Category Archives: medical

Made in God’s Image

It’s been one of those weeks…

Two patient deaths, a patient stabbed right outside of clinic, and the regularly scheduled patients still waiting to be seen. And it’s only Wednesday.

Today I spent some time talking to the daughter of one of the deceased patients who called from out of town. They had been estranged for some time so she had many questions, particularly about how he looked before he passed. Apparently his body had decomposed too much for her to see, so all she had was my general description. My heart was heavy after that call.

Talking to her reminded me that this patient was not just another homeless man, another name on my schedule, or another disease to treat. But he was someone’s father, someone’s son, someone’s friend.

It’s so easy to lose track of the person in the endless list of patients that need to be seen. I’m ashamed to admit that there have been days where I can’t remember a single patient name, but I can tell you their diagnoses and treatment plan.

It’s been a tough week. But it’s been a good reminder that each person has intrinsic worth. That was God’s design, making each person in His image. God help me to see and treat each patient that way.

To my patients who passed away…

Sorry for the super long no update. Life has been busy (but good!). Having a child really does change your life…

I found out this week that another patient I had gotten to know pretty well at the homeless clinic passed away. They say the average life expectancy of the homeless is around 50 years old. Sadly, I have found that to be true.

Some of these deaths were pretty expected, but this last one caught me completely off guard. I had just seen him a couple weeks ago, and I expected to see him in a couple of weeks for his monthly narcotic prescriptions (and usually some brand new complaint).

It has been hard finding the space and time to mourn. After finding out through an inbox message the very first thing in the morning, I had a full panel of patients waiting to be seen.

Medical school and residency didn’t teach me all that much about coping with patient death, and I have found that it has been much easier to just set it aside and forge ahead. After all, there are still living patients who need my immediate attention.

This morning as I took my daughter out for a walk, I realized something that made me sad; I am beginning to forget. I was thinking about the patients that I had gotten to know who have passed, and even now I can’t remember some of the names.

Well Bob (fictitious name), I don’t want to forget you. Here’s to your memory. I’ll try to do this for the patients I have gotten to know, but we’ll see how it goes. Hopefully it wouldn’t be too frequent.

—

Bob, I have to admit that I did not look forward to our appointments. Narcotic management is one of my least favorite things, and you certainly made it difficult. For the longest time it felt like a wrestling match of sorts, you always pushing for more and me trying to hold my ground. I confess that there were times I gave in because it was too much to deal with and I had too many patients waiting.

I’m happy to say that it has turned into much more of a partnership this past year. But still, I would always want to get out of the room as fast as I could because there was always “one more thing.”

You were a tough guy, and you have endured much. And you certainly looked the part: big, perpetual scowl, multiple tattoos. Yet you showed me a side of you that very few have seen, even shedding some tears. Thank you for that privilege.

Thank you for sharing with me one of your favorite Bible verses the last time I was with you, Proverbs 3:5-6. That’s one of my favorites too, so hopefully I will never forget about you.

I didn’t know I will never see you again (this side of eternity, anyway). Thank you for the reminder that tomorrow is never guaranteed, that no matter how difficult the patient encounter, that might be my last so I need to be present completely instead of already having one foot out the door.

I do hope to see you again one day. May you rest in peace.

“Trust in the Lord with all your heart
    and lean not on your own understanding;
  in all your ways submit to him,
    and he will make your paths straight.” Proverbs 3:5-6

Why God is Not Against Vaccines

I’ve been seeing a lot of news about vaccines lately in the social media headlines so I figured I would throw in my however much these thoughts are worth. A frustrating situation is when patients refuse medical treatment because they believe in God. But wait, I believe in God too, and I don’t remember the Bible ever saying we shouldn’t use medicine. The reasoning, I think, goes something like this: God is the all-powerful healer who holds our lives in His hands, and so if it’s His will that I get sick, then I’ll just get sick because if it’s His will to heal me, He can, and He will if I have enough faith in Him (and if I take medications, this would mean I don’t have enough faith).

While I do agree that God is the all-powerful healer who hold our lives in His hands who allows sickness in this world as a result of sin, and that if He wanted to, He could miraculously heal anyone of any disease, I do believe that medicine and faith are not mutually exclusive. God can do miracles, but usually God works through natural processes and the creative abilities and intellect that He has given to human beings, His image bearers. Those who would trust exclusively on God for medical needs probably would have no problem going down to the local store to buy food, or the mall to buy clothes. Even though God is fully capable of supernaturally providing food and clothing (manna for the Israelites and coverings for Adam and Even), He has chosen to meet those needs through people who He has given the knowledge and ability to harvest food and make clothing.

In the same way, God has given people the capacity to understand the workings of the human body, and the ability to do research to come up with ways in which to combat sickness. Yes, Jesus came and healed a lot of people of disease. But there were tons more who were not healed, because healing wasn’t the main purpose of Jesus’ ministry. Jesus came not to simply relieve physical suffering, but to usher in the kingdom of God. Jesus’ miraculous healings not only authenticated His claims to be the Messiah sent by God, but also pointed to the future reality of God’s kingdom that is without sickness, sin, or death. And so medicine is a means in which to bring creation back closer to how it was intended before sin entered the world.

In the Bible you don’t read anywhere a prohibition to use medicine. Paul even tells his fellow laborer in Christ Timothy to “use a little wine for the sake of your stomach and your frequent ailments” (1 Timothy 5:23), and not just pray for healing. The Gospel writer Luke, a traveling companion of Paul, was a doctor, and we don’t see Paul telling Luke to quit his job. Are there misuses of medicine? Of course, as there are misuses of everything else that is good because we live in a world of sin. We certainly can trust in what our hands can provide rather than God, but that can happen not just with healing, but with anything else (e.g., provision of food and future security). It’s a daily discipline to come before God in dependence even as we are active in using our gifts that God has given us for our provision.

All this is to say, the development of vaccines is an example of the grace of God given to us to combat the corruption of the natural order due to sin. Vaccines and antibiotics are probably two of the greatest medical discoveries in terms of lives saved and illness prevented. Are there side effects to vaccines? Sure. Is autism one of them? I can’t imagine the fear a parent would have hearing about the reports of children manifesting autism after routine vaccinations. I want to acknowledge those fears, but the vast bulk of scientific evidence would say no. 

Christ came to deal with sin in this world. And that means not just taking away the penalty of our sins against God by dying on the cross, but also ushering in a kingdom (that will come in full when He returns) that is how things were intended to be: no more tears, no more sickness, and no more death. In the meantime, let us use everything that God has given us to stay healthy so that we are best equipped to carry out the kingdom work.

Then I saw a new heaven and a new earth, for the first heaven and the first earth had passed away, and the sea was no more. 2 And I saw the holy city, new Jerusalem, coming down out of heaven from God, prepared as a bride adorned for her husband. 3 And I heard a loud voice from the throne saying, “Behold, the dwelling place of God is with man. He willdwell with them, and they will be his people, and God himself will be with them as their God. 4 He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things have passed away. 5 And he who was seated on the throne said, “Behold, I am making all things new.” Also he said, “Write this down, for these words are trustworthy and true.” Revelation 21:1-5

 

Is Universal Healthcare Unbiblical? (plus free audiobook!)

I came across this intriguing question while reading an article on the Christianpost, a Christian news website. The controversies over the contraception mandate and the question of whether governments can make people buy certain things aside, is the idea of making healthcare available to all against biblical concepts?

Just a cursory look at where political parties stand, it would seem universal healthcare is not something that God would care for given its lack of support by conservative groups. It seems to me, though, that from a study of Scripture (albeit quite brief), the more liberal parties support the kind of things that we see happening amongst the early Christian community, like sharing food and material goods with those in need and reaching out to those who were socially oppressed.

Acts 2:44-45 says, “And all who believed were together and had all things in common. And they were selling their possessions and belongings and distributing the proceeds to all, as any had need.” Now there are some that would say these passages simply describe what was going on in the early church because of their circumstances, and not a prescription for Christians today to follow, and I think there’s truth to that. Elsewhere in the New Testament letters there are calls to care for the needy, but not a command to sell all you have and give it all away.

Others would say that the caring for the poor ought to be done by the Christians, as seen in the early Church, and not legislated by the government. While I also agree that the church needs to care not just about spiritual needs, but to relieve physical suffering as well (as means to point people to Christ), I don’t think God would be against legislating to provide for the poor. In fact, God actually did.

God gave the nation of Israel its very own laws so that Israel could be a model of what a nation governed by God would look like. Despite being terribly difficult to read through, those first few books of the Bible gives us an idea of God’s heart and what He cares about. You don’t have to read much of the Old Testament to know that God cares about the down-trodden, the widows, the orphans, and the poor. Just read Isaiah 58 as one example.

God’s laws made various provisions so that those without means could be taken care of. Deut 24:9 says “When you reap your harvest in your field and forget a sheaf in the field, you shall not go back to get it. It shall be for the sojourner, the fatherless, and the widow.” The Israelites were forbidden to lend to their fellow people with interest (Deut 23:19). God commanded that every seven years, all debts would be canceled and servants be set free (Deut 15:1, Exodus 21:2).

God’s heart for the physical wellbeing of everyone in the Israel nation is captured by these amazing verses: “But there will be no poor among you; for the Lord will bless you in the land that the Lord your God  is giving you for an inheritance to possess— if only you will strictly obey the voice of the Lord your God, being careful to do all this commandment that I command you today” (Deut 15:4-5). God’s laws were such that if the nation obeyed, every member would be taken care of and not be in need.

Now of course I not suggesting that the Mosaic Law is meant for the United States. Thank goodness for that, or else I don’t think I will survive with my allergies if we had to do animal sacrifices. But I do think there are principles that are reflective of God’s heart for the poor and outcast that is appropriate for the government to legislate, and it’s not simply up to the church to do.

And as an additional disclaimer, I’m not advocating that everyone needs to just pool all our resources so that we all have the same (which the OT Law does not endorse either) or promoting liberal politics (as they are also for things that are clearly unbiblical). But I would like to suggest that the concept of universal healthcare, a provision of basic services (note basic, and not everyone have access to every single medical intervention) to optimize health through prevention, and promptly treat common illnesses, is a worthwhile goal to pursue, not as a means to itself, but as a way to extend the restoration of God’s kingdom to every aspect of this world.

Now the question is how, and I won’t even try to tackle that here. I will say though, that if you have a heart to meet the needs of those who are suffering, here is an excellent resource that is being offered free! When Helping Hurts is an eye-opening book that shows how well-meaning Christians (or anyone for that matter) can actually do harm in their attempts to do good. For those who don’t like to read, here’s a free audio download!

 

Are Multivitamins a Waste of Money?

Yes they are, according to an editorial in the recent publication of the “Annals of Internal Medicine.” You can read a summary of that article here, but basically, there have been three studies done that have not shown any beneficial effects of multivitamins on preventing heart disease or cancer, nor did those taking long-term multivitamins show any preservation of brain function in the elderly.

Of course supplements are necessary in patients with diseases that cause deficiencies, but for the general public, looks like your money can be better used elsewhere (perhaps in buying more fruits and vegetables?). Next time your relatives from overseas ask you to take home a luggage-load of some American-grade multivitamins, tell them they can put that money in a red pocket to give to you instead.

Need Health Insurance?

Do you or your family member need to buy health insurance? As you know, the Obamacare is being implemented, and one new element is the insurance market exchange. People without insurance now have the ability to shop for insurance through these exchanges and depending on how much you make, you may qualify for subsidies on your insurance premium.

If you live in California, this is the insurance exchange for California that can walk you through the process: https://www.coveredca.com/.  There’s a lot of good infomation on that site as well so if you are in need of insurance, or you know someone who does, take some time to go over it. There’s a calculator that will give you an estimate of your premiums based on your household size and income. Please share!

By the way, Amazon finally has the book in stock, woot!

 

Are Herbal Supplements Safe?

Americans spend an estimated $5 billion a year on unproven herbal supplements that promise everything from fighting off colds to curbing hot flashes and boosting memory. But now there is a new reason for supplement buyers to beware: DNA tests show that many pills labeled as healing herbs are little more than powdered rice and weeds.

O’Connor, A. (2013, November 3). Herbal Supplements Are Often Not What They Seem. Retrieved from http://www.nytimes.com/2013/11/05/science/herbal-supplements-are-often-not-what-they-seem.html?_r=1&

This is a bit of a scary introduction to an overivew of a recently published study on the composition of herbal products. This study supports a lot of the fears that most physicians have when it comes to over-the-counter medications and suppletments.

Not that I am against herbal medications since many of the medicines we rely on today are derived from plants. Even FDA approved medications have its dangers and often biases exists in how existing research is conducted. But, the article does highlight the lack of oversight and regulation in the herbal supplement business.

So, if you are taking supplements (or know people who do), please bring them to your next doctor’s visit. Many people forget to include over-the-counter medications on their med list, and unfortunately there are many interactions that exist between prescription drugs and these supplements.

 

Why Doctors are Always Running Late

I came across this interesting article this past week. If you are tired of having to wait for your doctor, this is a worthwhile read. If you are too busy to read this, then you can save this for the next time you have an appointment. The basic gist is that doctors are always late because it is pretty much impossible to do everything a doctor needs to do in the fifteen minute time slots that is given to us in our healthcare system today. I wrote about this in my book:

I wanted … to be able to see past the physical and meet the deeper needs of my patients, which was another reason family medicine appealed to me. Looking back, that was a great attitude when I had two hours as a medical student to see a patient. I could talk about all sorts of things.

But now in fifteen minute slots I am expected to address patient concerns, manage chronic conditions, keep updated an ever increasing list of health maintenance tasks, perform a physical exam, educate patients on the care plan and medications, and do all of this with active listening and empathy, partnering with patients to motivate them to take charge of their health—sometimes doing all this through a translator phone.

It was estimated in 2003 that a physician would need seven-plus hours per day to complete all the recommended preventative service for a typical patient panel, and another ten-plus hours per day to provide quality long-term care.11 With ever-improving technology we can do a lot of things quicker and more efficiently, but that just means more things are squeezed into the time that’s freed up. No wonder studies have shown physicians have higher rates of burnout compared to non-medical professionals, with the highest burnout among adult primary care providers.12

Worth the Cost? pg. 50-51

11 Yarnell KS, et al., “Primary Care: Is There Enough Time for Prevention,” American Journal of Public Health, 2003 April; 93 (4): 635-41.
12 Shanafelt TD, et al., “Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population,” Archives of Internal Medicine, 2012 Aug 20:1-9.

The sad thing is that we will probably have less and less primary care doctors like the one described in the article, one that actually cares more about the person and less about meeting quotas and checking off preventative service tasks. True, some doctors are slow. But many simply just care about each patient they see. Next time you have to wait, maybe that’s a good thing.

 

 

Get Your Flu Shots!

It’s that time again….Halloween stores, pumpkin patches, no more hot summer days (except in Southern California)… and flu shots! It’s a mad flurry of activity in the clinic with nurses trying to get every patient flu shots on top of all the other orders they have. If you haven’t gotten your flu shot yet, go and get one!

Here are some common misconceptions about the flu:

1. It’s no big deal.

Part of the reason people don’t get so worked up about it is because the flu vaccine works, and more people don’t get it. But sadly, tens of thousands of people still die each year from flu-related complications. Most of these deaths are in adults over 65 years. The very wee are at risk as well.

http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm#study

2. I’m a strappin’ young lad, the flu won’t affect me.

Maybe. But the world does not revolve around you my friend. Chances are you live with young kids or older folks, or you have friends with asthma, diabetes, or other chronic diseases that can be made worse if they get sick.  While the flu might just inconvience you for a time, you can easily pass it to someone who won’t be so fortunate.

3. The flu shot gives me the flu.

Most flu vaccines do not contain live flu virus so the flu shot does not give people the flu. You might feel sore, maybe a little off, but that’s just the body’s immune system mounting a response to the flu shot. And trust me, that’s nothing compared to what you will feel like if you actually got the flu, so it’s a small price to pay.

http://www.cdc.gov/flu/about/qa/misconceptions.htm

4. I’ll just get the flu shot when everyone starts getting sick.

It’ll be too late. It takes about 2 weeks for the body to make the antibodies to protect you from the flu.

5. Flu shot is unnatural, God doesn’t want me to use that stuff.

I think this will be a post on its own, but I will just briefly say that people who believe solely in healing prayer and will not accept medical intervention are misguided in their beliefs. While I commend their faith, a God who heals and a God who gifts people with the intellect and ability to bring about healing are not exclusive. We don’t wait in faith for food to appear, we work to produce it or make money to buy it with the gifts that God has given us (although there are times we can pray for God’s provision, again not exclusive).

Sin is a corruption not of just the spiritual, but the physical as well, and I believe God has given us the gift of medicine to combat the consequences of sin and give us a glimpse of the kingdom to come where there will be no more sickness and death. Yes there have been abuses in medical advancement, but that’s the case for every other good thing God has given us.

So with that, I hope you will all make an appointment with your doctor or go to your nearest pharmacy and get your flu shot (unless there’s a reason you can’t)! Here’s to a flu-free flu season.