Paid Advertisement
Paid Advertisement
Paid Advertisement
Editorial
by David Stevens, MD, MA (Ethics) – Chief Executive Officer
How Would You Like Your Change?
R
ichard Swenson use to startle his new residents during orientation with the assertion, “Half of what we are going to teach you is false. The problem is, we don’t know which half.” If you have been out of training long, you don’t have to be convinced. In my training days, you would have been laughed out of the room if you had suggested peptic ulcer disease can be caused by a bacterial infection or that cervical cancer was due to a virus. Much of what we believed then to be firm facts are (at least for now) fallacy. Medicine and dentistry are full of change. To remain competent you must be a life-long learner who appropriately adopts new knowledge and technology. We knew that when we made the bargain to become doctors and are reminded of it by the stack of journals at our bedside each night. What was not part of the contract is how radically other facets of medicine, and to a lesser extent dentistry, would change. Malpractice claims soared and premiums rocketed into outer space. Independence plummeted as managed care and its variants confined doctors in a morass of red tape and authorizations. Many docs spend half their time doing paperwork. As if that is not enough, add an unending hailstorm of government regulations, grading systems, and standards of care mandates. It is no wonder that doctors, battered and bruised, long for better days. They are overwhelmed with change - swept away in a torrent over which they have little or no control. They want to scream above the din, “Stop! No, more change! I need some stability, some certainty, some routine. Just let me take care of patients.” I understand that feeling, but the lack of chaos does not in itself bring satisfaction and fulfillment. Paul had a peace that passed understanding despite shipwrecks, beatings, and imprisonment. We can’t make the chaos go away. Despite our protestations, the storm clouds over medicine continue their deluge, and the cataract roars. The key to not being swept away is a rock solid immovable foundation. If you don’t have one, that is the first and most important thing you should change. Here is what it looks like:
Reaffirm and revisit frequently that God has called you to your profession. That sense of call reminds you that He is with you - always - and that you ultimately serve Him, not all the other entities that demand your attention. Your trust is in Him, and He guides and sustains you. You have His wisdom and strength to rely on. This sense of purpose, providence, and provision will anchor you no matter how difficult a day may be. Spend time with Him in prayer and His Word - the true source of peace. If you are too busy to do that, you are too busy, swept away from the only firm source of strength. Seek first the kingdom of God and all these things will be added to you. Stay focused on the Lord’s business and focused on His priorities. His business is people - caring for them, ministering to their needs, and introducing them to His Father. He gave us great examples of how to do this in the four gospels. You may need to refresh your memory by reading that section of the Manual if you have strayed from it in pursuit of profit, success, or prestige. Practice love, the greatest fruit of the Spirit, which is often shown through those unexpected and undeserved acts of kindness and compassion to patients, staff, and colleagues. Love means sacrificing your own interests for the interest of others. That is why a mission trip can recharge your emotional and spiritual batteries - but you don’t have to be on a mission trip to achieve that, either. The theme of this issue—”How Does a Christian Practice?”—puts practical wheels on the vehicle of your good intentions in this area. It will help you diagnose why the joy has poured out of your profession and give you sound suggestions on changes that will fix your foundational problem. Yes, I said “change.” But this change will make all the other changes you deal with tolerable. This change leads to contentment. This change transforms you and brings personal fulfillment. This change makes a difference in your life and in the lives of others. That’s how I like my change. Don’t you?
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
5
table of
CONTENTS V OLUME 3 8 , N O. 1
Spring 2007
( T C D ’s 5 8 t h Y e a r )
The Christian Medical & Dental Associations ––changing hearts in healthcare—since 1931. SM
Features 12 The Cry of the Patient Are we Listening? Keith Frey, MD and Elizabeth Boatwright, MD
16 That Rugged Frontier: Academic Medicine and Dentistry for Christ by Allen Pelletier, MD
20 Military Medicine for Christ Three Perspectives by Col. Alan Bruns, MD; Lt. Col. Jorge Klajnbart, MD; and Col. Arnie Aahnfeldt, MD
24 “On My Being Sick and the Passion of Jesus” by John R. Galloway, MD
28 Shall We Prolong Life in Order to Give a Patient Time to Decide About Faith? (2nd in a Series) by James Reitman, MD
Departments 7 30
6
T o d a y ’s C h r i s t i a n D o c t o r
Progress Notes Advertising Section
Editor: David B. Biebel, DMin Editorial Committee: Gregg Albers, MD, Ruth Bolton, MD, Elizabeth Buchinsky, MD, John Crouch, MD, William C. Forbes, DDS, Curtis E. Harris, MD, JD, Rebecca Klint, MD, Samuel E. Molind, DMD, Robert D. Orr, MD, Matthew L. Rice, ThM, DO, Richard A. Swenson, MD Vice President for Communications: Margie Shealy Classified Ad Sales: Gloria Gentry (423) 844-1000 Display Ad Sales: Gloria Gentry (423) 844-1000 Design & Pre-press: B&B Printing. CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). TODAY’S CHRISTIAN DOCTOR®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Spring 2007, Volume 38, 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 © 2007, Christian Medical & Dental Associations . All Rights Reserved. Distributed free to CMDA members. Non-doctors (U.S.) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tenn. SM
SM
Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Scripture references marked (NASB) are taken from the New American Standard Bible. Copyright © 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977 by the Lockman Foundation. Used by permission. Scripture references marked (KJV) are taken from King James Version. Scripture reference marked Living Bible is from The Living Bible © 1971, Tyndale House Publishers. All rights reserved. Undesignated biblical references are from the Holy Bible, New International Version ®. Copyright © 1973, 1978, 1984 by the International Bible Society. Used by permission. All rights reserved.
GHO Director Samuel Molind, DMD Honored by AAOMS Text adapted from AAOMS release
Dr. Samuel E. Molind received the American Association of Oral and Maxillofacial Surgeons’ 2006 Presidential Achievement Award in October, 2006. Dr. Molind left his Montpelier, VT, practice in 1998 to begin Global Health Outreach (GHO) - the short-term Dr. Molind (r.) was honored in October missions arm of CMDA. As the Director of GHO, Dr. Prior to his work with GHO, Molind and his staff organize, Dr. Molind served as Associate supervise, and train leaders to Professor of Surgery at the bring teams into developing coun- University of Vermont Medical tries around the world. He, himSchool. self, has led short-term medical Dr. Molind, a lifetime member missions into Vietnam, of the Christian Medical & Dental Afghanistan, Ethiopia and other Associations, has been on the third world countries where count- CMDA board of trustees and less numbers of patients have been served for six years on the Biblical helped. Medical Ethics Commission.
Paid Advertisement
For membership information, contact the Christian Medical & Dental Associations at PO Box 7500, Bristol, TN 37621-7500; Telephone: (423) 844-1000 or toll free, (888) 231-2637; Fax: (423) 844-1005; E-mail: memberservices@cmda.org; Website: http://www.cmda.org. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product, or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice, or instruction. I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
7
CMA Honored as “Modern Day Abolitionists”
Paid Advertisement
At a recent event in Washington, DC, the U.S. State Department recognized CMA as a “modernday abolitionist” for its work regarding the health aspects of human trafficking, or modern-day slavery. The recognition is a salute to the new abolitionist movement and states,”In sincere appreciation of your role in advancing the global effort to end modern-day slavery, we salute you. Due to your efforts, thousands of trafficking victims are now survivors, countless traffickiers are in jail, and innumerable potential victims have been spared the darkness.” Secretary of State Condoleezza Rice addressed the event, held in the historic Benjamin Franklin Room at the State Department in Washington, DC.
8
T o d a y ’s C h r i s t i a n D o c t o r
Dr. Jeffrey Barrows, CMA’s health consultant on human trafficking, has led the effort to educate healthcare professionals regarding human trafficking. For more information, including a CME presentation on this subject, see the Human Trafficking section of the CMA website (www.cmda.org).
Editor’s Note: In conjunction with the 200th Anniversary of the abolition of the British Slave Trade and the release of the film Amazing Grace, a campaign called Amazing Change seeks to abolish modern day slavery. The movie is based on the life of antislavery pioneer William Wilberforce, who took
on the English establishment and persuaded those in power to end the inhumane trade of slavery. A Petition to end modern slave trade will be presented to the US House and Senate, as well as global leaders around the world. To find out more how you can speak for those who cannot, go to: http://www.theamazingchange.com.
Ruth Bolton, MD President - CMDA
Some Things Change Some Things Don’t
MEDICINE AND DENTISTRY ARE CHANGING Patients come to me and tell me their diagnosis and give me a list of websites to look at, so I can know as much as they do about it. The hospital has a protocol for almost every diagnosis my patients are admitted with, and I had better have a good reason if I stray from those orders. Tolerance is the word of the day. People are shocked that I still make house calls (if needed). Medical and dental students no longer put up with a long work week. I just diagnosed a small bowel cancer with a swallowed camera. It is predicted that 80 percent of young American women will have had venereal warts by 2010. Cosmetic dentistry is in huge demand.
GOD DOESN’T CHANGE Go ahead and order the “acute MI protocol” with your next chest pain patient, but make sure you... Pray with and for your patients. Continue to learn to be holy as we are commanded in 1 Peter 1:16 “Be holy, because I am holy.” Teach truth; for example, abortion is the destruction of a human life, monogamy is healthy, etc. Keep giving – be generous with your time, money, and talents. Become a mentor – leave a legacy that matters. Be ready to give an answer “in and out of season” (see 2 Timothy 4:2). Take your real working orders from the God of the Universe. He’s a very good boss. Please tell us at CMDA how we can better serve you and get you the resources you need to succeed at this job you have been given “under the sun.”
Regional Ministries
Announcement Members who are interested in serving in a governance capacity as a representative or trustee for CMDA can refer themselves or another CMDA member by going to: www.cmda.org > About CMDA > Leadership > House of Representatives or Board of Trustees. Be prepared to submit a current CV via e-mail (preferably) or fax to the Executive Assistant, Debra Deyton at: debra@cmda.org; Phone: (423) 844-1000; Fax: (423) 844-1017.
Western Region Michael J. McLaughlin, MDiv PO Box 2169 • Clackamas, OR 97015 Office/Cell: (503) 522-1950 michaelm@cmdawest.com
Central Region Douglas S. Hornok, ThM 13402 S 123rd East Place Broken Arrow, OK 74011 Office/Cell: (918) 625-3827 • (918) 455-6036 CMDACentral@cs.com
Northeast Region Scott Boyles, MDiv 120 Cinnamon Road • Thorofare, NJ 08086 Office & fax: (856) 384-0433 Cell: (609) 502-2078 scott.boyles@cmda.org
Midwest Region Allan J. Harmer, ThM 9595 Whitley Dr., Suite 200 Indianapolis, IN 46240 Office: (317) 566-9040 • Fax: (317) 566-9042 cmdamw@sbcglobal.net
Southeast Region William D. Gunnels, MDiv 106 Fern Drive • Covington, LA 70433 Office: (985) 898-0895; Cell: (985) 502-4645 wdgunnels@charter.net
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
9
Medical Education International
Something Only God Could Have Planned by Shari Falkenheimer, MD, MPH Director, Medical Education International
My first MEI trip was quite an adventure. I had been Director of MEI for less than a month. Equipped with bioethics lectures, I found myself in a far eastern country I never expected to visit in a remote part of the earth. I had only the vaguest idea of the schedule and what I would do there. Flexibility would be key. Unquestionably, God had gone before us. To my amazement,
bioethics turned out to be of great and was viewed as a trusted friend. The medical university interest to national medical leadneeded a medical ethiers. Two of us cal code. Could MEI spoke in medical help draft it? settings in several What an opportunity parts of the capital to help a nation on topics ranging improve medical care from ethical sysand incorporate tems and HippoHippocratic ethics, so cratic medicine to compatible with bibligenetic testing and cal values! Only God human enhancecould have planned ment. that! Just before deparFor more information ture, we met with on how you can partia senior medical cipate in educational leader. I anticipated Dr. Falkenheimer endeavors on the misthe usual “thank sion field and upcoming you” session—but trips with MEI, contact Shari God had something much greater Falkenheimer, MD, MPH, in store! The meeting was to tell Director of MEI at: us that MEI had shown sincere shari.falkenheimer@cmda.org. care and concern over the years
*FOR INFORMATION ABOUT MEI OPPORTUNITIES SEE WWW .CMDA.ORG/GO/MEI
CMDA’s Center for Medical Missions held the first annual seminar, “Preparing for the Future! An Orientation for the New Medial Missionary,” in 2006. One participant wrote, “I would highly recommend this conference to everyone preparing for medical missions! Most sending organization offer general orientation, but nobody covers specific information for medical personnel as in this conference.” The second annual seminar will be held at the CMDA National Headquarters in Bristol, TN, April 20-22, 2007. Information and registration is available online at www.cmda.org/go/cmm. Early registration is $150 ($95 for students/residents) and includes all fees and five meals. This conference will discuss: “Integrating spiritual and physical healthcare in non-western settings,” “Cultural, political and environmental forces in developing world health systems,” “Dealing with suffering, death and dying in third world versus western society,” and other important issues central to your success as a medical missionary. 10
T o d a y ’s C h r i s t i a n D o c t o r
Lawndale Christian Health Center Chicago, IL Our mission is to show and share the love of Jesus Christ to the Lawndale and Garfield communities by providing wholistic, affordable, quality health care services. LCHC is a not for profit health center founded in 1984, is accredited by JCAHO and sees over 100,000 patients a year. We are seeking candidates that can exemplify our faith-based mission to the underserved. Please note all of our positions require the ability to work in a fast-paced, multi-cultural environment with excellent guest relation skills. Visit our Website: www.lawndale.org for our current positions and for more information. Qualified applicants, please forward your resume and letter of interest to: hr@lawndale.org No phone calls, please.
Paid Advertisement
Center for Medical Missions Plans 2007 Conference
Global Health Outreach Closer to the Heart of Christ by Samuel E. Molind, DMD Director, Global Health Outreach
God has knit our hearts together with our national partners, with a great desire to ”seek and save the lost.” The result is over 43 teams going out in 2007! Thousands of patients have been treated for their physical needs and directed to the One who can heal all wounds, the Great Physician. Tens of thousands of new believers are now in churches, but our work is not done. Currently over 25 percent of our teams are going into the “10/40 Window,” where 95 percent of the world’s unreached people groups and 80 percent of the world’s poorest live.
This year, Ricardo Castro, our Central America Director, will be moving his ministry from Honduras to Nicaragua. We hope to continue, in Nicaragua, the momentum we achieved in Honduras, where over 300 pastors have been trained. We want to have a long-term impact for the Kingdom and healthcare with an enriched emphasis on public health education and training of community health workers who will also spread the “Good News” long after we are gone. We are thankful for those who have stepped outside their comfort zones and served the Lord alongside GHO. Yes, it has been a sacrifice, but as David said, “I will not give the Lord a sacrifice that cost
Dr. Molind (right) in the field.
me nothing.” Today, more than ever, it will be costly, inconvenient, and time consuming. We have a choice to simply “spend” our life or we can “invest” it in things eternal. When I left my family, friends, practice, and home in Vermont to serve the Lord through GHO, I never imagined how that decision would strengthen my faith, change my Christian worldview, challenge me, and press me closer to the heart of Christ. This is the way I want to invest my life. How about you?
*FOR INFORMATION ABOUT GHO OPPORTUNITIES SEE WWW .CMDA.ORG/GO/GHO
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
11
The Cry of the Patient Are We Listening? A Christian Reflection on Patients’ Perspectives on Ideal Physician Behaviors Keith Frey, MD and Elizabeth Boatwright, MD
A
A recent Mayo Clinic study identified seven physician characteristics that are of primary importance to patients. The authors show how these characteristics were reflected by Jesus, “The Great Physician,” and they discuss practical ramifications for Christian physicians.
12
T o d a y ’s C h r i s t i a n D o c t o r
recent study published by our institution looks at patient perceptions of ideal physician behavior.1 This study highlights the fact that a patient’s relationship with his/her physician, and thus the patient’s experience of illness, is influenced by that physician’s behavior and interpersonal skills, not simply his/her technical knowledge. After interviewing nearly 200 patients seen at the Mayo Clinic across fourteen medical and surgical specialties, the authors generated and validated seven ideal physician behaviors that emerged as primary for patients. The ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough (see table 1). As Christian physicians, we hear this description of the ideal physician as a cry for God - for an all-powerful, yet all-loving Healer who will touch the sick person at his or her greatest point of need. Confronting the frailty of one’s physical body, even in the context of a minor illness, brings up the God-ordained longing we have for the eternal (see 2 Corinthians 4:16-18). Though we have been trained as physicians to focus on healing the physical body, we conduct our work in a uniquely spiritual context. It is therefore highly relevant for us to turn to Scripture and study the divine attributes of the true Healer, Jesus. As our ultimate physician role model, and the source of our life and strength, Jesus perfectly blends authority over all things with compassion for the lost and suffering. As God and Man, He has a unique understanding of the human condition that propels Him with the intense purpose of saving souls and pointing people to God. He consistently connects word and deed, healing in the context of teaching truth: “So he traveled throughout Galilee, preaching in their synagogues and driving out demons” (Mark 1:39). As He preached the word, people were drawn to Him and brought to Him their sick (such as in the healing of the paralytic, Mark 2:2-3). Jesus’ compassion and focus on the whole person is beautifully
recorded in the gospels, and serves as a high standard for Christians in the healthcare field. Jesus knew and understood the whole person’s needs, connecting both the heart and health in a compelling and personal manner. Many of the behaviors sought by patients in a physician are seen clearly in the life and ministry of Jesus. We would like to reflect on the ways in which these behaviors are seen in Jesus, and then think of practical ramifications for the life of Christian physicians.
Table 1. Ideal Physician Behaviors, Definitions, and Supporting Quotes Ideal Physician Behaviors
Definitions
Representative Quotes*
Confident
The doctor’s assured manner engenders trust. The doctor’s confidence gives me confidence.
“You could tell from his attitude that he was very strong, very positive, very confident that he could help me. His confidence made me feel relaxed.”
Empathetic
The doctor tries to understand what I am feeling and experiencing, physically and emotionally, and communicates that understanding to me.
“One doctor was so thoughtful and kind to my husband during his final days. He also waited to tell me personally when he found a polyp in me, because my husband died from small bowel cancer and he knew I would be scared.”
Humane
The doctor is caring, compassionate, and kind.
“My rheumatologist will sit and explain everything, medication, procedures. I never feel rushed. He is very caring. If I call, he always makes sure they schedule me. He told me he knows when I call, it is important. I appreciate his trust.”
Personal
The doctor is interested in me more than just as a patient, interacts with me, and remembers me as an individual.
“He tries to find out not only about the patient’s health, but about their activities and home life as well.”
Forthright
The doctor tells me what I need to know in plain language and in a forthright manner.
“They tell it like it is in plain English. They don’t give you any ‘Mickey Mouse’ answers and they don’t beat around the bush.”
Respectful
The doctor takes my input seriously and works with me.
“She checks on me. She also lets me participate in my care. She asks me when I want tests, what works best for my schedule. She listens to me. She is a wonderful doctor.”
Thorough
The doctor is conscientious and persistent.
“My cardiac surgeon explained everything well. The explanation was very thorough. He was very concerned about my recovery after the surgery. I thought it was special how well he looked after me following the surgery. Not all surgeons do that. They are not interested in you after you are done with surgery.”
Confident. The Mayo Clinic study, based on patient interviews, defines the confident physician as having an assured manner that engenders trust. Such confidence gives the patient confidence in his/her doctor and his/her diagnosis and treatment plan. In Jesus’ ministry, we see such confidence displayed in the healing of Jairus’ daughter after she died: “Don’t be afraid; just believe.... The child is not dead but asleep” (see Mark 5:21-43). Jesus’ confidence is based in His intimate knowledge of God’s world and His complete authority over the physical and spiritual realm. For the Christian physician, confidence is based in knowledge and experience, both medical and spiritual. Humility flows from the recognition that there is a God who is all-knowing and all-powerful, with much greater power than any we can claim in the medical profession. A delicate balance must be struck between a humility of spirit, dependent on God’s wisdom, and an assured manner which builds trust and hope with our patients.
Empathetic. Here the doctor tries to understand what the patient is feeling and experiencing, both physically and emotionally, and communicates that understanding to him/her. As both God and Man, Jesus understood the human condition better than we do ourselves, and therefore had ultimate empathy with humans. As Christian physicians, we can empathize with our patients because we are like them - mortal,
*The quotes in this table are excerpts of longer quotes in the transcripts. Respondents commonly mentioned multiple attributes in describing their best physician experience. For example, the quote used to illustrate “Humane” also incorporates “Respectful” and “Thorough” and was coded accordingly.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
13
Table 2. Ideal Physician Behaviors from the Patient’s Perspective Ideal Physician Behaviors
Clues the Patient Looks For*
Confident
Refers to state-of-the-art medical practices Refers to experience in treating specific medical conditions or performing procedures Not disturbed by patient’s queries about medical information acquired from other sources (regardless of accuracy or inaccuracy) At ease in the presence of patient, family members, and medical colleagues
Empathetic
Makes eye contact with patient as well as family members Correctly interprets patient’s verbal and non-verbal concerns Repeats the patient’s concerns Shares personal stories that are relevant Speaks in a sympathetic and calm tone of voice
Humane
Uses appropriate physical contact Attentive, present to the patient and the situation Indicates willingness to spend adequate time with patient through unhurried movements Helps arrange needed non-medical assistance for patient, e.g., chaplain or social work services
Personal
Asks patients about their lives Discusses own personal interests Uses appropriate humor Acknowledges patient’s family Remembers details about the patient’s life from previous visits
Forthright
Doesn’t sugarcoat or withhold information Doesn’t use medical jargon Explains pros and cons of treatment Asks patient to recap the conversation to ensure understanding
Respectful
Offers explanation or apology if patient is kept waiting Listens carefully and does not interrupt when the patient is describing the medical concern Provides choices to patient as appropriate but is also willing to recommend a specific course of treatment Solicits patient’s input in treatment options and scheduling Takes care to maintain patient’s modesty during the physical exam
Thorough
Provides detailed explanations Gives instructions in writing Follows-up in a timely manner Expresses to patient desire to consult other clinicians or research literature on a difficult case
*Specific clues will affect patients differently. Although many patients are likely to appreciate a physician’s empathy in sharing a relevant personal story, this can be a neutral or even a negative experience for some patients. There is no substitute for doctors knowing their patients and responding accordingly. The illustrative humanic clues presented in this table are consistent with the research reported in this article.
14
T o d a y ’s C h r i s t i a n D o c t o r
frail, and in need of God. There are many examples of Jesus understanding a person’s condition and needs, and directing them in a way that could result in ultimate healing: • Zacchaeus needed to stop cheating and give to the poor (Luke 19:1-10); • The Rich Young Man needed to go beyond the letter of the law and give away his wealth (Mark 10: 17-27); • The Samaritan woman, who had had many husbands, needed to drink the Water of Life (John 4:7-42). Jesus said, “It is not the healthy who need a doctor, but the sick. I have not come to call the righteous, but sinners” (Mark 2:17). As Christian physicians, we seek to understand our patients at the level of their deepest needs as Jesus did, show empathy for their condition and their emotions, and give healing advice in order to point them in a healthy direction.
Humane. Patients desire a physician who is caring, compassionate, and kind. The personal virtues of Jesus—His care, compassion, and gentleness—are consistently reflected throughout the Gospels. Faced with the leper who had faith that He could heal, Jesus, filled with compassion, “...reached out his hand and touched the man. ‘I am willing,’ he said. ‘Be clean!’ Immediately the leprosy left him...” (Mark 1: 40-42). Before miraculously feeding the 4,000, Jesus told His disciples, “I have compassion for these people; they have already been with me three days and have nothing to eat. I do not want to send them away hungry...” (Matthew 15: 32). As Christian physicians, we seek to model the life of Jesus, living in the power of the Holy Spirit and manifesting the fruit of the Spirit (Galatians 5:22-23) in our interactions with our anxious, ill, and hurting patients.
Personal. The ideal physician is described as one who is interested in a patient as more than simply a
patient, but who also interacts with him/her as an individual. This entails establishing a connection - one human to another - recognizing the person’s dignity and uniqueness as a human being. Jesus models this personal approach as He heals. When the woman with the flow of blood for twelve years touches His garment in the midst of a busy crowd, Jesus notices, turns, and speaks to her personally: “Daughter, your faith has healed you. Go in peace and be freed from your suffering” (see Mark 5:24-34). As Christian physicians, recognizing our patients’ unique traits is a way that we recognize the special attention God gives to each of us, made in the image of God Himself.
Forthright. Patients desire straight talk from their physicians; telling them what they need to know in plain language and in a direct manner. There are many examples of Jesus being quite clear and direct in His message, amidst many examples of people not understanding His meaning. Jesus works specifically with His disciples, translating the meaning of His parables, and He is very direct with those He intends to heal. Consider the rich man asking “What must I do to inherit eternal life?” Jesus responds that he is first to obey all the commandments; when the man stated that he had done this since his youth, “Jesus looked at him and loved him. ‘One thing you lack,’ he said. ‘Go, sell everything you have and give to the poor, and you will have treasure in heaven. Then come, follow me” (Mark 10:1724). Jesus teaches very clearly in the temple, “‘Repent, for the kingdom of heaven is near’” (Matthew 4:17). Jesus divinely connects the physical state with the spiritual state of those He heals: when He heals the paralytic let down through the roof, He proclaims, “Friend, your sins are forgiven” (Luke 5:20). As Christian physicians, we must strive to communicate clearly, sensitively, and effectively with our patients - clarifying diagnoses, prognoses, and treatment options. And we must seek to understand any underlying spiritual issue that may exist and prayerfully seek to address it as part of our treatment plan. Respectful. Respect is demonstrated in forging partnerships with our patients, taking their input seriously and working with them to arrive at a therapeutic plan. A physician shows respect by taking a patient’s preferences and values into consideration as he or she applies medical expertise to a problem. This is a clinical encounter, different in context and setting to the ministry of Jesus. Jesus did care for the individual, yet He also had a clear sense of the individual’s need from a divine perspective. Jesus balanced authority with respect for individual modesty with the deaf and dumb man in Mark 7:33: “After he took him aside, away from the crowd, Jesus put his fingers into the man’s ears.... ‘Be opened!’” As Christian physicians, we can help to bear our patients’ burdens by listening to their perspectives in order to tailor our recommendations.
Thorough. Our patients expect us to be conscientious and persistent in pursuing their healthcare needs. Complete explanations of a clinical condition or therapeutic plan, careful attention to detail during therapy, monitoring outcomes, and dealing with any issues in a timely fashion all convey competence and care to a patient. As Christian physicians, this thoroughness is a means of doing “all for the glory of God” (1 Corinthians 10:31).
The Attributes in Action. Interpersonal skills are not simply inherent in a physician’s personality, nor do they simply flow from the strength of his or her faith; just like the spiritual disciplines of prayer and Scripture study, they require studied attention and practice. Specific skills and interpersonal attributes can be learned and acquired.2,3 And one key to acquiring and practicing the skills that our patients value most, thus emulating the Ultimate Healer, is to consider these from the patient’s perspective, as expressed in Table 2. We encourage readers to prayerfully examine their own behavior, and to seek the input of fellow physicians and patients with regard to these qualities. In areas where they are lacking, we encourage readers to seek out people and courses (for example, courses in nonverbal communication, active listening, giving bad news, and so forth) to help acquire skills which will strengthen their practice of medicine, and ultimately help them to draw others towards the True Healer, Jesus Christ. 1. Bendapudi NM, Berry LL, Frey KA, Parish JT, Rayburn WL. Patients’ perspectives on ideal physician behaviors. Mayo Clin Proc. 2006;81:338-344. 2. ABIM. Project Professionalism. Available at: www.abim.org/resources/publications/professionalism.pdf; Accessibility verified October 13, 2006. 3. ACGME. Outcomes Project. Available at: www.acgme.org/Outcome/. Accessibility verified October 13, 2006.
Keith A. Frey, MD, is Professor of Family Medicine, Mayo Clinic College of Medicine, and practices and teaches Family Medicine at the Mayo Clinic Arizona. He received his MD from the Medical College of Virginia, a MBA from Duke University and completed his family medicine residency at the USAF Medical Center, Scott AFB, Illinois.
Elizabeth A. Boatwright, MD, is Assistant Professor of Medicine, Mayo Clinic College of Medicine, and practices and teaches in the division of Women’s Health Internal Medicine at Mayo Clinic Arizona. She received her MD from Harvard Medical School, an MDiv at Andover-Newton Theological School, and completed her internal medicine-pediatrics residency at Georgetown University Medical Center in Washington, D.C.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
15
That Rugged Frontier: Academic Medicine T and Dentistry for Christ by Allen Pelletier, MD
Academic practice has many opportunities and challenges for Christians called to serve there. 16
T o d a y ’s C h r i s t i a n D o c t o r
he world of academic medicine produces many rewards - both for the doctors who live there and for our society who benefits from their efforts. For Christian doctors, especially, academic medicine provides both challenges and promises of reward much like our western frontier early in our history. The going can be quite rugged, but the discoveries of God’s gifts in nature and the molding of new lives for Christ can make it all worthwhile. Much of the way is uncharted; most of the academicians who travel with us have their eyes on a different destination.
As Christians, we often are lonely travelers searching for a path that is difficult to find. But it is not hopeless. God is with us and the blessings are worth the struggle if we continue the course. Recently, as I was leading a discussion on “spirituality in medicine” with third year medical students, one of the students shared that she had grown close to the family of a critically ill patient and then had cried with them when the patient died. The student’s attending physician later took her aside and told her that her visible grief was unprofessional, that she needed to remain aloof and emotionally detached from her patients. I decided to write the student an alternative word of advice and encouragement: Dear Charity, Thanks for opening up and sharing your experience in the session today. It took courage to do that. I can imagine what a painful memory this is. Your preceptor, I’m sure, meant well and offered sincere (but I believe sincerely misguided) advice. No doubt this only added to your pain and confusion. And he is just plain wrong. I believe it’s not optional, but vitally necessary that we be fully human to fully engage in the practice of medicine. We gain nothing and lose everything when we suppress our humanity in the misguided attempt to achieve “professionalism.” A tender heart and a clear head are neither incompatible nor mutually exclusive - in the practice of medicine, or in life. Jesus wept over Jerusalem. He also warned about the danger of gaining the whole world but losing our soul in the process. So, I affirm your willingness to be deeply touched and moved (yes, even to tears) by the patients you meet. This is part of who you are. Hang on to this, and don’t let it go. Continue to keep an open heart, and learn the art as well as the science of medicine. You will be a great doctor, and your patients will love you. It’s worth all the pain, I promise!
I teach medical students and residents because God has called me to it. In my experience, being in a teaching practice is a great place to minister, to live for the glory of God and to serve Christ. I hope this is the motivation of all like-minded academic colleagues who identify themselves as Christians. There are many perks and advantages of being affiliated with a teaching practice: • Shared call responsibility in a group practice • Working with like-minded colleagues who, even if secular, share a vision and passion for teaching • A reasonable amount of office administration (depends on the position, obviously; more if one is a program director) • Reasonable job security • Opportunity to explore or develop special interests/skills • Opportunity to make a difference, through clinical research, improving educational strategy and curriculum development
• Opportunity to attend professional society meetings, network with peers and colleagues - probably more than afforded in a typical private practice • Stimulation and growth from interacting with students and residents often really sharp and smarter than me! • A varied practice that doesn’t get boring or stale • A flexible schedule, usually, that allows incorporation of mission trips - sometimes even with funds provided for me to travel on those trips • A unique opportunity to spend time with students and residents, allowing me to develop more than a superficial relationship, offering me the opportunity to share Christ, and mentor/disciple in the clinic and hospital. Academic practice also brings both real and potential challenges: • Traditionally, academic medical practice is thought of as a three-
I n t e r n e t We b s i t e : w w w. c m d a . o r g
•
Spring 2007
17
legged stool: medical practice, teaching, and research. It is difficult (maybe impossible) for most of us to be excellent at all three. This can lead to unrealistic expectations and demands that we cannot possibly fulfill - or at least not very well. The “publish or perish” mentality is very real at many institutions.
• Academic medicine is increasingly under-funded. Most departments have to “eat what they kill.” Hence there is increasing pressure to maximize economic productivity, which almost inevitably translates into pressure to see more patients or perform more procedures. Scholarly pursuits and teaching excellence get
Academic doctors, more than most, have the potential to change our medical and dental world for Christ. CMDA is forming an advisory council within our division of Campus and Community Ministry (CCM) to develop approaches to ministry within the world of academic medicine and dentistry. We have met and are moving forward with strategic initiatives to impact the academic world for Christ. If you are led by God to be a part of this process, please contact our Director of CCM, Dr. Al Weir at: al.weir@cmda.org. All for Christ. 18
T o d a y ’s C h r i s t i a n D o c t o r
lip service, but less and less funding or protected time. In spite of these demands for funding, the academic research, writing, and even teaching (the real reason we are in this) still must be accomplished and may assume the status of chores to complete in “my vast amount of spare time.” • Salaries in academic medicine haven’t kept pace. Even though many in private practice complain about cuts in reimbursement, the salary disparity between academic and private practice is real and growing. Many of us make significant financial sacrifices to stay in academic medicine. This is especially an issue with those just out of residency and burdened with student loans.
If you are willing to post your name as a Christian faculty member for our students choosing residency programs to identify, please e-mail your name and the name of your residency program to us at: christianacademics@cmda.org. We will post your information on a list on our student web page. This may be a God-sized step for you. May He bless you as you take it.
• Spiritual isolation, and with it loneliness, may be a problem for some in academic medical practices. Some departments and even whole institutions are hostile to expressions of the Christian faith in medical practice. This is most intense in the area of women’s health, where traditional/conservative views on abortion and contraception are an anathema in some places • Certain perspectives on sexuality, the nature of the family, adoption of children by gay/lesbian/transgendered couples, euthanasia, and physician-assisted suicide may be litmus tests of political correctness in some departments and institutions • We may face a kind of persecution when we stand up for our convictions. I believe that the umbrella of academic freedom still protects the Christian perspective in most places, but the climate is increasingly hostile to anyone who believes in absolute truth • Coupled with this, oddly enough, is an astounding resurgence of interest in spirituality among students. In many ways this openness is a huge opportunity for Christians, but there is a downside. Most likely this spiritual interest is predicated on the assumptions of philosophic and cultural relativism. Some (perhaps most?) of our students and residents assume, a priori, that all spiritual and religious insight and tradition are equal, and no tradition can lay claim to “the truth.” This kind of moral relativism is being widely promoted. I worry that this will almost unavoidably lead to an inoffensive, watered down approach to faith. This kind of “spirituality” in the medical encounter is likely to be so vague and non-committal as to render it useless, maybe even harmful, in actual practice. I believe that God has called some of us into this academic arena. We face challenges, but if we as Christians are not engaged in this theatre of the battle, we will leave the training of the next generation of physicians entirely in the hands of those who hold beliefs and convictions inimical to our own. I believe the great question Mordecai put to Esther is more relevant than ever: “And who knows but that you have come ... for such a time as this?” (Esther 4:14). Above all, should we fail to honor this calling, or should we carry it out poorly, we dishonor the Lord.
Allen L. Pelletier, MD, FAAFP, received his MD degree from LSU School of Medicine, Shreveport. With his family, he served with Mission to the World and SIM in medical missions in Nigeria from 1991-1999. He is currently Assistant Professor of Family Medicine with the Saint Francis Family Medicine Residency Program, University of Tennessee College of Medicine in Memphis. Dr. Pelletier may be contacted at: apelletier@utmem.edu.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
19
Military Medicine for Christ Three Perspectives Three CMDA members share how military medicine can provide unique opportunities for service to one’s country and one’s Lord, simultaneously.
The Military Needs Christian Doctors
I
am currently an Army head and neck surgeon deployed to Baghdad, Iraq as the Surgical Consultant for Task Force 3 Medical Command that has oversight of all the combat hospitals in Iraq. We are involved in improving the surgical care for our soldiers and assisting the Iraqi military in developing their health care system. I also have the opportunity to travel and work in each of the theater’s combat support hospitals discussing issues with surgeons and being available to provide surgical head and neck trauma care to our US military service members, coalition soldiers, Iraqi soldiers, civilians, and insurgents who end up as casualties in this war. I grew up during the Vietnam and post-Vietnam era, and in my childhood I never considered the possibility of entering military service. I contemplated medical school, but didn’t have a clear sense of direction. That changed during one noontime meal when as a college sophomore at Wheaton College I had lunch with an ROTC cadet who talked to me about the need for Christians in the
20
T o d a y ’s C h r i s t i a n D o c t o r
Surgery in Mosul, Iraq - Photo Courtesy of Dr. Alan Bruns
itary and he asked me about my long-term plans. After much prayer, reevaluating my life goals, and consultation with my parents, I accepted an ROTC scholarship and three years later entered the military Now, twenty years later as a Christian military physician, I reflect on the lessons that I have learned. From a military perspective, I understand the importance of the military mission and the awareness of the needs of commanders who must direct their soldiers into battle. As a Christian physician it is paramount to have an eternal perspective on life, health, and war. Every day here in Iraq we have an average of two American soldiers, usually in their late teens and early twenties, dying from improvised explosive devices and small arms fire. With damage control surgery techniques many lives are saved, but a large number of these soldiers have multiple amputations, facial injuries, and severe burns that will affect their lives forever. I must remind myself and those around me that life is more than just the physical that we see. There is the spiritual and eternal dimension of life. God’s providence and the knowledge that, “...in all things God works for the good of those who love him, who have been called according to his purpose,” helps sustain those of us who understand the gospel. We
also know that God is at work in the lives of soldiers, patients, and the now hidden Iraqi church. Today, I see my calling as a Christian Army officer in Iraq as a soldier, a physician, a team player, an evangelist, a Bible study leader, a moral compass, and an ear for soldiers. It is my prayer that God uses me not for my glory, but for His. And finally, whether I find myself in a combat zone or at home I am always reminded that the Christian must understand his sin and God’s grace, rely on prayer, commune with God through His Word, and be prepared to give an account of the hope that we have in Jesus Christ.
—Colonel Alan Bruns, MD, US Army
The Army is My Mission Board As an Army physician for more than fourteen years, I’ve seen the “core values” of the U.S. Army represent not only a system of what is expected of every soldier, but a standard of behavior which can be construed as necessary for an
Sometimes in the field, your yogurt is as fresh as it gets - Photo Courtesy of Dr. Jorge Klajnbart
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
21
orderly society. These values are placed around the post for all to read. They are on billboards and even on seven separate street signs as I drive into work—Loyalty, Duty, Self-less Service, Honor, Integrity, and Personal Courage. The list has also been issued to active duty personnel in the form a “dog tag” to wear around the neck. These seven principles are a template for all to follow in the form of the acronym, “LDRSHIP.” The characteristics are meant to be endorsed and practiced by every individual. As Christians within the medical profession, this ethos can most assuredly assist us in strengthening our commitment towards our call to glorify God in all we do. Currently, I am an active-duty orthopedic surgeon stationed in the beautiful state of Colorado. I have been
deployed twice with an FST (Forward Surgical Team), once to Jordan and most recently to Afghanistan. The Army has provided opportunities beyond my expectations, not only for my professional development, but also for the ability to “exercise” my faith. I believe the Army is my “Mission Board.” They sent me to Colombia and Chile to give lectures on ballistic injuries and extremity trauma, and they sent me to Guatemala on panels to discuss the implementation of care for those with war-inflicted medical disabilities. Over the past several years, as a team physician with the All Army Sports Program for soccer and basketball, they sent me to international events in Barbados and Holland. All of this extracurricular activity pales in comparison with my daily routine of caring for service members
Kids are kids, wherever you go - Photo Courtesy of Dr. Jorge Klajnbart
22
T o d a y ’s C h r i s t i a n D o c t o r
and their loved ones. The establishment of a relationship with those God places into my watch-care is essentially my “vocation of worship.” This is ultimately where I work out my “core” values. My occupation is ultimately an act of daily worship unto Him who has given me each opportunity. “Whether then, you eat or drink or whatever you do, do all to the glory of God” (1 Corinthians 10:31).
—Lt. Colonel Jorge Klajnbart, MD, US Army
Our Mission .... Ministry I have seen the hand of God in His sovereignty in my career as a military orthopedic surgeon. My father was an Army surgeon assigned to Fort Armstrong, Hawaii, near Pearl Harbor on December 7, 1941. Our family survived that attack and we continued to serve through the Berlin airlift and the Korean conflict, always knowing that home was not a building, but a family. I accepted Christ at Duke University and went on to the University of Colorado for my MD degree. Because of my desire to have missions as a central part of my life, I decided to join the Army in my senior year of medical school, trusting that I would have the opportunity to receive training in tropical medicine. This senior plan program paid my tuition and the salary of a second Lieutenant. I was then transferred with my new bride, Lois, to Tripler Army Medical Center in Honolulu for my internship. The time was 1969 and the Vietnam conflict was raging in Southeast Asia. Casualties from the war were being transported to the evacuation hospitals, which included Tripler. Every imaginable tropical disease was being air-evac’ed directly to these teaching centers. It was an incredible experience not only to be able to treat these men and women, but also to be
learning first-hand about diseases that one could otherwise only see in textbooks. The surgical and tropical medicine experience was superb! In the military I never had to worry whether patients could afford treatment or if insurance providers would approve of their care; their military benefits covered the whole expense of their care. As chief, I could order for our operating room the newest equipment and attend the latest conferences that could keep me up to date with the newly emerging technology and art of arthroscopy. While in the military, we saw our mission as ministry. We established an Officer’s Christian Fellowship Bible study in our home wherever we were stationed. Through our many contacts we were able to help establish a weeklong military medical family conference in Colorado every year for the past twenty-five years. After twenty-three years of service, I had accrued a significant retirement benefit by the age of 46. That safety net allowed my transition to private practice to be so much easier than it otherwise may have been. I still had twenty years of productive time to devote to my private practice. My mil-
Christian Military Medicine What an Adventure! • Service to my country • Diverse lands and cultures • Saving lives; rebuilding broken bodies with broken dreams • Facing questions with eternal significance • Loyalty, Duty, Self-less Service, Honor, Integrity, Personal Courage • Tough times; God’s grace • Opportunity for ministry • Preparation for future service CMDA currently has 151 military members. We have a tremendous opportunity to grow this ministry for Christ over the next few years. If you are interested in joining us at CMDA to develop a more effective ministry to military doctors, please contact Dr. Al Weir at: al.weir@cmda.org. itary experience in tropical medicine and transworld medicine has allowed me to lead mission teams and teach arthroscopy in multiple locales including Dominican Republic, Seychelles Islands, Siberia, Nepal, and the Ukraine.
Dr. Aahnfeldt, wife Lois, and Granddaughter Hope at Spring Canyon Ranch, Colorado - home to summer conferences for military families for many years
After seventeen years I had to close my practice and retire as I began chemotherapy for leukemia. The medical benefits I receive through Tricare (the military medical health plan) have paid for the catastrophic costs that I have accrued for my chemotherapy. I am now in remission from the leukemia and my wife and I are enjoying our grandchildren. Looking back at our life in the military, I can see the hand of God molding and developing us as a family to love and serve Him. It is not the easiest life choice. There are separations, which my Marine son-in-law and daughter have already experienced as he was deployed to Iraq. There is the instability of frequent change of assignments and new schools for the children. But, in spite of these inconveniences, the joy of serving the Lord in the military setting far outweighs the sacrifices.
—Arnie Aahnfeldt MD, Colonel, US Army, retired
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
23
“On My Being Sick and the Passion of Jesus” by John R. Galloway, MD Three years ago this very month, I walked out of the operating room and into the emergency room. I was short of breath, tachycardic, and had what we used to call at Grady the “weak and dizzies.” The right side of my face had begun to swell. I had just returned from a church medical mission trip to Peru and I thought that I had contacted some type of Peruvian “bug.” Unfortunately, as a dumb surgeon, I had already ignored the symptoms of fever, nosebleeds, and progressive malaise that were more consistent with my ultimate diagnosis of acute myelogenous leukemia. Little did I realize that a simple trip to 24
T o d a y ’s C h r i s t i a n D o c t o r
Editor’s note: This article is adapted from a longer presentation by Dr. Galloway, Professor of Surgery; Emory University School of Medicine available from the author upon request - “On Being Sick: Philosophical and Theological Ramblings of a Chemobrain” (An Oration for Emory Surgery Grand Rounds) June 15, 2006. Dr. Galloway is a three-year survivor of acute myelogenous leukemia.
the emergency room would turn into a year-long journey that included several rounds of chemotherapy, multiple long hospitalizations, staphylococcal pneumonia with empyema, bacterial embolism to my right eye causing temporary blindness, fungal cerebritis, venous thrombosis and gram negative bacteremia from my PIC lines, and finally an autologous stem cell transplant. Following my transplant, I developed auto-aggression syndrome (a type of graft versus host) resulting in a severe skin rash over my entire body that kept me itching and scratching for several months. Before my personal suffering began, I surely agreed with the typical Christian checklist for the possible reasons for suffering: • All things work together for our good and God’s glory. CHECK! • Hardships increase our faith. CHECK! • Suffering improves our character. CHECK! • Being sick makes Heaven more real to us. CHECK! • Suffering makes us more sensitive to others who are hurting. CHECK! • And so on. But when the unexpected happened and the cancer was diagnosed, and the storm began to rage and the fire began to burn, all of these mental machinations left my heart cool, partially empty, and modestly comforted. Thus, I was confronted with the emotional problem of evil, and bitterness began to seep in. This was where loving friends and family and sympathetic compassionate physicians and nurses were so noble and so magnificent as they tenderly cared for me, and comforted me and walked with me through this Valley of the Shadow, as I struggled with the various philosophical and theological questions common to many in such circumstances, learning some very important lessons in the process:
• My auto-aggression syndrome caused an itchy and painful rash, for which I received steroids, antihistamines, and soothing skin protectants. The skin and muscles of Jesus’ back were literally ripped to shreds by the “cat of nine tails” swung by the Roman lictors, leading to massive blood loss and hemorrhagic shock. • My right-sided pleural effusion due to staphylococcal pneumonia was carefully drained by a chest tube that was placed with ample amounts of Lidocaine. A Roman soldier ruthlessly thrust a spear into the side of Jesus, piercing His lungs and heart, causing water and blood to flow from His pericardial sac and failed heart. • I required multiple IVs and PIC lines in my arms for medications placed by caring hands, using local anesthetics to dull the pain. The hands and feet of Jesus were nailed to the Cross with six-inch spikes, either piercing the bone or rubbing against the sensitive periosteum, causing excruciating pain. • I received multiple blood transfusions for my anemia and low platelet counts; all carefully matched to prevent transfusion reactions. Jesus had hemorrhagic shock from the intense flogging, making it difficult to stand, let alone walk the Via Dolorosa carrying the cross, the instrument of His death.
Suffering’s Answers Converge in a Person Looking back now, however, I have come to know that the ultimate answer to my personal suffering, as well as to the problem of evil, is not a philosophy or even a well-honed theology, but a Someone, a blessed assurance, a strong deliverer. In particular, I have come to view my Jesus and His passion and His Cross in a much more personal sense. Over time, I have seen the following parallels: • I had headaches from multiple micro-brain abscesses and partial blindness in my right eye from bacterial embolism. Jesus had a crown of three-inch thorns thrust on His sacred head, making it, as the hymn says, despised and gory. • Bone marrow stimulants gave me severe bone pain in my legs, hips, and shoulders for which I received generous doses of narcotics. The bones of Jesus were pulled apart at the joints as He hung on the Cross, causing tremendous pain and agony.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
25
Jesus’ friends either betrayed Him, denied Him, or deserted Him and He was left surrounded by His Roman executioners and taunting, disbelieving crowds. • Throughout my illness, I was shown great love not only because of what I have accomplished in life, but because of who I was, notwithstanding my imperfections and past sins. Throughout His trial and crucifixion, Jesus experienced tremendous, unmerited hate even though He had healed the sick, caused the lame to walk, the blind to see, and had given hope to the poor, all the while showing the way to God and righteousness. He was hated and condemned not because of what He did, but because of who He said He was - the Messiah, the Son of God, the great “I Am.” Even though I was sometimes frightened and my convictions were shaken, I never once felt abandoned by my Heavenly Father. But my Jesus, on the Cross, in a way that I can never humanly comprehend, suffered the ultimate agony of separation from His Father as God poured out His justified fury upon His Sinless Son. The crimes of all humanity for all time, vast and immeasurable, were taken by Jesus upon Himself as if He alone were guilty of them all. And near the end of His precious innocent life, Jesus cried, “My God, my God! Why hast thou forsaken me?” so that I and all who trust in Him would never, ever have to say these words!
Suffering Connects Us to His Unfailing Love Famed hymn writer, Annie Johnston Flint, was orphaned at an early age. Soon thereafter, she developed rheumatoid arthritis that twisted her body and wracked her with pain and ultimately left her bedridden and incontinent. Cancer began to devour her body and blindness crept in. Alone, in pain, and blind, she wrote the words of a hymn (“He Giveth More Grace”) that both astounds and amazes us: • The chemotherapy I required produced anorexia, muscle wasting, and significant weight loss, for which I received specialized intravenous nutritional solutions filled with proteins, calories, vitamins, and trace minerals-all monitored by one of the top nutrition support teams in the world. Jesus, when He was thirsty on the Cross, was given only a sponge soaked in sour wine and made further undrinkable by the bitter herbs mixed with it. • My pneumonia caused me to become short of breath and hypoxic, but I was given oxygen, bronchodilators, diuretics, and antibiotics to help me breathe better. Jesus ultimately died on the Cross after six hours of tortuous suffocation as He attempted to exhale by pulling on the nails in His hands and pushing on the nail through His feet. I can only imagine the intense pain caused by such efforts to breathe as well as by His raw, shredded back rubbing against the coarse wood of the Cross. • I was constantly surrounded by my loving family and friends and consummate, caring physicians and nurses. 26
T o d a y ’s C h r i s t i a n D o c t o r
He giveth more grace as our burdens grow greater, He sendeth more strength as our labors increase; To added afflictions He addeth His mercy, To multiplied trials He multiplies peace. When we have exhausted our store of endurance, When our strength has failed, ere the day is half done, When we reach the end of our hoarded resources Our Father’s full giving is only begun. His love has no limits, His grace has no measure, His power no boundary known unto men; For out of His infinite riches in Jesus He giveth, and giveth, and giveth again. Such words defy the secular, humanistic framework. Nowhere in any other worldview or religion is such wondrous, magnificent, even supernatural love manifested
towards you and me. Ultimately our response to suffering is parallel to the contrarietal responses of the two thieves crucified on either side of Jesus. One thief experienced unyielding despair and hate, and blamed God for his human condition, and, while cursing God, taunted Jesus to save Himself and them. The other thief recognized his own personal evil as his responsibility and that he was justly condemned. At the same time he remarkably recognized the innocence of Jesus. And in so doing, he asked Jesus to remember him when Jesus came into His Kingdom, to which Jesus amazingly replied, “Today, you will be with Me in Paradise.”
Suffering Leads Us Toward His Joy If the Christian Story is true, and I believe with all my heart that it is, then we are God’s children, created in His image and, therefore, we are endowed with infinite value, dignity, and worth. Our lives have meaning and purpose, especially when we place all that we are and all that we do on the altar of worship. We are given hope for the present and for the future; for as we acknowledge the loving sacrifice of Jesus and accept His Lordship over our lives, then we can experience that incommensurable good of knowing God and enjoying Him for all eternity. But for now, while we are living our lives here on this imperfect Earth and experiencing the oft-times frustrating mixture of happiness and blessings with evil, pain and suffering, we do not lose our joy because God is our Father and He gives to us His Holy Spirit to abide with us and in
us. We know as His children that we can cry, “Abba,” “Father,” even “Daddy, I hurt” and He allows us to crawl up into His lap and He enfolds us with nail-scarred hands and He brings us close to His spear-pierced side, and He gives to us the comfort, strength, and peace to withstand the day until we hear those most wonderful words from His precious lips, “Well done, thou good and faithful servant. Enter into the Joy of your Lord!” This joy so singular and so indescribable that it caused the Apostle Paul to write, “For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all” (2 Corinthians 4:17). Paul also quotes the prophet, Isaiah, “No eye has seen, no ear has heard, no mind has conceived what God has prepared for those who love Him” (1 Corinthians 2:9).
John R. Galloway, MD, is Professor of Surgery at Emory University School of Medicine. His clinical practice includes complex gastrointestinal surgery as well as surgical treatment of hepatobiliary and pancreatic diseases. He is Medical Director of the Surgical Intensive Care Unit and is Section Chief for Surgical Critical Care and Nutrition and Metabolic Support. He is active on the CMDAAtlanta Council and has participated in numerous medical mission trips. His wife, Sharon, is a voluntary substitute teacher at Providence Christian Academy and he has two daughters, Jennifer and Rachel. Dr. Galloway may be reached by e-mail at: JGalloway@emoryhealthcare.org.
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
27
CLINICAL ETHICS
Shall We Prolong Life in Order to Give a Patient Time to Decide About Faith?
Second in a New Series
by James Reitman, MD QUESTION: Is it permissible to continue treatment, which it seems clear this patient would not want, at the request of his sister who believes the patient is not spiritually ready to die? The Case: Mr. Patterson is a 66-yearold widower who was admitted to the hospital nine days ago with severe crushing chest pain. The pain has continued intermittently and he has subsequently shown evidence of poor circulation to his brain and his kidneys. It has been determined that he has a large, previously undiagnosed, aneurysm of the aorta in his chest, and it developed a rupture part way through its wall nine days ago (a dissecting aortic aneurysm). When diagnosed, it was far too extensive to be surgically repaired. The tear has progressed both directions and the resulting diminished flow of blood to his brain has compromised his ability to communicate and interrupted flow to his kidneys and has now totally stopped his urine production. A “Do Not Resuscitate” order has been written after discussion with his two adult children. His ICU physician has asked them whether dialysis should be started, though he recommends against it since Mr. Patterson will almost certainly die from this condition within several days. The children have spoken with the patient and think he has said “no dialysis,” though it is not clear that he fully understands his situation. Both believe this refusal of temporary postponement of his death would be consistent with his values and previous life choices. The patient’s younger sister, Genevieve, a devout Christian from out 28
T o d a y ’s C h r i s t i a n D o c t o r
of state, has been at his bedside since shortly after admission. She says, “He’s not ready to die!” She reports that her brother is not a believer, but he has seemed receptive to Genevieve’s witnessing over the past week. She thinks the patient is about ready to accept Jesus, and she pleads for the use of dialysis to allow him time to make this eternal decision. The attending ICU physician has asked for an ethics consultation, asking the above question.
ASSESSMENT: The ostensible interests of one sibling (based on putative “non-medical” benefits of medical therapy) are pitted against those of two adult children (based on the patient’s prior expressed preferences) and the ICU physician (based on the notion of “medical futility”). The ICU physician very wisely requested formal ethics consultation, as there are a number of issues below the surface that beg for further clarification, and there is palpable danger of too quickly acceding to a “default mode” of decision making based on current autonomy-centered standards of clinical ethics. The way in which this dilemma is handled may also determine whether seeds of long-term resentment are sown or lines of communication are improved, with longterm salutary effects on whatever relationships continue after the patient’s imminent death.
DISCUSSION: 1 From the standpoint of current standards of clinical ethics this case would seem fairly cut-and-dried, presenting, again, a dilemma of “substituted judgment” (see Part 1 in this series, TCD, Fall 2006, pp. 30-31). This is to deter-
mine what course of action the patient would choose if he were able, based on prior expressed preferences, when his current capacity to understand treatment options and make decisions appears to be compromised. Only when this is not knowable do we drop to the lower standards of choosing what appears to be in his best interests. It would seem at first that since lifeprolonging therapy is medically futile, the only question to be resolved is: Who among the various parties to the dilemma owns the prerogative of surrogate decision making? Can this be determined by Advance Directive or (absent a Durable Power of Attorney for Healthcare) according to the line of priority established by state law? To follow such a procedure may in fact obscure other ethical “smoking guns”-it would be a mistake to accede solely to autonomy-based principles of decision making. Important submerged ethical issues to be clarified include: • Decision-Making Capacity. It is unclear how much cognitive function the patient retains. Presumably, he could be clueless about the potential benefits of dialysis, yet understand quite well the implications concerning his legacy and eternal destiny. What, if anything, can be done to further elucidate his capacity to understand treatment options, as well as the information that Genevieve has been trying to communicate to him on his deathbed? • Medical vs. Non-Medical Futility. Has the ICU physician subconsciously confused the futility issue? A “Do Not Resuscitate” order may spuriously signal that any current “heroic” attempt at life-preserving therapy is futile, simply because the patient
would not meaningfully survive a cardiac arrest. Since it is not at all clear how much of the patient’s current cognitive impairment is due to hypoxic brain injury or to the metabolic consequences of renal failure, a limited trial of dialysis could potentially reverse some of this impairment and allow for “non-medical” benefits of therapy such as Genevieve is pleading for. • Existential Guilt/Angst. Genevieve could be exemplifying the “sister from Michigan” syndrome, whereby an estranged relative of a dying patient has pangs of conscience and desperately seeks to resolve prior conflict before the patient dies, with a resulting unwillingness to acknowledge obvious medical futility. Has Genevieve overstated her brother’s responsiveness? Are there others who could help her deal with her own ambivalence, mourn appropriately, and say good-bye? • Hidden Resentment. How do the adult children feel about Genevieve’s sudden “24/7” dedication to her brother? Do they feel she is robbing him of dignity with selfish or illconceived attempts at deathbed conversion? Do they perhaps feel crowded from the bedside during his crucial last days of life? • Distributive Justice. Are there patients currently waiting for an ICU a bed? Would a trial of dialysis now unfairly restrict other patients competing for scarce healthcare resources? With ongoing managed care initiatives, the standards of clinical ethics are increasingly including more consideration of distributive justice, but such initiatives are often tainted by financial incentives-current standards still favor those patients already receiving ICU services.
RECOMMENDATIONS: (1) The first priority of consultation is to engage all three parties to the dilemma in further discussion, both individually and collectively. (2) The issue of cognitive capacity should be explored with appropriate mental status evaluation, probing just how well the patient can understand what is at stake. Since his capacity to understand may vary depending on which issues are being explored (medical vs. existential), the presently engaged parties - especially the ICU physician and ethics consultant - may be more attentive to these subtleties than a less “invested” psychiatry consultant. Capacity should not be confused with competence, since a court has not yet been petitioned to determine the patient’s legal competency, so formal psychiatric consultation is not automatically indicated. (3) Underlying family relationships and the moral justification for the positions held by the patient’s sister and two adult children should be explored with sensitivity. Initial discussions may well lead to involving a chaplain or other acquaintances who share Genevieve’s faith - even if only by telephone.
Ethical Considerations for Christian Physicians • When a patient is able to make a treatment decision for himself, or when those who know him best are able to make the decision they believe he would make if he were able, based on his wishes or values, it is rarely justified to impose a “best interests” decision that over-rides this choice. Exceptions to this general rule include (a) if the patient is making an irrational decision (i.e., one that is not consistent with his currently stated goals; (b) if the surrogate is making a choice that others believe is not consistent with the patient’s values. • Verbal witness to the saving power of the gospel message is a vital part of the life of the believer. The result of this witnessing is sometimes known, but often unknown. The eternal outcome of the interchange is the responsibility of the Holy Spirit and the person to whom the witness is directed. —Robert Orr, MD, CM (4) Concerns over distributive justice and medical futility can be further elaborated by the ICU physician. The plausibility of cognitive improvement with dialysis can be discussed and a limited trial seems at first blush to be indicated, even if Genevieve is “in denial.” Later withdrawal of such life-sustaining therapy should not be considered ethically tantamount to “killing the patient,” and this point should be clarified beforehand with the fullest possible understanding of all parties to the decision.
FOLLOW-UP: The ethics consultant reviewed the patient’s chart, spoke with the attending physician, the patient’s adult children, and his sister. Within moments of the consultant’s informing the attending physician of the above recommendations, the aneurysm ruptured into the patient’s esophagus and he died of exsanguination in seconds. His sister was distraught at her “failure” to lead him to salvation. The consultant spoke with her at length, emphasizing the role of the believer and that of the Holy Spirit. She was referred for further spiritual counseling. 1 The ethical foundation for this discussion is discussed at length in the author’s article “The Dilemma of ‘Medical Futility’ - A ‘Wisdom Model’ for Decisionmaking,” Issues in Law & Medicine 12, No. 3 (Winter, 1996), 231-64. This article can be accessed and viewed online at: www.arn.org.
James Reitman, MD, retired from the Air Force as an internist last July, having served as Chief Consultant in Medical Ethics from 1995-1998. He has a MA in Biblical Studies from Dallas Theological Seminary (1983) and is currently enrolled in the Doctor of Ministry program in Community Spiritual Formation at Denver Seminary. I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
29
CLASSIFIEDS Miscellaneous
Positions Open
Clinical Tropical Medicine and Parasitology Course Diploma course accredited by the ASTMH. 6/12-8/3/07. Sponsored by the West Virginia University School of Medicine Office of CME and the International Health Program. Contact: Nancy Sanders (304) 293-5916; e-mail nsanders@hsc.wvu.edu 381/0028/2454
Anterior Segment Surgeon - Midwestern ophthalmology practice desires an additional anterior segment surgeon due to rapidly increasing surgery volumes. A fellowship in glaucoma or oculoplastics is desired. Candidate must be able to perform 300+ cataracts in first year and display a servant attitude toward patients. Practice has been recognized as “best in region” for several years: beautiful office, excellent staff, well equipped with technology. Located in rapidly growing suburb of a metropolitan community. Practice is committed to performing surgical care at the NW Haiti Christian Mission. Please send info to Karen at kkennedy@moyeseye.com. Fax 816.587.3555
Overseas Missions Agnes Medical Resource Group is looking for volunteer physicians for a medical mission trip to Nigeria scheduled November 5-16, 2007. Contact: agneshealth@aol.com or (410) 371-8904. 381/0607/2460 Ghana - Year round opportunities for medical service, most specialties, ST/LT. Baptist Medical Center in “bush” of NE Ghana with 3 full time MDs on staff. Busy clinic & surgical service. Email: Mamprusi_HMT@yahoo.com, Earl Hewitt, MD. 381/0645/2457 Pakistan - Christian physicians urgently needed for ST/LT in rural Shikarpur Christian Hospital: female (GP/FP, OB/GYN, GS) for OB/general; male/female pediatrician, OB/GYN for ST teaching GYN surgery. Contact Bill Bowman, MD; 714-963-2620; drbillbow@aol.com.
374/0725/2445
Cardiologist - NON INTERVENTIONAL CARDIOLOGIST, RALEIGH, NORTH CAROLINA—-Outstanding opportunity for a BC/BE non interventional Cardiologist to join busy well-established nine-physician cardiology group in beautiful North Carolina. The capital city is part of the Research Triangle, home to three major universities, close to beach and mountains, excellent public and private schools. Echo, TEE and nuclear skills sought. CTA and cMR skills a plus but not required. Partnership track. Competitive salary and benefit package. Available immediately or July 2007. Please submit CV to Kathy Young at ky@cccheartdoc.com or fax to 919-863-8653. 381/0737/2465
Dental Practice in southern Washington state, the beautiful Columbia Gorge. Seeking younger dentist to share our busy practice. Outdoor recreation paradise. Great rural community to live and work in. Contact Eric at Paragon Transitions, 866-576-9809. 381/0724/2452 ENT - Exceptional opportunity in beautiful Scottsdale, Arizona. Rewarding and busy 3-physician ENT practice in a single state-of-the-art office seeking BC/BE general ENT candidate. Excellent salary, incentive and benefits. Email CV/cover to Entegrity@cox.net. 374/0720/2437 FP, NP or PA - Christian family medicine office that serves all who walk through its doors in Christ’s name is seeking an FP, NP or PA with a heart for service and ministry. Near Chicago in Hinsdale, IL. Contact: cfhjobopportunity@yahoo.com. 381/0731/2456
Paid Advertisement
Family Practice - Well-established FP group of 7 now looking for a BC/BE physician wishing to practice in College Station, Texas; a great location to raise a family. We do Hospital, Obstetrics, and NH work with easy access to two hospitals and any landmark in the community. A highly rated EMR was recently added. The amazing Texas A & M University is here. It is a brief commute to Dallas, Austin or Houston & 1 1/2 hrs to the coast. Call Dr. Ken Hillner @ 979-821-6300 or send CV to 2210 E. 29th, Bryan, Texas 77802 381/0596/2464 Internal Medicine - A private practice of three Internists plus a Geriatric specialist needs to replace a colleague who relocated. The BE/BC candidate selected will provide office-based and in-patient care and assist in opening a satellite office. Partnership available. Call 1:4. Competitive compensation. Practice is affiliated with 172-bed Battle Creek (MI) Health System, nationally recognized for patient safety and featuring EMR and CPOE. Contact John Edsall at 269-781-9100 or 800-241-9101 or BCHS@edsallinc.com. 381/0735/2462 (continued on next page)
30
T o d a y ’s C h r i s t i a n D o c t o r
Paid Advertisement
381/0361/2426
CLASSIFIEDS
Neurologist - North Carolina. Sandhills Neurologist, PA is seeking two BC/BE Neurologists, exclusively outpatient practice. Fellowship in stroke and pain management welcomed, but not required. This practice is interested in the physical and spiritual needs of the patient. Located in south central NC. World-renowned golfing resort, family-oriented community with large draw area. Approx. 2.5 hrs from beaches and mountains. Contact sandhillsneuro@earthlink.net. 381/0581/2453
Neurologist - Group of 3 Christian neurologists are seeking another physician. Call currently 1:6. Sub-specialty interests encouraged. Very active clinical research activities. Excellent schools. Recreational opportunities abound in Big Sky country. Call 406-727-3720 or email ansmanager@yahoo.com. 381/0736/2463 Obstetrics & Gynecology - An experienced, compassionate solo ObGyn needs a BE/BC colleague due to the growth of her new private practice. Candidates must be patient-focused with a service mentality. Part-time status is possible initially. Competitive compensation. Partnership available. Shared call can be 1:4. Jeremiah 31:8-9. Practice is affiliated with Battle Creek (MI) Health System, nationally-recognized for patient safety and featuring EMR and CPOE. Contact John Edsall at 269-781-9101 or 800-241-9101 or BCHS@edsallinc.com. 381/0735/2461 Ophthalmology CENTRAL TEXAS - The Scott & White Department of Ophthalmology and The Texas A&M University System Health Science Center College of Medicine are currently seeking an outstanding BC/BE fellowship trained Vitreo-Retinal Surgeon. Additionally,
the Department is also looking to add a Therapeutic Optometrist. The Department presently consists of 10 full-time Ophthalmologists and 4 full-time Optometrists committed to quality care delivery enhanced by resident and student education and research. For additional information contact: Dr. Glen Brindley, MD, Chairman, Department of Ophthalmology; c/o Jason Culp, Physician Recruiter, Scott & White Clinic, 2401 S. 31st, Temple, TX 76508. (800) 725-3627 jculp@swmail.sw.org 381/0730/2451
in underserved areas ranging from the urban US to the 10/40 Window. We desire a health care professional with a passion for medical missions to lead this ministry. Skills in vision casting, strategic planning and fundraising are key. Visit www.medsend.org. Direct inquires to Dr. Doug Drevets at douglas-drevets@ouhsc.edu.
381/0733/2459
Practices for Sale Orthopedists - Well-established practice of three orthopedists committed to providing orthopedic care with compassion as well as excellence. Time off for short term missions. Would like to talk with general and subspecialty orthopedists about the possibility of joining us in practice. On-site surgery center; local hospital within walking distance. Located in a family-oriented city where many recreational and cultural activities are available. Less than a 10 minute commute from any area of the city. Low malpractice rates and cost of living. Vacation at the mountains and the beach; live here and enjoy all four seasons. Please contact our Medical Director, Dr. Chris Wilkinson at 308-865-1403 or cwilkinson@kearneyortho.com. Our clinic manager, Vicki Aten, can be reached at 308-865-2512 or vaten@kearneyortho.com. 381/0467/2455 PRESIDENT - Project MedSend, an evangelical organization that makes grants to reimburse educational loans of health care professionals engaged in long-term missions, is seeking a leader to continue the rapid growth of its first fifteen years. Project MedSend grants have helped to place over 300 workers in medical ministries
Christian Family Practice for sale - Have you always thought about having your own Christian Practice but were afraid of start-up costs? Do you hear God challenging you to step out of your comfort zone? Consider purchasing an established Family Practice in Southcentral Pennsylvania, with excellent staff, an equipped office, and wonderful patients. I am leaving to enter Religious Life in Fall 2007. All terms are negotiable. Please email me at yometer@atlanticbb.net. 381/0729/2450
Practice for Sale: Phenomenal opportunity for Christian behavioral pediatrician or child psychiatrist. Thriving practice in North Dallas, Texas for sale due to sudden death of sole physician, a nationally-known, highlyrespected behavioral pediatrician. Solo practice but five other psychologists/therapists and two educational diagnosticians share same office suite and provide in-house referral source. Turn-key opportunity with clerical and nursing staff in place. For more information contact: Dexter Ward at 1-800-453-3995 or 214-906-5091. 381/0732/2458
Paid Advertisement
The Scott & White Department of Ophthalmology and The Texas A&M University System Health Science Center College of Medicine are currently seeking an outstanding BC/BE fellowship trained Vitreo-Retinal Surgeon. Additionally, the Department is also looking to add a Therapeutic Optometrist. The Department presently consists of 10 full-time Ophthalmologists and 4 full-time Optometrists committed to quality care delivery enhanced by resident and student education and research. Academic appointment and rank is commensurate with experience and qualifications. Basic and clinical research opportunities are available for interested candidates. Scott & White is the largest multi-specialty practice in Texas, with more than 530 physicians and research scientists who care for patients at Scott & White Memorial Hospital in Temple and within the 15 regional clinic system networked throughout Central Texas. Over $250 million in expansions are currently underway, including two new hospitals and three regional clinics. Led by physicians with a commitment to patient care, education and research, Scott & White is listed among the "Top 100 Hospitals" in America and serves as the clinical educational site for The Texas A&M University System Health Science Center College of Medicine. Additionally, the 180,000member Scott & White Health Plan is the #1 health plan in Texas.
Paid Advertisement
OPHTHALMOLOGY Scott & White Health System and Texas A&M College of Medicine Central Texas
Scott & White offers a competitive salary and comprehensive benefit package, which begins with four weeks vacation, three weeks CME and a generous retirement plan. For additional information, please call or send your CV to: Dr. Glen Brindley, MD, Chairman, Department of Ophthalmology; c/o Jason Culp, Physician Recruiter, Scott & White Clinic, 2401 S. 31st, Temple, TX 76508. (800) 725-3627 jculp@swmail.sw.org Scott & White is an equal opportunity employer. A formal application must be completed to be considered for this position. For more information on Scott & White, please visit our web site at: www.sw.org
I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
31
Toll Free Call - (888) 690-9054 Fax - (423) 844-1005 E-mail: Placement@cmda.org Website: www.cmda.org
Family Medicine allen.vicars@cmda.org
Donna Fitzgerald Cardiology Dermatology Emergency Medicine Endocrinology Gastroenterology Hematology/Oncology Internal Medicine donna.fitzgerald@cmda.org
OB/GYN
Allen Vicars
Rose Courtney
Cathy Morefield General Surgery Anesthesia Orthopaedic Vascular Surgery Cardio-Thoracic Dentistry cathy.morefield@cmda.org
This section represents a small portion of our opportunities. To view a complete listing, go to the Placement Section on our Website, www.cmda.org
32
T o d a y ’s C h r i s t i a n D o c t o r
Indiana - (OB-285) Practice of two OB/Gyn’s seeking third to join them. They are part of a larger group of seven more OB/Gyn’s that help with call coverage. They admit to a 180bed hospital with a Level III Nursery. Texas – (OB-290) Independent, single-specialty practice seeking another OB/Gyn. The practice is a little over 2 years old and consists of 1 physician and 1 NP. Call is 1:2 weekdays and 1:6 weekends.
Iowa - (MS-280) Join 40-physician multi-specialty group in Eastern Iowa. Interventional Cardiology increasing department- immediate patient load. May consider invasive Cardiologists. 2 hours from Chicago. Modern clinic with a service area of 100,000. Competitive compensation package. Great patient mix and low managed care penetration.
Cardiology
Med/Peds Nurse Practitioner OB/GYN Ophthalmology Pediatrics rose@placedocs.com
Florida - (OB-288) Independent, single specialty practice seeking an OB/Gyn. This is a 16-year-old practice, which currently has 5 physicians. Call is 1:7 weekdays and 1:5 weekend. Their practice philosophy is to treat their patients openly, honestly and with the highest quality medical care. They treat all faiths without prejudice and try to give to their community healthcare of the highest standards.
Internal Medicine
Placement Services Alabama - (SG-231) Two opportunities in independent, single specialty Christian practices. Call 1:7. Inpatient/Outpatient. Growing community in Southwest Alabama. Residents enjoy the conveniences and security of quaint, small city living along with the amenities of a big city close by. Gulf beaches are within a 60-minute drive. Florida - (MS-299) Multi Specialty practice searching for IM physician with Geriatrics. This is an inter-faith clinic, 45 miles north of Tampa. 50% clinic work and 50% hospital work. The group is the largest in the County and has been asked by the local Hospital to open a satellite clinic in a nearby County. Georgia - (IM-235) Busy independent Internal Medicine-Geriatrics practice. Call is 1:4. Friendly, relaxed atmosphere of a small Southern town. Strategically located 18 miles from Atlanta, 10 miles from Marietta and only minutes from Atlanta’s Hartsfield-Jackson airport.
Anesthesia IL, NE, VA, VA, VT
Washington - (MS-308) Busy Cardiologists seek general or invasive non-interventional cardiologist due to patient demand. Nuclear training a plus. Christian Group committed to their community. This family oriented community is 130 miles from Seattle and 90 miles from the Pacific Ocean.
Orthopaedic Surgery
Georgia - (CD-129) East Central. Serve and glorify the Lord in a practice seeking a fully trained Cardi-ologist/Electrophysiologist. Each physician sees an average of 20 patients daily. Cultural and historic attractions plus year round recreation. 2 1/2 hrs from the mountains and beaches.
TX - (OS-209) Independent, SS opportunity located in Dallas, Texas. Sixteen-year-old practice is seeking an Orthopaedic Surgeon with Sports Medicine. A Spine Surgeon would be welcome, but must be willing to do General Orthopaedics as well. Call schedule of 1:7 for weekdays and 1:4 weekends.
Toll Free Call - (888) 690-9054 Fax - (423) 844-1005 E-mail: Placement@cmda.org Website: www.cmda.org
Dentistry
TN - (MS-474) 47 miles from Nashville is a ministry oriented clinic geared towards providing healthcare for the indigent population. Seeking a FT Dentist. Salary is negotiable but very competitive with current market values. Malpractice insurance will be provided and all benefits are negotiable and open for discussion. CA - (MS-385) 3 great opportunities, located around the San Joaquin Valley. MN - (DT-251) Independent, 29 y.o. dental practice is seeking to add an additional FT or PT dentist. Practice currently has 1 dentist, 2 assistants and 2 hygienists. 4 operatories. Practice is located in southwest Minnesota near interstate 90 and are only 55 miles from Sioux Falls, South Dakota. MO - (DT-250) Located approximately 20 miles from Joplin, Missouri is a 5-year old health care group that is seeking to add dentists. They are a Federally Qualified Health Center, with 2 dental sites, 2 dentists, 4 dental assistants, and 2 dental hygienists to staff two practices. They are mission-minded and committed to Compassion, Access, Respect and Excellence. MS - (DT-253) Located in the northeast corner of MS. Independent,17+ year old practice. Currently there is 1 dentist, 2 dental assistants and 2 dental hygienists.
Peds
PA - (DT-205) Independent practice. Six operatories, 4 dental assistants, and 3 dental hygienists. Average number of patients per day is 25. New dentist will be brought on as an associate with compensation provided by an income guarantee and productivity. Practice is located in Lancaster County, Amish/Mennonite area; 1 hr from Philadel-phia; 2 hrs from Baltimore; 3 hrs from NYC.
Alabama - (PD-241) Independent, single-specialty pediatric practice seeking another pediatrician. This 15 year old practice is currently staffed with 4 physicians. Call will be 1:5 when new physician joins. Colorado – (PD-209) Single-specialty, inpatient/outpatient pediatric practice seeking another Pediatrician. Currently 4 physicians are on staff with a call schedule of 1:5 both weekdays/weekends. Practice strives to offer exemplary, compassionate, Christ-oriented care to their patients and their families.
Gastro
MS - (DT-254) Mississippi Gulf Coast! Independent dental practice is seeking a FT or PT Dentist to join them. The practice currently has 2 dentists, 3 assistants and 2 hygienists. Six operatories. Practice is 25 yrs old.
Mississippi - (GI-140) Join 1 GI and 1 NP in growing, Inpatient/ Outpatient practice. Complete freedom to pray with patients. A few miles south of Memphis, TN. Excellent school system and higher educational opportunities and all large city amenities are available within a few minutes drive. J1 and H1B Visas are welcome.
General Surgery
Placement Services MT - (MS-459) Great Bread & Butter General Opportunity for a surgeon trained in laparoscopic procedures, & capable of doing upper & lower endoscopy procedures. Located near Glacier National Park. Also, would prefer someone that is or could be trained to do a C-section (Family Practice Doctors would make the call and take over care after the procedure). MI - (SG-169) Independent Christian, SS group is seeking a BE/BC General Surgeon. Currently they have five surgeons & need to spread out to the rural areas to help a larger market of patients. Admit to two hospitals. PA - (SG-126) Located in south central PA at the edge of the Appalachian Mountains. Only 75 miles from Baltimore & 65 from Washington, DC. Independent, SS group. Procedures performed in office: all kinds of “lump & bump” surgery. Ultrasound – breast & thyroid. Need physician with good endoscopy skills. Call 1:4. Admitting hospital has 60 licensed beds. PA - (SG-261) Located northwest of Pittsburgh. Independent, SS practice associated with multi-surgical specialty group for administrative purposes & billing. Laparoscopic, vascular and endoscopic desirable. Two admitting hospitals.
Family Medicine Virginia - (MS-478) Independent practice in beautiful southwestern Virginia consisting of 3 family physicians and 4 mid-level providers seeking FP, no OB. Inpatient/Outpatient required with a call schedule of 1:4. Practice also open to physician serving on short-term mission opportunities. Only an hour away from the Tri-Cities area (Bristol, Kingsport, Johnson City), this area has abundant opportunities for outdoor recreation such as hunting, fishing, hiking, mountain biking, etc. with many national parks and the Virginia Creeper Trail/Appalachian Trail nearby. Florida - (FP-695) Independent three-physician group in north central Florida searching for family medicine associate, no OB. Physician has option of doing inpatient/outpatient or outpatient only. Call would be 1 in 8 weekdays and weekends. Daily average of patients per physician: 25-28. One of the fastest growing communities in Florida approximately 70 miles from Orlando in “horse country”. University of Florida is only 35 miles away. Georgia - (FP-1058) Wonderful opportunity to join an independent, outpatient only practice located 30 minutes south of Atlanta. Practice seeking family medicine associate, no OB. Inpatient referred to local hospitalists. Four day work week with no OB, no ER, and no nursing home work. Prefers Christian associate that desires to live in and become part of the community. I n t e r n e t W e b s i t e : w w w. c m d a . o r g
•
Spring 2007
33
CHRISTIAN MEDICAL & DENTAL ASSOCIATIONS P.O. Box 7500 Bristol, TN 37621-7500
Nonprofit Org. U.S. Postage
PAID Bristol, TN Permit No. 1000