&%#@- Words Matter

“It was f---ing crazy!”

Foul language doesn’t usually surprise me. Over the last few decades vulgar speech has become increasingly common and can be heard in almost every setting and circumstance. This particular instance of the f-bomb caught me off guard because of the speech that had preceded it.

The F-bomber and I had just been engaged in a casual conversation at the gym. We do not know each other well but we have had a number of gym conversations, enough for us to know one another’s professions and injuries. There had also been enough passing references to faith to lead us to consider one another to be Christians. On this particular evening he had talked about his pastor and how he had been helping the pastor get in better shape.

Thirty seconds later, while talking with someone else in the gym, his speech became more colorful. I was surprised, not by the fact that he swore, but at the ease with which he transitioned from spiritual to vulgar dialogue. It was clear that he did not think word choice mattered at all.

The next morning I had a medical appointment to get my knee brace adjusted. The brace adjuster is a nice man I have seen on a number of occasions to get my custom brace sized and fitted. In the course of our session I had learned that he was active in his church, hosting a small group Bible study and serving as a camp counselor for a week each summer at a camp for troubled children. In the course of my brief visit with him he used all of the language I had heard in the gym the night before. He did so with ease and without hesitation. It was clear that this was how he talked all of the time. I drove home thinking, “When did Christians quit caring about the language they used?”

My childhood home was anything but Christian and vulgarity was common. My step-father had been a sailor and he cursed like one. Like the father in the movie “A Christmas Story” profanity was an art form to my step-dad. In spite of his foul language I grew up with a clear understanding of the difference between good words and bad words. I learned that good people used good words whenever possible.

While I may be out of touch with current social mores, my sense that there are words that should not be spoken by good people, particularly Christians, is not a belief of my own invention. The idea that there is speech unbecoming godly people was clearly described by the apostle Paul almost two thousand years ago-

“But among you there must not be even a hint of sexual immorality, or of any kind of impurity, or of greed, because these are improper for God's holy people. Nor should there be obscenity, foolish talk or coarse joking, which are out of place, but rather thanksgiving.” Eph 5:3-4 NIV

Paul makes it clear that what we say matters. Christians are to be heavenly minded people who are continually thinking of the world in the context of their faith. As people who embrace the reality that we have been saved from our sin and called to be different we should seek to be better and different in every aspect of our lives. The desire to be different and better should extend to our speech as well as our actions. True followers of Christ take His teaching that “the mouth speaks out of that which fills the heart.”

Taking Jesus’ words to heart leads to the conclusion that our words matter. When, over and over again, God calls His people to be holy, he is calling His people to be clearly distinct from the world around them. It seems this teaching that Christians need to strive for higher standards of behavior has been swept under the church carpet.

My greatest concern is not that Christians use bad words. Far more important is what the casual use of profanity represents. Too many Christians are no longer concerned with sin. Excellence is no longer a virtue or a goal. It seems that many believe it more important to display our commonality with those outside the church than it is to show our differences. We are more concerned with being “one of the guys” than we are with being “one of the chosen.”

People of faith will do well to consider Paul’s instructions in a letter to his friend and protégé Timothy to “set an example for the believers in speech, in life, in love, in faith and in purity.” 1 Tim 4:12

Bart

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Why Would Anyone Want to be a Police Officer?

I posed the question to a police officer this week and he could not give me a good answer. Morale among officers is the lowest he has ever seen. He is not alone in his thinking as I have received similar answers from other officers. The job is difficult, dangerous and increasingly thankless. For these reasons many officers are considering leaving the profession and there is a fear that the quality of future officers may be on the decline. Excellent candidates may choose other careers.

In California recent law changes have made it easy on criminals and hard on everyone else. A state ballot proposition passed in 2014 converted many felonies into misdemeanors and made many crimes the equivalent of a parking ticket. Repeat offenders who used to get jail time are now given nothing more than a citation and sent on their way. The inability to remove many lawbreakers from the streets has been demoralizing to officers who want to protect society.

Recent events have highlighted the dangers that officers face on a daily basis. While shootings such as the one in Dallas get national coverage the dangers of the job are not limited to firearms. Police officers often find themselves attempting to detain uncooperative suspects who are bigger and stronger than they are. A police officer patient of mine recently related a terrifying story of fighting for his life. He was in a five-minute fight with a suspect in the midst of a hostile crowd. Punches were thrown, bodies were slammed into cars and weapons were drawn. It never made the news but it left him seriously shaken.

This officer and others like him have told me that they often worry about being killed or injured. They all relate the same primary goal. They want to go home alive at the end of the day. Many have told me of fearful spouses who have difficulty sleeping while their loved one is at work. Stress levels are incredibly high and depression and anxiety are common.

For men and women in a career filled with danger and stress attacks on the profession wage a heavy toll. When protestors march and chant about harming cops and when racism is assumed in every interracial interaction officers are on edge. Their work has become so highly politicized they fear that every interaction carries the risk of criticism and disciplinary action. One officer I know discharged his weapon at a suspect who was reaching for a gun while holding a hostage. Even though he missed and no one was harmed he was subjected to a grueling and demeaning performance review that lasted for over a year.

Adding insult to injury is the fact that many officers are not paid well. Starting salaries in the United States are as low as $26,000 a year, about $12.50 an hour. Patrol officers make on average less than $40,000 a year in 11 states and less than $50,000 a year in over half of the states. We cannot expect the best and brightest of our citizens to put their lives on the line when we do not pay them well or appreciate them enough.

Recent police shootings illustrate another seldom discussed reality of police work. Even well-trained, educated and experienced officers can sometimes struggle to perform in high stress situations. It is one thing to know what to do and to be trained on what to do. Doing it in a life or death situation is a different story all together. I have seen this in my own profession. I have observed firsthand as experienced doctors who had passed all the tests and completed all of the training melted down in a life or death situation. They had good intentions and wanted to do well but they did not have the psychological make up to perform under intense pressure. Regardless of training, we cannot escape the reality that we are all human.

I wonder if this is not a major factor in many police shootings. As I watch the videos from Minnesota and Louisiana I wonder if panic and fear were the primary factors leading to poor decisions and actions by the officers involved. From what I know of police officers, and about people in general, this is far more likely than racism to be the root cause of the tragedy.

If we want to minimize police errors and mistakes we will have to create an environment in which the best and brightest among us pursue careers in law enforcement. If we continue to attack and question the motives of police officers, if we paint with a broad brush and accuse them of racism or other ill motives, if we continue to pay them poorly and treat them poorly, the best and the brightest will turn to other careers. All of us will suffer as a result.

Bart

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When does Serving Become Enabling?

Get a group of Family Doctors together to talk about improving patient outcomes, any outcome, and one question is certain to come up, “What is the patient’s responsibility?”

Doctors are measured against a number of standards. Each month I get reports on the percentage of my patients who have had colon cancer screening, mammograms and pap smears. For diabetic patients the list is extensive and includes blood pressure control, cholesterol medications, blood sugar control and whether or not the patient has been screened for kidney disease.

In my office, staff members review the reports and make phone calls and send out electronic reminders to encourage patients to get the necessary tests and treatments. Every time I look over the list of names and review the charts I see that regardless of the test or screening all of the patients have something in common. Every one of them has been previously told what the tests were and been given the necessary orders and referrals to get them done. They just haven’t bothered to do it.

It is a source of unending frustration for doctors. We went to school to be doctors, to care for disease and provide treatment to patients under our care. None of us signed up to be patient care reminder professionals. Yet that is what we are becoming. My medical group recently announced a new quality measure that illustrates the absurdity of it all. We are now being measured according to how consistently our patients pick up their prescriptions at the pharmacy. Telling a patient to take a medication daily and sending the prescription to the pharmacy is not enough. If they don’t pick up their refills consistently we are held responsible!

Too many patients do not prioritize their health and instead expect their doctor to pick up the slack. Several months ago a diabetic patient came to our office for an initial visit. We started a new blood pressure medication, ordered the appropriate lab work and asked the patient to return in a month. Four months later the patient returned. The blood work had not been done, so the order was sent again to the lab.

Two months later, 6 months after the initial visit, the patient called the office requesting a refill of his medications. I checked the chart and saw that the patient still had not been to the labs. Reluctantly I decided I needed a firmer response. I left a voice mail and sent an electronic message saying that we wanted to partner with him in the care of his diabetes but that he had failed to follow our recommendations in spite of repeated calls from our office. I told him I would refill his medications for 5 days to allow him time to get his blood work done and be seen in the office and that no additional refills would be given until he was seen.

Nine days later on a Saturday I received a page from the patient. He had been to the lab that morning but he was out of his medications and he wanted an urgent refill. I was unable to hide my frustration when I returned his call. I reminded him that I had told him that he had to get his labs done and be seen in the office but that he had failed to follow my advice.

“So you are going to deny a diabetic his medication?” was his angry reply. My reminder that his lack of medication was a result of his personal choices did not go over well. He started to argue with me and I wondered what to do. I finally decided to offer a compromise.

“I’ll give you three days of medications and see you in the office Tuesday morning,” I said. He begrudgingly agreed. Before hanging up the phone I shared with him a truth that I often share with similar patients saying, “You know, If I care more about your diabetes than you do, there is something wrong.”

What was wrong with this patient is what is wrong with many patients. For a multitude of reasons, many of them understandable, patients fail to take care of themselves and to follow recommendations. Twenty years ago they alone suffered the consequences of their poor decisions. What few of them understand is how their poor decisions impact the physicians providing their care and how these consequences put a strain on the doctor/patient relationship.

As a physician who is committed to providing the very best care for his patients I find myself frequently wondering if I am enabling instead of serving, if there is a point when going the extra mile is actually a disservice to my patients, and how to determine when that point has been reached.

Although I think this patient may have reached it…

-          Bart

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When Schools Can't Be Trusted

The words on the page took us by surprise. The graphic description of the rape of a young boy was not something we expected to find in required reading for our 15 year-old daughter. We did not expect the faculty of a public school to go out of their way to encourage morality or protect the innocence of students but we did not expect that vulgar material would be chosen and assigned.

I arranged a meeting with the teacher and the principal to bring my concerns to their attention and see if there was a possible remedy. My concerns were summarily dismissed. While I expected my concerns to be ignored the reason given for the choice of reading material was not expected at all. One of the teachers said, “It is our job to expose children to mature content.”

I did not hide my anger well when I replied, “No, it is your job to teach them how to read and write. It is the parent’s job to decide what children should be exposed to.” The reality that teachers and administrators believed it was their responsibility to determine when and how children should be exposed to sexual content was deeply disturbing to me. The belief seemed to be that it was up to parents to simply shut up and go along, to allow the “experts” to teach morality to their children.

I had two goals in meeting with the principal and teachers. The first was to get an alternative assignment for my daughter. The second was to get them to reconsider their policy on assigned reading. While I was able to get an alternative assignment for my daughter, I eventually gave up the second  fight, convinced that there was nothing I could do to change the minds of the faculty and administrators.  For the remainder of her years in school I did my best to teach Biblical values to my daughter and to teach her how to determine right and wrong. There were a number of times when that meant correcting things her teachers said but I did not make any further formal protests. She graduated from high school a few years ago and the issue faded from my mind.

The issue returned to my mind this week. Recent developments in the state of Washington reveal that the sentiments expressed by my daughter’s teachers are not isolated. It seems that the belief that public schools are responsible for determining when and how children should be exposed to sexual concepts is widespread.

The State of Washington’s recently released K-12 learning standards include a section of “core ideas” to be a part of the sexual health portion of the health and safety education of elementary age students. It is suggested that kindergarteners “understand that there are many ways to express gender” and that by second grade children should “understand there is a range of gender roles and expression” and that by grade 4 children should be able to “define sexual orientation.” In the eyes of educators, hand washing, tooth brushing and basic nutrition are no longer enough. 5 year-olds need to be introduced to the concepts of gender identity.

The presumption that all children need to learn these concepts at such a young age is absurd. There are many families who try to protect the innocence of their children. I did not know where babies came from until I was 11 years old. My son was 10 when we had “the talk” and he was clearly overwhelmed with the concept. I did not think he was emotionally ready at that age but was compelled by the reality that his elementary school was going to have a class on the topic the following month. I had to change my parenting plans because of a school program.

Parents who wish to defer exposing their children to sexual concepts are going to find themselves increasingly at odds with their school districts. According to the state of Washington, almost all children as young as 9 are all old enough and mature enough to be able to understand sexual orientation. The fact that a significant percentage of families of faith do not believe that all sexual orientations should be expressed and acted upon seems to be irrelevant. It is the responsibility of the public system to teach morality. 

I am left wondering how it is that our society has evolved to this point. Public schools across the nation are failing in their essential responsibilities to teach children reading, writing and arithmetic, but they are deciding to take on the additional responsibility of teaching young children about sexuality. More remarkably, parents are allowing it.

It is clear that concerned parents need to be increasingly involved in the education of their children. Parental responsibility extends far beyond simply making sure students get their homework done and have good attendance. Parents need to know exactly what their children are being taught and be willing to stand up for their innocence. It is likely no one else will.

Bart

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reference: http://www.k12.wa.us/HealthFitness/Standards/HPE-Standards.pdf