Christian Witness in the Workplace
By George J. Pazin, MD, MS
Thoughts from a Physician-Infectious Disease Specialist
To begin with, I have to admit that it has been difficult to bear Christian witness in my workplace. Ordinarily, being a physician provides one with important opportunities to provide Christian witness. In particular, physicians have opportunities, and in a sense obligations, to deal with important religious issues such as the meaning of life, and death as not being a simple end-all. Those opportunities, if taken, provide considerable comfort for many people. However, not being in clinical practice means I have seldom dealt with those issues since my residency training over 20 years ago.
Instead, I have been in full time academic medicine, that is in internal medicine with specialty training in infectious diseases. I also have subspecialty training and expertise in the field of sexually transmitted diseases (STD) derived from my military obligation from 1968-1970 in the Public Health Service Venereal Disease Branch at the Center for Disease Control (CDC) in Atlanta, GA. Thus, most patients do not come to me for spiritual counseling.
I have to admit that it has been troubling to me to observe that some people in society do not want to consider, think about or hear that any behaviours, particularly intimate behaviours, should be limited, restricted or not practiced at all, in that they might be dangerous to one’s health and well-being. The secular public wants easy, simple answers to complex bio-psycho-social problems, even if the answers are not internally consistent, reasonable or sensible.
There appear to be at least four principles which guide my efforts to provide Christian witness as I work. I do not believe that these principles are restricted to Christian witness, but I believe they are consistent with and based upon or derived from my Orthodox Christian foundation.
The first and overriding principle is truthfulness. It may sound simple, but it can be exceptionally difficult in practice. After all, as a physician I do not like to provide information which may cause emotional trauma to my patients. I will cite several circumstances in which counseling and educating patients has led colleagues in the sexually transmitted disease field to be less than truthful. These misleading, partial truths have led to emotional and physical injuries, even death, to many people.
For example, patients have been told that their genital herpes is not contagious when their infection is “not active.” What they are not told is that there is a 1 to 2% chance that their infection may be active and infectious despite there not being any signs or symptoms that the infection is active. We refer to this as “asymptomatic shedding” of the virus. Unfortunately, 30-40% of transmissions of genital herpes occur from people that are asymptomatically shedding the virus. This type of information is not pleasant to share with infected patients, but truthfulness demands that we do so, and it is often not done.
Untruthfulness in the AIDS field
Another example of untruthfulness, this time in the AIDS field, is the phrase, there are “No Reported Cases.” The phrase is used to suggest that the event hasn’t or won’t happen. However, the hierarchical ranking of risky behaviour or special circumstances may preclude recognition of instances that do occur, e.g., the spread of HIV in a dentist’s office setting or the spread of HIV from a hemophiliac husband to wife and subsequently to his newborn child. In fact, in retrospect, we know that five patients had become infected with the AIDS virus in a dentist’s office while there were “no reported cases.” In the other instance, a western Pennsylvania man with hemophilia and his wife consulted a hemophilia center to find out whether they could safely conceive a child. They were told that there were “no reported cases” of a baby, whose father had hemophilia, developing AIDS. Regrettably, their son was one of the first, and at least 13 additional children born in that situation have been diagnosed with AIDS as of January 1, 1992.
There has also been an effort to try to define small risks out of existence. We have shown that the spread of the AIDS virus in casual or close personal contact settings is very, very unlikely, but some infectious disease specialists have extended those observations to say that the virus cannot be spread in the casual setting. I feel we AIDS educators have an obligation not to create undue alarm, but we should not overstate matters which may inadvertently promote careless or cavalier behaviours. In some situations, absence of evidence is not evidence of absence.
Another way in which medical educators may be untruthful is to avoid troublesome issues. We use “head in the sand” approaches, ridicule or laugh off small risks. Or we may make inappropriate correlations such as saying that the chance of getting infected with the AIDS virus by deep kissing is like worrying about getting “hit by lightning.” If one is on a golf course during a thunderstorm, it is appropriate to be worried about lightening. We should not avoid the issue of whether it is risky to deeply kiss persons infected with the AIDS virus.
Finally, we should not subvert truthfulness by distorting reality. We should not exaggerate the time that it takes for antibodies to the AIDS virus to develop, otherwise known as the “window of negativity,” and thus discourage the thoughtful use of testing for the AIDS virus infection. Similarly, we should not mislead people to think that premarital testing for the AIDS virus is not “cost effective.” It is probably worth $35 for a person about to be married to be able to find out that their husband or wife to be is or is not infected with the virus.
Please excuse me for citing so many examples of untruthfulness in the delicate sexually transmitted disease counseling workplace, but I wanted to call attention to the difficulties in this area of work. We should not take pleasure in giving patients unpleasant information, but we must not avoid, distort, misrepresent troublesome information solely to avoid alarm, stress or unpleasant troublesome realities.
Respect, a Second Principle
The second basic principle for dealing with patients in a manner which conforms with requirements for Christian witness that I have adopted is respect for one’s patient. In my clinical settings, I encounter patients whose behavior is contrary to my beliefs. I force myself to help the patient with understanding and compassion, but without judgment because they are part of God’s creation and as such, deserve my respect.
In accord with the principle of respect for all my patients, I try to avoid blaming my patients for having acquired their infections. For example, I deliberately avoid the term, AIDS “victim”, because when one uses the term, it is almost invariably followed by a comment that people particularly pity the “innocent” victims such as babies infected with the virus or people who have been infected through contaminated blood or blood products. The unspoken corollary to “innocent” victims are “guilty” victims, and I do not believe blaming people for having acquired infection with the AIDS virus is consistent with my Christian concept of mercy.
An Obligation to Provide Care
The third principle that I have adopted is an obligation to provide care to all people who are infected with the AIDS virus, and hence, are potentially infectious to us health care providers. Some physicians feel that while society may have an obligation to provide health care to AIDS virus infected people, individual physicians may not be obligated to provide that care. I believe that my commitment to providing health care to all in need of it presents an obligation to perform functions or duties within my area of competence to all who need that service.
Don’t Hide Your Moral Positions and Christian Foundation
Finally, the fourth operating principle which I have adopted is not to hide my moral positions and christian foundation from my patients. Whereas I deliberately do not broadcast my personal religious beliefs, in part because I believe it would be counter productive in my clinical circumstances, neither do I hide my beliefs, especially if asked. For example, in my office, I have photographs of my church, inside and outside. Also I am willing to discuss medical issues from an Orthodox Christian perspective, if asked. Lastly, in the process of educating medical students, student doctors, physicians and other health care workers, I often emphasize that chastity is medically, psychologically, and spiritually healthful, whereas promiscuity is medically, psychologically, and spiritually unhealthful.
Christian witness in the medical-infectious disease, sexually transmitted disease workplace is somewhat difficult, but it can be done to some extent. Despite working in the STD field, I try to provide Christian witness through
- truthfulness and trustworthiness
- respect for my patients as human beings subject to the frailties of human nature
- providing virtuous care to all my patients, and
- using my Orthodox Christian foundation to guide my personal and professional behavior
Fr. Hopko [during the St Vladimir’s Seminary Summer Institute where this was given as a paper] asked that we panel members also address how the Church has helped or has not helped us to bear Christian witness in the workplace.
My lifelong experiences in Orthodox Christianity have provided a foundation upon which I naturally function. Parenthetically, I should acknowledge that various opportunities to direct choirs have provided additional pleasures from time to time throughout my life.
On the other hand, I must admit that I have been distressed by the lack of overt promotion by our Church through its clergy of the concept of chastity before and within marriage. We medical educators and counselors need more guidance and support from our clergy. We need the clergy to speak out on these issues in forceful, effective ways from the pulpits, in church newsletters and through the newspaper and broadcast media.
Thanks again for the opportunity to share these thoughts with you.
This article is based on a talk given by Dr. Pazin at the St. Vladimir’s Seminary Summer Institute on June 25, 1992. The theme of the Institute for 1992 was “The Work of the Laity.” Dr. Pazin was specifically asked to share how he might be bearing Christian witness in his place of work.