Volume 48 No. 4 • Winter 2018
Today’s
Christian Doctor The Journal of the Christian Medical & Dental Associations
SEXUAL HARASSMENT IN HEALTHCARE
My
CMD A
Story
Jacob R. Morris, MD, serves as a Resident Trustee to CMDA’s Board of Trustees.
“I went into medicine with a desire to follow in the footsteps of Christ, the Great Physician. But medical training has been arduous. I have wrestled with climbing the ladder of academic achievement or merely looking forward to the luxuries that medicine can afford. While these things are not bad in and of themselves, they do not align with my primary calling. CMDA reminds me to keep first things first and wake up every day and live out Christ’s powerful words,
Follow me. CMDA has been an incredible blessing in my life and I am committed to serving with and through CMDA for the rest of my life. After attending the National Convention for the first time in 2015, I was so impacted that I knew I would need to commit to attending every year to ‘breathe life’ into my Christian walk and receive renewed encouragement to live for the kingdom and encourage others.” —Jacob R. Morris, MD
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P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.joincmda.org memberservices@cmda.org
JOIN CMDA TODAY You can join Dr. Morris and more than 19,000 healthcare professionals across the country who are part of this growing movement of “Transformed Doctors, Transforming the World.” Visit www.joincmda.org or call 888-230-2637 to join us today. Paid Advertisement
CEO EDITORIAL
FACING THE PIT OF EVIL
I
by David Stevens, MD, MA (Ethics)
never imagined I would be standing at the “Gates of Hell,” but I did so a few weeks ago at Caesarea Philippi.
Matthew 16 records that Jesus, toward the end of His earthly ministry, took His disciples to the region of Caesarea Philippi in Northeast Israel to examine them with a crucial question. He asked, “Who do you say I am?” Simon Peter answered, “You are the Christ, the Son of the living God.” Jesus then blessed Peter and told him, “…on this rock I will build my church, and the gates of hell shall not prevail against it” (Matthew 16:18, ESV). While leading a wonderful CMDA tour to Israel and Jordan recently, I stood in the same place where Jesus stood when He made that proclamation. Christ made His statement in front of a huge cliff with a large grotto that had a giant spring gushing from its floor. It came from a deep hole in the limestone bedrock. The water then tumbled down to the valley as a stream to flow into the Sea of Galilee. People believed that hole was a bottomless pit. Thus it was the gate through which demons traveled from hell into this world and back. The grotto was also a temple to Pan, the god of fertility and sexuality, so you can imagine the kind of “worship” rituals that took place even while Christ was there. The Greeks built a town there that was once called Panias in Pan’s honor. Today you can see the ruins of the temples and altars where these activities took place. Christ took His disciples to this pit—one of the vilest places in their country—to make sure they knew who He was and that His power was sufficient to defeat evil. Things were not going to be easy for the disciples after He ascended to heaven, so He wanted them to remember that His church, yet to come, could conquer evil through His power. Gates are defensive structures, but they are also the weakest point of attack. So in this place— this Gate of Hell—Christ told His disciples that they would have His power, His wisdom and His boldness to take on evil, and he promised that it would not prevail against them. When we follow our human nature, we are tempted by a desire to bunker down and protect ourselves from evil. The
Bible tells us to flee this temptation, but just as importantly, we should also fight evil. This issue of Today’s Christian Doctor deals with some of the evils in our world today: sexual harassment in healthcare, drug use and human trafficking. It also focuses in on healthcare professional burnout, which is happening in epidemic proportions and causing many to leave the ministry God called them to in healthcare. As you dig into these topics, as you work to battle some of these evils, remember that God’s grace is sufficient. The disciples faced the evil of the Roman Empire with its brutality and licentiousness. They were hunted by religious authorities who tried to eliminate them. Within a few decades, the temple in Jerusalem would be destroyed and the Jewish people would flee around the world. The Jews would be without their own country for almost 2,000 years. Most of the disciples would be martyred for their faith. And yet God’s power, manifested through His church, ensured the gospel reached you and me. His power has defeated evil in the past, and it is available to help us conquer evil now. Remind yourself, He walks with you as you speak and live the truth in love. You don’t face evil alone, and you do so “...not by might, nor by power, but by my Spirit, says the Lord of hosts” (Zechariah 4:6, ESV). God uses individuals, but He does His best work through the ecclesia, the body of His faithful believers, His church here on earth. CMDA, as part of His church, is here to stand with you, educate you, equip you and motivate you for the battles ahead. Transformed Doctors ➤ Transforming the World www.cmda.org 3
TO DAY ’ S C H R I S T I A N D O C TO R
contents
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VO LU M E 4 8 , N O. 4
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WINTER 2018
The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.
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Transformed Doctors, Transforming the World
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featuring Shelby Montgomery
Cover Story
Sexual Harassment in Healthcare by Autumn Dawn Galbreath, MD, MBA
How does this hot topic affect healthcare, especially Christians in healthcare?
16
A Second Drug Wave is Coming: Marijuana
by James A. Avery, MD
Earn continuing education credit with this article about medical marijuana
22
by Stan Haegert, MD, MPH
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by Patricia “Trish” Burgess, MD
Burnout at the Broom Tree
One physician shares how you can rely on Jesus during times of burnout
Living the Word
Trusting God while serving victims of human trafficking
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Disciple Making Medicine
by David S. Wilson, MD
An inside look at how one practice is focusing on making disciples
34
Classifieds
EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD; John Crouch, MD; Autumn Dawn Galbreath, MD; Curtis E. Harris, MD, JD; Van Haywood, DMD; Rebecca Klint-Townsend, MD; Robert D. Orr, MD; Debby Read, RN AD SALES Margie Shealy 423-8441000 DESIGN Ahaa! Design + Production PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). Today’s Christian Doctor®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Winter 2018, Volume XLIX, No. 4. 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© 2018, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tennessee. Undesignated Scripture references are taken from the Holy Bible, New In-
4 TODAY'S CHRISTIAN DOCTOR Winter 2018
ternational Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Other versions are noted in the text. Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.
TRANSFORMATIONS
A TITLE X FAMILY PLANNING GRANT COULD HELP YOUR PATIENTS AND PROGRAMS The U.S. Department of Health and Human Services (HHS) recently awarded a $2-million, three-year Title X family planning grant to CMDA members Drs. David and Janet Kim, who direct a faith-based health clinic in New York. The federal Title X program has undergone significant reforms, including an emphasis on conscience protections important for faith-based organizations and pro-life health professionals. Organizations that decline to participate in abortion, potentially abortifacient contraceptives or even contraceptives in general now can still participate in Title X grant programs. The Title X program now offers a broad range of voluntary family planning methods and services that includes information and education related to family planning, preconception care, contraception, natural family planning, infertility services, sexual risk avoidance education and more. CMDA CEO Dr. David Stevens recently conducted a Christian Doctor’s Digest interview with CMDA member Dr. Diane Foley, who helps lead the Title X program at HHS. Dr. Foley explained that non-profit entities, such as community health
centers, pregnancy resource centers and others could serve either as primary grantees serving a state or a particular patient population, or as sub-grantees specializing in certain services. For example, Dr. Foley noted, a pregnancy resource center could become expert providers of FABM [Fertility Awareness-Based Methods] and provide this for a grantee that covers the entire state. A new proposed Title X rule, expected to be finalized soon, further strengthens conscience protections and includes provisions that prevent the abortion industry from abusing the program. Read CMDA’s official public comment on the proposed rule at https://tinyurl.com/CMDAcomment.
LEARN MORE
Visit https://tinyurl.com/TitleXCMA for the most recent Title X funding opportunity news from HHS. For more information about Title X grant opportunities and requirements, visit https://www.freedom2care. org/title-x-family-planning. To sign up as a grant reviewer (working from home), email your curriculum vitae, along with a brief explanation of your expertise and interest, to CMDA Vice President for Government Relations Jonathan Imbody at JI@Freedom2Care.org.
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TRANSFORMATIONS
CMDA MEMBER RECEIVES AWARD Bruce C. Steffes, MD, FACS, a general surgeon from Linden, North Carolina, received an International Surgical Volunteerism Award from the American College of Surgeons (ACS) for his more than 20 years of providing surgical and administrative skill to underserved areas of the world. These awards recognize ACS fellows and members who are committed to giving back to society through significant contributions to surgical care as volunteers. From 1998 to 2005, Dr. Steffes worked in numerous countries throughout Africa, Asia, Central American and South America in multiple mission hospitals. Some of Dr. Steffes’ most impactful work has been in Africa, working with the Pan-African Academy of Christian Surgeons (PAACS) since 2003. As a ministry of CMDA, PAACS trains and disciples African surgeons to glorify God and provide excellent, compassionate care to those most in need. Dr. Steffes was the Executive Director of PAACS from 2006 to 2014, and he also served as Medical Director from 2014 to 2016. Dr. Steffes also travels throughout the U.S., recruiting young surgeons interested in mission work, mentoring and guiding many of them regardless of his other time commitments.
Pediatrician Needed for Busy Practice in Mississippi
Hattiesburg Clinic, one of the largest physician-owned and directed multi-specialty groups in the Southeast, is seeking a family-oriented, BE/BC pediatrician with a desire to join a well-established pediatric practice with 10 physicians. We are primarily an outpatient care clinic with inpatient care consisting of well newborn and general pediatric rounding while on call, which is currently at 1:8. Deliveries are attended by neonatology staff, and triage nurses manage after hours patient calls.
Please email CV to glenda.sharp@hattiesburgclinic.com or call (601) 579-5008 or (601) 606-5941. Visit our website, www.hattiesburgclinic.com, for additional information about our group and the Hattiesburg community. Paid Advertisement
6 TODAY'S CHRISTIAN DOCTOR Winter 2018
EVENTS For more information, visit www.cmda.org/events.
Northeast Winter Conference January 18-20, 2019 • North East, Maryland Foundations for Christian Coaching January 23-24, 2019 • Cannon Beach, Oregon West Coast Winter Conference January 24-27, 2019 • Cannon Beach, Oregon Marriage Enrichment Weekend February 1-3, 2019 • Miramar Beach, Florida New Medical Missionary Training March 14-17, 2019 • Abingdon, Virginia Remedy Orlando 2019 March 28-30, 2019 • Orlando, Florida Marriage Enrichment Weekend April 5-7, 2019 • Georgetown, Colorado 2019 CMDA National Convention May 2-5, 2019 • Ridgecrest, North Carolina Voice of Christian Doctor’s Media Training May 17-18, 2019 • Bristol, Tennessee Remedy West 2019 October 5-6, 2019 • Riverside, California
MEMORIAM & GIFTS Gifts received July through September 2018
Honor James C. Link in honor of Dr. David Stevens’ Birthday Dr. Ralph Buoncristiani in honor of Dr. Charles Wood Marcia O’Connor in honor of Dr. Lois Sastic
Memory Dr. & Mrs. Donald Wood in memory of Margaret Anne DeBord Tom & Dora Heath in memory of Henry Wallace Tom & Dora Heath in memory of Camille C. Newsom Dora Heath in memory of Sybil F. Perkins Ron & Jen Walters in memory of Robert Landes Sallie Anderson in memory of Robert Landes Dorothy Tu Yang in memory of Dr. John O. West Mr. & Mrs. Clifford Swanson in memory of Dr. John O. West Telford & Margaret Stevenson in memory of Dr. John O. West Janet C. Barker in memory of Dr. John O. West Candace C. Coles in memory of Dr. John O. West Nay Y Puor & Chang Tea in memory of Dr. John O. West Craig & Julia Breuninger in memory of Dr. John O. West Theing Trust in memory of Dr. John O. West Cecile Rose Vibat in memory of Dr. John O. West Joelyn Breuninger in memory of Dr. John O. West Kenneth, Jacquelyn & Ian Hanson in memory of Dr. John O. West Joseph & Eva Leonard in memory of Dr. John O. West Franklin & Theresa Tseng in memory of Dr. John O. West D. Scott & Holly Munro in memory of Dr. John O. West For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.
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TRANSFORMED TRANSFORMED Doctors
Featuring
SHELBY MONTGOMERY
CMDA: To get us started, tell us a little bit about your background (school, training, personal life, etc.). Shelby: I am a third year at LSU School of Medicine in New Orleans, Louisiana. I was born and raised in Lafayette, Louisiana and attended a small Episcopal school for middle and high school. I received my bachelor’s of science in kinesiology at LSU in Baton Rouge. I spent my junior year of undergrad at the University of Hawaii at Manoa on the island of Oahu through National Student Exchange. After graduating from LSU, I worked for one year at Pennington Biomedical Research Center in Baton Rouge as a research coordinator for the Heads Up project. This is a statewide project that investigates weight loss and other secondary outcomes of bariatric surgery compared to a 16-week liquid diet with lifestyle counseling. I began medical school in 2016. CMDA: When did you first get involved with CMDA? Shelby: I heard about CMDA the summer before medical school when I reached out to an upperclassman about class Bible studies. She was very enthusiastic about our local chapter and encouraged me to get involved. First year was certainly an adjustment, and the Christian community at school and my local church were invaluable examples of how to handle stress. Martin Luther reportedly said, “Were it not for tribulation I should not understand the Scriptures.” I experienced a glimpse of that added understanding my first year, because I had great influences that kept me consistently turning to the Word for guidance. CMDA: And how have you been involved since then? Shelby: At the end of first year I was elected the Southeast Regional Student Representative. This is a two-year position that entails helping lead the student activities at the CMDA National Convention and serving as a liaison between medical school chapters and national resources. I attended the CMDA National Convention in 2017 and 2018. And then I was the vice president of my local chapter in my second year. Ephesians 2:19-20 says, “So then you are no longer strangers and aliens, but you are fellow citizens with the saints and members of the household of God…Christ Jesus himself being the cornerstone” (ESV). CMDA: What would you say is the biggest way CMDA has impacted your life so far in your healthcare training?
8 TODAY'S CHRISTIAN DOCTOR Winter 2018
Shelby: My first National Convention had a major impact on my spiritual life, especially over the months that followed. So many men and women at the convention were using their medical careers to serve the Lord in ways I didn’t know were possible. I read approximately 10 books the following summer to prepare for Bible study beginning that fall. As I locked myself in the library the following spring preparing for Step 1, my focus drifted away from memorizing Scripture and praying. I realized Christian influence is not only encouraging but also necessary. The pastor of my local church compared community to a fire, with each individual amber glowing brightly when together and burning out when it drifts away. CMDA provides that national fire of possibility every young professional needs to stay inspired. CMDA: CMDA’s vision is “Transformed Doctors, Transforming the World.” What does that mean to you? Shelby: Luke 10:27 says, “…‘You shall love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind, and your neighbor as yourself ’” (ESV). This Scripture and the parable of the Samaritan that follows encapsulates the essence of what Jesus preached and how God wants us to love. A true neighbor’s love is sacrificial and indiscriminate. We are told to love as ourselves anyone who is on our path and in need. Many physicians are faced with this impossible task every day, often requiring their entire strength. I recently had a 30-hour shift in trauma surgery on a Friday night in New Orleans, and I witnessed a resident give his entire strength to the patients. A total of 10 trauma activations, numerous consults and a 5 a.m. exploratory laparotomy with an unfavorable outcome. I stood in awe of the resident’s strength later that morning as he patiently listened to another patient’s concern of her wound VAC change for 20 minutes. How amazing would it be to give one’s entire strength to loving the Lord? To loving everyone as oneself ? That would be a life and career that could transform the world.
TRANSFORMING TRANSFORMING
the World
CMDA: What’s the best advice you can give to others about how to get involved transforming the world for Christ?
Shelby: To end on a lighter note, my family and I went snow skiing over Christmas break of my second year. On Christmas day, the slopes were crowded, the snow was icy and my medical student stamina was failing. I had a nasty fall on the sharp turn of a blue, tumbling halfway down the slope and losing my skis. I didn’t lose consciousness but sustained a black eye and a badly sprained thumb. At 11 p.m. that night, I was awake and realized I could have an epidural hematoma, frightfully called the “walk, talk and die” syndrome. Of course I hadn’t lost consciousness, so the odds of an epidural hematoma are nearly zero, but I still sat in bed and read articles on my phone about the syndrome for about three hours. I continued to lay there defenseless, knowing I just needed to go to sleep. Like several times already in medical school, I needed to give this problem to God. Medicine has affected me in so many ways that I wouldn’t have expected. I pray the most frequently in the days before a test and during hectic days at a hospital. And what a gift that stress is if it strengthens my relationship with God!
Shelby: Katie Howe, a current surgery resident, graduate of LSU and leader of CMDA’s National Resident & Fellow Council, gave me great advice at the last convention. She told me that since you can’t do everything, do something that wouldn’t happen unless you do it. It can be difficult to narrow focus and put your energy into only a few things. I spent a lot of last year thinking about what I wanted to prioritize. Part of that thought process involved listening to podcasts. I am unabashedly a podcast groupie. It provides great exposure to law, ethics and student CMDA leadership. My Bible study co-leader and I based our spring semester study on Christianity and medical ethics, with most of my research coming from the Bible and podcasts. I would encourage others to research projects and needs both locally and internationally to discover how their unique skills and experiences can help transform the world for Christ. CMDA: Is there anything else you’d like to share?
WHAT IS REMEDY? Medical missions brings the remedy for disease. And medical missions brings the remedy for sin— Jesus Christ. But to do this, medical missions needs missionaries. Committed healthcare professionals are the greatest need in closed countries to provide God’s spiritual and physical remedy. Choose from two locations in 2019 for Remedy, a conference focused on bringing God’s remedy to the world.
Register at www.cmda.org/remedy
TWO CHANCES TO ATTEND
1
Remedy Orlando 2019
2
Remedy West 2019
March 28-30, 2019 First Baptist Orlando • Orlando, Florida October 5-6, 2019 California Baptist University • Riverside, California Paid Advertisement
SEXUAL HARASSMENT IN HEALTHCARE by Autumn Dawn Galbreath, MD, MBA
10 TODAY'S CHRISTIAN DOCTOR Winter 2018
R
aise your hand if you have ever had to sit in front of a computer at your workplace and watch a 20- to 30-minute video on sexual harassment. Raise your hand if you have ever thought the video was ridiculous and the examples it gave were so obvious that they were silly. Sexual harassment training can sometimes seem like harassment in and of itself, and it’s easy to feel like it is a waste of time. It is tempting to think sexual harassment is a problem that happens to other people in other places. Sadly, that is not the case. According to Medscape’s 2018 survey of 6,200 physicians, 7 percent of physicians have experienced some form of sexual harassment in the last three years.1 The number is even higher (11 percent) among nurses, nurse practitioners and physician assistants. If 7 percent sounds like a small minority of physicians, consider that this statistic means approximately 70,000 U.S. physicians have been harassed in their workplaces in the last three years alone. That is 4.75 times the population of the small town I live in—and that number does not include the 14 percent (or approximately 140,000) of physicians who witnessed an act of sexual harassment. Sexual harassment is happening in healthcare, despite the annual training videos, the news reports about sexual harassment in other industries and the generally increased national awareness of sexual harassment as a problem. As I talked with women in healthcare about this topic, I found that most have stories about being sexually harassed, with residency being a particularly vulnerable time. From “So, how’s your sex life?” from an attending across the operating table to “Are you pregnant? It looks like the booby fairy came!” from a male nurse on the ward, inappropriate comments are the most common type of sexual harassment experience these women report. But some women’s experiences extend to unwanted back rubs, requests for sex in call rooms, men publically viewing pornography in shared co-ed call rooms and even rape on hospital grounds. While some stories are years old, there are plenty of recent and current examples to support the data in Medscape’s study. And women are not the only victims of sexual harassment in healthcare. Recently, I came upon a conversation in which a group of women was looking at pictures of the male physicians and rating them on their looks. One doctor is often called “Dr. McDreamy,” both behind his back and to his face. And there is a quite a bit of discussion about staff members who have married male doctors, from “How did she manage to snag him?” to comments about wanting to “take lessons on marrying a doctor” from her. In addition, Medscape’s large survey shows that some male doctors are
sexually harassed by other male doctors or staff, with 23 percent of the male physicians who reported harassment reporting that the harasser was also male. Furthermore, in addition to the complex dynamics between colleagues, physicians can also be sexually harassed by patients. From lewd comments during a genital exam to being fondled by a patient while holding pressure on a bleeding femoral vessel, many physicians describe uncomfortable situations with patients.
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During team sign out in the evening, the male chief resident told me, ‘I brought a family pack of condoms and some movies. Let’s see what the night brings.’” —Female surgical resident Before we proceed with the specifics of the problem in healthcare, let’s agree on the basics. What is sexual harassment? The Equal Employment Opportunity Commission (EEOC) defines it as “unwelcome sexual advances, requests for sexual favors and other verbal or physical harassment of a sexual nature” and then specifies that, although “the law doesn’t prohibit simple teasing, offhand comments, or isolated incidents that are not very serious, harassment is illegal when it is so frequent or severe that it creates a hostile or offensive work environment or when it results in an adverse employment decision (such as the victim being fired or demoted).”2 Furthermore, according to Psychology Today, “sexual harassment can and does run the gamut from demeaning comments to requests for sexual favors to unwanted sexual advances. In addition, it doesn’t always but certainly can include sexual assault, which is any non-consensual or coerced sexual act, including sexual touching.”3 The stereotype of sexual harassment is a woman employee being harassed by a male superior, but both men and women can be perpetrators of sexual harassment, while the perpetrator does not have to be in a superior position to the victim. In fact, in Medscape’s recent survey, only 37 percent of victims of sexual harassment reported that their harasser was in a superior position to theirs. The remaining victims were harassed by a colleague in an inferior or equal position. Healthcare’s challenges in this area are not unique. Sexual harassment has become almost commonplace in the media over the last year. According to one website’s count, “219 celebrities, politicians, CEOs and others…have been accused of sexual misconduct since April 2017.”4 The #MeToo movement generated millions of social media posts in more than 85 countries, and TIME Magazine named “The Transformed Doctors ➤ Transforming the World www.cmda.org 11
Silence Breakers” (the voices of the #MeToo movement) their 2017 Person of the Year. As healthcare professionals and as Christians, we are marinating in a culture in which sexual harassment remains a backdrop to finding and keeping a good job and to climbing the ladder of success in one’s profession. One recent poll shows that 81 percent of women and 43 percent of men have experienced some form of sexual harassment in their lifetimes,5 while other polls show a figure closer to 20 percent.6 While this is a wide range, even 20 percent is an unacceptably high number of Americans having been harassed in their workplaces while simply trying to do their jobs.
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During my surgery rotation the attending I was assigned addressed me as ‘the little girl’ for the entire eight weeks. We were required to give a presentation to the entire department and the attending introduced me to give my talk as ‘the little girl.’” —Female medical student Most Americans would agree that individuals should be able to perform their job duties without fear of harassment. Yet some individuals harass. Why? It is possible they are simply tone deaf to the impact of their words and actions,
particularly if they came of age in a time when disparaging remarks toward others were more common. But it’s also possible certain psychological characteristics set them apart from the rest of the population. Dr. Ellen Hendrikson hypothesizes that harassers are narcissistic, manipulative, Machiavellian individuals who morally disengage from their actions in order to justify themselves and dehumanize their victims.3 Since a wide range of behaviors constitute sexual harassment, there is likely a wide variety of reasons why perpetrators harass, ranging from problematic lack of awareness to malignant destructiveness. The difficult thing about harassment is that the definition hinges on the effect of the behavior, not the intent of the behavior. So teasingly disparaging a colleague can have the same result as intentional insults if the impact on the victim is equivalent. Dr. Gregory Hood posits that issues “of sexual harassment are simultaneously extremely complex and yet profoundly straightforward. What may seem like flirting to one person may constitute sexual harassment to another.”7 Clearly, defining and recognizing sexual harassment is not an exact science. This is a complex interaction between multiple people from different backgrounds with different perspectives, and arguably there are times when the perpetrator of the harassment does not expect the words or actions to have a negative impact. In fact, in Medscape’s confidential, anonymous survey, very few doctors who were accused of sexual harassment agreed their behavior had crossed that line. But if the victim and the perpetrator do not agree that the behavior in question was harassment, how is this adjudicated? There are two critical factors in this equation: (1) the victim is believed and supported, and (2) the accused perpetrator receives due process. Unfortunately, healthcare does not have a shining legacy in either regard. Many victims’ stories end with no action being taken after they report their harasser. In fact, according to Medscape’s survey, less than one-quarter of events that were reported were officially investigated. The rationale for not launching an investigation ranges from minimizing the event to being concerned about the impact on the perpetrator’s career, but the end result is the same: the event is not investigated and everyone loses. On the other hand, even when incidents are officially investigated, the outcome is not always good. According to Med-
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scape’s survey, the perpetrator’s behavior can be trivialized (27 percent), the perpetrator can retaliate against the victim who reported the incident (16 percent), the organization’s management can retaliate against the victim (15 percent) or the organization can take no action (37 percent).1 Whether the incident is not investigated or the investigation does not result in appropriate action, the victim is left feeling violated and deprived of the opportunity to officially tell their story. The perpetrator is left with an unresolved accusation. If they are guilty of inappropriate behavior, they are not held accountable and may continue to offend, possibly in more serious ways. On the other hand, if they are not guilty of inappropriate behavior, the accusation hangs ominously in the air and the accused has no opportunity to defend himself. The institution is left with an unresolved issue between two of its personnel, which can cause a rancorous relationship and an undercurrent of concern or mistrust, as well as a breakdown of collegiality in other relationships. And, if the accused is guilty, the institution is left with a perpetrator whose behavior is unchanged and others in the institution will likely be affected. Presumably out of fear of these possible outcomes, many victims of sexual harassment do not even report the behavior to the institution in the first place. In fact, 60 percent of Medscape’s respondents stated they did not report their harasser at all. Power dynamics in the workplace appear to play a role in the decision to report, as medical residents were more likely (78 percent) than working physicians (55 percent) to keep silent and not confront or report the perpetrator. These silent victims often continue to work in what has become a very stressful work environment, with 36 percent stating the incident was “very upsetting” and 18 percent reporting the incident “interfered significantly” with their ability to do their job. More than 10 percent of victims reported actually quitting their jobs due to the harassment, and about onethird reported various coping mechanisms ranging from isolating themselves to food, sleep or alcohol/drug/tobacco use.1 In his blog post “Culture Quake,” pastor and author James Emery White wrote, “They wrestle with guilt. They wonder if they somehow asked for it. Could they have deflected it? Were they making a big deal out of nothing? And that brings about the darkest kind of shame there is. It’s the shame you feel for what was done to you. When you’re the victim, yet you feel the shame of how you were victimized. Instead of seeing the shame belonging to the perpetrators, you take it on as the victim.”8 Sexual harassment is not dead in healthcare. In fact, we have a long way to go. And sexual harassment is particularly
reproachful among a group of highly educated and gifted individuals who are held to a higher standard. Since the time of Hippocrates in the fourth century B.C., our profession has espoused a commitment to serving others with honor and compassion. Most of us recited the Hippocratic Oath when we graduated from medical school, stating: “Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free.” Given our undertaking to care for others as physicians, and given our promises to “help the sick” and “abstain from all wrong-doing and harm,” we are duty-bound to join the fight against sexual harassment in our own profession. As Dr. Hood wrote, “In the healthcare professions, we’re committed to being of service to others, to maintain a higher standard, and, above all else, to do no harm. There may be no greater abrogation of our responsibilities than to commit an infraction of a personal, sexual nature upon another person. Equally bad would be to witness another person engaging in such activity without taking appropriate action in response.”7 Furthermore, as Christian healthcare professionals, we are doubly committed to a higher standard. Sadly, the church has been in the news recently as much as any secular institution with regard to sexual wrongdoing. With two prominent evangelical pastors accused of sexually harassing multiple women and a huge cover-up of sexual misdeeds having been exposed in the Catholic church, American Christianity seems to have ceded the moral high ground in this area. And yet, we cannot deny that we are called to sexual purity as individual Christ-followers.
“
One attending nicknamed female students with fruit names based on their breast size.” —Female medical student More than 2,000 years ago, the apostle Paul cautioned that we “flee the evil desires of youth, and pursue righteousness, faith, love and peace, along with those who call on the Lord out of a pure heart” (2 Timothy 2:22). He also cautioned us to treat “...older women as mothers, and younger women as sisters, with absolute purity” (1 Timothy 5:2). Sexual misconduct is a long-standing problem for humanity. And yet, sexism and its expression have no place among God’s people. As Pastor White writes, “When God created mankind, He made us male and female. Men and women. And the Bible says that both were made, equally, in the image of God. There’s not more of the image of God in one than the other. And we have been given a mutual charge to Transformed Doctors ➤ Transforming the World www.cmda.org 13
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a discernment to know right from wrong, as well as a renewed commitment to follow a path of righteousness.
I have been grabbed repeatedly by a male nurse, even once my rear was forcibly grabbed and groped while treating a patient under anesthesia. When I made a complaint, nothing happened to him. They forced us to keep working together. It has been a demoralizing experience.” —Male attending BIBLIOGRAPHY
steward the world. Together. There is not an ounce of sexism in what God created, how God created, or the intent of God’s creation of us as men and women.” 9 Sexual harassment and misconduct is a difficult area to navigate. It is integrally interwoven with the history of healthcare, with our collegial relationships, with the politics of the organizations where we work and even with the reputation of the Christian church in the world today. And yet navigate it we must. We must hold ourselves apart from the behaviors that harass both men and women. We must confront those who engage in such behaviors in our workplaces. And we must “stand with the oppressed and assaulted and harassed and demeaned and disrespected no matter who the perpetrator may be.”9 Because we are healthcare professionals who have committed to caring for the well-being of others, and because we are Christians who are called to protect and defend the vulnerable. As caretakers, protectors and defenders, how should we respond to this difficult issue? If you have been guilty of sexual harassment, then I pray you will have the conviction and courage to seek forgiveness from God and those you have offended. If you have been guilty of turning a blind-eye to sexual harassment, then I pray God will give you eyes to see and the courage to respond. If you have ever been a victim of sexual harassment, I pray for healing, as well as for justice and protection in your workplace. And for all of us, may we have 14 TODAY'S CHRISTIAN DOCTOR Winter 2018
1 Leslie, K., MA. (2018, June 13). Sexual Harassment of Physicians: Report 2018. Retrieved September 01, 2018, from https://www.medscape.com/slideshow/sexual-harassment-of-physicians-6010304. 2 Sexual Harassment. (n.d.). Retrieved from https://www.eeoc.gov/ laws/types/sexual_harassment.cfm. 3 Hendrikson, E., PhD. (2017, November 9). Four Psychological Traits of Sexual Harassers. Retrieved September 01, 2018, from https:// www.psychologytoday.com/us/blog/how-be-yourself/201711/fourpsychological-traits-sexual-harassers. 4 North, A. (2017, December 22). More than 200 powerful people have been accused of sexual misconduct in the past year. Here’s a running list. Retrieved September 01, 2018, from https://www.vox. com/a/sexual-harassment-assault-allegations-list. 5 Kearl, H. (2018, February). 2018 Study on Sexual Harassment and Assault. Retrieved September 01, 2018, from http://www.stopstreetharassment.org/ resources/2018-national-sexual-abuse-report/. 6 Lee, H. (2017, December 19). One-fifth of American adults have experienced sexual harassment at work, CNBC survey says. Retrieved September 01, 2018, from https://www.cnbc.com/2017/12/19/one-fifth-of-americanadults-have-been-sexually-harassed-at-work.html. 7 Hood, G. A., MD. (2018, June 13). What We Can Do Together to Fight Sexual Harassment. Retrieved September 01, 2018, from https://www.medscape. com/viewarticle/897875?src=WNL_bom_180702_MSCPEDIT&uac=121128 EX&impID=1674167&faf=1. 8 White, J. E. (2018, February 8). Sexism. Retrieved September 01, 2018, from https://www.churchandculture.org/blog/2018/2/8/sexism. 9 White, J. E. (2018, February 5). Culture Quake. Retrieved September 01, 2018, from https://www.churchandculture.org/blog/2018/2/5/culture-quake.
AUTUMN DAWN GALBREATH, MD, MBA, is an internist in San Antonio, Texas, where she lives with her husband David, a restaurateur, and their three children. Autumn Dawn speaks to the issues of Christian marriage, being a working mother in the church and being a woman in medicine with an engaging humor that brings perspective to these difficult issues. She earned her MD from the University of Texas Medical School at San Antonio, where she also completed her internal medicine residency. She earned her MBA from Auburn University in Auburn, Alabama.
Honoring Past Leadership and New CEO Commissioning As we celebrate God’s faithfulness, we will also be celebrating the faithfulness of our leadership and looking ahead to the future. We invite you to join us as we honor Dr. David Stevens and Dr. Gene Rudd for their faithfulness to CMDA, as well as commission Dr. Mike Chupp, who will assume the role of CEO in September 2019.
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May 2-5, 2019
Ridgecrest Conference Center Ridgecrest, North Carolina Register online at www.cmda.org/nationalconvention
A SECOND DRUG WAVE IS COMING
MARIJUANA by James A. Avery, MD
I
love going to the beach and body-surfing the waves. When my kids were young, I always warned them about the second wave. The first wave knocks you silly, making you less aware of the arrival of the second wave.
The first drug wave was the opioid epidemic. In 2016, more Americans died from drug overdoses (67,000) than during the entirety of the Vietnam War (58,200).1 The second and more insidious wave is coming—it’s the marijuana wave. On April 11, 2018, Acreage Holdings, one of the largest marijuana corporations, announced John Boehner as its new spokesman. The Republican former Speaker of the House said in an interview, “Over the last 10 or 15 years, the American people’s attitudes have changed dramatically (towards the legalization of marijuana); I find myself in that same position.”2 Boehner is right. Sixty-four percent of Americans, including a majority of both Republicans and Democrats, want to legalize marijuana, according to an October 2018 Gallup survey.3 That’s the most since the pollster began asking the question in 1969. As of July 2018, 30 states, plus the District of Columbia, have legalized medical marijuana, while nine of those states (plus D.C.) also allow recreational marijuana.4 But does public opinion always reflect the truth of a situation? Is marijuana a beneficial medication? Is marijuana safe? Let’s dig deeper. MARIJUANA: A BOTANY LESSON Cannabis sativa is just a plant. Technically, it is an annual herbaceous flowering plant indigenous to Eastern Asia. It has been cultivated throughout recorded history and each part of the plant is harvested differently, depending on 16 TODAY'S CHRISTIAN DOCTOR Winter 2018
the purpose. The flowers (and to a lesser extent the leaves and stems) contain the psychoactive chemical compound, known as THC. As a drug it usually comes in the form of dried flower buds (marijuana), resin (hashish) or various extracts collectively known as hashish oil. Hemp, a variety of the Cannabis sativa plant species that has little THC and therefore no hallucinogenic properties, has proven to be valuable to mankind. It was one of the first plants to be spun into usable fiber 10,000 years ago, and it can be refined into a variety of commercial items including paper, textiles, clothing, biodegradable plastics, paint, insulation, biofuel, food and animal feed. MARIJUANA: A CHEMISTRY LESSON The two main cannabinoids, or active ingredients, in marijuana are tetrahydrocannabinol, also called THC, and cannabidiol, or CBD. THC is the “psychoactive” ingredient; it is what produces the euphoria or high that comes from marijuana. CBD is not psychoactive, but it does appear to have a mild anti-anxiety effect. Interestingly, CBD lessens the psychoactive effect and psychotic side effects of THC.5 There are many other cannabinoids and some of them may prove to be of value, but the two key cannabinoids we know the most about are THC and CBD. MARIJUANA: A HISTORY LESSON The natural levels of THC and CBD in a typical Cannabis plant were both under 1 percent until recently.6 Since CBD lessens the psychedelic effects of THC, some people speculate that marijuana in its original state was probably a relatively mild sedative or calming agent. This is based on records from India around 1000 to 2000 years BCE, when the Cannabis plant was celebrated as one of “five kingdoms of herbs ... which release us from anxiety” in one of the ancient Sanskrit Vedic poems.7
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However, the levels of THC in marijuana rose rapidly as investor money poured into improving the farming technology. Using powerful lights, selective breeding and special soils, the industry created a “new” marijuana. While the CBD stayed the same (under 1 percent), the average THC content in the new marijuana leaped to over 13 percent nationwide in 2015.8 And, in Colorado today, levels of THC are much higher as some plants push past 40 percent. That’s 10 to 30 times more potent than the marijuana of the 1960s and 1970s.9 Even in the Netherlands, where marijuana can be purchased in “coffee shops,” concern has grown about the potency. A Dutch government committee report in June 2011 recommended that Cannabis with more than 15 percent THC be labeled as a hard drug, putting it into the same category as heroin and LSD.10 MARIJUANA: IS IT A MEDICINE? The National Academies of Sciences, Engineering and Medicine recently called on the federal government to support better research, decrying the “lack of definitive evidence on using medical marijuana.”11 The U.S. still classifies marijuana as a Schedule 1 Drug, putting it into the same class as heroin. Underscoring the federal government’s position, U.S. Secretary of Health and Human Services Alex Azar recently said there was “no such thing as medical marijuana.”12 His point was this: there is not enough research or evidence to support the use of marijuana as a beneficial drug. Although some studies have been done, researchers lament that so little is known about how marijuana affects the human body and brain. It has not gone through the clinical trials all medications go through, and virtually no research has been done exploring potential adverse interactions with prescription and non-prescription medications.
MARIJUANA IN GENESIS In the beginning, God created Cannabis sativa and it was good. As Christians, we believe the story of Genesis that God created everything—man, cows and marijuana; it was all declared good (as written throughout Genesis 1). But the fall happened and man began using creation for selfish and sinful purposes. For example, fire is good. It keeps us warm at night, but many homes, businesses and lives have been lost to arson. Since the Bible tells us that humans were given dominion over all the earth and told to subdue it, our mandate is to use everything our Creator has given us to its fullest potential and greatest good—to God’s glory.
In other words, at this time, one would be hard pressed to consider marijuana as a legitimate “medicine” since it has not passed through the regular channels required for medicine in the U.S. POTENTIAL BENEFITS OR GOODS However, some solid studies show marijuana helps with the treatment of chemotherapy-induced nausea and vomiting, as well as appetite stimulation due to wasting diseases like AIDS. Because of these two indications, two drugs containing synthetic THC, dronabinol (Marinol) and nabilone (Cesamet), have been approved by the U.S. Food and Drug Administration (FDA). These are pharmaceutical-produced, quality-controlled and dose-specific medications. Curiously, they have not sold well. In June 2018, the FDA approved the first marijuana-derived drug, Epidiolex, for two rare forms of epilepsy. Unlike the synthetic medications, which contain THC, Epidiolex does not contain any THC. It is pharmaceutical-grade cannabidiol or CBD derived from the marijuana plant. The FDA considered many clinic studies before approving the medication. This approval should not be an endorsement of Transformed Doctors ➤ Transforming the World www.cmda.org 17
all CBD products, as most dispensary-grade CBD products are not well controlled or studied.13 In addition, there is another condition that is trending positively in studies: spasticity in multiple sclerosis. For other conditions, like pain, the evidence is weak. In chronic pain, only five out of 10 studies showed benefit from marijuana, and in neuropathic pain, only three out of six studies showed positive results.14 Finally, many other are conditions touted for medical marijuana, even though there is absolutely zero evidence. A good example is ALS. Despite multiple states including ALS on their list of approved illnesses for medical marijuana, there has been only one randomized clinical study and the results were unequivocally negative.15 Until proper studies are done, it would be beneficial for physicians to warn their patients about the marijuana hype. For instance, a study came out a few years ago showing that CBD (in doses 10,000 times of that found in the plant) reduced the size and growth of some brain tumors. You can guess the headlines: “Weed Cures Brain Cancer.”16
18 TODAY'S CHRISTIAN DOCTOR Winter 2018
A 2018 study in the Journal of Clinical Oncology found that 46 percent of cancer doctors say they’ve recently recommended medical marijuana to their patients, although 56 percent of them admitted they did not have sufficient knowledge to do so. This is irresponsible behavior by physicians who are kowtowing to their even less knowledgeable patients.17 RECREATIONAL MARIJUANA While marijuana as a medicine is clearly controversial, recreational marijuana is unequivocally problematic. Today’s culture has made it almost impossible to even talk about limiting its availability to adults. At the same time, advertising campaigns, conducted by powerful corporations and lobbyists, work to reduce the public’s perceived risk. Because of these lobbying efforts, many people view marijuana as a weak hallucinogenic or mild anti-anxiety drug. Some even see it as a safe natural substance that can even promote good health.18 One hospital in Pueblo, Colorado reported in July 2018 that nearly half the babies tested over a one-month period had marijuana in their systems. Vicky Houston, of Woodland Park, saw nothing wrong with using marijuana while pregnant. “I believe it’s beneficial, I
don’t think it’s toxic in any shape or form,” she told a local television newsperson.19 These claims can be easily refuted scientifically, but this false message is dominating the airways. RECREATIONAL MARIJUANA: A CHRISTIAN PERSPECTIVE It is my impression that most Christians base their opinions on marijuana in large part on their views regarding alcohol. So, let’s discuss the two dominant Christian perspectives on alcohol. Many Christians choose not to drink alcohol at all. They consider the harmful effects of alcohol on individuals and society—liver failure, divorce, physical and sexual violence, car accidents, etc.—and decide to abstain. This understandable position is strengthened by Romans 14:30, which calls on us to consider the effects of our actions on weaker brothers, and 1 Corinthians 6:12, which cautions us to not be mastered by anything. Clearly, teetotaling Christians could apply the same principles to recreational marijuana. Other Christians, however, choose to drink. They may like a glass of wine with dinner or a social drink at a party. Most in this camp will stress their awareness of alcohol’s dangers and acknowledge the biblical prohibitions against drunkenness. This is also an understandable position and is strengthened by Galatians 5:19-21, 1 Timothy 3:3 and Titus 1:7, which seem to permit alcohol as they only label drunkenness as sin. When Paul tells us “to not be drunk with wine,” he is not arguing against wine, he is arguing against drunkenness. Therefore, Christians who drink might think they can apply the same principle to marijuana: I will smoke a joint daily with dinner but I will avoid getting high. (I am assuming it is legal in their state as Christians do have an obligation to submit to government edits as directed in Romans 13). However, there are some serious problems with this position: 1. The moderate use of marijuana is rare. According to Dr. Kevin Hill, MD, an assistant professor of psychiatry at Harvard’s McLean Hospital and a marijuana expert, “Most people who use marijuana either use it rarely or regularly, with just a few in the middle. People either really like marijuana and use it very often or they are indifferent to it … This is different than alcohol, where the distribution of use is spread out fairly evenly, from rarely to daily to just about everything in between.”a 2. Getting high is the sole intent of marijuana. In other words, the thing we are forbidden by Scripture to do with alcohol is the only thing we can do with marijuana recreationally. It’s not like marijuana pairs well with beef. Therefore, in conclusion, I do not believe recreational marijuana has a place in the life of a believer. a
Hill, Kevin, Marijuana: The Unbiased Truth About the World’s Most Popular Weed, page 67, Hazelden Publishing.
Corporations, like Acreage, following the game plan of the tobacco companies are actively seeking profits by hiring big names like Boehner with apparently no thought to the long-term effects of what they are promoting and to whom. For instance, there are more marijuana dispensaries in Denver than Starbucks and McDonald’s combined, and most are located in low-income neighborhoods.20 As mentioned earlier, today’s marijuana is a potent, highly hallucinogenic drug, so recreational use is fraught with danger. Only a few credible studies have been done (and hardly any with THC above 15 percent), but they provoke concern about the new marijuana. The higher the THC concentration, the higher the likelihood of first episode psychosis and schizophrenia.21,22 Heavy marijuana use can damage brain development in youth ages 13 to 18. The 2015 Canadian Centre on Substance Abuse study confirmed the direct link between cannabis use and loss of concentration and memory, jumbled thinking and early onset paranoid psychosis.23 Dr. Phil Tibbo, one of the leaders in the medical field and initiator of Nova Scotia’s Weed Myths campaign targeting teens, has seen firsthand evidence of what heavy use can do as director of Nova Scotia’s Early Psychosis Program. His brain research shows that regular marijuana use leads to an increased risk of developing psychosis and schizophrenia, effectively exploding popular and rather blasé notions that marijuana is “harmless” to teens and “recreational use” is simply “fun and healthy.”24 Multiple researchers have all come to the same conclusion: the younger the brain, the worse the effects in both the short-term and long-term.25,26 Now, let’s look at some of the myths associated with marijuana: MYTH #1: MARIJUANA IS NOT ADDICTIVE. Substance addiction experts would not agree with such a statement: marijuana is definitely addictive. However, it is less addictive than other substances, but current studies (done with lower potency marijuana) estimate that one out every nine adults and one out of every six juveniles who use marijuana will, at some point, meet the DSM criteria for a substance use disorder.27,28 MYTH #2: NO ONE HAS EVER OVERDOSED ON MARIJUANA. While it is true that marijuana overdoses do not cause death, it can cause mental impairment and distressing emotional states, such as paranoia, hallucinations and psychosis. Overdoses can also cause arrhythmias, lethargy, clumsiness, dry mouth, dizziness and hypotension.29 Transformed Doctors ➤ Transforming the World www.cmda.org 19
MEDICAL MARIJUANA: A CHRISTIAN PERSPECTIVE What about medical marijuana? I believe Christians can explore the medical uses of the compounds in marijuana within established medical-legal bounds. As previously mentioned, our medical knowledge regarding marijuana is thin. Christians affected by diseases that may benefit from marijuana already have access to two marijuana-based prescription medications. As a hospice physician who has seen some of the worst cases of suffering, I can tell you unequivocally that we have more medications today than ever in the history of the world to reduce pain and suffering. Maybe marijuana will eventually fulfill its promise and help mankind as a medicine, or maybe its many uses as hemp are its greatest good. The jury is still out and wisdom dictates patience until some substantial studies come out.
MYTH #3: NO ONE HAS EVER DIED FROM MARIJUANA. Marijuana has and will kill people in the same way tobacco and alcohol have killed people. While people addicted to heroin decline visibly within a few years, people addicted to tobacco and alcohol don’t typically experience the negative effects for about 20 years. In a similar way, frequent users of marijuana will decline gradually, physically and emotionally. Lung diseases like chronic bronchitis and chronic obstructive pulmonary disease, schizophrenia, anxiety, depression and chronic apathy have all been reported in frequent users.30 Marijuana will cause fatal accidents. From 2010 to 2014, marijuana-related traffic deaths increased 92 percent in Colorado, while all traffic fatalities in the same period rose only 8 percent.31 In addition, marijuana deaths and injuries hit an all-time time in 2015 in Colorado as marijuana was named as the culprit in fatal fires, psychotic killings, explosions and suicides.32 MYTH #4: WE CAN PROTECT OUR YOUNG PEOPLE AND LIMIT MARIJUANA TO ADULTS. Surely our experience with cigarettes, alcohol and prescription drugs would tell us otherwise when it comes to teens; overall accessibility and availability lead to an increase in teen usage. And, in the May 2018 issue of Pediatrics, researchers disturbingly found that Cannabis use is on the rise among adults with children in the home.33 20 TODAY'S CHRISTIAN DOCTOR Winter 2018
CONCLUSION This second drug wave has the potential to devastate our country. As a physician, I worry that the next generation is going to grow up in a place where pervasive marijuana use is accepted and possibly encouraged. If that happens, we will be seeing the deleterious effects of marijuana on the brain and body play out in our offices, while society will see the harmful effects played out in our streets, schools, churches, neonatal units, hospitals and homes. BIBLIOGRAPHY 1h ttps://www.cdc.gov/drugoverdose/data/overdose.html 2h ttps://www.nytimes.com/2018/04/11/us/politics/boehner-cannabis-marijuana.html 3h ttp://news.gallup.com/poll/221018/record-high-support-legalizing-marijuana.aspx 4 http://www.ncsl.org/research/health/state-medical-marijuanalaws.aspx 5 National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017. 6 Cort, B, Weed Inc., Health Communications, Deerfield Beach, Florida, 2017. 7 “Marihuana: The First Twelve Thousand Years” (Springer, 1980). 8 Cort, B, Weed Inc., Health Communications, Deerfield Beach, Florida, 2017. 9h ttps://www.cnn.com/2013/08/09/health/weed-potency-levels/ index.html 10 https://universonline.nl/2011/06/27/garretsen-qualify-strong-cannabis-ashard-drugs 11 National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017. 12 h ttps://www.daytondailynews.com/news/local/such-thing-medical-marijuana-health-secretary-says-dayton/La8dTJgu6nF3ojSc1z6yPO/ 13 h ttps://jamanetwork.com/journals/jama/article-abstract/2661569. In this 2017 study published in JAMA researchers tested 84 products purchased from 31 different online CBD sellers. Roughly seven out of 10 items had different levels of CBD than what was written on the label. Of all of the items they tested, roughly half of the items had more CBD than was indicated; a quarter had less. And 18 of the samples tested positive for THC, despite it not being listed on the label. 14 Koppel BS, Brust JC, et al. “systemic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the Guideline Development Subcommittee of the American Academy of Neurology,” Neurology 82, no.17 (2014): 1556-63. 15 Weber B, Goldman B, et al. Tetrahydrocannabinol for cramps in ALS: a randomized, double-blind crossover trial,” Journal of Neurological Neurosurgery Psychiatry 81 (2010): 1135 – 40. 16 Here is an internet article that tries to appear more scientific than the headline I listed in the article: http://www.collective-evolution.com/2015/04/15/ the-us-finally-admits-cannabis-kills-cancer-cells/ 17 llana Braun, M.D., Boston; Andrew Epstein, M.D., et al. “Cancer Docs Seek More Study of Medical Marijuana,” Journal of Clinical Oncology, published online May 10, 2018. 18 h ttps://www.psychologytoday.com/us/blog/almost-addicted/201301/marijuana-is-all-natural-so-what-s-the-problem 19 h ttp://denver.cbslocal.com/2016/07/11/marijuana-pregnant-thc-positivebabies-colorado/
20 h ttps://www.coloradopotguide.com/colorado-marijuana-blog/2015/december/26/more-dispensaries-in-colorado-than-mcdonalds-starbuckscombined/ 21 h ttps://www.mdedge.com/psychiatry/article/97219/schizophrenia-otherpsychotic-disorders/high-thc-cannabis-use-tied-higher 22 American Friends of Tel Aviv University. (2017, April 26). Cannabis use in adolescence linked to schizophrenia: Psychoactive compound in cannabis may trigger the brain disorder, researchers say. ScienceDaily. www. sciencedaily.com/releases/2017/04/170426124305.html 23 R Douglas Fields. (2017, October 9) Link Between Adolescent Pot Smoking and Psychosis Strengthens: Research presented at a Berlin psychiatric conference show teenage cannabis use hastens onset of schizophrenia in vulnerable individuals. Scientific American. Retrieved January 4, 2018 from https://www.scientificamerican.com/article/link-betweenadolescent-pot-smoking-and-psychosis-strengthens/ 24 h ttp://www.ccdus.ca/Resource%20Library/CCSA-Effects-of-CannabisUse-during-Adolescence-Report-2015-en.pdf 25 Cookey J, Bernier D, Tibbo P. (2014) White matter changes in early phase psychosis and cannabis use: an update and systematic review of diffusion tensor imaging studies. Schizophrenia Research 2014 Jul; 156(23):137-42. 26 https://theconversation.com/marijuana-at-school-loss-of-concentrationrisk-of-psychosis-90374 27 Anthony JC, Warner LA, et al, “Comparative Epidemiology of Dependence on Tobacco, Alcohol, Controlled substances, and Inhalants: Basic Findings from the National Comorbidity Survey,” Experimental and Clinical Psychopharmacology 2, no.3 (1994): 244-68 28 Lopez-Quintero C, Perez de los Cobos J, et al, “Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis and cocaine: Results of the National Epidemiologic Survey on alcohol and Related Conditions (NESARC), “Drug and Alcohol Dependence, nos. 1-2, (May 2011): 120-130. 29 h ttps://drugabuse.com/library/marijuana-overdose/ 30 Volkow, ND, Baler, WM, et al, “Adverse Health Effects of Marijuana.” New England Journal of Medicine 370 (2014): 2219-27. 31 h ttps://www.denverpost.com/2017/08/25/colorado-marijuana-traffic-fatalities/ 32 h ttps://www.scribd.com/document/361299028/The-Legialization-of-Marijuana-in-Colorado-The-Impact-Volume-5-October-2017 33 Renee Goodwin, Keely Cheslack-Postava et al, “Cannabis use up among parents with children in the home”, Pediatrics, published on-line May 14, 2018.
JAMES A. AVERY, MD, is National Medical Director for Diversicare Healthcare and Visiting Assistant Professor of Medicine at the University of Virginia. Board certified in internal medicine, hospice and palliative and pulmonary medicine, Dr. Avery was awarded the Lillian B. Wald Award for his hospice and palliative care work in New York City and the Roger C. Bone Award for National Leadership in End-of-Life Care. Dr. Avery was named “One of the 50 Most Influential Physician Executives” by Modern Physician magazine. He serves as an elder at Trinity Presbyterian Church. Dr. Avery lives in Charlottesville, Virginia with his wife Jan. They have three children and one grandchild. His children’s book, How’s the Water, Girls? was published by Covenant Books in 2018 and is available online at Amazon and Barnes & Noble.
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1 HOUR NOW AVAILABLE We are now offering continuing education credits through Today’s Christian Doctor. One hour of self-instruction is available. To obtain continuing education credit, you must complete the online test and evaluation at https://www.surveymonkey. com/r/2018marijuana. • This CE activity is complimentary for CMDA members. • The fee for non-CMDA members is $50.00. For payment information, visit www.cmda.org/cepayment. If you have any questions, please contact CMDA’s Department of Continuing Education Office at ce@cmda.org.
Review Date: July 9, 2018 Original Release Date: November 28, 2018 Termination Date: November 28, 2021 EDUCATIONAL OBJECTIVES • Identify the benefits and risks of marijuana. • Discuss medical marijuana with colleagues. • Discuss medical marijuana with patients. • Cite journal articles on the subject of medical marijuana. ACCREDITATION The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PHYSICIAN CREDIT The Christian Medical & Dental Associations designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. DENTAL CREDIT CMDA is an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 1/1/2015 to 12/31/2018. Provider ID#218742. 1 Hour Self Instruction Available. No prior level of skill, knowledge, or experience is required (or suggested). DISCLOSURE None of these authors, planners or faculty have relevant financial relationships. James A. Avery, MD; David Stevens, MD, MA (Ethics); Mandi Mooney, CMDA Today’s Christian Doctor Editor; Michael O’Callaghan, DDS; Barbara Snapp, CE Administrator; and Sharon Whitmer, EdD, MFT CMDA CE Review Committee John Pierce, MD, Chair; Jeff Amstutz, DDS; Mike Chupp, MD; Lindsey Clarke, MD; Stan Cobb, DDS; Jon R. Ewig, DDS; Gary Goforth, MD; Elizabeth Heredia, MD; Curtis High, DDS; Bruce MacFadyen, MD; Dale Michels, MD; Shawn Morehead, MD; Michael O’Callaghan, DDS; David Stevens, MD (recused); and Richard Voet, MD THERE IS NO IN-KIND OR COMMERCIAL SUPPORT FOR THIS ACTIVITY.
Transformed Doctors ➤ Transforming the World www.cmda.org 21
at u t Burno by Stan Haegert, MD, MPH
I
had no idea what burnout was until it happened to me… twice…on two different continents. Actually, I knew what it was the second time, and I felt like I should have known better and seen it coming.
The first time I was serving in a small rural mission hospital near the edge of the Sahara Desert in West Africa, nearing the end of my second four-year term, and at the end of my wits. I was the only physician for around 30,000 people, and although other missionary and national staff supported me, I could not release myself from the feeling that I must always be available to others. I allowed myself very little time for rest or replenishment. The concept of Sabbath was unfamiliar to me. The results were predictable—I became cynical, irritable, withdrawn, physically ill and eventually “despaired even of life” (2 Corinthians 1:8b). This shouldn’t happen to believers, right? Shouldn’t our dedication and sense of calling prevent burnout? Actually, our dedication and sense of calling can set us up perfectly for burnout. James tells us, “Elijah was a man just like us” ( James 5:17a). Can any of us accuse Elijah of lack of calling or dedication? He faced down 850 false prophets, and he even had the guts to douse his offering with water three times before asking for fire from heaven. Yet, shortly after that victory, his life was threatened and panic seized him. He became the inventor of the ultramarathon, running well over 100 miles into the desert, leaving his servant behind before crawling under a broom tree and begging God to end his life. “I am no better than my ancestors” was his verdict on his life and ministry (1 22 TODAY'S CHRISTIAN DOCTOR Winter 2018
Kings 19:4). Exhaustion? Check. Depersonalization? Check. Reduced sense of effectiveness? Check. Burnout? Yep. Even though he was “called” and “dedicated.” OUR LIABILITIES Being a dedicated and called Christian healthcare professional carries with it certain liabilities. As we enter a patient’s room, we see an eternal soul with spiritual needs we long to engage. We have a Great Physician who almost always went beyond physical healing to address the whole person in His encounters during His time on earth. We value relationship and long to connect emotionally with our patients. These longings can lead to frustration as time constraints pressure us to “treat ‘em and street ‘em.” Positive values become part of our DNA as Christian healthcare professionals. However, these positive values may undergo malignant transformations as the patient numbers and pressures mount. We value truth, which may drive a need to fill all the checkboxes in an electronic health record. We value altruism (putting others’ needs first), which can mutate into a complete denial of mental, emotional and physical limitations, as well as a lack of attention to our own replenishment. We value accountability, but this can turn into constant availability. The drive for excellence (which is attainable) can subtly morph into a drive for perfection (which is unattainable). The false assumption that perfection is somehow attainable tempts us to believe we can control outcomes. So we label poor outcomes as “failures.” You see the problem, don’t you? Perfection is an attribute reserved for our Lord. Only God possesses all knowledge, is
the Broom Tree everywhere present, controls all outcomes and has no need for replenishment. We can only pretend to have these qualities, and we can drive ourselves crazy trying to be who we were never intended to be. If we’re not careful and thoughtful about our lives, the very qualities that make us compassionate, competent Christian healthcare professionals can render us liable to burnout when needs around us multiply. OUR ASSETS OK, so we have liabilities as Christian healthcare professionals. What do we have in the “assets” column? Well, we have Jesus…His example, His grace and His presence. Knowing Jesus may not protect you from burnout, but living like He did just might! HIS EXAMPLE Jesus, God the Son, did not independently use His attributes as God while He was on earth, but subjected them to the will of God the Father (Philippians 2). In His humanity, He limited His omnipresence and became focally present in a body. He was not invincible, and yet He did not succumb to Satan’s temptation to meet His physical needs supernaturally (Matthew 4:3-4). Instead, He took time to sleep and eat when He became tired or hungry. He did not run around frantically trying to meet all needs, but He limited His ministry to the confines of His Father’s will and entrusted outcomes to Him. Jesus often dismissed crowds—people whose needs were not yet met. He most often did so in order to rest and have
concentrated time with His Father. And when Jesus ascended to Heaven, there were still lots of sick people around, along with those who had not heard His message. And yet He could say to His Father in John 17:4, “I have brought you glory on earth by completing the work you gave me to do” (emphasis added). If the incarnate Word of God was given only a subset of the world’s needs to meet in His human body while on earth, surely you and I have permission to say “no” to some (perhaps most) of the needs we encounter! HIS GRACE In the 1960s, British psychiatrist Frank Lake noticed missionaries to India were quickly losing their joy, becoming cynical and burning out. He asked theologian friend Emil Brunner to look at the life of Jesus with him to discover why we do not see this happening to Christ. The result of their deliberations has come to be known as the “Cycle of Grace.” 1 The cycle begins with our acceptance by God and our identity rooted in Him. At His baptism, Jesus heard a voice from heaven saying, “This is my Son, whom I love; with him I am well pleased” (Matthew 3:17). At this point, Jesus had not even started His ministry. The basis for His acceptance by God the Father was not performance, but relationship, the communion He enjoyed with the Father and the Spirit from before the creation of the world. In the same way, our acceptance is based on our Lord’s choice and actions, not our own (Ephesians 1:4). Jesus’ acceptance by the Father sustained Him, and it gave Him the freedom to engage in sustaining activities such as Transformed Doctors ➤ Transforming the World www.cmda.org 23
I believe the “angel of the Lord” that got His knees dirty crawling under a shrub to touch His worn-out, despairing prophet was the Incarnate Son of God. The evidence? 1. Attributes of Deity seem to accompany this angel when He is mentioned in the Old Testament. 2. Jesus likes to touch people when He heals them in the gospels. Elijah’s angel chooses a gentle touch rather than standing beside the bush to shout him into wakefulness. 3. Jesus loves to make breakfast for people He wishes to restore ( John 21:9).
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CMDA’s Life & Leadership Coaching ministry has certified Christian coaches who are trained to coach Christian healthcare professionals. For more information about how they can help you address the specific challenges of burnout, visit www.cmda.org/coaching.
the cultivation of relationships and friendships, prayer, solitude, physical nourishment and Sabbath rest. His life was characterized by a rhythm of input and output, of work and rest, breathing out and breathing in. His significance and fruitfulness in obedient ministry flowed naturally from the nourishing fountain of the Father’s acceptance and sustenance. What happens if we get this reversed, trying to derive our significance, sustenance and acceptance from our accomplishments? As I was burning out in West Africa (and later in the U.S.) my diminishing ability to meet overwhelming needs, without boundaries or thought of rest, ate away at my sense of significance. “What if I can’t do this job any longer and can’t be known as a heroic missionary physician?” I wondered. Likewise, I didn’t feel I had time to engage in sustaining activities since I had to keep the “machinery” of my ministry going. I was trying to sustain myself on the accolades of those praising me for my performance. Ultimately, I secretly worried that such performance was the basis for maintaining God’s love. What if I turned out to be “no better than my ancestors?” HIS PRESENCE That’s pretty much where we left Elijah—the “man just like us.” After questioning his significance and begging God to take his life, Elijah curled up under his bush and fell asleep. That’s where Jesus found him. 24 TODAY'S CHRISTIAN DOCTOR Winter 2018
Our Great Physician and Wonderful Counselor doesn’t lecture Elijah, but rather He provides sleep and food. He then prescribes His presence, which shows up not in the wind, fire and earthquake but in the whispers to which Elijah hadn’t had time to listen. When the time is right, the Lord meets Elijah’s misconceptions with truth and then provides a new task for Elijah that is sized to Elijah’s new “normal.”
I have seen these actions of our Lord in my own recovery from burnout. I have learned to practice a Sabbath in order to remember that I’m human and to remind myself that someone else is in charge of the universe, which doesn’t fall apart when I rest. I am investing in my personal resilience through community, regular exercise and spiritual nourishment. I am learning to challenge lies that strive to pull me the wrong direction around the Cycle of Grace. I have modified my work life to be a better fit for my life stage. Most of all, I am trying to “practice the presence” of my Savior, picturing Him with me in ALL my moments, whether restful or challenging. SPEAKING INTO THE WELLNESS CONVERSATION CMDA wishes to speak into a gap in the burgeoning national and international conversation about burnout in the healthcare environment. Thus far, that conversation has primarily focused on maximizing workplace efficiencies, cultivating wellness-promoting environments and enhancing personal resilience. CMDA wishes to promote all of these efforts by articulating biblical foundations for them, as well as advocating a full-orbed approach to well-being that includes a recognition of the indispensability of spiritual well-being to resilience. Recognizing that the values that spring from our Christian heritage can become liabilities unless they are guided
by The Holy Spirit, and infused with the example, grace and presence of our Great Physician, CMDA is launching a Center for Well-being. This center intends to help Christian healthcare professionals face the challenges that may lead to burnout, ill health and decreased workplace satisfaction with biblical truth that holistically addresses all aspects of health—physical, mental, emotional and spiritual. We want to be a source of helpful resources, including a well-developed coaching ministry with certified physician-specific coaches. Plus, we will be nurturing relational connections and sponsoring retreats and conferences specifically designed to equip you to serve others with enduring joy. We encourage and invite YOU to join the conversation… especially if you feel like you’re no better than your ancestors! BIBLIOGRAPHY 1 Lake, Frank. 1966. “The Dynamic Cycle.” Clinical Theology: A Clinical and Psychiatric Basis to Clinical Pastoral Care, Vol. 1. Great Britain: Darton, Long-
man and Todd. Quoted by Karen Carr, “Personal Resilience,” in Schaefer, F. and Schaefer, C., eds. (2012). Trauma and Resilience: A Handbook. City unlabeled: Condeo Press. Pg.95ff. See also Hudson, Trevor and Haas, Jerry P. The Cycle of Grace: Living in Sacred Balance, 2012, Nashville: Upper Room Books.
STAN HAEGERT, MD, MPH, lives in Lafayette, Colorado with his wife Deb. They have two daughters, a son-in-law and two grandsons. After Stan’s medical training, the Haegerts served as medical missionaries in The Gambia, West Africa, over a 13-year period. Stan’s experience of burnout, recovery and return to the mission field has given him a passion to help others learn to care for themselves while serving others. In addition to practicing telemedicine and serving as Associate Director of CMDA’s Center for Well-being, he enjoys frequent opportunities to teach about wellness to healthcare personnel, missionaries and other groups. When not playing guitar, he is usually looking for a good game of chess.
InIn His Image is is a place ofof excellent training inin medicine, His Image a place excellent training medicine, spiritual care and leadership. residency, I learned spiritual care and leadership.During During residency, I learned how toto incorporate mymy Christian faith inin the practice how incorporate Christian faith the practice ofof medicine. gained competence and confidence medicine.I also I also gained competence and confidence with inpatient and outpatient procedures and learned with inpatient and outpatient procedures and learned obstetrics from IHIIHI family medicine faculty. obstetrics from family medicine faculty. Through unparalleled mentoring byby IHIIHI attending Through unparalleled mentoring attending physicians, I received leadership training and lifephysicians, I received leadership training and lifelong learning habits that enable me toto now serve inin aa long learning habits that enable me now serve teaching role. training atat IHIIHI gave me a firm teaching role.Residency Residency training gave me a firm foundation and launched me into a life ofof medicine and foundation and launched me into a life medicine and ministry. ministry.
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Living the
WORD by Patricia “Trish” Burgess, MD
26 TODAY'S CHRISTIAN DOCTOR Winter 2018
I
’ve heard people say, “The Scripture jumped off the page at me.” Or I’ve heard them say, “I’ve read that before, but this time it just ‘spoke’ to me.” Indeed, I have had the same experience as well. God often speaks to us through a phase in life or a particular circumstance along with His Word. And then sometimes we see the Bible come to life right before our very eyes! I was spiritually preparing for a challenging mission trip with CMDA’s Global Health Outreach (GHO) into an area of India that was rife with human trafficking. As part of my preparation for the trip, I began using a chronological Bible to read through the Bible in a year. I had attempted this before but somehow got lost somewhere between Leviticus and Numbers. This year I was determined because I knew I would need this for my upcoming trip. Some of the ancient laws in Leviticus did get me a little mad at God at times. They seemed particularly harsh toward women. They just did. And He and I had a discussion or three about that. I was able to give God my anger and trust Him more than I was able to understand these parts of Scriptures that were frustrating me. It wasn’t until I traveled to India that I realized God needed me to learn this lesson about trusting Him in order to be effective in His ministry in India.
When we arrived in India, we set up our clinic in a red tent along the streets of the city’s red light district. Trash, ginormous rats and human excrement thrown into the streets, along with the heat and stench, amidst the beautiful women in jewel colored gowns created quite an unforgettable sight. But even the sight and smells paled in comparison to meeting with these women. And men. Yes, men. We were taking care of the women in all their brokenness as well as the men, including pimps, customers and others. I had known we were going to do this before we left the U.S. In fact, it made me pause when I learned this detail about our trip during our preparations. We would be treating pimps with the love of Christ? I remember sitting back in my chair to contemplate this when God spoke to me quite clearly in four simple words: “I love him too.” My mind reading His Word knew this, but my heart still struggled. However, it no longer does, because now I know. He taught me this on the trip.
The women were easy to love, but restraining myself so as to not scare them was the challenge. I wanted to wrap my arms around them and insist God loved them. What I did was smile, touch them gently and let them know I truly cared about them. That is the amazing thing about being a healthcare professional. You get this immediate, intimate personal connection as you ask questions you normally wouldn’t dream of asking and touch areas they wouldn’t dream of letting someone else touch. They all were humble, embarrassed and full of shame. They knew what others thought of them. I saw nervous agitation as one woman told me she had to hurry because her “owner was waiting.” When in my “office,” they rarely looked up and almost never into my eyes. Most of them called their pimps their “husbands.” It took me a while to figure out they were talking about their pimps. And my heart wanted to hate these men, but God would not allow this. He had prepared me for this. I understood the men were even more broken than the women on some level. I kept up with my Bible readings during this mission trip and had my usual quiet time with my Lord. And as it happened, during our time in India I was in the middle of reading John 4 when Jesus talks with the woman at the well. Transformed Doctors ➤ Transforming the World www.cmda.org 27
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CMDA’s Global Health Outreach (GHO) is a short-term missions program that sends 40 to 50 medical, dental and surgical teams around the world each year to share the gospel and provide care to the poor. Sign up to travel on one of GHO’s short-term trips this year and join us in our efforts to transform the world. To find a trip that fits your schedule, visit www.cmda.org/gho.
“The woman answered and said, ‘I have no husband.’ Jesus said to her, ‘ You have correctly said, ‘I have no husband’; for you have had five husbands, and the one whom you now have is not your husband; this you have said truly’” ( John 4:17-18, NASB).
Christ-like behavior. Yet, “...they were saying to the woman, ‘It is no longer because of what you said that we believe, for we have heard for ourselves and know that this One is indeed the Savior of the world’” ( John 4:42, NASB).
Suddenly I was not reading my Bible, but I was actually living in the Bible. The women I was seeing were a modern-day representation of the woman at the well. We were ministering to the woman at the well along with Jesus. Two thousand years ago Jesus was tired and thirsty, so He sat down to rest and wait on this divine appointment. Along came this lonely woman to get water. She didn’t come walking with a group of friends enjoying the day. She came when she knew no one else would be there. She came humbled and ashamed. I can see her so clearly those 2,000 or so years ago. I suspect she didn’t look up at Jesus or make eye contact. She was probably startled when He spoke to her gently but honestly. I suspect these things because I feel like I know her. I met her in that red tent set up on the street in India. Suddenly something written more than 2,000 years ago came to life right before my very eyes during those two weeks I served in India.
Sometimes we serve or witness as though it all depends on us. God teaches us that we do not have to be perfect. Our efforts to show or teach others about Him are more dependent on His Holy Spirit than on us getting it exactly right. Indeed, on the mission field I frequently ask for His spirit to speak to the people I see in ways I cannot due to the language and cultural barriers. And God will use our brokenness, our mess-ups and our humility to reach people in His name. That is what is real. We are all broken on some level. We can be selfish and have a sin nature. If you stop to think about it, those quirks and imperfections in our friends and loved ones are the very things that endear them to us. Seeing this so clearly demonstrated in these women in India was what made me love them instantly and so deeply hurt to see the shame and self-condemnation in them.
I felt so completely humbled to be shown by my Almighty God that He lets us participate in His works. That can change our lives; change our perspective on sharing His love. And He revealed to me that we do not have to feel insufficient when we are being obedient to His call to spread the good news of God around the world. He shows us this in John 4:29 when the woman at the well goes back to town after speaking with Jesus: “Come, see a man who told me all the things that I have done; this is not the Christ, is it?” (NASB). Far from eloquent, she didn’t even remember to use the ABCs of becoming a Christian (admit, believe, confess)! She didn’t say the prefect prayer. And she certainly didn’t model the perfect 28 TODAY'S CHRISTIAN DOCTOR Winter 2018
I actually enjoyed being able to care for the men as well. Again, I knew Jesus loved them. The Bible tells me so! Were they Satan personified? It didn’t seem so to me, perhaps because they were there and showed me vulnerability, even if it was a physical ailment. They were indeed broken men with a sin nature. I shuddered to think of what they had been through in their lives to allow them to behave and treat women the way they did. It is easy to judge, but I fortunately have not had to walk a mile in their shoes. I have looked in their eyes and I did not see hope. None. And in all the thoughts and prayers for trafficked women, I wonder how many have been said for these men controlling them? Could it be if we joined together in prayer for them, as well as for the women, that God’s Holy Spirit can change their hearts?
That first day of our clinic, stepping off the bus into the heat and smells and sights, my first thought was, “Jesus is here!” And He indeed showed me a lot and taught me what I would need to learn for the work He had planned for me.
say it right. We just have to be willing to share and let His Spirit speak through us. Are you willing?
Before leaving the red light district, I was able to go into a brothel to further experience what these women live through every day. There was a calendar, but no pictures were hanging on the wall. No decorations or furniture, save for a bed designed like a stiff trampoline. So I sat on this bed with a young lady trafficked from Nepal to India. When the chance presented itself to share the gospel message with her, I suddenly felt so humbled to be “the one.” I was the one who got to share such a life-changing message as this? I felt a quickening in my spirit and felt so anxious for her to believe, to accept His love for eternity. I imperfectly shared the gospel message of Jesus Christ.
PATRICIA “TRISH” BURGESS, MD, joined CMDA as the new Global Health Outreach Director in 2018. Trish went to the University of Georgia for her undergraduate degree where she met her husband. She took two years off before attending medical school and worked as a firefighter in Athens, Georgia during this time. She attended the Medical College of Georgia and did her residency in emergency medicine at the University of Missouri in Kansas City. Dr. Burgess felt the call to shortterm missions early in her career. Her first mission trip was to Nicaragua. During this trip, she felt Him clearly telling her this was the reason He had created her, and His plans for her included continuing with short-term medical missions and leading teams. With GHO, Trish has also traveled to Cambodia, the Dominican Republic, El Salvador, Ethiopia, India, Kenya, Nicaragua, Moldova, Peru and Zambia.
The woman at the well in John 4 has meant so much to me since returning home from that trip to India. She proves that we don’t have to say it all, and we don’t even have to
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DISCIPLE MAKING MEDICINE by David S. Wilson, MD
“W
e just need someone to help us find our way,” the patient’s wife pleaded as she sat at the head of the table in our procedure room nearly four years ago. She was facing away from the surgical field where I was working meticulously on her husband to suture the vas deferens together using microsurgery under the Zeiss surgical microscope hanging above the table. I was struck by the wife’s unusual statement, as she had said the same thing at least once before during our conversation.
My patient and his wife had traveled halfway around the country from the East Coast to The Reversal Clinic in Oklahoma because they were certain they should have another child after his vasectomy. After reading descriptions in chat groups and blogs, as well as some testimonies on the website about the spiritual side of the practice, they scheduled an appointment online and flew out to Oklahoma. They gladly agreed to the offer to pray after the preoperative discussion. While the husband and I prepared for the procedure, he shared how he was reading through the Bible and had finished the first few books. I later learned they had explored some other religions without finding hope or 30 TODAY'S CHRISTIAN DOCTOR Winter 2018
peace before he began reading the Scriptures in earnest a few months before. Because the vasectomy reversal surgery is conducted under local anesthesia, we were able to converse throughout the procedure and he enthusiastically peppered me with question after question, mainly centered on Bible passages. It was obvious he was searching for the truth, since he had well-developed questions about meaning and details. I responded with the Scriptures, always looking for the opportunity to describe the beauty of our Savior and His ability to forgive sin. I told them both that the way to God is a Person and pointed them to the One who died
a study with a believer and together they had been reading weekly in Genesis, but it wasn’t long before that fell apart for a variety of reasons. When I heard the study had ended, I sent up a quick prayer and asked him if he wanted to study weekly by Skype or phone call. To my surprise, he responded, “Yes, that would be great!” I had studied the Scriptures with a number of patients and their families over the years, but never “long distance.” Over the next few months, both my patient and his wife received Christ. And during one of our study sessions, I heard the great news that they were expecting. We asked many of our friends to pray because her last two children had been premature (both children did well after long battles in the PICU). Nine months later, the Lord granted them a fullterm, healthy daughter. Soon after accepting Christ, the couple led their three older children to the Lord. They have joy and increasing peace in the home, and now they are sharing Christ with their friends and extended family.
Our experience with this family broadened my understanding of what the Lord can do in the lives of the patients who travel to my practice. And I pondered this again after reading David Watson and Paul Watson’s book Contagious Disciple Making, in which they describe a biblical strategy for disciple making that I now apply to our practice ministry.
for their sin at the cross and rose again, the One who is mighty to save. The time in surgery passed very quickly. After the postoperative discussion, I gave them a variety of resources to take home, as well as offered to introduce them to a friend of mine in the Northeast who could connect them with other believers for Bible study. They were very excited about that possibility and asked me to share their contact information with my friend. They left the office hopeful for a new life. Fast-forward a few weeks, and I called to check on how things were going. My patient told me how they had started
My daughter gave the book to me after hearing a missionary friend recommend it while speaking at a seminar. He described the disciple making strategy in this way, “Our greatest need is for our own lives to be pleasing to the Lord and to be obedient disciples. We ask that we be led to the persons God has prepared beforehand, we call them ‘persons of peace.’ These people are open, hungry and willing to share with their family and friends. Our next ‘goal’ is to invite them to begin a ‘discovery group’ and encourage them to invite their family or friends. We pray that they will come to know God as they read, beginning with creation and moving on through to the life of the Lord Jesus. It is a slow process, that challenges our faith and keeps us praying and believing that the Holy Spirit is working in their lives.” Other experienced disciple makers observe that the person of peace (Luke 10:1-9) will sometimes come to you instead of you searching for him. This occurs when others notice a life of obvious genuine spirituality. They also point out that when the Lord Jesus spoke the Great Commission to the 11 disciples on the mountain (Matthew 28:18-20), He told them to teach their disciples to observe or obey all things Transformed Doctors ➤ Transforming the World www.cmda.org 31
He had commanded them. “All things” includes teaching them to make disciples. So, we should begin with the end in mind. This partly entails making disciples who can themselves make disciples, sometimes referred to as reproducing disciples. As I reflected on my experience with this patient and his family, I began seeing that I was likely missing spiritual and disciple making opportunities with patients and couples coming through the practice. I determined to intently explore what God may be doing in every patient’s life. I started praying for every patient by name before each one’s appointment. All my patient appointments last about two and a half hours. I begin with casual, simple conversation during the appointment by, for example, asking about their trip, work or family. If they are open to casual conversation, I then move to meaningful, more serious conversation if the patient allows. These topics would include their passions, struggles, dreams, goals and purpose. If they open the door to meaningful conversation, then I have opportunity to speak of spiritual things in a natural way. If they don’t respond to my thoughtful “spiritual snack,” then the conversation can naturally move along as it was before, with no offense taken. A few months ago, a patient was talking about the struggles of his schedule with his wife working day shift and himself working night shift. I told him I had not gone through that exact situation, but at times during residency, I was often sleep deprived and basically did not see my wife much for stretches of time because of being on call and then sleeping the next day. The only way we made it through that difficult time was by leaning on the Lord. He did not respond to the comment or ask any questions. That was a “no thank you” to my spiritual snack, and the conversation went no further in spiritual matters. We returned to the level he was comfortable with as the appointment continued. 32 TODAY'S CHRISTIAN DOCTOR Winter 2018
Through these experiences, I have learned that only God can open the doors to my patients’ hearts. As it says in John 6, “No one can come to Me unless the Father who sent Me draws Him...Everyone who has heard and learned from the Father, comes to Me” ( John 6:44-45, NASB). Another way to gauge spiritual openness or hunger is to tell a story from the Bible or your life that manifests God, and then follow it up with a related question such as, “Do you think God is still able to guide us like that?” If the patient does respond positively to a mention of God or His work in Scripture or my life, I usually invite them at the end of their appointment to continue the conversation by email. If they are eager to do that, then I send email content centered around a felt need expressed during their appointment or a question in their mind. Retelling of a Jesus story on voice memo attachment to the email has been effective for the Holy Spirit’s working in lives. At some point, I offer to show them how they and their family can discover God or learn what God says about life through the Scriptures.
Traditionally discovery groups are face to face, but I am using Skype or phone for weekly discovery groups with out-of-town patients. If you have multiple patient encounters of shorter length in your local practice, the relationship and conversations may develop over time and, God willing, you will be able to have the typical face-to-face discovery groups. We have yet to see someone who received Christ through a discovery group then begin another discovery group with their friends or family, but our earnest desire is to see a second generation. Paul in 2 Timothy 2:2 describes four generations. This key level of reproducibility (four generations) is incorporated in most definitions of Disciple Making Movements (DMM), a term describing a goal for those using these disciple making principles.
DAVID AND FRAN WILSON live on a farm near Fort Gibson, Oklahoma. They have four grown children (two married to amazing spouses) and one very happy 2-year-old grandson. They have considered themselves missionaries to Oklahoma since moving to the area 23 years ago. A simple church meets in their home. David had to close his 10-year-old general surgery solo practice in 2005 after the decision to stop provider agreements with all private insurance and government payers due to his conscience regarding receiving payment from entities who provide compensation for elective abortion. The Lord redirected him to vasectomy reversal surgery, and the Reversal Clinic was established which, by God’s grace, is becoming a medical access ministry to make disciples who can make disciples who can make disciples. For more information or to be added to the clinic’s prayer update list, please contact drdavid@thereversalclinic.com.
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We believe prayer is one of the key components to seeing disciples come to Christ, grow in their faith and make reproducing disciples (Luke 5:16, Acts 1:14). We can do nothing without Him. We are excited about what God is doing and are developing a practice ministry plan in order to be intentional in our clinic encounters as well as our contact before and after their appointments. We would be delighted if the disciple making needs outside the practice become too great for the physicians. In that event, we will need wisdom as we consider hiring a chaplain or other possibilities for help outside the practice.
some of your patients and their families make disciples as our Lord commanded.
Do you have a practice ministry plan? Or have you seen the Lord work in similar ways in your practice with your patients and their families? Healthcare provides us countless opportunities for ministry, particularly in making and reproducing disciples. If you haven’t already, I encourage you to start bringing this important aspect of ministry to your practice. And I pray you will have the joy of seeing
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GENERAL Affiliate Needed — Protect life and bring joy into the lives of couples unable to carry a pregnancy to full term. The National Embryo Donation Center (NEDC) has reached maximum capacity and needs an affiliate who shares the same Christian worldview and can provide the full range of services currently offered at the NEDC. More than 760 children have been born through embryo adoption at the NEDC since it was founded in 2003, and the program has garnered an outstanding reputation with a success rate above the national norm. Affiliate physician must be a reproductive endocrinologist (REI) who is board certified/board eligible. Contact Dr. Jeff Keenan at 865-7770088 or email jkeenan@baby4me.net. Go to www.embryodonation.org.
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Pediatrician — BE/BC pediatrician needed for busy practice in Southeast Mississippi. Hattiesburg Clinic, one of the largest physician-owned and directed multi-specialty groups in the Southeast, is seeking a Christian, family-oriented, BE/BC pediatrician with a desire to join a well-established pediatric practice with 10 physicians. We are an outpatient clinic with inpatient care consisting of well newborn and general pediatric rounding while on call, which is currently 1:8. Deliveries are attended by neonatology staff, and triage nurses manage after hours patient calls. Excellent compensation and benefits package offered. For more information, contact Glenda Sharp, Physician Recruiter, at 601579-5008 or 601-606-5941, or via email at glenda.sharp@hattiesburgclinic.com.
34 TODAY'S CHRISTIAN DOCTOR Winter 2018
Psychiatrist — Washington, D.C. suburbs. Multi-specialty private practice - outpatient - fee for service. Full-time or part-time. Partnership opportunities available. Email donhallmd@aol.com. Reproductive Endocrinologist — Southeastern Center for Fertility and Reproductive Surgery (SCFRS) in Knoxville, Tennessee has an opportunity for a reproductive endocrinologist to join our dynamic practice. We also share a building and coordinate some operations with the Na-
Augustine College Summer Conference 2019 June 9-15, 2019 Ottawa, Canada The Roots of Medicine: Peril and Promise in Early Modern Thought Come listen and interact with John Patrick, John Robson, Graeme Hunter, Dominic Manganiello and others. What was gained over the centuries, and at what cost? How do we regain what we lost? For information, visit https://www.augustinecollege.org/ summer-conference-2019
tional Embryo Donation Center (NEDC). The NEDC is a non-profit organization whose mission is to protect the lives and dignity of human embryos by promoting, facilitating and educating about embryo donation and adoption. It is critical that the physician who joins the practice be philosophically aligned with the NEDC mission and values. We are offering a very competitive salary and benefits, which will be negotiable and commensurate with experience. SCFRS is located at the foothills of the Great Smoky Mountains National Park. The area’s natural beauty, recreational opportunities, high-quality schools, low cost of living and low crime rate make Knoxville a very desirable place to live, raise a family and work. Interested? Contact Dr. Jeff Keenan at 865-777-0088 or email jkeenan@baby4me.net.
MEDICINES FOR MISSIONS
Family Practice / Internal Medicine — Board certified/board eligible DO with an opportunity to join a thriving, well established faith-based family practice in Monterey, California. Outpatient based with strong ties to the local hospital. Substantial financial incentive package, including moving fees. The practice encompasses primary/ preventive care management, osteopathic manipulation, outpatient surgery, nutritional medicine, gynecology, pediatrics, reversal of chronic CV disease using a medically controlled ketogenic diet. Productivity-based salary. All insurances are taken. If interested contact Gerard Issvoran, DO, at 831 3332100 or send CV to Issvoran@mbcih.com
Pediatrician — Seeking a pediatrician for a group practice in Montgomery, Alabama. A busy general pediatrics group of four doctors looking for a full-time pediatrician to replace a retiring physician in Montgomery, Alabama. Four-day work week, attractive call, three hours from the beaches and solid patient base. Practice was established 37 years ago. All pediatricians are believers and are seeking a like-minded partner. Contact Den Trumbull at TrumbullD3@gmail.com or 334-273-9700.
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CMDA PLACEMENT SERVICES
BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other healthcare professionals and practices. We have an established network consisting of hundreds of opportunities in various specialties. You will benefit from our experience and guidance. Every placement carries its own set of challenges. We want to get to know you on a personal basis to help find the perfect fit for you and your practice.
“Our practice has a long history with CMDA. One of the partners in our practice was presented to us over 20 years ago by CMDA. Since we are a faith-based practice, we are looking for healthcare professionals with the same vision we have. The recruiters at CMDA have taken the time to understand our mission/vision and have worked with us to recruit Christian physicians and mid-levels for over 20 years. It has been my pleasure to work with various employees and recruiters with CMDA. In my position, I have had the opportunity to work with various recruiting agencies through the years, and CMDA has been and still is one of our most preferred agencies.” —Donna J. Warner Human Resources Manager Family Medical Center of Rocky Mount
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