Fall 2008, Volume 39 Number 3

In This Issue:   Motivating Your Staff The Problem of Time Physician as Employee Ten Questions about Alternative Medicine Treating Gospel Debt Miracles are Possible (Apologetics Series - Part 6)       TCD Fall 2008 (PDF)

What You and I Didn’t Learn in School
by David Stevens, MD, MA (Ethics) – Chief Executive Officer

How do you prevent embezzlement and what should you do if you catch a staff person doing it? How do you fire someone, understand a balance sheet, do a performance evaluation, or deal with a nurse who is not performing well?

No, you didn’t sleep through that class. They weren’t in the curriculum in medical or dental school.

Those topics and other business ones probably should have been added because they are some of the reasons why more and more doctors are becoming employees. That way they don’t have to deal with issues that face doctors involved in the small business enterprise called private practice. However, even if you are an employee, you still can’t totally escape it all.

It is not that you weren’t well trained in medicine or dentistry. They just didn’t spend much time teaching you what you needed to know to enable you to successfully use the knowledge you took so many years to obtain.

It was not such a big issue in the past. It was the doc, a nurse, and the receptionist out front in small town practices across America. Now it is dealing with regulatory authorities, complex labor and health care regulations, supervising a legion of staff, filing reimbursement forms, and trying to keep all your technology up and running.

Nowhere is this more a problem than on the mission field, where the doctor is in charge of a medium to large size “business” called a mission hospital. At times while I was in Kenya I was responsible for 500 staff, a multi-million Kenya shilling budget, and creating systems to get treatment and follow-up to 10,000 inpatients and 100,000 outpatients a year. Knowing the intricacies of the Krebs cycle wasn’t much help!

I learned that the business of healthcare is based on good principles and learnable techniques. I didn’t have time to go and get an MBA, but sought out resources and individuals who could teach me what I needed to know. I applied business principles, modified them for our situation, and in some cases improved on them to make our outreaches run well. Hey, if I can do that in the bush of Africa, you can do it here.

I first had to realize that as important as my clinical skills were, they were pretty much a given after going through a quality education process. What had more to do with my success as a missionary, relief leader, and now as the CEO of CMDA is my ability to plan, implement, manage, evaluate, and lead.

That is why this issue of Today’s Christian Doctor is devoted to practical practice issues looked at from a distinctly Christian perspective. We’ve picked a few important things to cover with the goal of providing information you can use, while also hoping to stimulate you to delve deeper into this important area.

Realizing the special importance of this type of training for missionary doctors, a few years ago I began a series of articles that have appeared in every issue of the e-Pistle, a monthly electronic resource for missionary doctors produced by CMDA’s Center for Medical Missions. It covers topics like “Boards that Work,” “Effective Communication,” “Conflict Resolution,” “Strategic Planning,” “Recruiting ‘A’ Employees,” “Leadership,” “Personnel Issues,” “Motivating People to Change,” “Excelling at Administration,” and much more.

These principles apply wherever you practice. If this TCD issue catalyzes you to spend some time learning more about practical practice issues, go to: www.cmda.org/ePistle to get what is now essentially a free electronic book. As a bonus you can learn how to write an effective prayer letter, learn about ethical issues in missionary medicine, or read some ideas on strengthening your family. You will find this resource easy to assimilate since it gives principles, tells stories to drive them home, and shares true and tried techniques.

So, read, absorb, and apply the articles in this unusual issue of Today’s Christian Doctor, and as a bonus visit our website, and learn more about what you and I didn’t learn in medical or dental school. I trust both will be a blessing to you.

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National Conference Awards

Editor’s note: The following awards are presented annually by CMDA. The award summaries are based on the actual statements involved, which can be accessed at: www.cmda.org.

Servant of Christ

Samuel Molind, DMD, and his wife, Dorothy Molind, have modeled Christ in serving others, not only in the U.S., but around the world. Through Dr. Molind’s leadership as Director of CMDA’s Global Health Outreach (GHO), and his passion for soul-winning, tens of thousands have come to know Christ. Sam has also used his skills as an oral and maxillofacial surgeon to treat the suffering in many lands, including Vietnam, Jamaica, the Ukraine, China, and Ethiopia. Dr. Molind has helped encourage and train other mission organizations; personally organized and led many teams; pioneered medical/dental education for short-term teams; trained numerous nationals in the latest surgical techniques; and has served in many prisons in partnership with Prison Fellowship International. Dorothy volunteers with GHO by assisting in the organization of mission trips, inventory management, and providing medicines and equipment for the many GHO trips. In recognition of the Molinds’ all-consuming passion to serve others, those whom Dr. Molind says are “without hope and without help in a world of need,” CMDA presented the 2008 Servant of Christ Award to Dr. Samuel and Mrs. Dorothy Molind.

Missionaries of the Year

Robert Chapman, MD, MPH, and Karon Chapman, DD, have inspired others to develop a passion for the Great Commission. In 1965, the couple became affiliated with the Christian Missionary Fellowship (CMF), eventually joining the CMF team in Ethiopia. Dr. Chapman’s medical work was quickly incorporated into the team’s church planting and evangelism programs. During their first term in Ethiopia, he did a training course at All Africa Leprosy and Rehabilitation Training Centre in Addis Ababa. On their first furlough, he earned a Masters in Public Health degree from the Loma Linda School of Health. In 1977, Ethiopia experienced a Marxist takeover and the entire Ethiopian team had to be evacuated. But by September of the same year, the Chapmans had begun work among the nomadic Turkana people of Kenya. Dr. Chapman instructed the Turkana people in hygiene and sanitation, taught and preached in their villages, provided literacy programs, and was heavily involved with the translation of the Bible into the Turkana language. The couple also helped the country of Kenya with development projects such as the Turkana women’s basket-weaving industry. To honor and celebrate these lives of service, CMDA presented the 2008 Missionary of the Year Award to Dr. and Mrs. Robert Chapman.

Educator of the Year

George Mikhail, MD, began his journey of excellence in medical education more than fifty years ago. That journey took a major change in direction during his first visit to Mongolia in 1996, when he had just retired as a professor of obstetrics and gynecology from UCLA. With the assistance of Dr. Bob Schindler, Dr. Mikhail led the first Medical Education Interna-tional (MEI) team into this country once thought to be nearly unreachable. As a result of Dr. Mikhail’s groundbreaking efforts, today MEI sends medical education teams to Mongolia twice a year. Under his leadership, MEI team members have taught at the Health Sciences University of Mongolia and have provided lectures, patient assessments, and clinical and surgical care in a wide range of specialty hospitals in Mongolia. In addition to typical healthcare topics, team members have included bioethics in their curricula. MEI team members have been encouraged to follow in Dr. Mikhail’s footsteps by developing personal relationships with their Mongolian colleagues. This has often opened the door to sharing the love of Christ. Team members also have been encouraged to minister to missionaries and local believers. Through Dr. Mikhail’s endeavor and those of the twenty-one MEI team members that have served in Mongolia, the Good News of Jesus Christ has been proclaimed and seeds have been planted among many Mongolian people, from medical professionals to hotel staff.

President’s Heritage Award

William Standish Reed, MD, MS, has been a surgeon and a physician for over sixty years. Kay, Bill’s beloved wife, went to be with the Lord in May 2005. She was the Director of Christian Medical Foundation International, Inc., a ministry Dr. Reed founded in 1962. Until her death, Kay served beside Dr. Reed. He credits his wife and children for their sacrificial support. In December 2007, Dr. Reed was married to Coppi McWilliams, a wonderful helpmate to him during this season of life and ministry. Dr. Reed is an active Christian writer, poet, and lecturer. Speaking opportunities and surgical missions have led him around the world, traveling to many countries including Poland and Czechoslovakia during the cold war. Dr. Reed has authored several books, including A Doctor’s Thoughts on Healing and Surgery of the Soul. Through Christian Medical Foundation International, Inc., Dr. Reed has influenced many lives: colleagues, patients, and friends. From this fertile soil, many others have come to know the Lord’s love and saving grace. Retired from his surgical practice, Dr. Reed continues to specialize in seeing patients who have been informed that “There is nothing more that can be done for you.” Dr. Reed emphasizes the truth of Luke 1:37 and James 5:14.

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Steury Scholarship Recipients Announced

The purpose of the “Dr. and Mrs. Ernest Steury Medical Scholarship Fund” is to assist with the tuition of medical students who are committed to a career in foreign or domestic missions. Applications are evaluated on the basis of academic record, spiritual maturity, cross-culture experience, leadership ability, the student’s sense of call, references, and extracurricular activities/ talents.

This year the Steury Scholarship was awarded to Jeffrey and Grace Larson. Jeffrey is a second year student at UIC, and Grace is pursuing a degree as an RN. Jeffrey's comments (here adapted) about his spiritual experience and calling included: “I have been blessed with three wonderful opportunities to catch a glimpse of how God might put flesh on my now well-formed theoretical ideas of what Christian healthcare could entail. In Tanzania, I was once again reminded of the great need for hope and healing around the world. I desire with all of my heart to care for the least of these who have been trampled by the world in so many ways. This trip confirmed to me that it was indeed this goal that would shape my life. Next, I was able to see Christian healthcare embodied in the inner city of Chicago at Lawndale Christian Health Center. This was a gleaming ray of hope for me as I saw Christians take their goal of empowering holistic health so seriously and comprehensively. I hope to model my future practice after much of what I observed and participated in during this time. Finally, I began my married life pursuing the calling that God had given both my spouse and I through learning of medical opportunities around the world with TEAM missions. We participated in a vision trip observing missionaries throughout Southeast China and Northern Pakistan. We cannot wait for our next opportunity to serve overseas. It is now an exercise in patience to be diligent to our calling to study when our hearts are already overseas. We have learned much about being bold in our faith amongst our peers in the sadly hedonistic environment of medical and nursing school.

“Jesus cared about people. He came to heal us; mind, body, and soul,” he added. “This is what I long to do. I am excited to enter boldly into the medical mission field with faith in the combination of medicine, prayer, and prophetic song for healing. Christ came to heal our whole being, and when we do the same, people are eternally changed. Through word, deed, and sign, I pray that the Lord will use me to draw many to Himself.”

For information regarding the Steury Scholarship, contact the office of the Chief Executive Officer, or download the application at: www.cmda.org.

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Login to our Website!

If you haven’t logged into CMDA’s website, www.cmda.org, you are missing out on a lot of valuable resources and services, such as PowerPoint presentations exclusively for CMDA members and the ability to personally update your member information in our records. Logging in is easy! Type www.cmda.org into your Internet browser to start. Our website is most compatible with Internet Explorer. Then click on the “Member Login” button in the far left column on the homepage. In the “Login” field, enter the e-mail address that we have on file for you. If you have never logged in to our site before, in the “Password” field enter the default password, “keepingfaith.” (Once you have logged in for the first time we strongly recommend that you personalize your password.) Click the “Sign on” button or hit the “Enter” key. You will then be logged in and automatically redirected to the “Member Support” page.

Just Add Water – Practice By the Book on DVD

Ten of the seventeen chapters of Practice By the Book are now available on DVD so you can easily share them with your CMDA chapter, staff, or other small group. They are presented variously by Drs. Al Weir, Gene Rudd, and David Stevens. Presentations vary in length from fifteen to thirty minutes, and are corporately called, “Just Add Water - Practice By the Book” set. In Dr. Weir’s presentation about compassion, for example, he suggests that the two most important things you can do for your patients are to reduce their suffering and to provide hope and value to their lives. He illustrates with a story about listening well. A patient whose cancer had a very low risk of recurrence had been worked into an already busy schedule. She went to great lengths to describe in detail a problem she was having with her right ear. He knew from early in the conversation that the condition she was describing was benign, but her level of anxiety was extreme, so he listened to the whole story. When she was finished, he did a quick examination and explained that the discomfort in her ear was caused by pressure on her eustachian tube due to a viral infection. She began to cry. She explained that her sister had died when her cancer spread to her brain, and she thought that’s what was happening to her. She said she hadn’t slept in three nights! What a blessed reduction in suffering she had that day! Many more illustrations are included on this and the other nine discs, which include Clinical Practice, Marriage and Family, Devel-oping Your Character, and Ethics, among others. The ten-disc set comes conveniently packaged in separate ring-bound pages secured in a one-inch thick 5.5 x 6.5 inch album. The complete set is available from Life & Health Resources for $50.00. Call 888-231-2637 or visit our website at: www.shopcmda.org to order yours. Or . . . if you’d rather prop up your feet and read in solitude, perhaps you’d prefer Practice By the Book in paperback, 263 pages, $16.95.

News Notes of Interest

• At the 2008 CMDA National Convention, a new ethics statement on “Chimeras and Human Hybrids” was approved by the House of Representatives. You can find this statement on our website at www.cmda.org and going to Issues and Ethics > Other > Genetics.
• CMDA has a new addition to the website under Resources and Services, called Online Library. It is a review of medical articles divided into categories of ethical, medical, legal, social, and religious. Check it out and let us know what you think. Send your opinion to: communications@cmda.org.
• The state of Washington will be voting on “Initiative 1000” this November. If passed by the people, Washington will become the second state in the nation to legalize physician-assisted suicide. In addition to creating a set of videos, public service announcements, and a brochure on “Initiative 1000,” we have developed an area on the CMDA website called “End of Life Care.” This section provides helpful information to both doctors and the general public on good end of life care. It is located under Issues and Ethics.

Leaders Wanted To Transform Doctors, To Transform the World

If you are interested in serving as a volunteer leader in the House of Representatives, on a council or commission, and through those ultimately on the CMDA Board of Trustees, you can go to our website at www.cmda.org and click on “About” and then “Leadership” and choose either House of Represen-tatives or Board of Trustees to find out more and get involved. Submit a current CV via e-mail (preferably) or fax to the Executive Assistant, Debra Deyton at: executive@cmda.org, phone: (423) 844-1000, fax: (423) 844-1017.

The House of Representatives meets once a year to approve bylaws changes, receive reports, and approve the budget and the ethical positions of the organization. During the year, they serve as two-way channels of communication between CMDA and its members. There is one representative from each state and from many of our local ministries.

New trustees are nominated by a joint committee of the House of Representatives and the Board of Trustees. They look at the service record of potential nominees to CMDA, their leadership capabilities, expertise, and Christian testimony. Their nominees then are approved by both the House and the Board. Trustees, who may serve up to two consecutive four-year terms, pay all their own expenses. The Board meets three times a year to set policies, oversee finances, and provide supervision to the CEO.

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What Kind of Innkeeper are You?
by Al Weir, MD, and Gene Rudd, MD

Most of us are familiar with Jesus’ story of the Good Samaritan (Luke 10:25-37). This story began with a question about eternal life. In responding, Jesus acknowledged our responsibility to God and others. He then told the parable to explain who “our neighbor” is, identifying especially those who are in need.

Which character in this story do you think is most representative of doctors in our society?

A few (fortunately very few) of our colleagues may be like the robbers: God forbid! Others, when going through difficult times, are like the one beaten and left for dead. Though each of us would prefer to be seen as the Good Samaritan, sadly and too often we respond like the priest or Levite - walking down the other side of the road to avoid the situation. While any of these characters might represent us, there is another character in the story that more commonly reflects most of us in our professional lives - the innkeeper.

After the Good Samaritan provided emergency services, it was the innkeeper who cared for the man until his wounds were healed. We know nothing about the innkeeper’s motivation, but we do know that he was given two silver coins for his work (enough to care for the man for a month) and promised more if it was needed. This scenario is fairly representative of the professional lives of most doctors in our culture. We care for those in need and receive compensation – usually adequate compensation. We often complain about the amount we receive, but there are very few of us who are destitute.

What would the innkeeper have done if he had been offered only one silver coin, or perhaps none? What if the Samaritan’s purse had been empy when he brought the traveler to the inn? Would the innkeeper still have helped with the care of this needy man? We don’t know. What would you have done if you were the innkeeper? More to the point, what are you currently doing in your practice to help the needy, especially those without resources?

For the past few years CMDA has been encouraging doctors to provide services to the poor to honor God’s heart for the broken and oppressed. We called it “The Four Percent Solution,” asking doctors to commit 4 percent of their time, talent, or treasure to the care of the underserved. Many have accepted the challenge. Some have committed far more.

But now, going forward at CMDA, we wish to move away from formulas and focus more on our identity and obligation as children of God. As physicians and dentists, we are the innkeepers for the sick and wounded of the world. We ask you to consider how many coins are necessary for you to care for those in need. Each of us needs to open our hearts to the underserved and be certain that we apply policies and give care in a way that reflects God’s heart for the poor.

So we ask you, please consider ways to intentionally care for those in need. Perhaps you can increase the number of uninsured patients that you see in your practice, or volunteer at a healthcare clinic for the poor, or help establish policies with your local hospitals or government bodies that honor God’s heart for the poor. Become an innkeeper who is willing to provide care to the needy even when there are no silver coins. In doing so, you will share the grace and mercy you have received from Christ; you will reflect God’s love; and, you will hear the words of Christ, “. . . whatever you did for the least of these brothers of mine, you did for me” (Matthew 25:40).

If you are committed to caring for the poor in your practices in an intentional way, please let us know your plan. Contact us at: ccm@cmda.org.

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Daily Challenges in Healthcare
By Bruce MacFadyen, MD – President

It was a typical busy day. I had surgeries to do, administrative decisions to make, meetings to attend, and teaching responsibilities to students and residents. The day was packed, and delay in any one of these areas would significantly alter my schedule. There was no question I had overbooked the day.

My first operation was delayed due to patient issues; by mid-morning my planned schedule had significantly changed. I would not be able to complete all the things I had hoped to do and thought were important to accomplish. I was becoming impatient at anything that further delayed the day.

I think all of us have been in similar situations. We are trying to do more with less, often becoming impatient when things do not go as planned. At times we have no margin in our lives, so impatience often follows our frustration. Patient care issues, among other things, can change quickly and can cause many disruptions, challenging our ability to remain patient.

In Galatians 5:22-25 Paul writes about patience as a fruit of the Holy Spirit within us. Peter emphasizes this character trait in 2 Peter 1:5-9 when he teaches that faith produces virtue, virtue knowledge, knowledge self-control, self-control patience, patience godliness, godliness kindness, and kindness love. These verses reflect the biblical principle that if we commit our way to the Lord and trust in Him, the Holy Spirit will increasingly produce these qualities in our lives. We will grow in being effective and productive as we experience the presence of Christ in our lives at work and elsewhere. Are we growing in our relationship to Christ so that His Spirit is working in us and transforming us? Is His presence in our lives enabling us to trust in Him at the same time we are dealing with stresses coming at us? Are we demonstrating these Christlike characteristics in spite of the circumstances in the daily practice of medicine and dentistry?

When we are being transformed into the person God wants us to be, we can have fruitful lives in spite of stresses. Instead of feeling rushed, we can have time to encourage those around us. In 1 Thessalonians 5:11 we read that encouragement uplifts others. In addition, 1 Thessalonians 2:12 directs us to walk in a manner worthy of God. These are our real daily challenges as we live and work. Our standard of practice is to become more Christlike every day.

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Medical Education International (MEI)
Sharing Christ Through Building Relationships

Christians often differ on the “gray areas” in Scripture. The apostle Paul spoke of the freedom we have in Christ. We must be careful around the “weaker” brother or sister not to use our freedom to needlessly offend or cause them to stumble. However, at times it is our willingness to use our freedom in Christ and forgo legalism, which may help open an unbeliever or nominal believer to consider the claims of Christ. Both of these judgments require wisdom and sensitivity. An MEI participant recently dealt with this issue in reaching out to a colleague. Here is his story, with some details changed into a parable to not offend any readers with scruples about the actual issue in question:

Marin, a young surgeon, interpreted for MEI team member Doctor AB during his week in Moldova, a country in Eastern Europe. He was thoroughly exposed to people on the team, who they were and what they were about. Marin sat in on the team’s orientation meeting and some of the team’s daily spiritual devotions. He heard the personal conversations of team members as they interacted with each other, local believers, and colleagues. But as with many people, his preconceptions went deep and prevented him from being open to what the team believed about God and the gospel. Marin knew on their first Sunday they attended the annual Harvest Festival at one of the largest non-Orthodox churches in Moldova that they had come to the city of Chisinau at the invitation of Emanuel (Christian) Clinic. He had also experienced first hand the legalistic way in which a local non-Orthodox denomination approached the Christian life. Marin drew some conclusions about the team as he traveled, ate, and translated for them. But in this short week, he was not able to shake off his preconceived ideas about non-Orthodox Christians.

On the last day, after the sessions had concluded, Marin commented, “I would love to have some meat sacrificed to idols.” AB said, “Okay. I will have some with you.” More than a little surprised, Marin queried, “You would eat that with me? You, a non-Orthodox Christian, would go to the temple restaurant and eat meat sacrificed to idols?” “Yes” replied AB.

So off they went. Marin was baffled as his mutually exclusive thoughts warred with each other. These Christians were different from his past experience. Still puzzled, he asked, “How is it that you, a Christian, can do such a thing? Only Orthodox Christians in my country would eat this type of food with me, not those from other Christian groups!?"

AB began to explain that Jesus said, “It is not what a man puts into his mouth that defiles him, but it’s what comes out of his mouth that defiles him.” Food itself, regardless of its type, doesn't defile a man. You know the impact that poor eating habits or overeating can have on an individual’s health and how it affects families, health care costs, etc., but eating this meat today will not hurt me. Idols are nothing but wood and stone, so the meat is the same whether sacrificed to them or not.”

“Well, I also like the ladies, you know,” Marin commented sheepishly. AB perceived that he was intimating that he slept around a bit. He shared with him that he must know that it   wasn’t a healthy thing to do, nor was it something that pleased God. Marin’s silence acknowledged his assent.

They continued this exchange about their different faith traditions for awhile. AB then had an opportunity to share the gospel with Marin. This not only rocked Marin’s preconceptions about non-Orthodox Christians, but redefined the “main thing” of Christianity to him. It was not following a set of rules, but the message of God’s mercy and grace. Through Jesus’ death on the cross, Jesus was able to offer to pay the debt to God that results from our sinful rebellion. AB then gave Marin his own copy of the Scriptures and for the first time in his life, he read the gospel for himself.

Marin did not acknowledge faith in Jesus in that day, but he had his worldview reshaped more than a little bit as a result of AB’s creative faithfulness.

“This unplanned event was one of the greatest things that I witnessed on this trip,” AB commented as he shared with us that evening around the dining table.

God may use practices on which believers differ to show others that Christianity is not a religion of rules and legalism, but a relationship with God and His Spirit in the daily practical decisions of life. Will you pray for Marin and others like him to believe in the gospel and for MEI team members to be ever sensitive to how to handle cross-cultural situations for His glory?

For Information About MEI Opportunities, visit: www.cmda.org/mei.

Global Health Outreach (GHO)
God of the Details
by Gloria Halverson, MD, and Brenda Wilcox Abraham, MD

April 19-27, 2008 marked the first Women in Medicine and Dentistry (WIMD) mission trip through GHO. Seventeen women and three men traveled to Cuenca, Ecuador, as a medical/ surgical team. We had physicians, medical students, nurses, a pharmacist, a translator, and a general helper.
 

From our first moments in Ecuador, we saw God at work – and we saw Him in all the details. Coming through customs, one of our team members lost her passport, money, credit card, and driver’s license. The specific prayers for the details had begun.
 

The statistics from the trip don’t give a complete picture. So much more happened than 607 patients treated, eight minor and twenty-one major surgeries done, and 1107 prescriptions filled. As a microcosm of the body of Christ, God brought different personalities, ages, backgrounds, and talents together and united us as one.
 

The connections began at the U.S. airports. They continued as He matched roommates with similar life experiences to help each other. Our devotionals were God-inspired to speak to each of our hearts. And our worship connected us in praise. One person decided while still at home to make laminated Bible verses for the group, and just happened to pass them out the morning another person gave their devotional on THAT VERY verse.
 

Each person was needed and appreciated. For exam-ple, a man who had sought medical help futilely for three years because of progressive weakness “just happened” to come to our clinic that week and “just happened” to be triaged to our rheumatologist, who looked at his hands and immediately diagnosed dermatomyositis. One pediatric patient needing a huge hairy nevus removed from her arm came the day our pediatric O.R. nurse could spend the entire day with her. We didn’t have enough anesthesiologists for the number of cases to be seen, so our pulmonologist moved from the outpatient clinic to the O.R. to do conscious sedation, so more patients could be helped. We were all stretched to use our gifts in new ways.
 

God made very clear to us what we have heard in statistics at home. Many physical problems presenting to doctors are really a manifestation of spiritual problems. We were sponsored by the Verbo church, which allowed us to counsel with patient after patient, addressing their true problems while ministering to the spiritual nature of their complaints. Pastors and church members will follow through with these patients and their spiritual needs. It was amazing to see God’s work in pairing patients with just the right counselor.
 

A woman whose husband was unfaithful was triaged to a physician who had walked that same road. A woman who was infertile was able to hear how her physician had found God faithful in that same difficult time. A couple, who came in fighting so much that they were sent for counseling before even having the medical part of their appointment, left after her surgery holding hands and with her carrying the bouquet of flowers he had bought for her. They planned to go to church together the next Sunday.
 

A patient with an early gynecologic cancer who could not afford treatment and was widowed with six children to care for did not thank us for doing her surgery or for paying for the surgery and pathology needed. She thanked us for caring about her. It was the love of Christ.
 

What started out as our first WIMD mission trip was unanimously declared the first ANNUAL WIMD mission trip. The tentative dates for next year’s team are April 25-May 2. Consult the WIMD section of CMDA’s website for details.
 

By the way, as our doctor with the missing passport was packing to leave the team, fly back to Guayaquil and the U.S. embassy, pay extra for a hotel and to take a translator, a cab driver called from near the airport to say that he had found her passport, charge card, and other papers. Yes, God was in all the details.

For Information About GHO Opportunities, visit: www.cmda.org/gho.

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Motivating Your Staff
by David Stevens, MD

Your success as a professional requires more than just knowledge, skill, and the wisdom to know when to apply them. You must also motivate the healthcare team you lead in the hospital, your practice, or your research lab.

Why? Because motivated staff provide compassionate care to your patients. Enthusiastic team members embrace change. Their contagious devotion and commitment make your job easier to do. They stimulate trust, encourage each other, and inspire you to do your work even better. A motivated team has cohesion that makes work a lot more fun.

God taught me about motivation long before I knew I would need that skill. For two summers during college, I sold family Bibles and other Christian books door to door for Southwestern.

Every year they recruit hundreds of college students, with no guarantee of pay, to work seventy-five or more hours a week in spite of doors slammed in their faces and dogs chasing them down the street. Not only do they recruit them, they motivate them to work harder than they ever have in their lives knocking on every door in some county far from home. Every Sunday afternoon, all of us would meet in a regional location for a sales meeting to reveal how well we had done the week before and to get motivated to go out again and work twelve to thirteen hours a day. I remember everyone yelling together, “I feel healthy! I feel happy! I feel terrific!” I learned a lot about self-discipline, determination, and attitude during those two summers.

Twelve years later, God used that training to help me motivate other people. It was 1983, and I was starting Tenwek’s Community Health Program. I had arrived as a new missionary two years earlier, the third doctor for 300,000 people. We only had seven to eight trained nursing staff. The hospital was averaging 185 percent occupancy for the year with two and sometimes three patients to a bed. One day during a malaria epidemic we had 485 inpatients in our 135-bed hospital! Days and nights were long as we took care of a never-ending stream of patients. A look at our statistics revealed that preventable diseases were the cause of half of our admissions and half the hospital deaths.

The light bulb went on! I could keep working sixteen-hour-days and every third night call for the rest of my career, but things wouldn’t change unless we figured how to motivate people to boil their water, immunize their children, build latrines, space their children, and  adopt twenty or so other important health practices.

There was no way we could reach 300,000 people if we had to pay our “Health Helpers” to educate their communities. We would need to recruit volunteers and motivate them to continue to work three half days per week to help their communities for the rest of their lives.

Fast-forward twenty-five years. Today there are over 1,200 community health workers and they reach over a million people whose health has been radically changed. The vast majority of the people we recruited are still volunteering a quarter of a century later.

Okay, that was Africa. What about the U.S.? A few years ago, Christianity Today and the Christian Management Association honored CMDA as the best Christian workplace in the United States. We were picked because our staff love working at CMDA! They are motivated with many of the same principles I used in Africa with our volunteers. The techniques used may be a little different here, but the principles are the same and they will work for you. Focus on:

Unique Identity

Your team needs to know their distinctiveness. What is your unique mission? Why is it important? What does each individual contribute toward accomplishing your collective vision? How are they recognized and lauded for what they do?

Every person desires to invest their life in something significant. They long to know they are needed and are making a unique difference in an important endeavor. They want others to recognize their contribution. To accomplish these goals:

 • Inspire staff with your mission, vision, values, and  goals.
 • Develop a slogan that encapsulates your vision.
 • Create a logo that communicates your mission and use it widely.
 • Develop a badge, uniform, or other visible means of setting your staff apart.
 • Give certificates for training completed or skills mastered.
 • Laud your staff for their accomplishments in front of significant others.

Communication

Good communication vertically and horizontally lets staff know what is going on. Poor communication breeds distrust or worse, apathy. Tell stories of how staff have made a difference in a patient’s life or done something extraordinary to do their job better with a new innovation or extra education. Share dreams, discuss problems, seek input, reveal your financial situation, or whatever else you can do to be transparent. This gives your staff a sense of ownership and importance.

• Formally – start a staff newsletter, have regular meetings to keep everyone updated, send e-mails, have senior staff meetings and task them to pass on information. Have general staff meetings. Encourage questions.
• Informally – seek input, share thank you notes, post pictures, tell success stories.

Comparison

Staff are motivated when they know they are doing a good job. In med school they posted our grades using our ID numbers. The first thing I did was look at my grade. The second thing I did was to look to see how my grade compared to everyone else’s. How are individuals doing compared to the standards you have set for your practice, others doing jobs similar to theirs, national standards, or similar practices?

•  Formally – working with your staff, set measurable goals that everyone knows – waiting times for patients, lab turn around, call backs, etc. Let staff report how they are doing, and make the overall report known to all on a monthly basis. Compare them to national averages. Have small groups focus on how to improve their work to meet their goals.
• Informally – give real time feedback when things go well or don’t. Laud individual staff in front of their significant others. Reward them - it is not what you give, but how you give and what it means. Communicate that you are going to be the best practice in your town, state, or even the country.

Competition

Competition is a great motivator. Create two types of opportunities – those that everyone can win by meeting a minimal level and those that recognize your top people. Rewards can be privileges (employee of the month parking space), financial rewards, prizes, or recognition. You might reward:

 • Fewest rejected insurance claims.
 • Best new patient information sheet.
 • Greatest suggestion this month.
 • Employee of the month.

Sense of Family

When I interview prospective employees, I tell them that we don’t hire new staff; we adopt people into our family. I constantly refer to “our CMDA family.” I believe God has entrusted each of my staff into my care to help them serve Him through their work. I want to disciple, counsel, encourage, train, and supervise them to be all that God has designed them to be. You might consider:

• Parties – any excuse, fun, crazy . . . and get right in the middle of them. Take pictures that they can share with others. You want to make memories. CMDA’s staff parties are legendary!
• Celebrate – accomplishments, birthdays, new babies, weddings.
• Show concern – deaths, illnesses, other crises.
• Surprise them – let staff off early, invite them to your home, take them out for lunch in small groups to get to know them better.

There are many more techniques than this short article allows me to share. Be creative. Brainstorm things you can do for each principle. Last year we had a community garden on CMDA’s property, where everyone could garden together in the evening or weekends. Recently, we had a CMDA yard sale where staff had fun selling their junk in our parking lot. There was a lot of laughter and we made some good memories. When the movie “Amazing Grace” came out I surprised the staff, shut the office, rented a bus, and took them all to the movie and for ice cream sundaes afterward. Human trafficking is one of CMDA’s issues, so it was inspirational, educational, and family fun!

I challenge you to motivate for success. You will have better staff retention, higher work output, better served patients, and a lot more fun at work every day!

David Stevens, MD, MA (Ethics), is the CEO of CMDA. From 1981 to 1991, Dr. Stevens served as a missionary doctor in Kenya, helping to transform Tenwek Hospital into one of the premier mission healthcare facilities in that country. As a leading spokesman for Christian doctors in America, Dr. Stevens has conducted hundreds of television, radio, and print media interviews. Dr. Stevens holds degrees from Asbury College and the University of Louisville School of Medicine. He is board certified in family practice. He earned a master’s degree in bioethics from Trinity International University in 2002.

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The Problem of Time
by Al Wier, MD

I had it all figured out. I told my office to schedule my last patient at 3:30. With the likelihood of being one hour behind by then, I could just make it to see my son pitch his 6 o’clock baseball game. Deacon’s meeting was at 8 o’clock and Bowen should be finished by then. Supper could wait – I had a cup of yogurt for breakfast.
 

Just as I was finishing up with my last patient at 5 o’clock and starting to leave the examining room, I saw a look of anguish on her face and watched her begin the question, and then hold it in. I had a choice to make, and either way I would hurt someone I cared for. Why is there just not enough time?

Most of us have had days like this. Time often rules our lives and time decisions hurt. I know this is true for doctors because we surveyed our membership in 2005 and found that 41 percent of our doctors listed time management as their chief life challenge and 32 percent listed stress. When we surveyed Christian medical and dental students last year, time management was listed as their second greatest challenge behind the volume of material they had to learn. I could lay out twenty reasons why this is so, but the bottom line truth is that doctors are too busy and overcommitted.

The real crux of time management as Christian doctors is what we choose to put into time rather than how we attempt make more of it. Margie Shealy, one of my co-workers at CMDA, recently lost her mother in death and sent to us this note of warning:

“One thing that I would like to share with you, that I am sure you already know, is that time is very precious; it is so important to use it wisely, to invest it in others and to not be selfish with it. Don’t look at that time you spend with those who need you as an obligation, but as a privilege.”

With what should we be filling our time? My pastor has told us many times, “The only things you take to heaven are your character and others.” So, what do we fill our time with? A year ago, I surveyed about two hundred Christian doctors with the question, “What is it that has brought joy to your life, both in your practice and outside your practice?” The importance of the question is this: If we can discover that which brings joy to our lives, we should pursue it, placing these things into our time schedule above all else. There were five major avenues to joy described. The first was service: to care of others solely out of a desire for their good. The second was relationships: with patients as whole persons, our families, our colleagues, and our friends. The third was devotion: devoting ourselves to the one relationship that makes all other relationships matter, to God through Christ. The fourth was mission: living out the mission and missions in life that God has called us to. And finally, personal growth: pursuing the God-given passions and longings of our lives in ways that honor the Creator.

I have no doubt that these are the things of eternal substance that should fill our time. The question is, “Have we let life stuff our time with other things of less importance?” And, if so, “How do we retake time from the less important so that it may be filled with eternal substance?”

This second question can be addressed in practical ways. There are a number of skills we can develop that can help us recover time from the less important:

In my own life when I take all of this information and distill it, managing time as a Christian doctor comes down to simplify, surrender, and select. I need to simplify my lifestyle so that I am free to complete God’s best plan for my life. I start this process by setting boundaries on my expectations and acquisitions, then move toward removing possessions or activities in my life that use my time in less than vital endeavors. Each morning, I surrender myself to God. I look to heaven and give God all I am, all I have, all my dreams, all my plans, all those I love. Let God entangle me where He will. And, finally, I need to select: these things I will do and these things I will let go. Here I must be deliberate about setting priorities and choosing only the best. For most of us, this should be reviewed yearly during a special time of reflection.

One final lesson is critical: our time is in God’s hands. If we truly offer our lives to Him, if we invite Him to the race each day, no matter what the pace, God will keep up with us. We need not despair when we seem to be losing the battle with time.

Dr. Nabil Jabbour, a retina specialist from Morgantown, West Virginia, told me of a day that his life seemed too fast-paced even for God. His office had overbooked him to the tune of seventy-two patients. He knew the task was impossible and that even God would not find a slot to show Himself. The day just had to be survived. It began in the hectic, time-pressured way he imagined, but then God stepped in as if to say, “No matter how fast you run, you won’t leave me behind.”

A woman he had treated for some time with progressive blindness greeted him, “I’ve done it!” This patient had consistently denied God’s presence in her life and felt that life had no purpose. Her husband was confined to a nursing home and she was steadily losing her sight. Dr. Jabbour had been seeking to bring her to the Lord, but she had rejected his God for months as her vision deteriorated and her husband weakened. On this overwhelming, fast-paced day, where even God could not keep up, she exclaimed, “I’ve done it! I’ve found purpose in life.” She had awakened that day at a point of despair such that she would try anything, and had said to God, “Okay, God, you prove to me today that I can find purpose in life, as I walk nearly blind through a nursing home filled with hopeless people, and I’ll believe in you.”
 

She carried with her a box of donuts and passed them out perfunctorily as she moved from bed to bed toward her husband. Then, as she left the bedside of one elderly man, he would not let go of her hand. “You don’t know what you’ve done for me,” he said. “What?” she asked. “No one has held that hand for seventeen years.” She fell to her knees in tears and then, during the most hectic office day in Dr. Jabbour’s life, she told him, “There is purpose in life and I know God is real.”
 

Redeemed from hopelessness, this woman spoke and God said to Dr. Jabbour, “Be wise with your time. Order it well. Walk when you can walk – but when you have to run, remember that I am God and I can keep up with you.”

Al Weir, MD, is CMDA’s Vice President for Campus and Community Ministries. He is a past president of CMDA. He served as a medical missionary (1983-1985) at Eku Baptist Hospital in Eku, Nigeria. His interests include the relationship of science to Christianity, end-of-life palliative care issues, the role of faith in the practice of medicine/dentristry, and the development of local ministries for CMDA.

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