making decisions

Psychiatry or paediatrics? Or perhaps orthopaedics or obstetrics? Or enjoying everything so much that you choose general practice? Or instead, do you meet with that recruiter from Citibank — the one whose business card your old schoolfriend gave you last week when she took you out for dinner in a restaurant that even your registrar can’t afford?

Healthcare degrees are some of the few that usually launch us directly into a given career path, and are prerequisite to a first professional job. For others it is more fluid; I know a data analyst who begun with a history degree, as well a war studies graduate who is now a judge.

Even with a broad career direction chosen, the panoply of choices facing us towards the end of our studies can be daunting. Here are eight pointers to help you navigate the maze. I focus here on medicine where my own experience lies, though the general principles are equally applicable across the healthcare sector.

1. know who you follow

Jesus … said: ‘I am the way, the truth and the life’. Her Late Majesty’s example was not set through her position or her ambition, but through whom she followed. Justin Welby, Sermon for the State Funeral of HM Queen Elizabeth II[1]

What really influences us? As the Archbishop of Canterbury rightly understood in his words above, even the Sovereign is not truly autonomous. Even if we claim complete independence, something will drive our decisions, whether values coming from our upbringing, obedience to the laws of the country in which we live, or the counsel of wise friends. At other times, practical constraints such as illness or finances may influence decisions. So, we are following something, even if we don’t realise it. Even if we don’t want to follow anyone or anything, we do.

Who we follow should be crystal clear for the Christian. ‘Who do you say I am?’, Jesus asked Peter (Mark 8:29). The God who we follow is ‘the way, the truth and the life’. (John 14:6) He is the ‘First and the Last’, (Revelation 1:17) and the ‘firstborn over all creation’. (Colossians 1:15)

Therefore, if we want to know what to do, it must surely start with him.

2. know that God both speaks to us, and cares about how we act

So, if choosing what to do starts with God, we need to know whether he cares what we do, and whether he tells us anything about what to do. The answer to both questions is surely yes.

‘…in these last days he has spoken to us by his Son, whom he appointed heir of all things, and through whom also he made the universe.’ (Hebrew 1:2)

‘If you love me, keep my commands.’ (John 14:15)

A detailed exposition of how God speaks here would make for a very long article![2] For our present purposes we need to be clear that God does speak, that what he says can be understood, and that our actions matter to him. Therefore, his Word should be central to the decisions we make. This does not just apply to ‘religious’ decisions, like how to pray, nor just to tricky ethical situations, but includes major life decisions we make, such as career choices. While the Bible tells us everything we need to know to be saved and live a life pleasing to God, it doesn’t necessarily tell us everything we want to know, and sometimes we will need to apply general principles from it to reach a conclusion.

3. God is sovereign — we will not ‘mess up’ his plan

God’s ultimate plan is clear — to bring everything in heaven and earth into unity under Christ.[3]

I have met Christians who worry a great deal over what seem quite minor decisions, because they are worried that they might ‘mess up’ God’s plan. While their devotion to obeying God is commendable, this level of worry suggests that they have not fully grasped the extent of God’s sovereignty. It is he who creates,[4] and sustains.[5] It is he who directs history,[6] and will ultimately bring history to and end and usher in a new heaven and earth.[7]

Even the biggest of our decisions doesn’t compare to these things; indeed, even when humans get things wrong the Lord may use it for good.[8]

So please feel reassured as you make decisions; you are quite simply not big enough or important enough to disrupt your creator’s purposes in the universe.

4. God is more interested in us than in our career

Or, put another way, there is salvation outside the GMC or NMC register! Nowhere does Scripture give a general instruction to all Christians about what their job should be. Both Scripture and church history show God’s people working in all manner of things.

God’s greatest desires for us are surely that we love him and love our neighbours.[9] We are to seek first his kingdom and righteousness.[10] Out of following these commands will come the answers to many questions we have.

We are not, however, to think that God doesn’t care what we do at work, or how we do it. Loving God and keeping his commands applies just as much in the workplace as anywhere else; loving our neighbours similarly. We will only keep these commands by working ‘as for the Lord’ (Colossians 3:23). While our work is important to God, medics prone to idolise their career can easily come to see it as a higher priority than he does.

5. (most) Christians can work in (most) medical jobs with a clear conscience

There are a few careers that are clearly not compatible with keeping God’s commands. Living from the proceeds of serial burglary is clearly not compatible with ‘You shall not steal’. (Exodus 20:15) Only a small number of areas in healthcare fall into this category — for example being the lead doctor in a euthanasia clinic.

There are more roles that, while not in themselves sinful, are not an option as they so obviously facilitate the breaking of God’s commands. This might include an apparently morally neutral secretarial job, which becomes sinful if you are the secretary to the serial burglar above. A medical example might include a job where much of the work was pre-assessing patients for abortion. While taking a medical history and even performing an ultrasound scan is morally neutral enough, most Christian doctors will not want to enable the prescription of abortifacient drugs.

So at least for medical and nursing students in the UK and Ireland, the ‘must not do’ list will be mercifully short. Of course, the healthcare systems in which we work are in no way perfect, but we will not normally find the systematic corruption seen in some parts of the world. Jobs we must avoid will usually therefore centre on moral issues where we feel we cannot perform a particular procedure that we feel to be against God’s law.

Beyond these obvious examples, we should be wary of choices that will cause difficulties of conscience for us, even if these might not be over issues that will trouble every single Christian. The student convinced that the Bible mandates pacificism would face a lot of challenges as a military doctor. If we are very uneasy about prescribing contraception to unmarried teenagers, we may well avoid family planning, and need to think carefully about how this would work in general practice.

However, we need to take care that we do not become so keen to ‘keep our hands clean’ that we end up entirely separated from the world, struggling to do any work at all. Exactly where we draw the line on conscience issues is often a prayerful decision for the individual; we might, in common with many Christians, exercise our legal right to conscientious objection to abortion and refuse to participate, but accept that a hospital in which we work may perform abortions without our involvement. Although explicit legal protections for conscience are limited, the principle of ‘reasonable accommodation’ can often make work in a particular field possible, particularly when only a small proportion of the work causes conscientious concerns.[11]

6. wisdom from God

So, relatively little is ruled out. Therefore, most of our decisions will be based on wisdom rather than specific commands. Indeed, wisdom could be said to be the process of applying general commands like ‘love your neighbour’ to situations we face.

‘The fear of the Lord is the beginning of wisdom…’. (Psalm 111:10) Much of ‘wisdom’ really comes from our very first point — knowing who we follow. If we live with God as our priority, our minds are much more likely to know his will.[12]

Wisdom may well come from God’s people. This might be Christians in your family, or in church. They are unlikely to have immediate insight into exactly which subspecialty of orthopaedics you should choose for your elective, but might give good insights into how you respond to stress, how your faith holds up when you are busy or tired, or how well you cope with frequent moves of home or job. All these things can be a key part of discerning the right career choice.

God may also speak through straightforward circumstance; he is surely sovereign over these. If we need to remain living in particular town, perhaps to care for parents or other family, this is telling us something. If we find early on that we are physically very unsuited to working overnight, some specialties are clearly going to be better choices than others. God has created and will use each of us, which includes not only our gifts and skills, but also those things we don’t do so well.

7. don’t discount ‘common sense’

God’s wisdom may also come simply via day-to-day learning. You will get a chance to experience something of most specialisms at medical school. But exposure varies, and while most students get a reasonable amount of general medicine and surgery, fields like ENT and ophthalmology easily get squeezed out, and exposure to general practice differs hugely. Some specialisms, like chemical pathology or neurophysiology, may get no curriculum space outside the lecture theatre at all.

But so long as you are aware of these biases, medical school should help. It may not give you that great an insight into the day-to-day life of your vascular consultant, but if you consistently faint in theatre and can’t stand the sight of large amounts of blood, it should be obvious that vascular surgery is not the career for you.

Exam results do help — but in a limited way. Medical school exams are usually set to ensure that students have reached a minimum safe level of competence, rather than to discern excellence. Therefore, most students often achieve surprisingly similar marks; so being on the 20^th percentile rather than the 80^th may mean very little in terms of marks achieved, and is probably not a good guide to future aptitude. However, if you are consistently very high ranked in a subject, and enjoy putting extra work into it, his may well be a field in which your God-given skills would be put to good use.

The point regarding exams continues into postgraduate life; it is very common to take postgraduate examinations more than once, and occasional failure does not mean that a specialty is unsuitable.

8. can CMF help?

Yes! Although CMF doesn’t purport to give formal careers advice, being part of a big network of healthcare professionals can be really helpful.

CMF has members in almost every specialism. A CMF conference is one of relatively few places where it is absolutely fine to approach a senior doctor you don’t know and ask about their work and career, and how their faith plays a part in this. Most will be not only delighted to help but encouraged by students taking an interest. Similarly junior doctors can advise on job applications and requirements.

If you have deeper questions about the issues raised in this article, you could also contact your local CMF medical school link, one of the student team in the office, or the Pastoral Care and Wellbeing service.

concluding

I appreciate that I have not given easy or complete answers. Part of this is deliberate. Clearly there are some things that godly Christians must do, and must not do. But in a great many things there is freedom. Although not everything may be wise, we can too easily become paralysed with indecision, leading us to do nothing (which is rarely the right option either!).

Understanding God’s will should be liberating — if we are living within his boundaries, and our hearts are inclined towards obeying him, we have a wonderful freedom to live our lives. We can be confident in the decisions we take, knowing that we have included him in them. After all, in his sovereignty he will find a way to change what we are doing should he wish to.

Then we can be free to wholeheartedly pursue the career we work in, and serve God effectively as we do this.