from fixing my eyes on Christ again. I have a long way to go in really understanding how to trust Him and give up the control I have grown so accustomed to, but I am working on that each day. If you are standing on the edge of burnout like I was, I encourage you start taking steps to overcome burnout and find your joy in healthcare again. Here are a few things I have learned along the way that may help you in your journey. 1. W hat you surround yourself with influences you, whether you realize it or not. I was spending so much time in the trenches of keeping up with change that I did not have time to be grateful for the good things that already existed. I was spending so much time wondering what the world was coming to, rather than spending time praying for the world and recognizing God is ultimately in control. We can really know His character and promises by seeing His faithfulness play out in our lives. 2. In a culture driven by accomplishments and success, we have to be extra diligent in our efforts to focus on God. From productivity to quality measures, it seems 32 TODAY'S CHRISTIAN DOCTOR Fall 2017
3. It is arrogant to think that you alone can accomplish a task. Are we more capable than Jesus Himself ? Jesus demonstrated two very important things during His time on earth: first, He sought the will of His Father always; and secondly, He had disciples (and ultimately the early church) who extended His reach further than He could have as one man. We should emulate these same vertical and horizontal relationships as we are His representation in today’s broken world.
4. We need rest. I enjoy being busy and contributing to things. I have gone months without heeding His command in Deuteronomy 5:12-15 to observe a day of rest each week, but that only ended up with me being more tired and less productive. More importantly, I lose out on the rejuvenation that stems from a pace allowing me to focus on Him. It is for our benefit that God gave us time and structure, because He understands what we need.
5. Doing good does not necessarily mean you are within God’s will for you and your life. Even though my intentions of improving our clinical practice were good, I lost sight of why and how to do that. Had I sought the daily direction of the Lord, my experience and success might have been quite different. 6. W hat is complete joy? According to John 15:1-17, complete joy comes from three things: loving each other, keeping Jesus’ commands and remaining in Christ to bear much fruit for the Father’s glory. I absolutely believe those things give me the greatest purpose and fulfillment, but I so often trade them for lesser things. How would our lives look if we kept this in mind each day as we serve Him?
“Therefore, whoever humbles himself like this child is the greatest in the kingdom of heaven.” —Matthew 18:4 I am far from having all the answers for a more Godhonoring, fulfilling life and career. My expertise in burnout comes from my sins, life’s lumps and God’s grace. As a re-
sult, I no longer look at joy the same way. Joy is not a feeling of happiness; it is a daily commitment. According to Psalm 51:12, joy stems from understanding our worth in Christ and what we receive through His salvation. Joy starts with having the humility of a child that Jesus talks about in Matthew 18:4. Joy continues through an obedient life and trials that lead to perseverance according to James 1:2-3. As it turns out, I could have had true joy all along had I properly decided to put my focus on God and not my circumstances or myself. I pray that He gives me the wisdom and endurance to do better each day forward.
BETSY MANOR, MD, has been a Christian since she was a young girl. She grew up in Madison, Wisconsin, where she attended the University of Wisconsin for undergraduate education. She moved to Milwaukee, Wisconsin to attend medical school at the Medical College of Wisconsin. She then completed residency at Columbia-St. Mary’s Family Medicine Residency in 2008 and has remained there as an assistant professor since then. They predominantly serve the inner city community in Milwaukee.
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In His Image encourages and provides great opportunities for international rotations during residency. I explored the option of long-term medical missions while spending a month overseas during my second year of residency at IHI. The faculty physicians and many of the program’s graduates have extensive experience in international medicine and were enthusiastic in helping to provide me with training and counsel for my future. After graduating from IHI, my family and I moved to Malawi, Africa. My husband teaches at a village school and I work at a hospital in the capital, treating patients and training Malawian family medicine residents. We are so incredibly thankful for the guidance and experiences God gave us through IHI as we prepared for service in Malawi!