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Editorial
by David Stevens, MD, MA (Ethics) – Chief Executive Officer
Good Tools – Good Results Who would have thought sucking on a small dry seed while playing could have such a devastating effect? As children often do, this young Kenyan boy fell down while playing tag with his siblings and scraped his knee. The bean dislodged from his cheek and fell into his hypopharynx. It was then sucked into his lung as he took a big breath to cry. His parents had done the right thing by bringing him to the hospital, but we didn’t have a bronchoscope small enough to get down his small airway to dislodge the swollen and impacted obstruction in his right lung. Without removal, the child would go from pneumonia, to lung abscess, to sepsis and likely death. One of the greatest frustrations for this fledgling missionary doctor was to have the skills and experience to save a patient’s life, yet lack the equipment needed to do it. You learn to improvise around some problems (Did you know you can sterilize a pair of Sears bolt cutters to cut through the hardened steel of a barbed arrow head that has skewered the colon to the kidney and then buried itself in the spine?) but many problems are unsolvable without the right tool. The same is true for you as you share your faith, minister to patients, struggle with an ethical issue, or endeavor to stay close to God in the midst of your hectic life. You need the right tools to be successful. That is why CMDA includes “equipping” in its statement of purpose: The mission of the Christian Medical & Dental Associations is to motivate, train and equip Christian doctors to glorify God. The doctors that lead CMDA know how busy your life is, but they also know that you can incredibly leverage your influence if the right tools are in your hand. If the lever were long enough, you could move the world. But you don’t have time to screen the right books to
recommend to your patients. You don’t have enough margin to prepare a PowerPoint on short notice to speak on an ethical topic. You need good information to help you learn how to better manage your practice, lead your family, and share your faith. You want a convenient way to keep up with health care policy on one hand and to go on a short-term mission trip on the other. That is why CMDA spends so much of its time and efforts creating and putting good tools and services into your hands. They not only make your job easier, they enable you to do what you otherwise couldn’t do. Need a Christian partner? We have a service to help you find one. Need resources on malpractice? We will put then into your hands with the bonus of a trained doctor to counsel you. Want to know how to organize a mission hospital and manage its staff? The Center for Medical Missions’ e-Pistle covers that topic every month. Struggling with an illness, family problem, or difficult practice situation? We will pray for you regularly and corporately that God will equip you with wisdom, strength, and the courage you need. Trying to speak up on an important issue in your community or state? We will train you in how to write letters to the editor, do radio and TV shows, and let your voice be heard. Equipping you with the right tools so you can be effective in glorifying God is so important that we have made it one of four key result areas in our strategic plan – Transformation, Service, Equipping, and Voice. That is why this issue of TCD is dedicated to this important topic. Some articles will equip you. Some will inspire. Others will let you know how to get the resources you need. Our goal is to put the levers in your hand to help you move your world for the glory of God. Read on and find out how. ✝
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table of
CONTENTS
V OLUME 3 9 , N O. 2
Summer 2008
The Christian Medical & Dental Associations®–Changing Hearts in Healthcare–since 1931.
Features
14 CMDA’s Fight for Physician’s Conscience Rights by Jonathan Imbody, MA An update from your Washington Office
16 Equipped to Serve
Changed Doctors Changing Our World – Four Examples
Church Planters with MD Degrees by John Yoon, MD
The “Saline Solution” Opened My Eyes by William T. Griffin, DDS
“Completing Your Call” – a Life-Changing Experience by William Poston, MD
How the Lord Made “Plan B” my “Plan A”
24 Standing Orders for the Christian Medical Student by Karl Benzio, MD
by Ronald L. Machado, MD How to Keep Your Faith Vibrant in Training
27 Gospel Debt
by Harry Kraus, MD Adapted from Breathing Grace: What You Need More Than Your Next Breath
30 Pregnant with Thyrotoxicosis – Ethical Options Fourth in our Bioethics Series by Christian Vercler, MD
Cover photo by John Bray, CMDA Digital Media Center
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Progress Notes Advertising Section
Editor: David B. Biebel, DMin Editorial Committee: Gregg Albers, MD, Elizabeth Buchinsky, MD, John Crouch, MD, William C. Forbes, DDS, Curtis E. Harris, MD, JD, Rebecca Klint-Townsend, MD, Bruce MacFadyen, MD, Samuel E. Molind, DMD, Robert D. Orr, MD, Richard A. Swenson, MD Vice President for Communications: Margie Shealy Classified Ad Sales: Margie Shealy 423-844-1000 Display Ad Sales: Margie Shealy 423-844-1000 Design & 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, Summer 2008 Volume XXXIX, No. 2. 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© 2008, Christian Medical & Dental Associations ®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (U.S.) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tenn. Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Scripture references marked (NASB) are taken from the New American Standard Bible. Copyright© 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977 by the Lockman Foundation. Used by permission. Scripture references marked (KJV) are taken from King James Version. Scripture references marked Living Bible are from The Living Bible© 1971, Tyndale House Publishers. All rights reserved. Undesignated biblical references are from the Holy Bible, New International Version®. Copyright© 1973, 1978, 1984 by the International Bible Society. Used by permission. All rights reserved. Other versions used are noted in the text.
For membership information, contact the Christian Medical & Dental Associations at: PO Box 7500, Bristol, TN 37621-7500; Telephone: 423-844-1000, or toll -free, 1-888-230-2637; Fax: 423-844-1005; E-mail: memberservices@cmda.org; Website: http://www.joincmda.org. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product, or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice, or instruction.
Tenth National Conference: “Basking in the Son” The tenth WIMD national conference will be held September 25-28, 2008, in San Diego. Featured speakers include: • Nahid Hotchkiss, MA, PhD – a counselor and mentor for physicians, with an emphasis on women in medicine. Nahid has been married to John Hotchkiss, MD, for 31 years. They have led medical couple’s relationship/parenting groups for medical students and graduates for over twenty years. Women’s Bible studies and physician accountability groups are also part of their ministry. Nahid’s plenary will address: The Hidden Weaknesses of Strong Women. • Carol Spears, MD – a board certified General Surgeon who serves at Tenwek Hospital in Bomet, Kenya as a career missionary surgeon. Dr. Spears’ non-traditional journey to medicine started over fifteen years ago, when she left a successful career in the telecommunications industry due to a lifechanging vacation in Africa, when she felt God’s call to a career in medicine. Her testimony of faith through a dark time in Kenya testifies to God’s power and faithfulness. Carol’s plenary will address: Reflecting God’s Glory. • Gene Rudd, MD – serves as Senior Vice President of CMDA, with responsibility for overseeing its operations. He trained and served in the military as an OB/Gyn before entering private practice in an underserved area of North Carolina. Before joining the administration of CMDA in 1995, he served at Samaritan’s Purse and led work in Russia, Bosnia, and Rwanda. Gene’s plenary will address: Healthcare without Conscience, Unconscionable. For more information about the conference, including registration details, visit: www.cmda.org/wimd/conference.
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Dentist Ministry Revival CMDA loves dentists! Recognizing the necessity of developing better resources and ministry for our dental members and students, CMDA recently held a phone conference with CMDA dental leaders. With the purpose of exploring ways that CMDA might add ministry resources specific for dentists to the present efforts at CMDA, the conference attendees settled on a two-fold purpose for these new resources: to better help dentists live authentically as Christians, and to present a substantive dental ministry that will be more inviting to possible new dental members. From that phone conference, the following 10 step plan was formulated (some now accomplished): 1. Establish a Dental Leadership Team under the administrative oversight of Campus and Community Ministries consisting of the following: Will Gunnels, MDiv, Louisiana, Administrative Director David Campbell, DDS, California, Co-director, Dental Leadership Team Van Haywood, DMD, Georgia, Co-director, Dental Leadership Team John Gillan, DDS, Arizona William T. Griffin, DDS, Virginia George Kuryllo, DDS, New Jersey Alex McCulloch, DDS, New Hampshire Neal Smith, DDS, Ohio Dale Willis, DDS, Tennessee. 2. Explore possibilities of CMDA dinner meetings at dental conferences. 3. Explore possibilities of CMDA prayer breakfast meetings at dental conferences. 4. Identify CMDA resources that are appropriate to dentists, and increase visibility. 5. Increase other dental resources’ visibility and availability. 6. Plan to generate a monthly ethics article or newsletter, using materials from faculty who teach ethics. Dr. Stan Cobb at Baylor and Dr. Alphee Bouffard at MCG have both agreed to write. 7. Further develop the Christian Dental Association home page (part of the CMDA website) with appropriate e-mail addresses and search options. CMDA is re-organizing the categories for dentists to align with ADA titles, and has created an e-mail address: dental@cmda.org, as well as home page addresses for: www.cmda.org/dentist and www.christiandentalassociation.org. 8
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Jean Arthur (left) and Mary Kirkpatrick staff the dental booth
8. Develop an e-mail base for dentists and an e-community for contact. 9. Develop the CMDA booth with a CDA focus at dental meetings, strategically use booths for visibility, and to connect visitors to prayer breakfasts and dinner meetings. 10. Develop “dental specific” devotionals and practice tidbits for e-mail distribution and audio sharing. Already CMDA has a weekly e-mail devotional for both dentists and physicians that can be subscribed to online. This list only highlights the major areas that are currently in process. There were many other ideas shared. Plans for events will be made known as they become more formalized. The “take-home message” is that God is working in CMDA for dentists, and dentists need to “be aware” so they can be “ready to share” His blessings in their lives and with their colleagues. Please be in prayer as to how you might be used in your area of expertise or geographic location to further the kingdom through CMDA. All for Christ, Dr. Van Haywood Dr. David Campbell Co-Chairs CMDA Dental Leadership Team If you would like to be involved in moving our dental initiative forward, please contact: Will Gunnels, MDiv - Southeast Regional Director 106 Fern Drive - Covington, LA 70433 Cell: 985-502-4645; E-mail: wdgunnels@charter.net
Washington Office Update The CMA Washington Office worked with Senator Jim Bunning of Kentucky on legislation to provide tax credits to families who adopt children. CMA wrote and circulated a letter of support for the legislation, signed by other national groups. In March 2008, Senator Bunning along with Senators Jim DeMint (SC) and Ben Nelson (NE) introduced an amendment to the Budget Resolution to make certain adoption incentives permanent in the Adoption Tax Relief Guarantee legislation. The Senate agreed to the amendment by Unanimous Consent, and Senator Bunning expressed his appreciation for CMA’s leadership.
Prescribe-A-Resource® is now on the Web! Prescribe-A-Resource® is still a FREE, easy-to-use tool that lets you prescribe Christian resources for your patients – without exhausting your own library! Simply log on to www.cmda.org/par and follow the simple instructions. You can bookmark the catalog on your Web browser or print it out, whichever is easier and more convenient for you. The catalog begins with a topical list to make finding the appropriate book convenient. There is a patient prescription flyer that you can print and keep in your exam rooms – one version with a Bible verse and one version without – so you can use it as a faith flag if you wish. Some practitioners like to buy the books they’re most likely to prescribe so they have them in their office as a handy reference. When the patient takes the “prescription” home, they can call the toll-free number shown on the form and order the book, paying with their credit card. The catalog will be updated periodically – just check the date at the top of any catalog page. Enjoy this ministry tool, compliments of your CMDA!
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The Just Add Water DVD series now includes a Practice by the Book set! You loved it in print, now you can watch it on DVD, use it to host a meeting, or use it as a discussion starter in a small group. This 10-disc set covers ten different topics from the book – one session per disc. Single sessions vary in length from about 16 to 27 minutes and are narrated variously by Drs. David Stevens, Gene Rudd, or Al Weir. The ten discs come conveniently stored in ten secure ring-bound pages in a oneinch thick album. Sessions covered are: Marriage & Family; Our Spiritual Foundation; Our Testimony; Developing Your Character; Clinical Practice; Managing Money; Practice of Compassion; Missions; Ethics; and, What in This World Is a Christian Doctor? All this for $50.00! Call 888231-2637 to order. I n t e r n e t W e b s i t e : w w w. c m d a . o r g
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Picture this scenario: a friend, patient, or colleague is suffering from the death of a loved one, a divorce, or even the loss of a job. You want desperately to provide some comfort, but you’re unsure of what you can say or do that will be helpful in these sad circumstances. This may be something that you have not had to deal with in your own life and you feel inadequate for the task. Refuse the urge to do nothing! Take a look in this helpful book and find things to say as well as what not to say. There are suggestions of what to write in a card and ideas of some practical things you can do to let your friend know you care. There are suggested prayers and even a few recipes, in case you’d like to prepare food for the family. Whatever level of care you choose to give, you will find priceless advice in this excellent book.
The Art of Helping by Lauren Littauer Briggs
Softcover. 287 pages. Available from Life & Health Resources for $14.99. Call 888-231-2637.
New “Get Well” Cards Available Here’s something you might like to consider as a vehicle for your personally written note to someone needing encouragement because of an illness: get well cards adapted from the book, Jesus, M.D., written by David Stevens, CEO of CMDA. A box of 12 cards (3 of each design) is just $4.99! That’s only about 42 cents per card, and you’ll have them on hand when a need arises. Available from Life & Health Resources by calling 888-231-2637; or via our website: www.shopcmda.org.
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Beyond Information Overload with CMDA’s Help Bruce MacFadyen, MD President - CMDA
Recently I was preparing for a medical lecture. As I began searching the Internet, I was overwhelmed by the number of search engines available and the many reference sources on just my medical topic. All of us are dealing with the issue of information overload through Google and PubMed. Even though we have access to these databases, how much of this knowledge are we actually able to use in preparing ourselves to provide the best possible medical care? Thinking about this abundance of resources available to us brings to mind the most valuable resources in life, those offered to us by God. He gives us salvation
and His presence in our lives. He gives us the Bible. 2 Timothy 2:15 tells us to study God’s Word. 2 Timothy 3:17 reminds us that Scripture makes us “thoroughly equipped for every good work.” Our families and friends are important sources of wisdom, encouragement, and support. Our churches provide many resources, including teaching and fellowship. But there is a unique and rich resource specifically designed for the Christian physician and dentist. It is the Christian Medical & Dental Associations. I joined when I started medical school and through it, I have made deep friendships, become involved with students and graduates and innumerable ministries, attended conferences, and been enriched in countless ways.
The many resources available are so great that it is impossible to list them here. It would be most worthwhile for you to go to the website, www.cmda.org and see how much is offered – devotionals, books, many ways to become involved in missions, conferences, national convention, medical practice helps, ethics considerations, and much more. All of these equip us to more effectively serve where God has called us. Please carefully review all the resources available from CMDA. I believe you will find, like I have found, an amazingly large supply of helpful information that will both enrich your life and better enable you to serve others.
President, CMDA
Regional Ministries Midwest Region CMDA Midwest Attn: Allan J. Harmer, ThM 9595 Whitley Dr., Suite 200 Indianapolis, IN 46240 Office: 317-566-9040 • Fax: 317-566-9042 cmdamw@sbcglobal.net
Western Region Michael J. McLaughlin, MDiv PO Box 2169 Clackamas, OR 97015 Office/Cell: 503-522-1950 michaelm@cmdawest.com
Northeast Region Scott Boyles, MDiv P.O. Box 7500 • Bristol, TN 37621 Office: 423-844-1092 Cell: 609-502-2078 Fax: 423-844-1017 scott.boyles@cmda.org
Central Region Douglas S. Hornok, ThM 13402 S 123rd East Place Broken Arrow, OK 74011 Office/Cell: 918-625-3827 cmdacentral@cs.com
Southeast Region William D. Gunnels, MDiv 106 Fern Drive • Covington, LA 70433 Office/Cell: 985-502-4645 wdgunnels@charter.net
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Global Health Outreach (GHO)
The Privilege of Being An Answer to Prayer by Kelly Wright, MD
Victoria Falls
In June of 2007, my husband, Matt, and I participated in our first medical mission experience, a GHO trip to Kitwe, Zambia. Preparing for Zambia took months. I studied Isaiah 6 and Matthew 28, and read Oxford’s Handbook of Tropical Medicine to be sure of every malaria parasite and schistosome I might encounter. Fortunately, I had the staff at GHO to help me with obtaining a visa, scheduling flights, and guiding my quiet time. GHO supplied a Bible study as well as the Handbook for Short-Term Medical Missionaries, a must for anyone considering service overseas. Even as Matt and I were wondering how we would fund our trip, CMDA came through with a substantial scholarship. GHO also put me in contact with veterans of the trip whose recommendations to bring extra toilet paper, hand sanitizer, and an abundance of Cipro helped me pack with confidence.
Zambia is called “The Real Africa,” and I learned why the day that we arrived at the Mulenga Clinic. I met countless children with asthma, seizures, and sickle cell anemia. But without inhalers, Phenobarbital, and transfusion programs available, I struggled with the gap between my medical knowledge and my patients’ realities. Kenny, a 12-year-old with abdominal pain from intestinal parasites, changed my outlook. His grandmother was a Jehovah’s Witness, so she instructed him to take the medicines and leave quickly, making sure that no one would pray for him. I told him that if he ever wanted to hear about the true Jesus, he was welcome to come back anytime. Kenny walked halfway to the door before pausing and turning around. Returning to his chair, he asked me about the true Jesus. After I explained and as I led him in prayer, Kenny told me that he was proud to know the true Jesus. Kenny helped me understand why I had come to Zambia, to offer Christ to people who need Him. It is easy to feel great pity for an entire continent stricken by poverty, but I quickly learned that though the African people suffer greatly,
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they have been granted an overwhelming portion of grace. Confronted by tragedy each day, I was overwhelmed with the faith and thankfulness I saw in the Zambians. Matt acted as the local optometrist, distributing reading glasses to over 500 people. One woman came offering praises because she had prayed that someone would give her glasses. After a week at Mulenga, I realized what a privilege it is to be an answer to prayer.
We all enjoyed taking care of the little ones.
Even if I had nothing else to offer, I gave each child I saw vitamins and prayer. By meeting their needs, we were able to demonstrate God’s love for the Zambian people and help them see the reality of the gospel. As some believers remarked in the New Testament, “We no longer believe just because of what you said; now we have heard for ourselves, and we know that this man really is the Savior of the world” (John 4:42). ✝ (Editor’s note: A more extensive article about this trip is posted at: http://www.mattandkellywright.com.)
WWW .CMDA.O R G/GHO
Medical Education International (MEI) What Exactly is Your Agenda? Below is a note from a recent team member who taught in a war-torn country. The location and team member’s name are not listed for security purposes, but it is clear that, even when surprising things happen, God is in control!
“Honestly, I am here to serve you. I have heard about the ‘brain drain’ in your country, and I thought I would come equipped to lecture on various psychiatric topics to whomever will listen. If that is not what your needs are, then I am willing to help you as a colleague in any manner that I can. I don’t have an agenda. I am here to serve you.” In one corner of the room, a resident was listening intently and appeared open to new ideas. I later learned that he planned to make the most of the opportunity for all of the residents to hear my lectures. Within the span of two weeks, I was able to share in teaching a lecture with the psychiatrist who had asked me not once, but three separate times, in our
FO R I NFORMATION ABOUT MEI OPPORTUNITIES, VI S I T:
initial meeting what my agenda was! In that lecture, he described his own traumatic experiences in his war-torn country. The young resident who was in the corner remains in contact with me. We share academic information, but mostly I try to encourage the residents I taught to take time to consider their own mental health, since they are stretched to the breaking point treating trauma victims. During my short stay, we had many open conversations about issues that you might never discuss with colleagues in North America, including my thoughts on abortion, the family in America, and ethics in medicine. God is good and is at work, even when things don’t go as we had planned! ✝
WWW .CMDA.O R G/MEI
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When I arrived in the Chairman’s office, it was clear that I was somewhat of an unexpected guest. At least, I was offered coffee by his receptionist, who smiled and exchanged an Arabic greeting with me. The language of medicine in the country is English, so the Chairman’s command of English was pretty good and made my job a bit easier. Other members of the faculty soon filled the room. After a brief exchange of pleasantries, one of the faculty looked at me suspiciously and said, “What exactly is your agenda?” Wow, I thought. How do I answer this without engendering more suspicion than already clearly exists? Suddenly, I felt very calm and out of my mouth came these words,
CMDA’s Fight for Physician’s Conscience Rights by Jonathan Imbody, MA
The American College of Obstetricians and Gynecologists Committee on Ethics in November 2007 issued an ideological assault on physicians’ conscience rights in its Opinion Number 385 entitled, “The Limits of Conscientious Refusal in Reproductive Medicine.” The missive against conscience rights took on extra weight when paired with the new Bulletin of the certifying body, the American Board of Obstetrics and Gynecology (ABOG). The 2008 ABOG Bulletin refers broadly to revoking certification “for cause” on the basis of “violation of ABOG or ACOG rules and/or ethics principles.” To respond to the attack on conscience, the Christian Medical Association Washington Office alerted Congressional pro-life leaders, White House and federal agency officials, and nonprofit pro-life organizations. CMA wrote a protest letter to ACOG and gathered signatures by other national groups including Focus on the Family, Family Research Council, American Association of Pro Life Obstetricians and Gynecologists, Catholic Medical Association, Prison Fellowship, Concerned Women for America, and others. Members of the U.S. Congress signed a letter, coordinated by obstetrician Rep. Phil Gingrey of Ga., to ACOG. U.S. Secretary of Health and Human Services Mark Leavitt sent a letter to ABOG noting federal laws prohibiting discrimination for refusal to participate in abortions. The backlash soon had ACOG and ABOG officials apparently backpedaling, trying to explain to the media that their written policies may not necessarily be enforced. In March, ACOG sent a letter to its Fellows claiming that Opinion 385 would not be binding and
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that ACOG “does not compel any Fellow to perform any procedure which he or she finds to be in conflict with his or her conscience…” ACOG did not, however, address the issue of compelling physicians to refer patients for objectionable procedures. An ABOG official stressed that “such an issue is not a consideration in the applications or in the examinations administered by ABOG,” but did not explicitly rule out future ABOG actions related to ACOG’s ethics position on conscience. In April, CMDA CEO Dr. David Stevens wrote again to ACOG and ABOG to push for official published clarifications that would serve to protect physicians disagreeing with ACOG’s new ethics statement. (Full texts of CMDA’s letters and other related documents are available at www.cmda.org under Issues/Healthcare/Conscience Rights.) Meanwhile, CMA, represented by Christian Legal Society, won a federal court decision in California related to conscience rights and the federal Hyde-Weldon amendment. The result of the decision is that California remains prohibited from discriminating against healthcare workers or institutions on the basis that they do not perform or refer for abortions. CMDA CEO Dr. David Stevens noted, “I am making this a top priority for this movement of Christian doctors. We will continue fighting to protect your conscience rights.” ✝
Jonathan Imbody, MA, is the Vice President for Government Relations in the Christian Medical Association’s Washington Office, where he serves as CMA’s liaison with Congress, the administration, and public policy groups. He has been a participant at twenty meetings at the White House related to policy and legislation. Jonathan’s work has appeared in national media such as the Washington Post, USA Today, Los Angeles Times, San Francisco Chronicle, Chicago Sun-Times and many other publications. He testified in the U.S. Senate on euthanasia research conducted on site in the Netherlands. He may be reached via phone/fax at: 703-723-8688; by cell phone at: 703801-4287; or, by e-mail at: washington@cmda.org.
Rights of Conscience Survey - Early Results Below are the results from our right of conscience survey after approximately one month. Percentages shown relate only to those who responded.
In your medical training and/or practice, have you ever been pressured to compromise your biblical or ethical convictions (e.g. refer a patient, perform a procedure write a prescription, hasten death, etc.)? Yes 41.23% No 58.77% Do you know of a colleague in medicine who has experienced this kind of pressure? Yes 46.43% No 53.57% Has your stand for your right of conscience cost you position, promotion, or reimbursement, or influenced your decision on what training to take or where to live/practice medicine? Yes 24.84% No 75.16% How big a problem are right of conscience issues in medicine and dentistry? Rare 12.01% Occasional 48.95% Constant 14.41% Frequent 24.62% How do you see the problem? Diminishing 0.29% Staying the Same 10.53% Getting Worse 89.18% In the years ahead, how important do you believe it is for Christians in the medical profession to win battles to practice according to their moral and spiritual convictions without being coerced, marginalized, or even punished? Not Very Important 1.41% Somewhat Important 2.54% Very Important 96.05% CMDA Conscience Rights Resources Posted at www.cmda.org: CMDA Ethics Statement: Moral Complicity with Evil CMDA Ethics Statement: Healthcare Right of Conscience CMDA Issues: Conscience Rights News & Views Special Edition: Healthcare Conscience Rights Talking Points: Right of Conscience More Conscience Rights Resources
Dear CMDA Family Member, Thanks for your words of encouragement and more so your prayers. They empower us to articulate your concerns on this important issue. I’d like you to do a couple of other things. Stories are powerful weapons in this fight because the public and many leaders form their opinion on their basis or use them to drive home their concerns. Can you take a few minutes to send me an e-mail with your story if standing for conscience cost you a position, promotion or reimbursement, or influenced your decision on what training to take, or where to live/practice medicine? We may use your story to raise awareness that there is a problem that needs to be addressed. If you want to remain anonymous, simply indicate that on your note. You can contact me directly at: executive@cmda.org. We are keenly interested in examples that show how states, medical schools, accrediting organizations, other institutions, and laws make the exercise of conscience rights particularly problematic and reveal how the system works against conscience. Secondly, help increase CMDA’s ranks by encouraging a colleague to join. We have quality materials available for you to give that tell the CMDA story. They are available by calling 888-230-2637. As we continue to fight this battle, our influence will increase as our numbers increase. The great bonus is that each new member will be better motivated, trained, and equipped to glorify God in their practice and insure the next generation of Christian doctors through this fellowship. God bless you for your faithfulness. David Stevens, MD - Chief Executive Officer Christian Medical & Dental Associations
What Members Are Saying We have received many member responses over the past months on this issue. Here are a few of the more recent ones. • Well done! I am excited about the victory that we have won here, and I appreciate your cautious perspective to future events. It is wonderful to see God’s hand at work here in protecting the unborn! • I have been praying for you and the work of CMA in the battle to allow us to care for our patients according to biblical principles and our conscience. I am recently partly retired and never thought that our Christian principles and beliefs would ever put our ability to practice medicine or teach our students/house staff in jeopardy. God is good and I share in praising Him for the progress in the ongoing battle. The wiles and schemes of the adversary “keep coming” and will do so, until Jesus returns, as we know. • Thank you so very much for your concern and efforts to protect our right of conscience! • I am so glad you guys are heading up this fight. I discussed this with a Christian OB colleague of mine – was surprised to see how much of the “woman’s right” philosophy he had bought into from years of indoctrination. I expected a stronger response to ACOG’s actions – but it looks like we have a way to go still, even in educating our own members. Thanks for being faithful. FOR M ORE I NFORMATION R EGARDING T HE WORK O F O UR WASHINGTON O FFICE, VISIT: WWW .CMAWASHINGTON.ORG I n t e r n e t W e b s i t e : w w w. c m d a . o r g
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Equipped to Serve
Editor’s note: The next eight pages tell four very different stories, all with the same focus – how CMDA equipped various members to better serve the Lord. Enjoy. Be blessed. Be inspired. Get involved!
Church Planters with MD Degrees by John Yoon, MD
Pre-med student Emily Weimer helped me with this particular patient
I would like to thank CMDA’s Center for Medical Missions and my sponsors for the Johnson Short-Term Mission Scholarship. This scholarship allowed me to participate in a short-term medical mission trip to Tulcan, Ecuador, January 11-19, 2008. Unlike my previous experiences with medical mission trips, this short-term medical missions trip was intimately linked to church planting. I went with a medical and church planting team from Crossroads Community Church and E3 Missions (formerly Global Mission Fellowship).
Our hope and prayer was that through meeting the physical and spiritual needs of the Tulcan residents, hearts would soften toward the gospel and God would establish a strong Christian presence that would continue long after we left. The logistics of the clinics included a medical clinic (three licensed triage nurses, five physicians, and one licensed pharmacist). We also had an eye clinic staffed by an optometrist and an assistant who provided eye exams and free glasses. Fortunately, we had many Spanish translators as well. A pre-medical student from my church, Emily Weimer, had the opportunity to shadow the physicians as well as assist in the pharmacy. The first day of clinic was a bit overwhelming as we gradually adapted to seeing many patients with complicated medical issues that were beyond the capability of our clinic to treat. The overwhelming physical needs combined with the sheer volume of patients who stood in line that day severely drained the physicians’ stamina. This felt harder than residency, was my thought at the end of the day. We quickly realized that we would not be able to see every patient that came to the clinic. The physical needs seemed limitless. Turning patients away was heart-breaking but a realistic necessity in order to preserve the morale and strength of the team for subsequent clinic days. On subsequent clinic days, we became more experienced, efficient, and organized. Meanwhile, a church-planting team as well as local national believers witnessed to patients while they were waiting in line, ministering to their spiritual needs. Our team leader emphasized that we were not just medical doctors but “church-planters with MD degrees,” so he
Our team of “church planters” brought many skills to the field
Together our American teams linked up with local Ecuadorian pastors who selected four different sites in Tulcan, Ecuador, which they considered to be the most unreached with the gospel and medical care. Tulcan is a region north of Quito, near the border of Colombia. 16
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One clinical encounter personally stands out in my mind. I developed a habit of greeting each patient with the words, “We came from America to tell you that Jesus loves you.” After treating one young mother, I concluded my encounter again with the same words, “Jesus loves you” – almost as a routine afterthought. To my surprise, she began weeping uncontrollably. I turned to my translator, asking her whether I had said something wrong. But instead my translator explained that for the patient it was the first time anyone had told her of Jesus’ love. What had been something I had taken for granted all my life turned out to be truly good news for someone else who had never heard this wonderful message. In total with four and a half days of clinic, the medical clinic saw a total of 702 patients; the eye clinic saw 685 patients. There were many professions of faith as well and new churches planted during this trip. Please pray for strong discipleship among these new churches. I came to this trip feeling somewhat exhausted and jaded from residency training. But God used this trip to encourage me spiritually and renew my vision for missions. I entered medicine because of American medical missionary role models who devoted their lives to serving Koreans during the early 20th century. I remember reading a story of an American missionary doctor who successfully treated one Korean emperor’s son, thus opening the door to future successful Protestant missions in Korea. Korea’s Christian heritage today is in part a fruit of these early medical missionar-
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encouraged us to share our faith with our patients. As a result, we spent a lot of time sharing our faith with patients, even leading several patients to Christ using the innovative E3 gospel cube approach. One of the evangelism teams working alongside the medical team remarked that they felt they had little to do since the medical team was already doing all the sharing during the clinical encounters! It was the first time that the team leader experienced MDs doing so much sharing of the gospel. Nevertheless, we experienced the tension between trying to see as many patients as possible, while also taking the time to address spiritual needs, which we viewed as “divine appointments” during the medical clinics.
ies. I wanted to be a medical missionary like them, someday. However, throughout medical school and residency training, a combination of stress, the disillusioning, secular learning environment, and personal anxieties related to the future were starting to erode away at my vision. While in Ecuador, God renewed my vision of how medicine could be used to advance the gospel. On the first day of our trip, one elderly woman was openly hostile to our team, serving as the “chief instigator” of opposition against us. The next day, she came to the clinic and after receiving compassionate medical care was subsequently led to Christ by one of the physicians. The day after that, she openly hosted a Bible study in her home. This showed me how God can use medicine to soften the hearts of those initially hostile to the gospel! Through this trip, God also began to renew my dedication to becoming a holistic healer. Through my training, I had become quite adept at treating physical ailments, while gradually neglecting the person’s other needs. Soon my medical care became more depersonalized as I started treating people as medical diagnoses, becoming more of a “body technician,” rather than a healer who treated the whole person. Through the experiences of sharing my faith, praying with patients, and even leading some patients to the Lord, God began to heal the areas of my heart that had hardened during training. I had gone to heal but instead was healed, myself, by the grace of Jesus, the Great Physician. I thank God for healing the healer through this trip and renewing my vision to serve Him as a Christian healer who treats the whole person. This was a life-changing experience for me, and one that undoubtedly will shape the direction of my medical career. I will further rely on His grace in making decisions that are in accordance with the vision He gave me at the beginning of my medical career. Dios le bendiga! (God bless you!) ✝
John Yoon, MD, grew up in Southern California and graduated medical school from the University of Texas Southwestern at Dallas. He is completing his third year internal medicine residency at Chicago and will be a research fellow in hospital medicine at the University of Chicago. He hopes to study professionalism, medical ethics, and quality improvement, particularly in the context of medical missions. He currently resides in Chicago with his wife, Mary, and their two daughters, Evangeline and Mary Sarah.
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The “Saline Solution” Opened My Eyes by William T. Griffin, DDS
Before attending the “Saline Solution” seminar, a formidable wall had developed in my mind between my profession and evangelism. On those rare occasions when I attempted to speak of the gospel to my patients, it was awkward and disjointed, thereby making it less likely that I would try again any time soon. My “Saline Solution” experience enabled me to integrate my faith into my practice, creating an almost infinite number of opportunities to reference the spiritual realm from within the context of patient care. By demonstrating the strong connection between the delivery of healthcare and the Christian faith, this seminar has made spiritual conversations with my patients almost as natural as breathing. My wife and I drove about seven hours to attend the first-ever “Saline Solution” seminar in Asheville, North Carolina in November, 1995. A couple years later it was offered in Washington, D.C., so I attended once more, this time with two staff members. Then, when the course was presented in Williamsburg, Virginia, I couldn’t resist making the 30-minute drive to take it all in for a third time.
My wife, Linda, and I (second and third from the right) are shown here at the very first “Saline Solution” conference, in 1995.
The title of the course comes from the fact that the body can only function at a specific pH; if it becomes too acidic or too basic, serious problems develop. In a similar vein, Jesus declared His followers to be “the salt of the earth” (Matt. 5:13). He alludes to the danger of becoming “tasteless,” which happens when we blur the distinctiveness of the gospel by being too much like the world. However, there is also the potential for the opposite error, that of repulsing the 18
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nonbeliever by giving them so much of the truth that they feel steamrolled. With this in mind, the goal of the “Saline Solution” seminar is to teach those in healthcare to “speak the truth in love” (Eph. 4:15). So why would a person spend the time and money to attend this program three separate times? My answer: The course was full of practical ways to naturally proclaim the Christian faith, while still meeting the healthcare needs of our patients. In short, it helped me become more comfortable expressing my faith in the everyday practice of dentistry. Rather than contemplating “whether” to point to Christ, the issue became “how” to let Him show through everyday interactions with patients and fellow staff members. The program helped me see that evangelism is, for most people, a process involving numerous steps and exposures to the gospel. The chart entitled, “Microdecisions of Faith” listed a continuum of stages that a person might go through in their transition from unbelief to faith. Very few non-Christians move from blatant disregard for Christ to transforming faith in one short step. Instead, it’s far more common for the Lord to use multiple exposures from a variety of sources. For example, a person who is hardened against the gospel might first experience the kindness of a Christian neighbor, and could come to the conclusion that perhaps all Christians aren’t crazy after all. Then at some point the non-Christian could experience problems in his marriage, and a Christian co-worker might have opportunity to share elements of God’s blueprint for joy in marriage. As a result of such positive interactions, the “soil” of this person’s soul has been tilled, creating a higher potential for the seed of faith to someday sprout. Paul’s described this collaborative process like this: “I planted, Apollos watered, but God was causing the growth” (1 Cor. 3:6). I also learned through this seminar about the use of “faith flags,” which are short, matter-of-fact references that a person can make during everyday conversations, illustrating some basic truth regarding the Christian faith. They aren’t conversation-stoppers, and they aren’t meant to bring the hearer to his knees begging for God’s grace. Rather, they are honest references to the truth of the gospel as it affects the everyday affairs of life.
For example, after performing an examination in which all is well, the healthcare provider could casually mention, “It looks like the Lord has blessed you with great health; let’s try to keep it that way.” Now the patient may be an atheist, yet we know that “Every good thing given and every perfect gift is from above…” (James 1:17), so the statement is justified. It may cause the patient to ponder for a moment, but it’s unlikely to be highly offensive. Another example of a faith flag would be an offer to pray for a patient’s concerns, whether they are health-related or not. In order for faith flags to be honoring to the Lord, they cannot be contrived or pre-meditated. We are not selecting from a list of possible “God-phrases” in order to try to manipulate the patient toward Christ. Rather, our comments are a natural outworking of who we are in Christ. We speak of what He has done, and what He regularly does, in our lives. There is a major benefit to the use of faith flags that I did not initially anticipate. When we are regularly using faith flags as a way to communicate spiritual reality to our patients, we are concurrently reminding ourselves of the spiritual dimension of life, as well. As we give verbal attention to the works of God through-
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The program was developed by Drs. Bill Peel (shown) and Walt Larimore.
out the day, we are following Paul’s advice to “look… at the things which are unseen, knowing that… the things which are unseen are eternal” (2 Cor. 6:19, 20). Our fellow staff members can also be greatly encouraged by the use of faith flags. A final reason for my great appreciation of the “Saline Solution” seminars is the awareness it gave me that there are so many other doctors seeking to proclaim Christ through their practices. At times it is easy for us to feel the despair of Elijah, who thought he was the only one in his day still speaking for the Lord (1 Kings 19:10). In truth, the Lord has His spokesmen throughout the world. Being at a “Saline Solution” seminar gives one the opportunity to rub shoulders with local Christian colleagues of a similar mindset, making it clear by their presence that the gospel has many ports of entry within one’s healthcare community. In addition, the small group discussions at the seminar were a powerful asset in envisioning how to personally apply the theoretical information that had been presented. I simply cannot recommend the “Saline Solution” seminar highly enough. Participating in this program is the best way I have ever found to insure that the “salt” of my practice doesn’t lose its flavor. Because of what I learned there, sharing the love of Christ with my patients is no longer an awkward or rare event. Instead, it’s just a matter of communicating the goodness of the Lord within the context of my practice, so that others are brought one step closer to faith. ✝
William T. Griffin, DDS, a member of the CMDA Dental Advisory Council, practices general dentistry in Newport News, Va. He has been a part of CMDA since 1982.
The “Saline Solution” Movement Since its introduction in 1995, the original program has evolved and gone worldwide, having been used now in more than twenty countries with more than 3000 doctors trained internationally. This is in addition to the thousands of doctors and others in the US who have benefited from this program. Outside the U.S., International Saline is the new tool used by International Health Services in collaboration with seven medical-mission organizations committed to a sense of urgency in completing the great commission. For information related to the international program, see: www.internationalhealthservices.org. Meanwhile, the US strategy has become focused on smaller groups (versus larger regional meetings) and the program is available in VHS and a new DVD format for use in this context. A document is available for download on the CMDA website, explaining step-by-step how to plan and conduct a “Saline Solution” Seminar in your home town. To order “Saline Solution” materials, visit: www.shopcmda.org.
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“Completing Your Call” – a Life-Changing Experience
by William Poston, MD
I had the privilege of participating in the first ever “Completing Your Call” (CYC) program, offered by CMDA, which started in October 2007, with our “graduation” planned for the June 2008 CMDA National Convention. For me, the net effect has been to change my focus and, as a result, to engender changes in many areas of my life. The program began with a weekend seminar experience, held at the CMDA national headquarters in Bristol, Tennessee. Dr. John Patrick’s Sunday morning two-hour sermon exploring “The Sermon on the Mount” was a profound focal point for me in preparing myself to “better serve” in all respects. Dr. Patrick equated the first beatitude, “Blessed are the poor in spirit, for theirs is the kingdom of heaven” with asking, “Lord, how do You see us?” – a very effective way of eliminating pride from our spirit.
Dr. John Patrick was the conference keynote speaker.
Dr. Dick Swenson was one of our featured authors who held a telephone conference with us in the CYC program. His way of helping us bring focus to our lives during this fascinating time in history was voiced in his fundamental mantra that “people are more important than things.” Dick’s commitment to people, especially his wife, Linda, and their children and granddaughter, brought focus into my life regarding my commitment to my wife, Kathy, and our kids, all of whom are now either in college or beyond. This imperative to focus on people, especially family, amidst the complexity of this life has become another valued outcome of the CYC program. 20
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During the opening conference Dr. Al Weir’s story of his walk with Christ brought with it the lesson that truly listening to God’s call for yourself includes listening to God’s call for your spouse. I have personally thanked Al’s wife Becky for being so tuned into God’s call for her life. Prior to joining the leadership at CMDA, Al wanted to return to missionary work in Africa; however, Becky did not feel the call to Africa. As a result of Al’s devotion to Becky and their “oneness in Christ,” they eventually accepted God’s call to CMDA – our gain and Africa’s temporary loss (I am convinced God is amplifying Africa’s gain through Al’s and Becky’s service at CMDA). In the same conference, Dr. David and Jody Stevens described a slightly different spin on the call to Africa – God overcame Jody’s concerns about life in Africa (30 foot snakes, etc.) to allow them to join as husband and wife in response to God’s call for their lives. Jody also was instrumental in David’s consideration of taking the leadership position at CMDA. These examples of faithfulness by the spouse have inspired me and Kathy to put mentoring medical couples on our list of priorities for completing our call. One of Dr. Gene Rudd’s stories inspired me to place student mentoring on my list of priorities for completing my personal call. Gene shared about the spiritual desert he experienced in medical school, and then how he had recently returned to speak at a Christian student retreat for that same medical school. There he was overcome with joy when he discovered 120 Christian students participating in the retreat – students who were amongst the most spiritually mature he had ever met. The model of physician mentors there included five doctors who had limited and reorganized their practices so they could serve as mentors for these students. At another conference during the course Dr. Carol Spears’ story of faith gave testimony to the fact that it is never too late to respond to God’s call to the ministry of medicine. After a successful career in business, Carol followed God’s call to become a doctor, even to become a surgeon. Carol also displayed enormous faith in God’s power and protection by returning to
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Tenwek as a full-time medical missionary despite a harrowing experience of personal trauma when she had been there earlier as a surgical resident. Dr. Bill Peel, one of our course directors and conference leaders, introduced us to the process of defining our true “giftedness” during an on-site workshop in Bristol. Although I was unable to attend that component due to family and work issues, the preparation “homework” for the meeting helped me determine that mentoring was a gift shared by me and by Kathy and it should be the focus for us as we seek to complete our calls. There were a number of other speakers and writers who contributed to the impact of the CYC program. I am grateful to all of them. In the end, participating in the Completing Your Call program prepared me to better serve the Lord, and to better serve my patients, my colleagues, and my family by exposing me to these mentors who personify the completion of these commands in the book of Joshua: “Be strong and very courageous. Obey all the laws Moses gave you. Do not turn away from them, and you will be successful in everything you do. … I command you – be strong and courageous. Do not be afraid or discouraged. For the Lord your God is with you wherever you go” (Joshua 1: 7, 9). ✝
William Poston, MD, received his MD degree in 1974 from Duke University Medical Center. He completed his pathology residency at New England Deaconess Hospital in Boston followed by a pathology fellowship at Memorial Sloan-Kettering Cancer Center, in New York City. He has practiced pathology in Memphis, TN and Oxford, MS since 1980. He and his wife, Kathleen, have three children: Kathryn, a neonatal intensive care nurse in Memphis, TN; Will, an environmental science student at the University of Tennessee, Knoxville; and, Elizabeth, a music major student at Belmont University, Nashville, TN. Dr. Poston’s hobbies include woodworking and gardening.
The next CYC distance learning experience will begin October 17-19, 2008 with a standalone weekend conference, “Seeking Your Call,” to be held at the national CMDA headquarters in Bristol, Tennessee. For more information about this conference, including a brochure, e-mail Dr. Al Weir at: ccm@cmda.org, call: 423-844-1000 or 888-230-2637, or visit: www.cmda.org/meetings, then to “October 2008.”
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How the Lord Made “Plan B” My “Plan A” by Karl Benzio, MD
As a kid, I was interested in understanding people, especially how and why they made their decisions. I wanted to become a psychiatrist, but I found that the Christian community frowned on psychiatry and was grossly unaware of psychological and emotional processes, addictions, and psychotropic medications. Yet Christians struggled with these issues just as others did. With my background in biomedical engineering, medicine, and psychiatry, God equipped me to start Lighthouse Network, a nonprofit ministry, integrating the three spheres of spirit, mind, and body in a way that would be scientifically cutting edge and biblically accurate. My goals were to help people: 1) understand and be better at daily decision-making; 2) obtain better access to Christian treatment for behavioral health issues; and, 3) understand how to advocate for a biblical worldview within the context of understanding sound psychological and biological science. Sometimes I felt very frustrated when Christians spoke in the media, as they often failed to articulate the psychological aspects
Voice of Christian Doctors Media Training From Congressional testimony to network television, God continues to open doors for CMDA to amplify the Voice of Christian doctors on the critical life issues of our day. CMDA’s next media training will be held on May 14 & 15, 2009 at CMDA National Headquarters in Bristol, TN. Each year, CMDA responds to over 400 media calls. By providing media training to our members, we are better able to respond to these requests. Many of our members who have gone through the training have realized they are being called to be a voice in a dark world and have come to enjoy a new ministry in their lives. For more information, contact Vice President for Communications Margie Shealy at margie.shealy@cmda.org or 1-888-230-2637.
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of the particular issue, often focusing only on spiritual factors. I would exhort these spokespersons, in my mind, but despite my good background in the sciences, I was not a gifted speaker. God had a plan to provide for me. In 2004, I helped a CMDA internist from the Midwest find a Christian treatment program for one of his addiction patients. Several months later, he was asked through CMDA to respond to an interview request about marijuana potency and increased use. He remembered how I helped him navigate the addiction treatment options, so he consulted my expertise on marijuana. This time, after we spoke, he passed my name on to the CMDA Media Training ministry to consider for future training. In 2005, Margie Shealy invited me to come to the CMDA headquarters in Bristol, Tennessee, for the Media Training program. What a fantastic opportunity! CMDA staffers Cathy and Joel Newton volunteered to be my hosts (ministry finances were tight), enabling me to afford to attend. Through the tutelage and teachings of Drs. David Stevens and Gene Rudd, and CMDA VPs Margie Shealy and Jonathan Imbody, I learned more in a short time than I had expected. The didactic trainings were fantastic. The mock interviews and pointed feedback equipped me to more effectively advocate for kingdom truths in a secular setting. The experience was encouraging and inspirational, and I returned home excited, less nervous than before, anticipating the various opportunities that might arise. Since then, I’ve been asked by Margie and CMDA to present in many different settings in my arenas of expertise including medical, brain chemistry, psychological, sociological, and spiritual aspects all at once. I have debated Kevorkian’s lawyer on TV. I’ve addressed many issues, including sexual abuse, depression, addictions, suicide, HIV education to kindergartners, the effect of violent video games on future behavior, and various other topics.
afterward, after which one congressman said, “All things work together for good for those that love the Lord and are called according to His purpose.” I am so thankful to CMDA for equipping me to be a good steward of my education and faith and for giving me the opportunity to speak boldly for my Lord. I offered up my meager loaves and fish and He multiplied my offering immensely. If I can do such a thing, anyone can. So I would encourage you to search your heart and see if God wants to use what you may have to offer. ✝
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The most impactful opportunity came in June 2007, after Margie connected me to a Focus on the Family legal advocacy ministry in my home state of Pennsylvania. A state congressman had fast-tracked a bill that would mandate all hospitals in the state to provide information and access to the “Plan B” emergency contraceptive to every rape victim. Even though we got involved “late in the game,” our protest hearing was granted. With little hope of turning the presiding opinion of “Why shouldn’t we help a rape victim erase any evidence of the rape?” I was given five minutes, and I had to prepare quickly. So I contacted Gene Rudd, an OB/Gyn, to get a sexed primer and “Plan B” in-service training. Gene connected me to an OB/Gyn in Kentucky who had recently been interviewed on the “Plan B” issue, and he gave me some research studies and reproductive science. With this foundation and my background articulating the non-medical issues, I addressed the ramifications of decision-making of this importance on brain chemistry, personality, and future functioning. After that, I briefly broached the spiritual and moral slippery slopes related to the question, as a result of which the better-informed congressmen defeated the bill. There was even a Q&A
Participants of the 2005 Media Training in Bristol, Tennessee
Editor’s note: To hear some of Dr. Benzio’s testimony, go to: http://www.cmda.org > Issues & Ethics > Reproductive Technology & Health.
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Karl Benzio, MD, is a board certified psychiatrist. He has a BSE in bio-medical engineering from Duke University, an MD from UMDNJ-NJMS, and training in Psychiatry from UC-Irvine. He has directed adolescent psychiatric units over the years and has a psychiatric practice, “Lighthouse Psychiatry.” Karl founded and directs Lighthouse Network, a nonprofit ministry that helps people understand how to maximize their potential, and through their national call center, also helps people access Christian psychiatric, counseling, and addiction services. He can be contacted by phone at: 887-562-2565 ext. 102 (work); 215-630-8846 (cell); or, by e-mail at: kbenzio@lighthousenetwork.org.
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Standing Orders for the Christian Medical Student 24
Standing Orders for the Medical Student by Ronald L. Machado, MD It is 5 p.m. as my first call night as an extern at the VA Medical Center begins. I receive a sudden barrage of pages from internal medicine interns ready to check out their patients to me until the next day. Despite an entire year of clinical rotations as a third-year medical student, I am overwhelmed by what is happening. These physicians are handing the care of their patients over to me for the night and even though I am part of a call team including two interns and a resident, I represent the first layer of overnight coverage for these patients. I become quite frantic as night nurses page me with patient concerns that range from constipation to acute respiratory distress and the resident pages me about new patients that I must evaluate and help get admitted to the hospital. This intense, month-long experience was outstanding preparation for what I would be doing one year later as an intern in Family Medicine, and it illustrates the point that a medical student benefits from experiences that are preparation for future challenges and responsibilities. I believe a similar principle must be followed by the Christian entering medical school, because the structure and challenges of one’s life change dramatically during those years. Interacting with Christian medical students and physicians and maintaining local church involvement will come easy during the first two years of medical school, but it will be quite a challenge thereafter. The Christian medical student cannot fully anticipate the changes that occur as he or she transitions to the third year clinical clerkships. Suddenly, the formulaic, structured, and predictable schedule that a “classroom” student has become accustomed to is replaced by a whirlwind of rapidly changing schedules, overnight call, early mornings, late nights, and weekend rounds. This does not include the internal stress felt by such simple things as wondering what HCTZ is. The combination of a hectic, ever-changing schedule, periods of loneliness, and the stress of
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learning is a true threat to the most formidable of faith defenses. The Christian medical student needs preparation for the faith challenges that will occur. In medical practice, I have learned that some welltimed “standing orders” can truly help keep a patient’s health on track. A standing order for a serum ammonia level may help keep a patient with EndStage Liver Disease and encephalopathy out of the hospital or Emergency Department. Scheduled bleeding time testing in patients with mechanical valves and certain arrhythmias can prevent thrombotic or bleeding complications. In the same way, I feel compelled as a “Christian who happens to be a physician” to present some “standing orders” for the Christian medical student to benefit his or her spiritual health. The spiritual “complications” of medical education and training in a fallen world are real, and the student must be prepared and equipped to meet these challenges. Order #1 – Don’t Stop “And let us consider how we may spur one another on toward love and good deeds. Let us not give up meeting together as some are in the habit of doing, but let us encourage one another—and all the more as you see the day approaching” (Heb. 10:24-25). Christians are called to fellowship. This deep sharing of faith with others is a fundamental Christian experience, as can be seen in Acts 2:42-47. A Christian is a member of the universal church body of which Jesus is the head. If a Christian is not meeting with others of the faith, then his “faith health” is in jeopardy. What member of the body is “alive” when separated from the body? While a medical student may have consistent worship and fellowship time during the first two years of training, this suddenly becomes more difficult to maintain during the clinical years. If a student’s
Order #2 – Beware “The acts of the sinful nature are obvious: sexual immorality, impurity and debauchery; idolatry and witchcraft; hatred, discord, jealousy, fits of rage, selfish ambition, dissensions, factions and envy; drunkenness, orgies, and the like. I warn you, as I did before, that those who live like this will not inherit the kingdom of God” (Gal. 5:19-21).
Preventive care is one of those aspects of medicine that is easy to comprehend, but so difficult to implement. Even as a primary care physician, I always struggle with spending more time on the needs of the moment than on the warnings for the future. It is likely more important for me to ask and educate that young child about their seat belt usage than it is to listen to the same normal heart sounds I have heard for many years. Christian medical students need to be warned of the struggles, temptations, and failures that will beset them. Christians are certainly aware of their past sin, as it is that very sin from which they were rescued by their faith. Even with proper warning and preparation, failure in the face of temptation is more likely in the setting of exhaustion, loneliness, and stress. BEWARE the temptations of alcohol and illicit drugs. BEWARE the ease with which adultery can fracture a marital relationship that is under the strain of medical training. BEWARE the selfish motivations of the heart that competitive medical specialization can bring forth. BEWARE the anger and rage that easily settles on the student of medicine who is being pulled in multiple directions while on call and can’t seem to get on top of all the work to be done and material to be studied. BEWARE the sexual immorality and impurity of thought that can enter the Christian’s life with the widespread availability of pornography. BEWARE the effects of success and financial gain on your priorities and hobbies. The temptations will occur. The medical student will be in a state of weakness. Even the most intact of immune systems can succumb to devastating infections such as the unfortunate college student who contracts meningococcal disease. Imagine the results in the life of a Christian medical student whose faith journey has already started veering off course due to the pursuit of those lofty professional goals. Sin’s work can be very subtle, especially if the only measuring stick around you is those students and physicians that do not live by the Spirit. In other words, the failing faith life of a Christian medical student will fit right in with the secular, relativistic approach to life of those around him or her.
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affiliation with their church body is weak to begin with, then this change in schedule is sure to break what was weak in the first place. Even the most disciplined of believers with strong connections in their church and with other Christian medical students will discover first-hand how a month on a busy medical or surgical service can decimate their fellowship bond to their brothers and sisters in Christ. I do not want to minimize the opportunities a student will have to display love and compassion and interact with patients and their families on a spiritual level. These unforgettable opportunities will occur, but they will be overshadowed in time by the worldly nature of prerounds, work rounds, scut work, surgery, late rounds, and in-house call. Just as chemotherapy leaves cancer patients weak and at risk for infection as they battle their disease, the demands upon Christian medical students leave them vulnerable to spiritual attack. DON’T STOP meeting together with fellow believers. When you finally have a free weekend, DON’T STOP giving your faith the priority it deserves. If you must choose between a self-indulgent road trip and staying close to home to meet your spiritual need for worship and encouragement from God’s Word, you need to choose wisely. Each choice that leads you away from the fold can lead to a seemingly unintentional shift of focus in life as worldly professional pursuits replace the spiritual sanctifying work taking place in the disciplined Christian.
Order #3 – Be Prepared to Change “Do not merely listen to the word, and so deceive yourselves. Do what it says. Anyone who listens to
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Standing Orders for the Christian Medical Student
the word but does not do what it says is like a man who looks at his face in a mirror and, after looking at himself, goes away and immediately forgets what he looks like” (James 1:22-24). Every physician is familiar with the joy that is experienced when a patient is seen, significant medical conditions are diagnosed, and then that patient proactively adjusts his lifestyle, follows through on all treatment recommendations, and later returns to the office “healed.” In contrast is the frustration felt when a patient is found to have a treatable condition, is educated and given all the appropriate treatment recommendations, and yet these are not carried out. The information has seemed to land on deaf ears. The time is now for Christian medical students to examine their faith and conscience, gauge their level of spiritual discipline, and make proactive changes based on the “reflection” they see in the “mirror” of God’s Word. A body that houses the Spirit, a Christian marriage, and a heart softened by God’s love are worth preserving. The time for perseverance and holiness is now. If the student fails at recognizing obvious “planks in the eye” or minimizes fleshly weaknesses, then there is a real danger that those conditions will worsen as the student’s medical training becomes more consuming in the clinical years and beyond, unless some form of change takes place. A few “treatment” examples might be: • Disciplined time in God’s Word • Accountability with a known Christian friend • Counseling/guidance from church leadership • Development of fellowship bonds outside the weekly worship time
long-term effects of that fracture. It has been the repetitive mild injuries that have damaged the sensitive cartilage and ligaments that do not heal well. In retrospect, I never considered that my minor injuries could turn into a chronic problem. I assumed healing from each injury would leave me “good as new.” I could have equipped myself with better wrist protection. My ignorance and failure to react and change caught up with me. Similarly, the “injuries” of sin occurring in the student’s life that are ignored can have delayed effects. A momentary lapse of judgment that is obvious and addressed swiftly can lead to healing and victory, but it is the subtle and repetitive failures that can lead to chronic problems throughout life. It is these kinds of problems that can destroy personal faith, fellowship with God and man, marriages, family relations, physical health, and even the very career that contributed to the problem. The improperly equipped and prepared Christian medical student must expose these issues and recognize the need to change. Conclusion Our profession overflows with spiritual symbolism. Luke 5:29-32 describes Jesus’ visit to the home of Levi the tax collector. The Pharisees pointed out that Jesus was interacting with “sinners.” Jesus’ response gives the modern physician reason to take notice. “It is not the healthy who need a doctor,” He said, “but the sick.” Every interaction between physician and patient represents needed spiritual salvation. As much as our culture may secularize the medical care we provide, the profound biblical truth represented is eternal. The words of our Lord give lasting spiritual meaning to a career in medicine and should be an ongoing source of encouragement in the faith. However, while there is incredible blessing and significance in becoming a physician, a student’s spiritual health must be cared for. These “standing orders” should remind future Christian physicians that they are also patients. ✝
Ronald Machado, MD,
On a personal note, a series of repeated mild traumatic injuries to my wrist has led to a state of weakness and chronic pain in that joint. While a fracture of this joint would have been an obvious and painful experience, I would have perhaps preferred this because I would have likely healed and not experienced chronic and
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is a board-certified family physician and a member of the family medicine faculty at the Tallahassee Memorial Family Medicine Residency Program in Tallahassee, Florida. He attended the Florida State University Program in Medical Sciences (PIMS) and received his MD from the University of Florida College of Medicine. He has been a member of CMDA since 1993.
Gospel Debt
The following article is adapted from the book Breathing Grace: What You Need More Than Your Next Breath by bestselling author Dr. Harry Kraus, one of our missionary members. Dr. Kraus’s writings have been a great encouragement to me, and I’m sure they will be to you, too. – David Stevens, MD
Gospel Debt by Harry Kraus, MD
Ray sat bolt upright, fighting for air. Then, he fell back, thudding against the operating table. Pulseless. Without respiratory effort. Time for the ABC’s.
Few events sear themselves on the memory of the surgeon with more heat than a patient without an airway. Seconds tick away, each a hammer-blow against survival. A cascade of negative metabolic consequences rocket forward with the precipice of death in sharp focus. Without a workable immediate plan, the patient will plummet in a freefall into eternity. I’ll never forget Ray Stafford. I was a chief resident on the trauma service the night Ray died on my watch… My trauma-alert pager sounded the five-minute warning to assemble the team. The Sikorsky medical transport helicopter raced towards the University hospital rooftop carrying a critical patient. I stopped in the small cubicle that housed the flight dispatch in the center of the emergency room. “Hi, Joe, what’s coming?” He leaned back in his chair and gave me a bullet presentation. “Twenty-seven year old male, victim of a close-range GSW to the face.” I smiled in spite of my fatigue. Penetrating trauma meant surgery, a welcome contrast to the majority of blunt-trauma victims who the general surgeons baby-sit for the orthopedic service. “Sweet,” I said. It’s a response I doubt non-surgeons will understand. I wasn’t glad the patient was injured, but if it was going to happen, I wanted it to happen when I could gain the experience through the case. It’s the twisted sort of attitude that makes a competent surgeon. A few minutes later, I met Ray as the team transferred him off the transport stretcher onto one of ours in a trauma bay. I observed the rise of his chest and placed my stethoscope against his thorax. Airway. Breathing. Circulation. “What happened to you?” His face contorted with pain. “Some dude shot me,” he grunted. I’d heard a similar story dozens of time. It was always “some dude.” Later, I learned that a vengeful father shot Ray because of Ray’s intimate relationship with the angry man’s daughter. The interesting stories always came out later, but in the midst of the initial work-up, the histories all sounded the same and were surgically succinct: “Young white male involved in a social altercation sustaining a GSW to the…” Ray had a small entrance wound on his left cheek. His right upper neck was swollen and an exit wound was visible on the right lateral, posterior neck near the hairline.
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Gospel Debt 28
The team swarmed. Vital signs were assessed. Blood pressure 140 systolic. A nurse secured a second intravenous line. Follow the ABC’s. A chest X-ray was taken. A urinary catheter inserted. After a phone consultation with my surgical attending, Ray was taken to the angio suite for an arteriogram, a specialized X-ray that visualized the blood vessels and provided a “road map” to locate possible arterial injury. I threw the X-rays up on the view-box as they came out of the processor. I examined the films, still warm from the developing process. An arterial blush clouded the area lateral to the internal carotid artery, an indication of bleeding, a serious injury, which was partially contained, a situation that needed STAT attention before the artery could free-rupture, ensuring exsanguination and death. Although stable for the moment, the patient needed emergency surgery and was soon whisked across the hall to the operating suite, while I called in my attending surgeon. Blood bulged the neck, tenting up the skin near the exit wound. How long would it be before the bleeding could not be contained or the airway was compressed by the expanding collection of blood? Nurses positioned Ray on the operating table as his eyes widened in fear. The anesthesiologist prepared to put the patient to sleep and slide a breathing tube into Ray’s trachea. The vascular surgeons scrubbed their hands. But the patient’s restlessness escalated, his knuckles whitening as he gripped the sides of the operating table. And then, in a moment, he wretched, vomiting what appeared to be undiluted blood. A lot of blood. Ray sat bolt upright, fighting for air. Then, he fell back, thudding against the operating table. Pulseless. Without respiratory effort. Time for the ABC’s. The anesthesiologist slid a laryngoscope into Ray’s mouth. “I can’t see anything,” he yelled. “There’s too much blood.”
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With the airway obstructed, without oxygen, Ray was dying in front of me. On my watch.
Oxygen debt: When our bodies are screaming for payment and the currency is oxygen.
At that moment, my patient was in shock, a clinical diagnosis defined as inadequate perfusion of the end organs, the kidneys, heart, and brain. Of course, what the vital organs are starving for, and what defines the crisis, is a lack of oxygen. At a cellular level, all the metabolic activity is screaming for payment and the currency is oxygen. Without an adequate supply, a situation occurs that we know as oxygen debt. We’ve all experienced it at some time or another, perhaps at the end of a footrace across the school playground. Our heart races; our respirations increase, all in an attempt to supply oxygen to starving muscle. We collapse with our hands on our knees. All other activity ceases as we gasp to overcome the debt of oxygen. So what does all this have to do with the gospel? What about the times when my soul is breathless?
Gospel debt: When our souls are demanding payment and the currency is grace.
Sometimes subtle and insidious, but no less critical, is the current epidemic found within the church and within all of us: gospel debt. Just as every cell requires a constant supply of oxygen, so every spiritual, emotional, and social aspect of our life needs a constant saturation with the gospel of grace. Surgeons are trained to think on their feet, to make life-and-death decisions in spite of their own fatigue. Dozens of other details clamor for the surgeon’s attention, distracting from the priorities at hand. Fortunately, there are simple guidelines, a mnemonic to focus the priorities. Airway. Breathing. Circulation. Simple enough to be remembered by everyone. Succinct. To the point. Targeting the critical first need, the life-or-death problem that will determine the patient’s ultimate end. Without oxygen, a death-spiral begins; the metabolic machinery within every cell unravels into inefficiency. Unless reversed, irreversible consequences loom as the brain-cells starve and die. Without the true gospel, we quickly turn to other methods to fill the void, false gospels of self-sufficiency,
But just as the trauma surgeon turns to the ABC’s, we can turn to the ABC’s of spiritual resuscitation. Guidelines simple enough to be remembered by us all, even in the clamor of life’s everyday disasters. So that’s where we will start. The beginning, the elementary school chalkboard of our Christian lives. We’re going back to the ABC’s, except now, instead of Airway, Breathing, and Circulation, we have: A) Acknowledge your need B) Believe the gospel C) Communion We’ll take a closer look at the ABC’s of spiritual resuscitation next issue, so allow me just to introduce the concept and issue a warning! I want to caution against viewing the spiritual ABC approach as a onetime quick fix. I’ve assembled the steps into the ABC’s as a tool to help jog our memories, and not as a threestep effortless launch into spiritual maturity. More than anything, my hope is that my treatment guidelines will nudge us towards a life of grace-appreciation, a life where grace recognition is constant and grace exhalation is the natural result. The foundation of such a life is repentance, faith, and communion that cycle as regularly as breathing. But what about Ray? We left our story as he fell lifeless onto the operating table. At that point, a branch of his carotid artery had ruptured into the back of his throat. Ray was in full circulatory collapse, his airway obscured by blood and the swelling from the bullet’s path. So I followed the ABC’s! I made an incision through the skin, palpating for landmarks, opening the cricothyroid membrane, and inserted a breathing tube directly into the trachea, actions accomplished to
secure an Airway. We began to ventilate through the tube, forcing oxygen into his lungs. That took care of Breathing. CPR was initiated, externally pumping on Ray’s chest as additional blood and fluids were pushed into his empty veins, actions to support Circulation until a pulse was detected again. The ABC’s guided our steps. And Ray was brought back to life. Of course, that didn’t solve all of Ray’s other problems. There was still an angry father who preferred to see Ray pulseless and cold rather than carousing with the madman’s daughter. So we admitted our patient under an assumed name to protect him from the father who wanted him dead. And in a few days, we let Ray go again, with a scar on his neck as a permanent reminder of his brush with the grim reaper. So we cared for his physical life, following established guidelines. What he needed next was someone to guide him through a spiritual resuscitation to reorder his dysfunctional life. But we’re all like Ray. We may not have the same set of problems, but we’re all dysfunctional in our own ways. One moment, saturated with the gospel, content in the sufficiency of the cross. The next, we’re in gospel debt, showing all the symptoms. Some are subtle, visible only with dissection below the surface of false gospels. Some are pulse-pounding terrifying, and require urgent intervention. We all live only seconds away from the possibility of oxygen debt. Unfortunately, at any moment in time we also live only seconds away from gospel debt. It saddens and amazes me how quickly I can turn from rejoicing in the adequacy of the cross to judging my brother, anger, anxiety, or a myriad of other symptoms pointing to gospel debt and my need for grace. That’s why I need a simple tool to nudge me back into grace. So that’s where we’ll go next time with spiritual resuscitation. ✝
Gospel Debt
blaming circumstances or others, all futile attempts to make up for a gospel debt. Without the gospel, we begin a death-spiral of sorts, a slide into a life empty of peace. Joyless. Mechanical. We follow the rules. Outwardly holy. Inwardly starving.
Harry Kraus, MD, FACS, is a missionary surgeon practicing in Kijabe, Kenya. He is the bestselling author of multiple novels and Breathing Grace: What You Need More Than Your Next Breath, from which this article is adapted. Used by permission of Crossway Books, a publishing ministry of Good News Publishers, Wheaton, IL 60187, www.crossway.com. Copies of Breathing Grace can be purchased through CMDA Life & Health Resources: 888-231-3637, or visit: www.shopcmda.org.
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BIOETHICS SERIES
Pregnant with Thyrotoxicosis - Ethical Options by Christian Vercler, MD The following consultation report is based on a real clinical dilemma that led to a request for an ethics consultation. Some details have been changed to preserve patient privacy. The goal of this column is to address ethical dilemmas faced by patients, families and healthcare professionals, offering careful analysis and recommendations that are consistent with biblical standards. The format and length are intended to simulate an actual consultation report that might appear in a clinical record and are not intended to be an exhaustive discussion of the issues raised. – Column Editor: Robert D. Orr, MD, CM.
QUESTION: What are the ethically permissible treatment options for this pregnant woman (16-17 weeks’ gestation) with severe thyroid problems? Kristen is a 30-year-old librarian who has two healthy children and has had one spontaneous miscarriage. She developed severe thyrotoxicosis (over-activity of her thyroid gland) just before the beginning of her last pregnancy two years ago. This caused persistent vomiting for the entire pregnancy, such that she was unable to adequately retain her thyroid suppressing medication. She had two life-threatening “thyroid storms” (abrupt worsening of the condition with anxiety, agitation, sweating, nausea, palpitations and many other symptoms) lasting a few hours each during the pregnancy. During those episodes, she felt certain she was going to die. She delivered six weeks early, stopped vomiting, her thyroid condition was controlled with medication, and she felt quite well for several months. The plan was to treat her thyrotoxicosis with radioactive iodine once there was complete control of the thyroid symptoms (radioactive iodine cannot be used during pregnancy). However, she became pregnant again before this transpired in spite of faithful use of oral contraceptives. Although she had tried to avoid pregnancy because of the thyroid problem, she was not upset with the prospect and does hope to have at least one more child.
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She is now 16-17 weeks pregnant and has been even more ill than with the last pregnancy. This is her second admission for dehydration. The endocrinologist who has been treating her thyroid disorder since the original diagnosis has told her that her options now are: 1) continued attempts at medical control throughout pregnancy with definitive treatment after delivery; 2) medical control of the thyrotoxicosis followed by surgical removal of the thyroid during pregnancy; or, 3) termination of pregnancy followed by definitive treatment with radioactive iodine. While thyrotoxicosis successfully treated in pregnancy is compatible with good maternal and fetal outcomes, continued thyrotoxicosis in spite of treatment places the patient at risk of thyroid storm, heart failure, and toxemia of pregnancy, each of which carries some risk of maternal death. Because of how awful she felt during her thyroid storms, she finds the prospect of continuing the pregnancy with further attempts at medical control to be unacceptable. She has been fearful of thyroid surgery during pregnancy because of potential complications including damage to her vocal cords, inadvertent loss of her parathyroid glands, or transient precipitation of thyroid storm. At present, Kristen is inclined toward termination of her pregnancy to enable definitive thyroid therapy. Her husband, family, and friends are supportive of her and have encouraged her to terminate the pregnancy. She has never considered abortion to be morally acceptable and reports she has never known anyone who had an abortion. Her greatest reluctance is her fear of God’s judgment if she chooses this option. She and her husband are Baptists, though not currently active in a church. She states that this is the hardest decision she has ever had to make. ASSESSMENT: This 30 year-old pregnant female with thyrotoxicosis is favoring termination of her pregnancy over continued medical or surgical management of her condition. She is conflicted, however, because she feels that abortion is morally wrong and is condemned by God.
DISCUSSION: Abortion on demand has been a legal option exercised by women in the United States for several decades now. Although abortion laws vary from state to state, abortions for medical conditions threatening the life of the mother may be legally performed in all jurisdictions even into the third trimester. Traditionally, Christians have been opposed to abortion on the grounds that it violates the sanctity of the life of the unborn child. Some Christians would maintain that in general abortion is to be avoided, but that there may be some instances when it may be acceptable as the “lesser of two evils” – namely, in cases of rape, incest, or when the life of the mother is threatened. The question in this case is whether Kristen’s thyrotoxicosis satisfies that final criterion of exception to the general moral prohibition of abortion. Her family and friends feel that it does, yet her Baptist-informed conscience gives her pause. The key element is the moral status of the fetus and what role these considerations play in the deliberations regarding Kristen’s options. Continued medical management appears to be failing, and Kristen has little enthusiasm for pursuing this course. Both the well-being of Kristen and her fetus are at risk if this course of treatment fails. If the goal of treatment is to bring a healthy baby to term and to preserve the life of the mother, then this treatment currently seems the riskiest. However, since the risk is shared by the mother and child relatively equally, some would consider this a justifiable choice if Kristen elected this option. A thyroidectomy is generally considered the safest option for pregnant women with thyrotoxicosis. A recent review of 4,426 patients undergoing total thyroidectomy for hyperthyroidism (Grave’s disease) showed an incidence of 0.4% for permanent recurrent laryngeal nerve palsy and an incidence of 1.5% for hypoparathyroidism requiring ongoing calcium supplementation.1 The risk of general anesthesia to the fetus is also acceptably low. Strictly speaking, thyroidectomy affords the greatest benefit to both patient and her unborn child for the least amount of risk to each. Furthermore, thyroidectomy is the procedure of choice for women of childbearing age to abate symptoms and preserve fertility. Only if the moral status of the child is discounted can an abortion in this case be considered an option. It is true that the medical risks of an abortion for the mother are less than that of a thyroidectomy, but there is no benefit to the fetus. Hence, this decision is inconsistent with Kristen’s belief about abortion and her previously stated goals of having another child. It can also
be speculated that if she does terminate the pregnancy she will be distressed by the guilt she will feel in frustrating her own goals, as well as her feeling that she has incited God’s judgment upon her. RECOMMENDATIONS: 1) However unwise, it is ethically permissible to continue medical management. 2) It is ethically permissible to have a thyroidectomy to cure the thyrotoxicosis, as the risks to both the mother and child are relatively low and the potential benefit for both is high. 3) It is ethically permissible to counsel this patient against abortion in this case. It is incongruent with her stated Baptist beliefs and her wishes to have another child. The exception of “to save the life of the mother” does not apply in this case, as there is another option that is low-risk. FOLLOW-UP: In spite of the above counsel, the patient and her husband could not overcome their fear of surgery and continued pregnancy. They jointly chose to terminate the pregnancy. ✝ Gaujoux S., et al. Extensive thyroidectomy in Graves’ disease. Journal of the American College of Surgeons. 202(6): 868-73, 2006. 1
TCD Editor’s note: This series of consults are intended to stimulate thought and discussion. Ethical positions stated within the article may or may not reflect CMDA’s official position on the issues involved. CMDA’s ethical statements on a wide variety of issues can be reviewed at: www.cmda.org.
Christian Vercler, MD, is a surgery resident at Emory University Hospital and a clinical ethics fellow at the Emory University Center for Ethics. He has a BA in biology and an MA in theology from Wheaton College. He graduated from the University of Illinois College of Medicine-Peoria in 2003. He received an MA in bioethics from Trinity International University in 2007.
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CLASSIFIEDS Dentist – General Dentist position available in Newport News, Virginia, associateship leading to partnership. Excellent location, near Williamsburg, an hour from the beach and three hours from Washington, D.C. Progressive practice offers implants, cosmetic services and CEREC restorations in modern facility complete with digital radiography, cosmetic imaging, and computers in treatment rooms. Owner is a member of CMDA Dental Advisory Council. For more information, visit www.dentalcare4u.com. E-mail resumes to wgriffin14@cox.net. Dermatologist - Exceptional opportunity in beautiful Asheville, North Carolina. Busy solo derm in well-established practice recruiting for BE/BC general dermatologist as well as cosmetic. Moh's would be a plus. Great area to raise a family with many outdoor opportunities. Competitive compensation package including salary guarantee and incentive and benefits. E-mail CV/cover letter to ehorner@charter.net. Emergency Medicine Physician Opportunity – Washington State. Stable fee for service democratic group is expanding services and recruiting board certified/prepared emergency medicine physicians for full-time positions. Excellent compensation, work environment, specialty, and administrative support for this 30K/year VED. Excellent schools and outdoor recreation make Wenatchee a desir-
able place to live. Contact Scott Stroming at 509-679-3635 or Stroming@nwi.net. Family Practice – Cedar Falls, Iowa. Step into a busy practice with a well-respected Christian group of six FPs. The need for two additional practitioners was created by a retirement and steady growth. Salary guarantee with a bonus structure. Living in a university town with excellent schools, a four season climate and a supportive group of colleagues who live their Christian values make this an outstanding opportunity. Contact Janice Yagla at 888-780-0390 or e-mail CV to Janice.Yagla@wfhc.org. Internal Medicine & Family Medicine – Family Medicine Center of Rocky Mount, North Carolina. FMCRM’s goal is to be known as the medical practice with the most satisfied and loyal patients in the region. FMCRM is accomplishing this through the skills and the friendly and caring attitude demonstrated by our BC Christian providers, combined with the latest medical technology. Our physicians see 25-30 patients per day (no OBGYN). Call is 1:6. FMCRM utilizes Nash Healthcare Systems hospitalist program so hospital call is minimal. Competitive compensation and benefits package is offered. The direct patient care area is 130,000 with a potential four county service area close to 400,000. We are located at the crossroads of I-95 & I-64 just 45 miles from Raleigh, 2.5 hours from the beach and 4 hours from the mountains. Look at our website at www.FMCRM.com or contact Lois Woodall, RN, Ed.D at 252-9375463, llwoodall@nhcs.org for e-mail. Interventional Pain Management – Cleveland (Westlake), Ohio. Seeking a BE/BC Fellowship trained Christian physician to replace a retiring physician. Out patient only, a Christian private practice. For more information, go to www.clearwaterpainclinic.com. Salary comparable, M-F 8:45 am – 5:30 pm. Position available summer 2009. Contact Practice Manager Sun-Hee J. Choi at 440-899-8622 or 44clearwater77@adelphia.net.
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Neurologist – North Carolina. Sandhills Neurologist, PA is seeking two BC/BE Neurologists, exclusively out-patient practice. This practice is interested in the physical and spiritual needs of the patient. Located in south central NC. World-renowned golfing resort, familyoriented community with large draw area. Approx. 2.5 hrs. from beaches and mountains. Contact: voss.sandhillsneuro@gmail.com. Orthopedic – Well-established practice of three orthopedists committed to providing orthopedic care with compassion as well as excellence. Time off for short-term missions. Would like to talk with general and subspecialty orthopedists about the possibility of joining us in practice. On-site surgery center; local hospital within walking distance. Located in a family-oriented city where many recreational and cultural activities are available. Less than a 10 minute commute from any area of the city. Low malpractice rates and cost of living. Vacation at the mountains and the beach; live here and enjoy all four seasons. Please contact our Medical Director, Dr. Chris Wilkinson at 308-865-1403 or cwilkinson@kearneyortho.com. Our clinic manager, Vicki Aten, can be reached at 308-865-2512 or vaten@kearneyortho.com. 32
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CLASSIFIEDS This position is available immediately and would be a two-year to partnership contract with a base salary and bonus incentives. Call is one in nine or ten nights. The lifestyle and income this practice affords is in the top 25% in the country. Please contact Steve Lucey, M.D. at 336275-6318. Pediatrician – Nebraska. Five-family physician group seeking BC-pediatrician to join Christ-centered practice, 40 miles south of Lincoln. Growing practice with two new young OB/GYN’s in strong family-oriented community. Call coverage available. Contact Randy at 402-228-3436 or gc92621@alltel.net. Pediatrician – Burlington, North Carolina. Private Practice seeking BC/BE pediatrician proficient in Spanish. Full service practice, neonatology coverage. Call 1:4. Competitive salary and benefits. 2 hours from coast/mountains. Accepting H1B visa. Contact Dr. Stein at 336-570-0010; Fax: 336-570-0012; E-mail: infamclin@bellsouth.net.
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Orthopaedic Surgeon – The Sports Medicine and Orthopaedic Center of Greensboro, North Carolina is seeking to add a couple of fellowship-trained surgeons, preferably foot and ankle or spine. There are five partners in our group, which was established in 1976. We are affiliated with four other groups to form a larger umbrella orthopaedic group, which offers us contracting leverage, economy-of-scale savings, and ancillary income opportunities. Greensboro is in the heart of the piedmont of North Carolina, which means it is an easy three hour drive to the beautiful beaches or mountains. Greensboro has been consistently rated as one of the best cities in which to raise young families. The cost of living is low; the school options are excellent; the growth in our community is exciting. Many of the partners have done short-term foreign missions trips and that flexibility will continue to be available for new partners.
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Pediatrics – Plant City, Florida. A busy well-established practice in the beautiful Tampa Bay area of Florida, is looking for a Pediatrician who shares our strong sense of Christian values, to join our group. Our office is dedicated to quality, with compassionate patient care. The ideal candidate is an MD or DO, who is caring, energetic and has good work ethic. An easy nature is also a key attribute. This position would be employed by the practice. We offer a competitive salary plus production bonus, 401K, Health Insurance, Malpractice Insurance paid, three weeks off per year. EMR system in place since 12/2005. If you are interested in an opportunity that combines the best in practice with a very pleasant working environment, send your CV to mkifer@plantcity-pediatrics.com, or fax to 813-659-9807. “Children are a gift from the Lord.” Psalm 127:3 Physician's Assistant – Dallas-Ft. Worth, Texas. Christian PA for Christian family practice. Great family community. Call Amber at 817-431-0606 or e-mail Dr. Mary Van Hal at mama6doc@juno.com. I n t e r n e t W e b s i t e : w w w. c m d a . o r g
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