The following was one of the case studies we looked at during the recent Annual Fellowship Meeting (AFM) of the Christian Medical and Dental Fellowship (CMDF), Singapore. (It is a composite story drawn from different cases.)
You are doing locum work in a neighbourhood GP clinic. One day, you spot a familiar name on the list and before you can ask your nurse for details, someone from your church whom you recognise walks in. He seems a little disconcerted to see you but realises that you are already reading his chief complaint from the triage note and so he cannot back out of the room. He tells you that he has dysuria and a urethral discharge. You are somewhat surprised as he is a worship leader and is happily married with a wife and two children who are all active in church.
You prescribe ceftriaxone and azithromycin and mention to him that most of these infections are transmitted sexually. He then tells you that on a business trip to an East Asian country recently, he had too much rice wine at a banquet and woke up to find that he was not alone in his hotel room the next morning. He pleads with you not to tell his wife. You suggest that he get an HIV serology and a syphilis screen and a week later these return as negative. You reassure him but he is still worried and insists on a re-test as well as urethral swabs.
The following Sunday, his wife notices him talking with you and asks if everything is alright. You avoid answering her. You do not hear from your friend again until six months later when he approaches you after the service and tells you that he needs his blood tested and the antibiotics again. He wants to know if you can see him again in the clinic on Monday. He has remained an active worship leader through this time and his wife is apparently oblivious.
What is your response to him? His wife? The worship team? The church? How does medical confidentiality interact with interpersonal relationships and church discipline?
The members of my small group came up with different responses.
“We are doctors first and we must respect medical confidentiality. Of course we should strongly advise him to change his sinful behaviour but we cannot tell others even if he does not change.”
“At least we must warn the wife. That is the principle of saving lives. Otherwise he might infect her with some sexually transmitted disease, even HIV.” (The presence of HIV takes time to appear in tests.)
“We are followers of Jesus first. The demands of Scripture take precedence over man-made laws of confidentiality. The man is your brother in Christ. You must confront him in love to ask him to repent from his sexual sins. If he doesn’t we must bring the matter to church leadership.”
All agreed that we needed to pray.
Well, what would you do? All who spoke were serious about their faith and wanting to do the right thing. All spoke passionately but cordially. We wished we had more time because at the end of the allotted time the group was not unanimous in deciding how to proceed in this case. No easy answers. Just like real life.
For some time now, the CMDF has been looking at such case studies at our AFM and at other times. I fully support this exercise. In fact, I wonder why we don’t do more of this in Christian education in general. Most of the time we teach the faith in terms of general principles. But when the follower of Christ tries to live out Christian principles in a fallen and complex world, he or she finds that, often, real-life issues are not that simple. When this happens often enough, the disciple will do a few things. He or she may begin to compartmentalise his or her life, living out Christian principles in the safe places of church activities but living by other principles in the “real world”. Some will decide to take up church-related vocations thinking that they will be spared such moral and ethical conundrums in the safe confines of the church or church-related work. Some will say that Christianity just doesn’t work in the real world and simply walk away.
We fail our people when we do not prepare them adequately to live out their faith in the world. Maybe we have something to learn from the Harvard Business School who popularised the use of case studies in their teaching. Here is a summary of the method:
The case method is a form of instructor-guided, discussion-based learning. It introduces complex and often ambiguous real-world scenarios into the classroom, typically through a case study with a protagonist facing an important decision. The case method represents a shift from the traditional, instructor-centered model of education to a participant-centered one in which students play a lead role in their own and each other’s learning.
Case method instructors use questions, dialogue, debate, and the application of analytical tools and frameworks to engage students in a challenging, interactive learning environment. Not only does this approach raise the likelihood of greater retention—it also allows for learning that goes beyond the transfer of knowledge to include the development of analytical, decision-making, and communication skills, and the cultivation of self-awareness, judgment, and the capacity to lead. (“Core Principles,” Christensen Center for Teaching and Learning, Harvard Business School)
We note that Jesus often taught through stories, presenting “cases” like the story of the Good Samaritan, and asked for a response. He often used questions in His teaching, engaging His disciples in interactive learning.
Often, we don’t teach like Jesus. The most common method I see in a lot of Christian instruction is a lecture of some sort — sermons, talks, homilies, etc. Someone speaks and the students listen. The teaching is one sided and students are passive receptacles of information. No wonder many find Christian education boring and unable to equip people to follow Christ in the real world.
So I am glad for what the CMDF is doing. Of course many professional schools use the case-study method as well. And I am not arguing for neglecting sermons and talks. That too is a biblical method of teaching. But if we really want to help our people be more equipped to follow Christ in the real world, we need to teach in a way that really helps them grow in their capacity to live out their faith in every sphere of life. The case-study method is messy, it takes time, it brings out the fact that sometimes there are no simple answers to the questions we face — well, just like real life. We truly believe that the Word of God has all the answers we need to live our lives, but we must appreciate how complex the questions can be.