Today's Christian Doctor - Spring 2019 by Christian Medical & Dental Associations

Volume 50 No. 1 • Spring 2019

Today’s

Christian Doctor

DOCTOR SUICIDE

C MDA

Story

I don’t stand alone. “I was called into healthcare from a very young age to ‘speak up for those who cannot speak for themselves, for the rights of all who are destitute’ (Proverbs 31:8-9, NIV 1984). As a physician assistant, I’ve been able to share with patients the value of life by helping women choose life for their babies and helping families think through hard end-of-life issues. I need CMDA to advocate for me nationally so I can continue to have these rights to practice healthcare according to the dictates of my conscience. As a member of CMDA’s Fellowship of Christian Physician Assistants, my colleagues have come alongside me with advice about tough ethical patient situations and offered prayer and camaraderie. At the CMDA National Convention each year, I hear from ethical experts who also follow Christ. As a CMDA member, I know I am not alone in standing for life, and I would encourage all my physician assistant and nurse practitioner colleagues to consider joining CMDA so we can continue to stand together.” —Caroline Pilgrim, PA-C

Introduce Your Practice Team to CMDA Is everyone on your team a CMDA member? CMDA membership is beneficial to all healthcare professionals, so we encourage you to introduce the physician assistants, nurse practitioners and others in your practice to CMDA. Together, you can join Caroline and more than 19,000 healthcare professionals across the country who are part of this growing movement of “Transformed Doctors, Transforming the World.”

Visit www.joincmda.org or call 888-230-2637 to join us today. Paid Advertisement

CEO EDITORIAL

THE NOOSE

by David Stevens, MD, MA (Ethics) he noose is tightening.

In case you didn’t hear the story, here is what happened. A Virginia school board unanimously voted to fire a Christian teacher when he stopped using pronouns when referring to a female student who “transitioned” to being a male. He simply used the student’s new name in an effort to accommodate the student. He believes God created human beings male and female and using a masculine pronoun for a biological female student was being complicit in a lie. Peter Vlaming, the teacher, told the press, “I’m happy to avoid female pronouns not to offend because I’m not here to provoke, but I can’t refer to a female as a male, and a male as a female, in good conscience and faith.” That effort at accommodation was not enough. His principal commented he couldn’t “think of a worse way to treat a child.” (Really?) He then referred the matter to the school board, which didn’t hesitate to act. Incidents like this in schools, homeless shelters and businesses are publicized as powerful cautionary tales by making an example of what will happen to people who won’t conform because of their religious beliefs. It is happening in healthcare as well. I could tell you stories of CMDA members who have loss their academic titles, been forced out of their jobs or were denied a promotion or a learning opportunity because of their Christian beliefs. Laws are in place to protect healthcare professionals from discrimination and persecution when they are unwilling to participate in abortion or sterilization. There is little legal protection on a host of other issues except for the First Amendment. Even there, many courts interpret the phrase, “the free exercise” of religion to mean the freedom to worship whoever and whatever, but once you leave your church, synagogue, mosque, temple or meeting house, you have no religious rights in the public square. The transgender issue is one of many where you can get hung out to dry if you transgress the new orthodoxy. Our Christian colleagues in Quebec can lose their licenses if they don’t refer for “MAID” (Medical Assistance in Dying), the latest euphemism for physician-assisted suicide. In October, the American Academy of Family Physicians (AAFP) voted to take a position of “engaged neutrality” on physician-assisted suicide, to only use the MAID term (it sounds positive) and to advocate that the American Medical Association do likewise. I’m not a prophet, but I predict in the next decade physicianassisted suicide will be legalized in the majority of states, non-

physicians will be allowed to do it and healthcare professionals who refuse to participate will be considered unethical because they are “forcing patients to suffer.” Yet, now is not the time to hunker down in fear. If we ever needed more “David’s” to fight the giants, it is now! Their ultimate goal is to force all committed Christians out of healthcare. The odds are daunting. We have lost ground despite our efforts. The forces against us seem overwhelming, but we dare not retreat or just try to delay the seemingly inevitable. God is saying to us what He said to Joshua after Moses died and he was leading the Israelites across the Jordan to face seemly unbeatable odds, “Have I not commanded you? Be strong and courageous. Do not be frightened, and do not be dismayed, for the Lord your God is with you wherever you go” ( Joshua 1:9, ESV). God is with you as you speak the truth in love. CMDA will stand with you in your battle. We go before you working to get better laws, to set precedents in the courts and to educate our country. Will we win every battle? I doubt it. I do know God is calling us to be faithful. I know He wants us to be voices of righteousness. He wants us to live out our faith in healthcare. If not us, who? And He promises He will be with us, just like He was with the apostle Paul who said he was “...hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed” (2 Corinthians 4:8-9). Together, we can break the rope that threatens to strangle us. 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

VO LU M E 5 0, N O. 1

SPRING 2019

The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.

30 22 Women Physicians in Christ: ransformed Doctors, 10 TTransforming 30 Providing Community and Support the World

featuring Dennis Palmer, DO,

and Catherine E. Wolf, MD, MPH Authors of The Handbook of Medicine

14 Cover Story Doctor Suicide

by Thomas H. Okamoto, MD

How is healthcare responding to the increasing rate of doctor suicides in the U.S.?

Injecting God’s Word into Healthcare: Leading Bible Study

by Jeffrey Maudlin, MD

A physician shares how to start a Bible study for your colleagues

Being Normal...Weight, That Is

by Amy Givler, MD

Is weight keeping healthcare professionals from focusing on their own health and the health of their patients?

by Patti Francis, MD

Celebrating 25 years of meeting the needs of women in healthcare

Classifieds

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, Spring 2019, Volume L, No. 1. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2019, 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-

4 TODAY'S CHRISTIAN DOCTOR Spring 2019

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

INTRODUCING ENCORE

by Gene Rudd, MD

kay, I admit it; we can find some element of joy in leisure activities. Perhaps it’s in golfing, fishing or woodworking (my personal favorite). But how long will you find fulfillment and God’s favor if you’re only trying to lower your handicap or catch the “big one?”

in education, training and practice. So your approach to decision-making must be just as intentional. I recommend a time of strategic planning as you prepare for retirement, as it provides an opportunity for God to reveal His will as you clarify His mission, vision and values for your future.

Through the years, countless CMDA members have called me months into their retirement with stories of disillusionment. They thought days on end of leisure activities would be rewarding. But it wasn’t so. An “empty” retirement can quickly disappoint, but know that God has a better plan and purpose for your life. So let’s discuss solutions. Ready?

So now it’s your turn. That’s what Encore is all about, because we want to help you find God’s purpose for your retirement years. And one easy way is to get involved with CMDA in retirement. How?

Ask God. Seriously! Through the years I’ve been amazed how few people I’ve interviewed took time to seek the wisdom of God about what they were to do during their “retirement” years. Your retirement years are no less important than the years spent

• Put your skills and experience to use on a Global Health Outreach short-term mission trip. • Can you teach? Join a Medical Education International teaching group doing peer-to-peer education. • Join your colleagues on an exciting, educational and inspiring tour to Greece, Israel or Italy. For more information, visit www.cmda.org/encore.

APPLICATION DEADLINE

MAY 1

Is God Calling You to Long-Term Medical Missions?

Our World Medical Mission ministry can help you get started through the Post-Residency Program. Two-year assignments provide opportunities to work alongside missionary doctors and share the love of Jesus Christ— all in preparation for a career in medical missions. To apply today, go to samaritanspurse.org/prp. Paid Advertisement

Franklin Graham, President | P.O. Box 3000, Boone, NC 28607 | 1-800-528-1980 SamaritansPurse

@SamaritansPurse

Transformed Doctors ➤ Transforming the World www.cmda.org 5

TRANSFORMATIONS

CMDA Welcomes New Vice President for Dental Ministries William Griffin, DDS, joined CMDA as the new Vice President for Dental Ministries in January 2019. With a renewed emphasis on the dental aspect of CMDA’s ministry, he will be working to support dental professionals and students as they integrate Christian faith into all aspects of their lives, while also providing opportunities for training and equipping. A member of CMDA since dental school, Dr. Griffin has served on the Dental Advisory Council since 2013. He is a 1983 graduate of Virginia Commonwealth University School of Dentistry, and he has been practicing in Newport News, Virginia for 35 years. Dr. Griffin formerly served as Board Chairman and Dental Director at the Lackey Clinic, a Christian medicaldental clinic in Yorktown, Virginia. He averages four international dental mission trips each year, and he is passionate about opportunities to communicate the love of Christ to others, both domestically and internationally. Dr. Griffin is also a big fan of CMDA’s Grace Prescriptions conferences. He and his wife Linda have been married since 1983, and they have been blessed with two married children, Katherine and William, Jr., and one grandson, Barrett. We are excited to welcome Dr. Griffin to CMDA. To contact him, please email dental@cmda.org.

LEARN MORE

For more information about CMDA’s Dental Ministries and to get involved, visit www.cmda.org/dentist.

EVENTS For more information, visit www.cmda.org/events.

Dermatology Section Annual Breakfast Meeting March 3, 2019 • Washington, D.C. New Medical Missionary Training March 14-17, 2019 • Abingdon, Virginia Remedy Orlando 2019 March 28-30, 2019 • Orlando, Florida Marriage Enrichment Weekend April 5-7, 2019 • Georgetown, Colorado 2019 CMDA National Convention May 2-5, 2019 • Ridgecrest, North Carolina Psychiatry Section Meeting at the APA Conference May 18-22, 2019 • San Francisco, California Deer Valley Summer Conference June 15-22, 2019 • Nathrop, Colorado Women Physicians in Christ Annual Conference September 19-22, 2019 • Mobile, Alabama Remedy West 2019 October 5-6, 2019 • Riverside, California Marriage Enrichment Weekend October 11-13, 2019 • South Lake Tahoe, California

MEMORIAM & GIFTS Gifts received September through December 2018

Honor Mr. Stan Sytsma in honor of Dr. John Galloway Dr. John S. Pittman in honor of Dr. Robert Cropsey Dr. and Mrs. James Kistner in honor of Dr. and Mrs. Matthew Schaffer Drew Cochran in honor of Jayne Zbinden Joshua Smith in honor of Mr. John Beasley Ms. Laurel Johnson in honor of Thelma and Delmar Johnson New Life Pregnancy Center in honor of Dr. Dennis Costerisan

Memory Ruth A. Landes in memory of Robert Landes Jim and Frances Burgess in memory of Al Herold Louis and Jane Pisters in memory of Wilhelmina and Louis Pisters Jan and Brett Lacey in memory of Paula Gaba PJ Greathouse in memory of Paula Gaba Karen A. Galvan in memory of Timmy Galvan Ellen H. Lee in memory of Dr. Linda Marshall Joan and Alan Burrows in memory of Dr. John O. West Tom and Dora Heath in memory of Guy Cecil Pardue Judith Petry in memory of Dr. J. Duff and Mrs. Marjorie Brown Joseph R. Seats in memory Shirley Copenhaver King Esther L. Meyers in memory of Dr. Wayne Meyers Glenda Kirkpatrick in memory of Robert Kirkpatrick For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.

6 TODAY'S CHRISTIAN DOCTOR Spring 2019

Honoring Past Leadership and New CEO Commissioning As we celebrate Godâ&#x20AC;&#x2122;s faithfulness, we will also be celebrating the faithfulness of our leadership and looking ahead to the future. We invite you to join us as we honor Dr. David Stevens and Dr. Gene Rudd for their faithfulness to CMDA, as well as commission Dr. Mike Chupp, who will assume the role of CEO in September 2019.

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May 2-5, 2019

Ridgecrest Conference Center Ridgecrest, North Carolina Register online at www.cmda.org/nationalconvention

TRANSFORMATIONS

IT’S TIME FOR A CMDA CHURCH COMMISSION by Brick Lantz, MD

n Oregon, we are often at the forefront on a variety of bioethical issues. So recently I brought two Christian brothers with me to a parent’s night at a mainline denominational church. The guest speaker, who is the state director of Planned Parenthood, told about 100 parents that it is good for their teenage kids to have sex. The youth pastor responded positively and told them he provides condoms for the youth. The three of us left nauseated and got on our knees to pray. We need to understand that non-believers have a desire to be in control of their own lives. We in our sin often do as well. That is the root of these issues. But we are not our own. We are bought with a price, as Paul writes to the Corinthians. Why don’t many churches and pastors deal with these issues now? I believe there are three main reasons: fear, ignorance and apathy. In the future, there will be a greater need for unity among our churches. We will need to support each other as we speak truth in our culture, because the culture may respond harshly and believers may be at risk.

I believe CMDA will be strategic in overcoming these obstacles. For these reasons, CMDA is starting a new Church Commission. The vision for this commission is “churches proclaiming biblical bioethics.” We want to answer four main questions: 1. W hy does the church need to teach on bioethical issues? 2. How can CMDA help? 3. How can you help? 4. W hat are the impediments and what are the strategies to teach on these issues?

The mission of the Church Commission is to motivate, train and equip churches to be strong voices for biblical bioethics to their congregations, their communities and their country. There are five basic categories to address including: 1. End of life issues (physician-assisted suicide, euthanasia, advance directives, futile care). 2. Beginning of life issues (abortion, contraception, assisted reproductive technology, mentally and physically challenged, orphans). 3. Gender identity disorder (Can we still call it a disorder in today’s culture?). 4. Right of conscience (which transcends beyond healthcare, but healthcare is at the forefront of this issue). 5. Addictions (opioids, marijuana, alcohol, tobacco, performance enhancing drugs, pornography, sexuality). Other issues can also be addressed in the future such as resource allocation, genetics and human enhancement, transplants, vaccinations, alternative medicine, community health with sexually transmitted infections and sexually transmitted diseases and human trafficking.

8 TODAY'S CHRISTIAN DOCTOR Spring 2019

Many states have been actively involved with these issues at the legislative level, recently with physician-assisted suicide, restrictions on abortion, opioid addiction, and legalization of marijuana. This is important and we should continue to be actively involved and pray for those testifying. But politics is downstream of culture, and culture is influencing the church. The greatest impact to influence our culture is with the church. CMDA is in a unique position to teach on these issues to support the church.

The early church and New Testament Christians had to deal with many of the same issues. The light of Christ shines bright in a very dark world. Unconstructive anger, hate, accusations can hurt the gospel message.

Please pray. This is a spiritual battle. “For our struggle is not against flesh and blood, but against the rulers, against the powers, against the world forces of this darkness, against the spiritual forces of wickedness in the heavenly places” (Ephesians 6:12, NASB). After Paul lists the armor of God, he asks for prayer, “With all prayer and petition, pray at all times in the Spirit, and with this in view, be on the alert with all perseverance and petition for all the saints” (Ephesians 6:18, NASB). Scripture, research, science, stories and vignettes will provide the basis for materials. We plan to create workbooks, discussion questions, videos, sermon outlines and seminars for free for churches to utilize. In addition, we will strategize implementation and distribution of these materials. CMDA’s Standards4Life will be a great sorting point. These materials are already available at www.cmda.org/standards-4-life/.

This will be a large task for this commission, so our desire is to have a lead person for each of the five categories, with others providing input. If you would like to participate in this commission, please contact me at bricklantz@comcast.net or communications@ cmda.org.

“Now to Him who is able to do far more abundantly beyond all that we ask or think, according to the power that works within us” (Ephesians 3:20, NASB).

TRANSFORMATIONS

INTRODUCING FREE CONTINUING EDUCATION

Regional Ministries Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community

One of the benefits of CMDA membership is FREE or complimentary continuing education at CMDA events and activities where continuing education is provided. Through CMDA’s Department of Continuing Education, you can earn continuing medical and dental education credits at a variety of CMDA events around the country. You can also earn continuing education credits through articles in Today’s Christian Doctor. In this edition, check out the article on page 14. For more information, visit www.cmda.org/ce.

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 Northeast Region Akeem Z. Walker, DMin P.O. Box 1216 Suffolk, VA 23439 609-502-2078 northeast@cmda.org Southern Region Grant Hewitt, MDiv P.O. Box 7500 Bristol, TN 37621 402-677-3252 south@cmda.org

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TRANSFORMED TRANSFORMED Doctors

Featuring

D ENNIS PALMER, DO, AND CATHERINE E. WOLF, MD, MPH

Authors of The Handbook of Medicine

CMDA: To get us started, tell us a little bit about your background (school, training, personal life, etc.)

Dr. Palmer: My wife Nancy and I are from rural Southwest Missouri. We went to high school together and got married at an early age. After college, we spent two years in the Public Health Service on the Pine Ridge Indian Reservation. After my military service, I entered medical school, completing in 1976. I spent two years in primary care in North Dakota then came to Cameroon as a medical missionary.

Dr. Wolf: I grew up in Princeton, New Jersey and was exposed at an early age to missionaries through my family’s involvement with the International Student Program at Princeton Theological Seminary. I loved hearing stories about other countries and realized what a privilege it was to be born, raised and educated in the U.S. Education is something so coveted by people from other countries, and I decided I would pursue my education as far as God would allow me. For me, the ultimate accomplishment educationally was to be a physician, so as a teenager, I had the goal of getting accepted into medical school. I went to Wheaton College where I had a wonderful academic experience but also grew tremendously in my faith. It was at an Urbana conference in 1973 that I dedicated my life to long-term missions. My first missions experience was in 1973 when I came to Haiti as part of Wheaton’s Student Missionary Project. My heart was captured by Haiti and I haven’t looked back. I did my residency in internal medicine in Milwaukee at the Medical College of Wisconsin and applied shortly after that to Worldteam mission organization to return to Haiti as a full-time medical missionary. I worked under Worldteam at Hopital Lumiere, a 120-bed mission hospital in the mountains of South Haiti from 1982 to 1987 and again from 1990 to 1994, and I practiced internal medicine, pediatrics and OB as well as serving for several years as Medical Director of the hospital. After my return to the U.S. in 1994, I practiced emergency medicine from 1994 to 2006 but felt a strong desire to return to the mission field. In 2006 I founded

10 TODAY'S CHRISTIAN DOCTOR Spring 2019

Dennis Palmer, DO (left), and Catherine E. Wolf, MD, MPH (center), were joined by new author Burton W. Lee, MD (right) in releasing the fifth edition of The Handbook of Medicine at the 2018 Global Missions Health Conference.

Friends for Health in Haiti and began a new project from the ground up. CMDA: When did you first get involved with CMDA?

Dr. Palmer: In 1983, we attended CMDA’s Continuing Medical and Dental Education (CMDE) Conference in Kenya. I was more involved later when we returned to Kansas City after serving in Cameroon. I was a representative to the House of Representatives meeting at the CMDA National Convention for several years and was involved in the student chapter at UMKC in Kansas City. Dr. Wolf: I first became a member of CMDA when I was at Northwestern University Medical School in Chicago from 1974 to 1978. CMDA: And how have you been involved since then?

Dr. Palmer: For the last 15 years, we have been in full-time missionary service and attending the CMDE conferences. Dr. Wolf: I was involved with CMDA in Milwaukee when I was a resident and attended several CMDA conferences during my time in the U.S. As a missionary, I benefitted from CMDA publications and communications but rarely have had time to go to their annual conferences. Most of my involvement with CMDA has been because of the Handbook. CMDA: Has faith always impacted your life and/or career?

Dr. Palmer: Yes, but at different levels. Over the years I have experienced a lot of personal growth as a result of being involved with medical missions. CMDA has always been an encouragement through their conferences and publications.

TRANSFORMING TRANSFORMING

the World

Dr. Wolf: My faith has always been an integral part of my life and my career. When I was practicing in the U.S., my time as a missionary always served as a topic of discussion with patients, and that usually led to opportunities for witness and sharing of my faith. Missions has been the focal point of my entire career. CMDA: How have you incorporated your faith into your practice/and or career over the years?

Dr. Palmer: My understanding of the Christian life is trying to follow Jesus’ command to be doers of the Word. That works out in following the calling God has on my life to follow closely after Him and obey the direction He provides. That leads to a sense of living in the kingdom and being a partner with God wherever and in whatever way He leads. This has led to a much more fulfilled and exciting life than I would ever have imagined at the beginning. Dr. Wolf: The Haitians are very well aware that I am in Haiti because I am a believer following the Lord’s leading. Faith is discussed very openly here, and it is always integrated into discussions with patients during their consultations. Haiti is a well-evangelized country, but people lack discipleship and often don’t live out their faith as they should. So, much of our discussion is centered on really living for the Lord in all aspects of our lives, in spite of poverty and suffering that is so common here.

each had written for our respective hospitals and then wrote the rest of the chapters ourselves. The first time we actually met face-to-face was at O’Hare Airport in Chicago, Illinois when we were flying together to Nairobi, Kenya to attend a CMDE conference, at which we obtained feedback from nationals and missionaries who were using the Handbook.

CMDA: One of the key components of the book is that multiple authors contribute to it. How did you work to make that happen?

Dr. Palmer: The first edition was written by just the two of us. When we started working on the later editions, we found others who were willing to edit specific chapters. The list of authors continued to expand until we have several authors writing most of the chapters.

Dr. Wolf: After attending that conference in Kenya, we realized the book would benefit from having contributing authors update some of the most important chapters, in order to keep it relevant and make use of expertise other than our own. So, with the second edition, we added some contributing authors and over the years have added expert authors for each of the chapters.

CMDA: Tell us about how the project for The Handbook of Medicine got started.

Dr. Palmer: For my part, I was given a short set of handwritten common protocols by one of my missionary colleagues when I first arrived in Cameroon. I carried those for years in my pocket. After I had more experience, I expanded the treatment protocols into a small booklet. Knowing how valuable those protocols were to me when I first arrived on the field, I wanted to expand that idea. It eventually led to collaborating with Dr. Wolf to write the first edition of the Handbook.

Dr. Wolf: When I returned to the U.S. in 1994, Dr. David Stevens suggested I get in touch with Dr. Palmer to see if we could put together a handbook for practicing on the mission field. Dennis and I worked together for the next three years, interacting by phone and internet, to produce the first edition of the Handbook. We initially used the protocols we

Dr. Catherine Wolf (right) sees patients in her work as a healthcare missionary with Friends for Health in Haiti.

Transformed Doctors ➤ Transforming the World www.cmda.org 11

Dr. Wolf: Dr. Lee has helped with identifying and contacting some of the contributing authors, and he and Dr. Palmer have done most of the work regarding content. I have worked more in the final editing and formatting, to be sure what we say is grammatically correct and in a consistent format (punctuation, spacing, italics, etc.). It’s tedious, but an important part of editing! CMDA: What are your plans for the future of The Handbook of Medicine?

Dr. Catherine Wolf founded Friends for Haiti in 2006, and they began the project from the ground up. Today, they seek 50 to 60 patients each day. Underlying all of their activities is a spiritual ministry that involves daily witness in the clinic, as well as partnerships with local Haitian churches.

CMDA: How has the book impacted you?

Dr. Palmer: We have a great group of co-authors and they have ensured that each edition has improved. I have enjoyed working with them on each edition. Also, knowing that the Handbook is useful to physicians who are going overseas for the first time or working outside of their area of expertise gives a great sense of satisfaction.

Dr. Wolf: I see the book as being a source of blessing to residents, students and visitors who serve with us in Haiti because I can offer copies of it to them to keep and use in their own practices, in school and on other mission trips. It’s been a joy to share it with others and to hear, on occasion, about faraway places where people have seen the book in use. CMDA: What’s the biggest way you’ve seen the book impact others and change the world for Christ?

Dr. Palmer: Occasionally, we get feedback from those who have used the Handbook and found it useful. For example, a fellow missionary told me he translated the chapters into French to use in a primary care residency. Dr. Wolf: I think the book has helped short-term and longterm mission physicians, nurses and students provide excellent medical care to their patients, no matter what the setting. And, when we provide excellent medical care, this serves as a witness to the healing ministry of Jesus. So, in this sense, I think it has helped change lives for the good, both physically and spiritually. CMDA: As we move into the fifth edition of the book, you’ve added another author to join you as writers. How has Dr. Burton Lee’s addition helped?

Dr. Palmer: Dr. Lee has been great. He has a whole set of contacts who were added as authors that Dr. Wolf and I didn’t have. He is also a great editor.

12 TODAY'S CHRISTIAN DOCTOR Spring 2019

Dr. Palmer: I would like to see it published in a digital format and distributed as widely as possible. I would like to get it into the hands of medical students across Africa if possible. My plan is to hand over most of my responsibilities with the next edition.

Dr. Wolf: I would like to see us strive in future editions to revise the content even further to be sure it is relevant to the majority of settings in which the book is being used. It’s gotten larger with each edition, and we need to undertake the difficult task of making the content more succinct and relevant. CMDA: CMDA’s vision is “Transformed Doctors, Transforming the World.” What does that mean to you?

Dr. Palmer: I believe that the motto is exactly correct. Our focus is on missions, which seeks to transform the world by changing lives and serving others. Looking back, I think we have been successful in many ways.

Dr. Wolf: When you truly give your life to Christ, He uses your life and your career to further His ministry in the world. Sometimes that means becoming a missionary overseas, and sometimes that involves staying in the U.S., but we are all called to live according to our faith, wherever that may lead us. I think CMDA plays a vital role in helping medical students and young healthcare professionals learn what it means to live for Christ and keep that vision of changing the world in front of them throughout their difficult studies and early years of residency and practice. CMDA: Is there anything else you’d like to share?

Dr. Palmer: Being involved with the Handbook project for the last 25 years has been a great joy, as is doing any task God gives to you. One has no idea where these things may lead, but God, in His wisdom, always does. Dr. Wolf: Just that it’s been a joy and a privilege to work on this Handbook. I pray the book is helpful in bringing excellent medical care to the most needy in the world and that the excellence of that care serves as a witness to the transforming nature of the gospel of Christ.

The Handbook of Medicine A Manual for Practitioners in Low Resource Settings Fifth Edition Dennis Palmer, DO Catherine E. Wolf, MD, MPH Burton W. Lee, MD

Have you ever seen a patient with leprosy? What is the best drug to use for the routine deworming of children? Have you ever diagnosed leishmaniasis? These are just a few of the vast challenges you will face while providing healthcare in low resource settings. And these are complications you certainly aren’t trained to face while practicing healthcare in the U.S. Whether you are a student, resident or seasoned healthcare professional, this reference book is absolutely essential if you are planning on working in a limited-resource setting. With contributions from some of today’s top specialists, this new fifth edition is an invaluable resource because it covers a wide variety of diseases, offers the latest treatment recommendations and is easier to use than ever. Pack it in your travel bags for your next mission trip. Browse through it before you go to read about the common diseases you may not see in your everyday practice of healthcare. Keep it close to quickly look up symptoms and diseases, because The Handbook of Medicine will help you provide competent and compassionate care to those in desperate need.

Purchase Your Copy Today $49.95

CMDA Bookstore www.cmda.org/shop • 888-230-2637 Paid Advertisement

DOCTOR SUICIDE by Thomas H. Okamoto, MD

EARN CE CREDIT

You can now earn continuing education credits through Today’s Christian Doctor. One hour of self-instruction is available for this article. See page 17 for more information.

14 TODAY'S CHRISTIAN DOCTOR Spring 2019

magine your colleague Bill, a middle-aged hospitalist you attended medical school with years ago. With a full census of intensive care patients, Bill’s stress level just dramatically increased when he found out a lawsuit was filed against him and the hospital. The lawsuit alleged staff failed to follow up on a patient’s discharge appointment, while the patient’s medication likely caused a loss of sight. You’ve been concerned about Bill, as lately he had been short and irritable, but you simply assumed it was related to the lawsuit. You know he’s also had a past history of alcohol abuse. Bill has told you in the past about meetings with hospital administration, reportedly for “issues of unprofessionalism with patients,” but he was never concerned as he thought the meetings were required by the hospital only to follow protocol. On top of all that, he’s been absent from church lately, plus he’s been withdrawing socially, despite not having long work shifts. You had worried momentarily that his previous marital troubles were returning, since his wife and children had been recently taking “trips away.” And yet, despite all the warning signs, it was still an awful shock to hear that Bill was found across town, dead from a self-inflicted gunshot wound.

Articles just like these report the disturbing phenomenon of doctor suicide, while others report physicians having the highest rates of suicide of all professions.5 The healthcare establishment is mounting efforts to study and remedy the problem, while physician burnout and dissatisfaction with the profession continue to trend upward. Prioritizing physician wellness and developing physician resilience is becoming the industry’s response to try to remedy these trends.

SUICIDE IN THE UNITED STATES

Before we delve further into the problem of doctor suicide, it’s important to understand more about suicide in the United States in general. The American Foundation for Suicide Prevention reports the following statistics for the general U.S. population: • The 2017 age-adjusted suicide rate is 14.0 per 100,000 individuals. • In 2017, men died by suicide 3.54 times more often than women. • White males accounted for 7 of 10 suicides in 2016. • Firearms account for 51 percent of all suicides in 2016. • The rate of suicide is highest in middle age—white men in particular.6 Suicide rates overall in the U.S. have risen nearly 30 percent since 1999.7

DOCTOR SUICIDE STATISTICS Sound familiar? For most of us in healthcare, it doesn’t take too much imagination to conjure up a scenario just like the one I described. More than likely during your career, you’ve lost a colleague, a co-worker, an employee or a friend to doctor suicide. No matter how many times you’ve seen it happen, it never gets easier. And we still continue to be shocked each and every time we see it happen. Since John Charles Bucknill, MD, and Daniel H. Tuke, MD, first published A Manual of Psychological Medicine and addressed physician suicide in 1858,1 we are frequently reminded of how the stresses of the healthcare profession can bring lives, similar to our own, to destruction. According to recent headlines, it’s happening more and more. Check out the headlines of a sampling of articles published in 2017 and 2018: • “ When doctors struggle with suicide, their profession often fails them”2 • “Suicide is much too common among U.S. physicians: It’s the second-leading cause of death for residents— and the leading cause for male residents”3 • “Doctor burnout and suicide at dangerously high rates”4

For physicians, the statistics are more extreme: • Estimates for physicians are 28 to 40 suicides per 100,000 per year.8 • Male physicians have a 1.41 times higher suicide rate than the general male population. • Female physicians have a 2.27 times higher suicide rate than the general female population.9 A systematic literature review presented at the 2018 American Psychiatric Association meeting reported suicide rates in physicians are the highest of any profession. In fact, physician suicides occur more than twice as often as in the general population. They also found that physicians often have untreated or undertreated depression or other mental illnesses. Even more startling, suicide rates in physicians were higher than those found in the military.10 Other studies have similarly found that physicians’ suicide rates, at 300 to 400 physician suicides per year, are higher than those in the general population. Even more alarming is physician suicide statistics are likely underreported, an attempt to maintain denial and acquiesce to shame and pressure by organizations, families and peers, to avoid the reality of suicide.11,12 Other pressures include the stigma of Transformed Doctors ➤ Transforming the World www.cmda.org 15

veyed physicians sometimes, often or always experienced feelings of burnout, while 46 percent plan to change career paths.18

FACTORS INCREASING SUICIDE RISK

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.

suicide13 and the wish to perpetuate the image of the invulnerable physician.14 Statistics of physician suicide during training are also significant, as suicide was found to be the primary cause of male resident deaths and the second cause of deaths in female residents.15 Statistics of doctor suicide vary according to specialty. A 2001 study from the United Kingdom found significant differences in physician suicides between specialties, with anesthetists, community health doctors working for the National Health Service, general practitioners and psychiatrists having significantly increased rates compared with doctors in general hospital medicine.16

JOYLESSNESS IN HEALTHCARE

Some doctors in today’s healthcare system are finding the practice of medicine less rewarding, and lately, many are considering leaving the profession altogether. A study published in Mayo Clinic Proceedings in 2017 surveyed physicians and their plans to continue their medical careers. It reported that one in five were planning to decrease clinical hours in the next year, while one in 50 planned to leave their medical career completely within two years. Dissatisfaction in work-life integration, burnout or dissatisfaction with electronic health records were independent predictors of either planning to reduce clinical hours or leave medicine altogether.17 These results were confirmed by the 2018 Physician’s Foundation survey, which studied nearly 9,000 U.S. physicians across the country. They found that 78 percent of sur16 TODAY'S CHRISTIAN DOCTOR Spring 2019

In the general population, a recent study released by the Centers for Disease Control and Prevention (CDC) found that higher risk of suicide was increased by: • Mood disorders • Relationship problems • Job/financial problems • Physical health problems • Substance abuse19

Higher rates of physician suicide are affected by multiple risk factors most commonly due to untreated or inadequately treated mental health conditions.20 Haskins et al. reported that mood disorders including major depression and other mood disorders, substance abuse, adverse life events, access to lethal means, medical illness, family history of mental illness, age of 50 or older and gender (male more common overall) also increase the risk of physician suicide.21 In his book on physician suicide, Michael F. Myers, MD, documented the higher pressures of being a physician, including perfectionism instilled by the medical culture and encouraging a self-worth dependent on the striving for and achieving extremely high standards, often leading to negative personal consequences. Specific pressures include the burden of high student debt, business costs, pressure to maintain certification and licensing, demanding patient care, the documentation burden including electronic health records and threats of lawsuits.22 According to Brooks et al., multiple stressors are high risk factors for physician suicide.23 These stresses include current personal, financial, health and occupational problems. In another article he published, Brooks further describes specific multiple risks for physician suicide as including: • Being named as a defendant in a lawsuit • General job problems (e.g., concerns about job security, increased work demands) • License restrictions • Financial problems • Professional isolation24 In his book Physician Suicide: Cases and Commentaries,

Peter Yellowlees, MBBS, MD, describes physician suicide risk as also elevated because they have higher knowledge and skills, allowing for more effective suicidal plans and actions.25

THE AMBIVALENT IMAGE OF DOCTOR/HEALER

The Western image of doctor/healer has evolved from the idealized and caring television doctor “Marcus Welby” to a devolved, conflicted “Dr. House.” The image has changed from a doctor who dispensed care and wisdom by a walk in the park, to a narcissistic intensivist with suicidal impulses, hospitalized for opiate addiction. This cultural shift is discussed by Rupinder Legha, MD, in her article on the history of physician suicide in America.26 The pre-1970s cultural rejection of troubled, suicidal physician-outcasts shifted to embracing the suicidal physician of the modern era (1970 onward), an imperfect human being, deserving of support and care. Dr. Legha interprets this shift as reflecting the profession’s ambivalence in promoting unattainably high ideals against the reality of the vulnerability of physician health and well-being. The idealized image of the doctor’s strength and invincibility and the denial of physician vulnerability not only impedes comprehensive study of doctor suicide, but it also hinders appropriate prevention and treatment efforts that reduce doctor suicide risk.

FACTORS DISCOURAGING DOCTOR SELF-CARE

Physicians are uniquely trained since medical school to resist patient hood, refusing acknowledgement of vulnerability. This is enhanced by the demand to problem solve, while encouraging emotional denial and self-reliance.27 The medical board, which licenses physicians, is in existence for the safety of patients, not to advocate for the physician. Involvement with the medical board can place a physician in an adversarial and dependent position with the board, as control of their ability to practice medicine is relinquished. Physicians fear a negative future career path, as credentialing privileges at hospitals or job/career advancement can be affected by reputation, rumor, legal actions and mental health conditions. The stigma of mental health issues actively discourages physicians from asking for help.28 These concerns and fears contrast with the realities of asking for help, as early intervention actually can be significantly less detrimental regarding one’s future career, especially when compared to negative consequences and severe disabilities caused by untreated mental illness, substance use disorders or suicidal outcomes. In the long run, unaddressed mental health conditions are more likely to have a negative impact on a physician’s professional reputation and practice than reaching out for help early, according to the

EARN CONTINUING EDUCATION

1 HOUR NOW AVAILABLE We are now offering continuing education credits for this article through Today’s Christian Doctor. One hour of selfinstruction is available. To obtain continuing education credit, you must complete the online test at https://www.surveymonkey.com/r/2019DrSuicide. • This CE activity is complimentary for CMDA members. • The fee for non-CMDA members is $50.00. For payment information, visit www.cmda.org/cepayment. If you have any questions, please contact CMDA’s Department of Continuing Education Office at ce@cmda.org.

Review Date: January 21, 2019 Original Release Date: March 1, 2019 Termination Date: March 1, 2022 EDUCATIONAL OBJECTIVES • Describe the long history of high rates of physician suicide. • List risk factors that increase the risk of physician suicide. • Discuss how to increase awareness of efforts to facilitate doctor wellness, resilience and institutional health. • Identify interventions personally, interpersonally and institutionally that may help reduce the risk of doctor suicide. ACCREDITATION The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PHYSICIAN CREDIT The Christian Medical & Dental Associations designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. DENTAL CREDIT CMDA is an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 1/1/2018 to 12/31/2022. Provider ID#218742. 1 Hour Self Instruction Available. No prior level of skill, knowledge, or experience is required (or suggested). DISCLOSURE None of these authors, planners or faculty have relevant financial relationships. Thomas H. Okamoto, MD; David Stevens, MD, MA (Ethics), CEO; Mandi Mooney, CMDA Today’s Christian Doctor Editor; Barbara Snapp, CE Administrator; and Sharon Whitmer, EdD, MFT CMDA CE Review Committee John Pierce, MD, Chair; Jeff Amstutz, DDS; Mike Chupp, MD; Lindsey Clarke, MD; Stan Cobb, DDS; Jon R. Ewig, DDS; Gary Goforth, MD; Elizabeth Heredia, MD; Curtis High, DDS; Bruce MacFadyen, MD; Dale Michels, MD; Shawn Morehead, MD; Michael O’Callaghan, DDS; David Stevens, MD (recused); and Richard Voet, MD THERE IS NO IN-KIND OR COMMERCIAL SUPPORT FOR THIS ACTIVITY.

Transformed Doctors ➤ Transforming the World www.cmda.org 17

CMDA’S CENTER FOR WELL-BEING CMDA is launching a Center for Well-being to help Christian healthcare professionals address the challenges that lead to burnout, ill health, decreased workplace satisfaction and even suicide. We meet these issues face to face with biblical truth that holistically addresses all aspects of health—physical, mental, emotional and spiritual. We want to be a source of helpful resources, including a well-developed coaching ministry with certified physician-specific coaches. For more information, visit www.cmda.org/coaching.

CHRISTIAN SPIRITUALITY Just as Dr. Norcross encouraged spiritual perspectives and beliefs as part of restoring the troubled physician, physicians who believe in Jesus Christ believe the practice of healthcare has a higher meaning. Worshipping an omnipotent God voids the idealized image of the modern doctor, allowing us to accept our vulnerabilities to practice medicine in humility with diligence. Our faith motivates us by gratitude toward excellence while calling us to care for ourselves, our patients, our families and our coworkers. The Christian commandment to love God and love others as ourselves leads us toward realistic self-expectations not to set our self-esteem on our own perfection, but allow and attend to our own vulnerability to mental health issues within daily battles and stress. Balancing meaningful work and life activities consistent with our faith, and focusing on relationships, supports our identity within and outside of our role as a physician. CMDA is a preexisting model for institutional programs of physician wellness and resilience. Through personal and marital retreats, conferences for medical education and spiritual renewal, mentorship and life coaching, CMDA’s programs inherently support self, relational and collegial development. They are consistent with many of the strategies of other physician wellness and resilience programs and have the potential to reduce physician suicide, all within the communion of faith.

American Foundation for Suicide Prevention.29 Dr. Yellowlees also reports that, in reality, the bar requiring medical board involvement and restricting a physician’s practice is actually high.30 Maintaining the image of the idealized doctor is errant as well as personally destructive.

PHYSICIAN WELLNESS

The concept of resilience has become part of the physician wellness rubric, which is defined as the ability of an individual to maintain personal and social stability despite adversity.31 Beresin et al. described this concept not just as a trait but also as a teachable skill set.32 A current definition of resilience was described by Epstein and Krasner as the capacity for mindfulness, limit setting and self-moni18 TODAY'S CHRISTIAN DOCTOR Spring 2019

toring, as well as attitudes promoting healthy engagement with work challenges, rather than withdrawal from those challenges.33 The hope is for an overwhelmed doctor or at-risk physician to experience a work environment that responds to and promotes physician well-being, allowing the physician safety and confidentiality to ask for help and receive it, and to be restored to health before having to return to full practice. A variety of programs have been developed to provide guidelines for this supportive work environment including: • Mayo Clinic group34 • American Medical Association’s (AMA) Steps Forward program35 • American Psychiatric Association’s physician wellness program36 • National Academy of Medicine’s Action collaborative for physician well-being and resilience37 • Stanford’s wellness framework38 • American Medical Association’s Joy in Medicine program39 • University of California Davis Well Being program40 • University of California San Diego Well Being program41 Practical suggestions included in the AMA’s Steps Forward program are: 1. Talk about the risk factors and warning signs for suicide. 2. Take steps to standardize care-seeking in your organization. 3. Make it easy to find help. 4. Consider creating a support system for physicians in your organization. Early identification/intervention of peers who may be in trouble include spotting: • “Difficult doctors” • Decreased performance • Warning signs of excessive substance use, impulsive behaviors, erratic judgment, etc. In a paper on physician stress and burnout presented at the 29th Annual Western Regional Conference on Physician Wellbeing in Riverside, California, William Norcross, MD, encouraged the development of balance in life for physicians, including life meaning, spiritual perspectives and beliefs, focusing more on relationships, exercise, hobbies, holidays and interests outside of medicine, as well as resilience development as personal interventions to hopefully reduce suicide risk.42

CONCLUSION

Without question, suicide is tragic, be it a member of the “general public” or a doctor. But are the already high rates of doctor suicides truly increasing? And are they increasing disproportionately faster than the recent increases in the general public? Do physician cultural pressures and risk factors alone explain the elevated statistics of doctor suicide, or are there intrinsic risks towards self-destruction that we as doctors accept as we don our white coats? Until more studies reveal the answers to doctor suicide, we can only apply what we know regarding enhancing physician wellness and resilience, as well as work toward reducing the stigma of mental healthcare. We can attempt to replace the culture of perfectionism and the destructiveness of an idealized physician image with a balance toward physician wellness and resilience, while preserving the goal of excellence in the practice of healthcare. We also need to be vigilant for our disruptive or troubled colleagues, and monitor all for signs of burnout, mood and substance use disorders, ready to encourage and facilitate appropriate care for the restoration of the healthy practice of healthcare. BIBLIOGRAPHY 1 Bucknill, JC, Tuke DH.(1858). A Manual of Psychological Medicine. London, England: John Churchill 2 Farmer, B. (2018, July 31). When doctors struggle with suicide, their profession often fails them. Morning Edition at National Public Radio. Retrieved from https://www.npr.org/sections/health-shots/2018/07/31/634217947/toprevent-doctor-suicides-medical-industry-rethinks-how-doctors-work. 3 Morris, N., (2017, August 11). Suicide is much too common among U.S. physicians: It’s the second-leading cause of death for residents—and the leading cause for male residents. Observations at Scientific American. Retrieved from https://blogs.scientificamerican.com/observations/suicide-is-muchtoo-common-among-u-s-physicians/. 4 Lyndon, A. (2017, April 24). Physician News Digest. Retrieved from https:// physiciansnews.com/2017/04/24/doctor-burnout-suicide-high-rates/. 5 Anderson, P. (2018, May 7). Physicians experience highest suicide rate of any profession. Medscape. Retrieved from https://www.medscape.com/ viewarticle/896257#vp_2 6h ttps://afsp.org/about-suicide/suicide-statistics/ 7 Stone DM, Simon TR, Fowler KA, Kegler, S.R., Yuan, K., Holland, K.M., … Crosby, A.E. (2018, June 8). Vital signs: Trends in state suicide rates — United States, 1999–2016 and circumstances contributing to suicide — 27 states, 2015. MMWR Morb Mortal Wkly Rep, 67(22), 617–624. DOI: http:// dx.doi.org/10.15585/mmwr.mm6722a1 8 Anderson, P. (2018, May 7). Physicians experience highest suicide rate of any profession. Medscape. Retrieved from https://www.medscape.com/ viewarticle/896257#vp_2 9 Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161:2295–302. doi:10.1176/appi.ajp.161.12.2295 10 Anderson, P. (2018, May 7). Physicians experience highest suicide rate of any profession. Medscape. Retrieved from https://www.medscape.com/ viewarticle/896257#vp_2 11 Center, C., Davis, M., Detre, T., Ford, D. E., Hansbrough, W., Hendin, H., … Silverman, M. M. (2003). Confronting depression and suicide in physicians. JAMA, 289(23), 3161-3166. doi:10.1001/jama.289.23.3161 12 Schernhammer ES, Colditz GA. Suicide rates among physicians: a

quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161:2295–302. doi:10.1176/appi.ajp.161.12.2295 13 Gold, K. J., Sen, A., & Schwenk, T. L. (2012). Details on suicide among US physicians: data from the National Violent Death Reporting System. General hospital psychiatry, 35(1), 45-9. 14 Legha, R.K. (2012). A History of physician suicide in America. J Med Humanit. 33, 219–244. https://doi.org/10.1007/s10912-012-9182-8 15 Yaghmour, N. A., Brigham, T. P., Richter, T., Miller, R. S., Philibert, I., Baldwin, D. C., & Nasca, T. J. (2017). Causes of death of residents in ACGMEaccredited programs 2000 through 2014: Implications for the learning environment. Academic Medicine, 92(7), 976–983. http://doi.org/10.1097/ ACM.0000000000001736 16 Hawton K., Clements, A., Sakarovitch, C, Simkina, S., Deeksb, J.J. (2001). Suicide in doctors: A study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995. Journal of Epidemiology & Community Health, 55, 296-300. http://dx.doi.org/10.1136/ jech.55.5.296 17 Sinsky, C.A., Dyrbye, L.N., West, C.P., Satele, D., Tutty, M., Shanafelt, T.D. (2017). Professional satisfaction and the career plans of US physicians. Mayo Clinic Proceedings, (92)11, 1625-1635. DOI: https://doi.org/10.1016/j. mayocp.2017.08.017 18 The Physician’s Foundation. (2018). The Physicians Foundation’s 2018 survey. Retrieved from https://physiciansfoundation.org/research-insights/thephysicians-foundation-2018-physician-survey/ 19 Stone DM, Simon TR, Fowler KA, Kegler, S.R., Yuan, K., Holland, K.M., … Crosby, A.E. (2018, June 8). Vital signs: Trends in state suicide rates — United States, 1999–2016 and circumstances contributing to suicide — 27 states, 2015. MMWR Morb Mortal Wkly Rep, 67(22), 617–624. DOI: http:// dx.doi.org/10.15585/mmwr.mm6722a1 20 American Foundation for Suicide Prevention. (2018). Facts about physician depression and suicide, in After a Suicide: A Toolkit for Physician Residency/Fellowship Programs. Retrieved from https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention/#section1. Accessed September 24, 2018. 21 Haskins, J., Carson, J.G., Chang, C.H., Kirshnit, C., Link, D. P., Navarra, L.,… Yellowlees, P.(2016).The Suicide prevention, depression awareness, and clinical engagement program for faculty and residents at the University of California, Davis Health System. Acad Psychiatry, 40(23), 23-29. https://doi. org/10.1007/s40596-015-0359-0 22 Myers, M. (2017). Why physicians die of suicide: Lessons learned from their Families and others who cared. San Bernardino, CA: Michael F. Myers. 23 Brooks E, Gendel MH, Early SR, Gundersen DC. (2017). When Doctors Struggle: Current Stressors and Evaluation Recommendations for Physicians Contemplating Suicide. Arch Suicide Res. 22(4), 519-528. doi: 10.1080/13811118.2017.1372827. Epub 2018 Jan 8. 24 Brooks, E. (2018). Preventing physician distress and suicide. American Medical Association. Steps Forward. Retrieved from https://www.stepsforward.org/modules/preventing-physician-suicide. Accessed February 6, 2018. 25 Yellowlees, P. (2019). Physician suicide: Cases and commentaries. Washington D.C.: American Psychiatric Association Publishing. 26 Legha, R.K. (2012). A History of physician suicide in America. J Med Humanit. 33, 219–244. https://doi.org/10.1007/s10912-012-9182-8 27 Brimstone, R., Thistlethwaite, J.E., Quirk, F. (2007). Behavior of medical students in seeking mental and physical health care: Exploration and comparison with psychology students. Med Educ, 41, 74–83. 28 Yellowlees, P. (2019). Physician suicide: Cases and commentaries. Washington D.C.: American Psychiatric Association Publishing. 29 American Foundation for Suicide Prevention. (2018). Facts about physician depression and suicide, in After a Suicide: A Toolkit for Physician Residency/Fellowship Programs. Retrieved from https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention/#section1. Accessed September 24, 2018. 30 Yellowlees, P. (2019). Physician suicide: Cases and commentaries. Washington D.C.: American Psychiatric Association Publishing.

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31 Luthar, S.S., Cicchetti, D., Becker, B., (2003). The Construct of resilience: A critical evaluation and guidelines for future work. Child Dev, 71(3), 543-562. https://doi.org/10.1111/1467-8624.00164. 32 Beresin, E. V, Milligan, T. A., Balon, R., Coverdale, J. H., Louie, A. K., Roberts, L. W. (2016). Physician wellbeing: A Critical deficiency in resilience education and training. Academic Psychiatry : The Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 40(1), 9–12. doi: 10.1007/s40596015-0475-x. Epub 2015 Dec 21. 33 Epstein, R.M., Krasner, M.S. (2013). Physician resilience: What it means, why it matters, and how to promote it. Acad Med., 88(3), 301-3. doi: 10.1097/ ACM.0b013e318280cff0. 34 Shanafelt, T. D., Kaups, K. L., Nelson, H., Satele, D. V., Sloan, J. A., Oreskovich, M. R., & Dyrbye, L. N. (2014). An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. Annals of surgery, 259(1), 82-8. 35 Brooks, E. (2018). Preventing physician distress and suicide. American Medical Association. Steps Forward. Retrieved from https://www.stepsforward.org/modules/preventing-physician-suicide. Accessed February 6, 2018. 36 American Psychiatric Association. (2018). Well-being and burnout: Take charge of your well-being. Retrieved from https://www.psychiatry.org/psychiatrists/practice/well-being-and-burnout 37 National Academy of Sciences. (2018). National Academy of Medicine: Action collaborative on physician well-being and resilience. Retrieved from https://nam.edu/initiatives/clinician-resilience-and-well-being/ 38 Stanford Medicine. (2019). Stanford Medicine WellMD Center. Retrieved from https://wellmd.stanford.edu/center1.html. 39 Winkler, A.M. (2017, December). Joy in Medicine™ physician well-being: A discussion on burnout and achieving joy in practice. American Medical Association. Retrieved from https://www.ama-assn.org/sites/default/files/ media-browser/public/ps2/tcip-webinar-joy-medicine.pdf

40 Haskins, J., Carson, J.G., Chang, C.H., Kirshnit, C., Link, D. P., Navarra, L.,… Yellowlees, P.(2016).The Suicide prevention, depression awareness, and clinical engagement program for faculty and residents at the University of California, Davis Health System. Acad Psychiatry, 40(23), 23-29. https://doi. org/10.1007/s40596-015-0359-0 41 Moutier, C., Norcross, W., Jong, P., Norman, M., Kirby, B., Tara McGuire, T., Zisook, S. (2012). The Suicide prevention and depression awareness program at the University of California, San Diego School of Medicine. Academic Medicine, 87(3):320–326. DOI: 10.1097/ACM.0b013e31824451ad 42 Norcross, B. (2017, May 24) Physician burnout, depression, and UC San Diego HEAR. 29th Annual Western Regional Conference on Physician Wellbeing, Riverside, California.

THOMAS H. OKAMOTO, MD, received his medical degree from UC Los Angeles, and he completed a residency in psychiatry at Cedars Sinai Medical Center in Los Angeles, California. He is a specialist with adolescents and mood disorders, and he is a Distinguished Life Fellow with the American Psychiatrist Association. He is a Councilor with the Orange County Psychiatric Society. He is also currently Assistant Clinical Professor at UC Irvine School of Medicine. Dr. Okamoto is a member of CMDA and is active with CMDA’s Psychiatry Section. For more information, visit www.cmda.org/ psychiatry.

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!

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INJECTING GOD’S WORD INTO HEALTHCARE: Leading Bible Study by Jeffrey Maudlin, MD

GET INVOLVED

Want more information about starting your own Bible study for your healthcare colleagues? Or do you want to find a local chapter in your area? CMDA’s Campus & Community Ministries is a network of more than 80 local graduate ministries and more than 300 campus ministries providing opportunities for members to connect and live out their Christian faith in their practices, on campus and in their communities. To get involved, visit www.cmda.org/ccm.

t says in Romans 8:22, “For we know that the whole creation has been groaning...” (ESV ). Just like Paul expressed to the Romans, we know healthcare is experiencing groaning as it passes through the gyrations of this culture’s and, in fact, the entire world’s struggles. In our healthcare arena, many patients are not doing well, third-party payors are becoming more powerful and hospitals often struggle to pay the bills. As healthcare professionals, we may feel as though we are becoming “bashi22 TODAY'S CHRISTIAN DOCTOR Spring 2019

bazouk” soldiers (Ottoman expendable soldiers). Like it says in Colossians 1:14, the redemptive work of God is needed at this time in ourselves for our ministry of healthcare. What can we do? It is not enough to try to individually power through our busy days with just a prayer in the morning and church on Sunday. Our 12+ hour days sap us of our spiritual energy far before the end of the day, leaving us with less vigor than

obediently opened our meetings for decades with a reflection, which could be led by anyone of any philosophy or worldview. The matter that will make a difference is to inject the Word of God into our professional arenas. “All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in righteousness” (2 Timothy 3:16, ESV). So much of the Word of God pertains to every aspect of healthcare. For example, the Psalms offer great consolation to our daily struggles with our patients. Jesus was the Great Physician, and lessons from His healthcare ministry can also be seen in Luke 4. For decades, I have hosted Bible studies for healthcare professionals in our community. Of course, Jesus called us to do this in His famous last words: “Go therefore and make disciples of all nations...teaching them to observe all that I have commanded you...” (Matthew 28:19-20, ESV). But what does it take to lead such a Bible study?

“

He has delivered us from the domain of darkness and transferred us to the kingdom of his beloved Son, in whom we have redemption, the forgiveness of sins.” —Colossians 1:13-14, ESV First, an analysis of who is in the local healthcare community is needed. This is a community needs assessment of sorts. Which healthcare professionals are followers of Christ, and who would be interested in such a group? Are they willing to meet, or are they too involved in other activities? What other healthcare workers would want to attend? Spouses can also offer a great perspective on how to support one another. Which members of the local healthcare community are not Christian but might be interested in attending a “support group?”

we need to bless that last patient of the day. As believers, we need to encourage one another in the Lord in our healthcare settings, like is directed in 1 Thessalonians 5:11. Numerous hospitals, clinics and corporations offer a time of reflection before meetings. Massive businesses and corporations recognize that we need vision, motivation, overall view and direction for the complex work we try to do every day. The Catholic healthcare organization I have worked for

Then, substantial prayer needs to occur. Ask God who should be invited and how a Bible study might impact them. Praying for our associates necessitates that we get to know them: What are their struggles? What are their schedules like? Are they open to spiritual matters? Do they recognize the need for help in their work? Can we pray enough to bring ourselves to care for others, to sacrifice our time for them, to serve them, as we lead them toward our Savior? In Colossians 2, we read that Paul suffered as he prayed for the believers. Are we prepared to do the same? Sometimes finding a companion to help start a study is critical. I found once that another local physician of a difTransformed Doctors ➤ Transforming the World www.cmda.org 23

ferent church was very willing to help pray, communicate, lead, attend and support our studies.

“

Therefore encourage one another and build one another up, just as you are doing.” —1 Thessalonians 5:11, ESV Next, a “call” must be made to get the word out about what you’re going to be doing and how studying God’s Word relates to your work in healthcare. This call can be an email, a flyer, a text, a social media post, etc. But I’ve found that individual contact is the best, such as a personal visit in the hallway of the hospital or clinic, or even a phone call. With that, we can discover what that specific person’s needs are, which day or time would be best for them, which setting, how they like to be contacted, what their spiritual history is, where they would prefer to meet, etc. Sometimes the results from this step are encouraging, and sometimes they are negative. Don’t be discouraged, as opposition is well known as is written in 1 Peter 2:20b, “But if when you do what is right and suffer for it you patiently endure it, this finds favor with God” (NASB). So keep praying, and pray even more as feedback comes in, because God always faithfully brings in someone who recognizes that we need God’s Word in our professional lives to say, “I’m coming, I’ll be there.” Before you finally get together for the first time, more communication typically transpires. What time are we meeting? At your clinic? In the hospital conference room? Can I bring something to drink? Should I bring my Bible?

What are we going to study? I’m running behind on a consult, can I come late? The leader must have thought these matters out ahead of time, so the answers are ready. Don’t bring food or drinks; I already brought them. We’ll leave the door open for you, so come whenever you can. Bring your son or daughter you just picked up from school with you, if necessary. It’s an exciting time to see who God eventually brings to your meeting. The rules are delineated: we will study Scripture only. We will look at it from the point of view of its healing effects in our lives, such as how Jesus acted in Luke 4. We will NOT study other books or materials (one doctor brought a book of New Age philosophy to study, which we explained we would not study in our current meeting, and rebutted with John 1:1). We will not talk about our separate churches, and we won’t even talk about politics! Let’s just see what the Word of God says to us and how we can apply it to our lives.

“

All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in righteousness.” —2 Timothy 3:16, ESV The method we’ve used is the Inductive Bible study method. We make observations, study diligently, then follow that with interpretations and finish with applications. The New How to Study Your Bible by Kay Arthur has been instrumental in learning and then teaching others how to study God’s Word. When I lead, I try to have four or five questions ready, with what I feel in my mind are reasonable answers, then we see what the participants come up with. Of course, if I’ve studied four to five hours in preparation, then the Word has already made an impact on my life as a physician. I don’t preach, or even “teach,” very much. In Luke 4:40-42, when Jesus was healing various kinds of diseases, what was His key to ministry success? My interpretative answer would be that He withdrew! For Jesus, time in prayer and the Word is what gave Him the ability to minister to everyone around Him. That answer applies to all of us in the study, does it not?

Dr. Jeffrey Maudlin (back left) with his healthcare Bible study group members.

24 TODAY'S CHRISTIAN DOCTOR Spring 2019

Time allotted to the study is important, and we’ve found a half-hour warm up social period helps to gather

people, while the Bible study might only be 30 minutes long. Then, if people still have some energy left (remember this is potentially their 13th or 14th hour after a long shift), we can talk about prayer requests and pray a little bit. Of course, the power comes as we pray for each other during the week. Numbers and success are non-important measures. I’ve led the study with myself alone, just studying God’s Word and praying, or it can be just two of us. Matthew 18:20 says, “For where two or three have gathered together in My name, I am there in their midst” (NASB). But commonly we have a group of six to eight of us enjoying each other’s company and supporting one another as we study His Word. The result of such group study time is an extremely powerful unity. We care for each other, pray for each other, socialize together, visit each other with gifts and celebrate our cultural differences. I am convinced that unity carries over into our hospital. The administration of our hospital, for example, has noticed the closeness and constructiveness by which our team works together.

Also, as “we see the day approaching,” we pray for larger groups of interested participants! “They are not of the world, even as I am not of the world. Sanctify them in the truth; Your word is truth...I do not ask on behalf of these alone, but for those also who believe in Me through their word; that they may all be one...that the world may believe that You sent Me.” —John 17:16-21, NASB

JEFFREY MAUDLIN, MD, has worked for 33 years in various under-served medical regions. He wrote a book about medical missions in Ecuador entitled Grace In Practice: A Mission in Medicine, which is available through the CMDA Bookstore at www.cmda.org/shop. You can visit Dr. Maudlin’s website at www.GraceInPractice-Mission.com. He and his family reside in Southern Arizona.

In fact, this same unity even spills over into those who don’t come, by the power of the Holy Spirit. They notice how we work together, how our complaining is less, how we pray for patients and how God blesses us. Our hospital has the highest scores from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) in the nation within our network!

CONCLUSION

In healthcare, we find tremendous efficacy in injections. Think about substances such as ceftriaxone, Depo-medrol, methylprednisolone LA, chemotherapy, Tdap and HIB vaccines, and even B12! The injection of God’s Word into the healthcare facilities (AKA healing ministries) of our communities is even more powerful. The “sword of the Spirit” in Hebrews 4:12, although not a 27-gauge needle, reaches the “soul and spirit, of both joints and marrow, able to judge the thoughts and intentions of the heart” (NASB).

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“

For where two or three have gathered together in My name, I am there in their midst.” —Matthew 18:20, NASB

Leading an “MD Bible study,” as we’ve called it, for healthcare professionals will be one of the most vibrant things you can do in your practice. The unity is spectacular.

Transformed Doctors ➤ Transforming the World www.cmda.org 25

{Weight, That Is} by Amy Givler, MD

26 TODAY'S CHRISTIAN DOCTOR Spring 2019

’m a family physician whose patients come from rural Louisiana. Too many are overweight. All right, I admit it, most of them are obese. Often morbidly obese. But during my first 28 years of practice, I didn’t have much to offer them. “Eat less,” I’d say (if I broached the subject at all). “Avoid fat. Eat more fruits and vegetables. But mostly—eat less. However much you’re eating, eat less.” They would leave my office agreeing to try my advice, but the next visit they would be heavier. And heavier. And year after year, on and on it went. The trouble is, I couldn’t keep my own advice. I was last a normal weight sometime in high school, maybe earlier. For decades I bounced around in the “overweight” category without caring much about my weight. Every few years I’d try to eat less, and I was able to reduce a few pounds. But the weight crept back on and slowly I gained about one or two pounds a year. And so, 18 months ago, I found myself at age 59 not only overweight, but obese. Seventeen pounds over the obesity threshold, in fact. I felt awful. My joints hurt, I had lots of reflux symptoms, I didn’t want to exercise and my clothes didn’t fit. I either needed to buy an entire closetful of new clothes, or I was going to have to find some way to lose weight. I tried eating less, but it didn’t work this time. I kept gaining weight. The obesity train was gaining momentum and I couldn’t slow it down. I stumbled upon the ketogenic diet (low carbohydrate/ high fat/moderate protein) touted as an option in a Facebook group of women physicians who supported weight loss. It ran contrary to the “low fat” message I’d been taught, but the more I read about it, the more I realized there was good science behind it. Since 36 percent of U.S. adults are obese according to the Centers for Disease Control and Prevention—and that percentage rises every year—it’s obvious that whatever diet Americans are following is not working. 1

I jumped in with full commitment. I threw out or gave away all the processed foods in our kitchen, which emptied our shelves. My entire diet had pretty much consisted of carbohydrates, most of them refined. The result of this new way of eating has shocked me, more than anyone else. I’ve lost 58 pounds, so far, and am now a normal weight. I feel terrific, both physically and mentally. My thinking is clearer, I have fewer arthritis symptoms and my gut never feels bloated. Because I eat delicious healthy fats, I’m not hungry. I had given up all hope of being “normal” ever again. Now I know I can maintain this weight or lose more. It’s all a matter of how many carbohydrates I eat. This is not the place to explain exactly what the ketogenic diet is, as I figure most people have heard of it, and I’m not promoting it as the only way to reduce. There are many healthy ways to eat which lead to weight loss. But being in ketosis has been extremely successful for me, probably Transformed Doctors ➤ Transforming the World www.cmda.org 27

2.6 points off her BMI. She stopped eating corn and most flour, sugar and potatoes. She is eating more healthy fats and a moderate amount of protein. Deborah is not alone. Dozens of my patients are either maintaining their weight (Huzzah! They are no longer gaining!) or they are losing weight—all by limiting carbohydrates. With all the enthusiasm of a new discovery, I’m discussing weight with patients far more freDr. Amy Givler in November 2017 (left) and in August 2018 (right), nearly one year after beginning her weight loss journey. quently than I did before. because I have insulin resistance. Ketosis keeps my insulin That’s not too surprising, since when I was obese a little voice level low, but not dangerously low. Here’s what boggles my whispered to me, “You’re hardly one to talk. Don’t bring up mind: For the first time in my life I feel in control of what I weight until you have your own act together, you hypocrite.” weigh. For those who want some doctor-friendly information, here are some resources: But it turns out I could have ignored that devilish voice. A 2012 study profiled in Preventative Medicine showed • The Obesity Code by Jason Fung, MD that patients have high trust in the diet advice their pri• The Diabetes Code by Jason Fung, MD mary care physicians gave, regardless of the BMI of the • Simply Keto: A Practical Approach to Health & Weight Loss, physician.2 Though physicians are thinner, as a group, with 100+ Easy Low-Carb Recipes by Suzanne Ryan than the general population, a full 50 percent of us are • www.thedietdoctor.com still in the overweight or obese category. If half of all physicians are reluctant to give weight-loss counsel, then As a corollary, what has radically changed in the last seven many patients are being deprived. And here is the incenmonths is the nutritional advice I give to my patients and tive for all of us: A meta-analysis showed that adults who the enthusiasm with which I give it. For the first time in my are overweight or obese are four times more likely to try professional life, I know I can help obese and overweight to lose weight if they were counseled to do so by their patients successfully lose weight. healthcare professional.3 One such patient is Deborah—and yes, that is her name. She insisted I use her real name. She is proud of herself, and I am proud of her. I’ve taken care of Deborah for many years. At her first appointment after I “discovered keto,” her weight was up (as usual) and she was discouraged. “I really don’t eat that much,” she said. She noticed my weight loss, which led to a long discussion on what a low carb diet entails. Trying to keep it memorable, I’ve simplified it down to this statement: “Avoid any food that contains flour, sugar, potatoes, rice or corn.” She was eager to try it. Three months later she was down 15 pounds, shaving

28 TODAY'S CHRISTIAN DOCTOR Spring 2019

Deborah is determined to stick to this new way of eating, but she has some obstacles before her. The entire food industry, for one. She will have to ignore millions of dollars worth of advertising for processed, sugary foods. And our own government subsidizes corn production ($90 billion between 1995 and 2010).4 Three-quarters of the corn grown in the U.S. is used for ethanol or animal feed, and much of the rest is exported. But almost all of the corn consumed by Americans is in the form of high fructose corn syrup, which is sweeter and cheaper than sucrose, and is thus very hard for food manufacturers to resist. Those of us committed to promoting health—that is, all of us healthcare professionals—need to work to remove the

barriers between our patients and their thriving. This may mean getting involved in changing government policy. After all, the tobacco industry was once heavily subsidized by our taxes. Didn’t we health professionals have something to do with changing that situation? Before I started eating this way, people told me I’d stop craving sugar once I stopped eating it. I nodded pleasantly, but inside I thought, “Not me. I am the Sugar Queen. I love, love, love sugar. I will always have a sweet tooth.” But they were right. I stopped eating sugar, and now I don’t want it. Not. At. All. I am amazed, and when you stop eating sugar, you will be too. Sucrose, or “table sugar,” has two sugar molecules: one glucose and one fructose. High-fructose corn syrup consists of anywhere from 55 to 90 percent fructose. It’s the fructose that’s the problem. Every cell in the body can use glucose, but only the liver can metabolize fructose. And the liver is very good at turning excess fructose into triglycerides, which leads to liver fat, visceral fat and muscle fat.5 Eating fructose is what makes us fat. Why is this important for Christian health professionals? Two words: Obesity kills.6 Treating obesity successfully will mean our patients have less cardiovascular disease, type 2 diabetes and some cancers. And our nation is drowning in the medical cost of obesity—$147 billion yearly. As Christians, we care about our patients. Do we care enough to bring up difficult issues? As pediatric endocrinologist Dr. Jessica Sparks Lilley writes, we need to stop tiptoeing “around the issue that is fraught with emotional baggage and imminent physical harm.”7 In a 2015 article, Dr. Lilley writes to Christians specifically: “Like every good gift, our Enemy perverts the blessing of food. Eat just a little honey, says Proverbs 25:16, but ‘too much, and you will vomit.’ Indeed, some of the earliest church traditions involve feasting, from agape meals to holy days, but the modern church often skips the fast, the delay in gratification that sets the feast apart.”8 In traditional Christian thinking, gluttony has not just referred to overeating, but to living for immediate pleasure rather than for future ultimate satisfaction. In God’s Wisdom for Navigating Life, Timothy Keller puts it well: “The spirit of gluttony is always to take the easy way out.” And as Dr. Lilley writes, “As an individual, as a Christian, as a physician, I must crucify my greed for food as I work to care for

this body, to serve as a role model for my patients, and to honor my Creator.” When we gather as a church for a fellowship meal, are there healthy choices on that heavily laden table? And what about food at medical conferences, and the snacks in the break room? Will these items strengthen and nourish us? Are they even really food? And here is my personal pet peeve: Are we still giving lollipops to pediatric patients? And what about our own diet—does it reflect what we believe about nutrition? This is a Christian issue because it involves our bodies, and our bodies matter to God. Let’s lead the way in modeling a lifestyle that promotes health. BIBLIOGRAPHY 1 https://www.cdc.gov/nchs/data/databriefs/db219.pdf 2 Bleich, S. N., Gudzune, K. A., Bennett, W. L., Jarlenski, M. P., & Cooper, L. A. (2013). How does physician BMI impact patient trust and perceived stigma? Preventive Medicine, 57(2), 120-124. doi:10.1016/j. ypmed.2013.05.005. https://www.ncbi.nlm.nih.gov/pubmed/23743418 3 Rose, S. A., Poynter, P. S., Anderson, J. W., Noar, S. M., & Conigliaro, J. (2012). Physician weight loss advice and patient weight loss behavior change: A literature review and meta-analysis of survey data. International Journal of Obesity, 37(1), 118-128. doi:10.1038/ijo.2012.24. https://www.ncbi. nlm.nih.gov/pubmed/?term=Int+J+obes+2013%3B37%3A118-28 4 Foley, J. (2013, March 05). It’s Time to Rethink America’s Corn System. Retrieved January 22, 2019, from https://www.scientificamerican.com/article/ time-to-rethink-corn/ 5 Stanhope, K. L., & Havel, P. J. (2009). Fructose Consumption: Considerations for Future Research on Its Effects on Adipose Distribution, Lipid Metabolism, and Insulin Sensitivity in Humans. The Journal of Nutrition, 139(6). doi:10.3945/jn.109.106641. https://www.ncbi.nlm.nih.gov/pubmed/19403712 6 Overweight & Obesity. (2018, August 13). Retrieved January 22, 2019, from https://www.cdc.gov/obesity/data/adult.html 7 Lilley, J. S. (2018, May 24). We Can’t Just Give Up on Obesity. Retrieved January 22, 2019, from https://www.medscape.com/viewarticle/896852 8 Lilley, J. (2016, August 17). Our Plates Runneth Over. Retrieved January 22, 2019, from https://www.christianitytoday.com/women/2015/august/ourplates-runneth-over.html

AMY GIVLER, MD, FAAFP, is a family physician in Monroe, Louisiana. She and her husband Don met in 1980 at a CMDA student event her first year of medical school, and they have both been active members of CMDA ever since. She works in two outpatient clinics and travels to Kenya yearly to teach LSU-Shreveport medical students and residents for their global health rotation. She is a regular writer for CMDA’s “The Point” blog, and she has also written a book for people newly diagnosed with cancer, Hope in the Face of Cancer: A Survival Guide for the Journey You Did Not Choose.

Transformed Doctors ➤ Transforming the World www.cmda.org 29

Women Physicians in Christ: by Patti Francis, MD

30 TODAY'S CHRISTIAN DOCTOR Spring 2019

PROVIDING COMMUNITY AND SUPPORT

Social connections are so important—they are what keep my 99-year-old mother going strong, and they are what WPC is all about. Ladies struggling through a divorce find one another for encouragement. Spontaneous prayers can be heard in the hallways as one shares a burden with another. The times of worship were heartfelt as we sang passionately about our Savior Jesus. There is no better place to be for ministry to happen among women physicians, dentists and other medical professionals. Even the husbands who came to the conference hiked in the rain and ate Ben & Jerry’s ice cream. If you missed this year’s conference, you can still order CDs from our website at www.cmda.org/wpc, and while you are there, register for the 2019 WPC Annual Conference in Mobile, Alabama on September 20-23, 2019.

“Stepping into a WPC conference, I find myself wanting to cry—it seems to be a place where I can let down my defenses, share my struggles and feel God’s presence.” The 15 members of WPC Commission met the day before the conference began. To introduce ourselves to the new members of the commission, we started out by sharing why we initially got involved with WPC. “I have found these women to understand me.” “This group of women is my lifeline.” “Knowing these women are praying for me through this hard time has gotten me through.” I was so moved, and I was proud to be a part!

A LITTLE BIT OF HISTORY GET INVOLVED

Women Physicians in Christ (WPC) is a key resource for women in integrating their personal, professional and spiritual lives. To learn more and get involved, visit www.cmda.org/wpc.

hat do I love most about Women Physicians in Christ (WPC)? It has to be our annual conference. During our conference in Burlington, Vermont in September 2018, we heard great speakers, we attended valuable workshops and we laughed. I heard laughter in the hallways and during Dr. Jean Wright’s talk when she told us we need telomeres to live longer, and we can grow those telomeres through social connections. People don’t usually laugh about telomeres, but they do when Jean Wright talks about them. She is one funny lady!

I just became chair of the WPC Commission, but this is not my first time to serve these Christian women in medicine and dentistry. When Dr. David Topazian, then President of CMDA, asked me in 1992 to form an ad hoc committee to explore the needs of women in CMDA, I felt honored and humbled. But where should I start? Rev. Marti Ensign was on staff for CMDA in the Seattle, Washington area, and together we invited a small group of women to meet at Mount Hermon, California to discuss where God might take this. These women were pioneers and mentors to me on how to be a Christian woman physician. Marti, who served us for 12 years, shared these reflections: “I have a very clear memory of (former Executive Director) Hal Habecker calling me to his office after I’d been at a family practice convention with the CMDS booth. Transformed Doctors ➤ Transforming the World www.cmda.org 31

He said, ‘Marti! We have got to have someone who these women physicians can get in touch with when they need prayer or answers who’s not male.’ I was the only female on the staff and was pretty clueless. I said, ‘Other than answer the phone, what do you think I could do?’ He said, ‘Have a national conference and get all these women together.’ Having never done any meeting planning before, I started to protest that I hadn’t the skills to do a program, get a venue, register guests and all of that. He said, ‘ You don’t need all of that. Just get them together and let them talk with each other and compare experiences, and we’ll help with the other details.’ Well, Philadelphia was the result, and there was lots of sharing as you remember. I am in awe now of what’s accomplished...CME credits, great venues and lots of benefits.” Dr. Dorothy Barbo was part of that first ad hoc committee. She remembers how “so many women physicians and dentists felt isolated, didn’t fit in to the women’s groups

at church, couldn’t relate to the women in their own field. The WIMD group (WPC was initially called Women in Medicine and Dentistry [WIMD]) met a need for fellowship, friendship and prayer. Seeing each other each year at the annual meeting kept connections strong and supportive. We became comfortable with who God called us to be and what God called us to do. Since medical and dental schools have around 50 percent of women in their classes, CMDA is approaching that in their membership as well. Yet our needs are quite different than the men. They need to be acknowledged and addressed. Many women say they have finally found their group. Yet we also benefit from the entire CMDA network with the many other ministries and resources available to us. It’s a great partnership.”

“The first year I attended I was 32, single and feeling burned out after two years of primary care practice. I prayed God would bless me with meeting one person at the conference who would be a friend and encouragement. My first session I sat next to a woman who lived and practiced only 20 miles from my childhood hometown. This led to two fantastic friendships with two wonderful single Christian female doctors. It was such a blessing to me!” Back in those early days, we sent out a questionnaire asking how CMDA could better serve women in the organiza-

32 TODAY'S CHRISTIAN DOCTOR Spring 2019

tion. We got such a high response rate that we knew we had struck a nerve. We moved into the status of a commission within the organization. We decided to hold our first ever Women in Medicine and Dentistry conference in Philadelphia, Pennsylvania in 1994. Cynthia Hale played the piano, several speakers spoke and the women who came were blessed. We started the tradition of “tea and testimonies” which was a great way to learn about each other, and it was a favorite activity until we became too large.

LOOKING INTO THE FUTURE

We have deliberately rotated our conferences around the country, and each year we have a larger attendance. The need is great for women to connect with each other in our unique calling to follow Christ into medicine and dentistry. Our burdens need to be carried by each other, such as the balance of family and work, singleness and loneliness, demanding schedules and exhaustion, lawsuits and mission work—to name just a few of the needs of our members. We also welcome to our conferences women medical professionals who are not physicians or dentists.

“With WPC, I see the diversity of heaven, sisters of all skin tones, one in Christ. I can pray and cry with them like no others. My church family cares, but they don’t get me as well.” The ministry of WPC is expansive. We have many local groups for graduate physicians and dentists, as well as for students. We also sponsor Marriage Enrichment Weekends specifically for female physicians and dentists and their husbands, as well as weekend retreats for six to eight

women called Grasping Power Through Surrender (GPS). A women-focused GHO trip to a ministry in Nicaragua takes place twice yearly to help women trapped in prostitution receive much needed medical care and to experience the love of Christ to help them leave their desperate life. We have supported several missionary partners each year and fund a medical student in Nicaragua. Those of us on the commission, as well as our full-time administrator Debbie McAlear, have felt so supported by other CMDA staff in all we do. They always come help out at our conferences each year. Having started as the first chair of what was once WIMD and is now WPC, I never thought I would come full circle and get involved again. Yet I love working with women in our field. I am amazed at the quality of women serving and being served by WPC, from young to old. We are all called to both find a mentor, and to be one, as part of God’s calling to go and make disciples. It is only with God’s power through His Holy Spirit we can accomplish this task and be a blessing right where we are. If you are a woman medical professional, come join us in Mobile, Alabama on September 20-23 as we celebrate God’s faithfulness and 25 years of ministry!

PATTI FRANCIS, MD, is a practicing pediatrician who has been in private practice for the last 35 years in Lafayette, California. She has two adult married daughters. She has been married to Ron for over 41 years, a result of serving on the Marriage Enrichment Commission for more than 20 of those, she is convinced! She loves to hike, backpack and take wildflower pictures wherever she travels. She has been involved in CMDA since her first year of medical school at Boston University School of Medicine.

Transformed Doctors ➤ Transforming the World www.cmda.org 33

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11 doctors and surgeons and specialties teams from the U.S. Hospital recently renovated with four OR suites, clinic and ED and reliable solar power with an excellent administrative staff. Clean housing provided on secure compound. For more information, visit www. harvestcall.org/provide-medical-care or contact dlwidmermd@gmail.com.

CMDA PLACEMENT SERVICES

BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other healthcare professionals and practices. We have an established network consisting of hundreds of opportunities in various specialties. You will benefit from our experience and guidance. Every placement carries its own set of challenges. We want to get to know you on a personal basis to help find the perfect fit for you and your practice.

“Our practice has a long history with CMDA. One of the partners in our practice was presented to us over 20 years ago by CMDA. Since we are a faith-based practice, we are looking for healthcare professionals with the same vision we have. The recruiters at CMDA have taken the time to understand our mission/vision and have worked with us to recruit Christian physicians and mid-levels for over 20 years. It has been my pleasure to work with various employees and recruiters with CMDA. In my position, I have had the opportunity to work with various recruiting agencies through the years, and CMDA has been and still is one of our most preferred agencies.” —Donna J. Warner Human Resources Manager Family Medical Center of Rocky Mount

P.O. Box 7500 • Bristol, TN 37621 888-690-9054 www.cmda.org/placement placement@cmda.org Paid Advertisement

Hostility 20% to Hospitality DISCOUNT

SPI R I TUA LI T Y A N D P RO F E SS I O N A L SO C I A LI Z ATI O N WI TH I N M E D I C I N E

Michael J. Balboni & Tracy A. Balboni • The first book-length argument in more than a generation focused on solving the dilemma around the practice of medicine and the religion of patients as they face serious illness • Synthesizes scholarship from empirical studies, interviews, history and sociology, theology, and public policy October 2018 | Paperback | 9780199325764 352 pp | $35.00 $28.00

• Points toward a 21st Century pluralistic model for medicine and spirituality to partner together in the service of patients

Visit our website to claim your 20% discount by entering the discount code AMFLY1Q at the checkout

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