A Competent Physician: Medical Decision Making, A Baháʼí Consideration, Part 1
"Resort ye, in times of sickness, to competent physicians; We have not set aside the use of material means, rather have We confirmed it through this Pen, which God hath made to be the Dawning-place of His shining and glorious Cause." - Bahá'u'lláh, Kitáb-i-Aqdas, par. 113
As a Physician Associate (PA) with 35 years of experience as a family medicine provider, I have encountered many people who have acknowledged being challenged when making important medical decisions. I have, for many years, filled the role of being that “go to source for all things medical” for patients, family, and friends.
Medical decision making can be a daunting task for any person, how much more for the many people who have no medical training to help guide them. Many may not feel comfortable making important medical decisions for themselves or a family member without consulting their primary medical provider, or the counsel of family and/or friends. This makes sense for Baháʼís as we are directed to ‘consult on all matters’ with the community or the institutions, and in following the directive of Bahá'u'lláh’s Kitab-i-Aqdas quoted above to ‘resort to competent physicians’. This raises important questions, however, as to what constitutes a ‘competent’ physician, and how do we come to sound conclusions in our consultation on matters of health?
Given the highly personal nature of making medical decisions, we are likely to be selective in who we choose to consult with, however, I know of many Baháʼís who have successfully consulted on health issues with Baháʼí institutions and members of the community-at-large. The efforts of Baháʼís and their communities in contributing to personal and societal wellness will undoubtedly benefit to the extent that our consultations are guided by the Baháʼí Teachings. In that light we will turn to some of these resources in this article. In addition to the Writings of Bahá'u'lláh, a perusal of the Baháʼí compilation Lights of Guidance compiled by Helen Hornby allows us to appreciate the volume of letters on health issues from ʻAbdu'l-Bahá, Shoghi Effendi, and the Universal House of Justice, the majority being in response to questions posed by individual believers. In this article and one that follows we will consider some facets of the Baháʼí teachings on the topic of seeking a competent physician, the contributions of other highly trained medical providers towards one’s health, and the challenges that persist when making decisions about one’s health.
Health and Wellness in an Age of Misinformation
Medical decision making is challenged in this day due to the public and highly partisan assault on science and the erosion of truth in what some have characterized as a ‘post-truth society’. It is not uncommon to encounter conspiracy theories with the most outlandish statements regarding health issues from all levels of government, religion, the media, and the public. Agencies (Centers for Disease Control and Prevention, National Institute of Health, others) that were once held in the highest regard have been manipulated and censored, creating mistrust in the very health agencies that are supposed to provide the best scientific evidence to guide the public. People do not know where to turn for scientific truth, and this has further muddied the medical decision-making "waters."
Many people simply do not know where to begin when confronted with making important medical decisions. I am often asked by patients, family members, and friends, "Who do I turn to?", '“How do I know if this medical statement in the news or on television is true or false?", "How do I know if this drug or treatment is safe?", "Can I trust my medical provider(s) to give me the best information?", "I've seen several medical providers and they all tell me to do something different to treat my medical issue!" Part of the issue here relates to the concept of “health literacy”, a term, according to the National Institute of Health, describing one's ability to "... find, understand, and use information and services to inform health-related decisions and actions for themselves and others." (NIH website accessed 2.26.25)
Health literacy is a significant concern in the U.S. (and globally) contributing to the challenges involved in medical decision-making due to leaving patients disempowered, uninformed, or lost in a sea of misinformation. It has been my experience that, as with the general decline in trust in institutions and watering down of truth broadly, many people do not know how to find dependable medical/health information sources. Many do not know how to access research articles on medical topics, and if they do access such articles using the many on-line search engines, many do not know how to determine the credibility of the medical information published. They are bombarded with medical content daily, especially about prescription drugs, as the U.S. is one of a handful of industrialized nations that allows direct-to-consumer advertising from pharmaceutical companies. This only serves to confuse the citizenry who lack medical training. It also puts added pressure on medical providers by having to expend significant effort to correct the misinformation common in the media and popular culture.
A patient encounter comes to mind from years ago demonstrating the challenges of medical decision-making for both the patient and the medical provider. Years ago, when the drug esomeprazole (Nexium) was made available for prescribing, I was covering for a colleague one day when a patient presented to clinic adamant that they should be discontinued from their chronic acid reflux medicine omeprazole (Prilosec) and prescribed esomeprazole (Nexium) in its place despite their formulary-accepted omeprazole working effectively. The patient was unaware of the pharmacological similarities and differences between the two drugs. They were unaware that the two medicines were "cousins" from the same drug class called Proton Pump Inhibitors. I began by asking why they wished to switch to the newer Nexium, and the only response was that the patient wanted to take "the purple pill" because the television ad from the pharmaceutical company said it was the best and they should "consult their doctor today." I have had many similar patient encounters over the years, especially when a new drug "hits the market."
Direct-to-consumer advertising has opened a pandora's box for medical providers who now must address many drug-related issues with patients who have little to no training in the complex science of pharmacology. It has also presented challenges to citizens who are bombarded with advertisements telling them they need to consult with their medical provider immediately about this drug or that treatment. It can cause a lot of anxiety and worry, not to mention much confusion in the medical decision-making process.
To further complicate the matter, there is often conflicting medical information in the news or on the internet muddying the waters and making it difficult for the public to make clear decisions about their medical care. I have encountered patients who have elected to avoid coming into the clinic for much needed care simply because they were confused about how to proceed. The result of this confusion was to avoid the healthcare system all-together. Out of sight-out of mind. Most people, even some trained medical providers, do not know how to read a medical research article to assess its validity and then determine if the findings can be generalized to their specific condition/situation. In Part II of this article, I will present easy to understand tips for the layperson to help with this validation process.
What goes into Medical Decision-Making?
Medical decision-making, even concerning relatively “straightforward” health matters, involve a whole complex of factors. These include:
Cultural norms
Personal/spiritual beliefs & values
Personal autonomy & agency
Cognitive ability to make medical decisions for oneself.
Prior experience or lack of experience in the healthcare system.
Financial and socio-economic status
Nature of the diagnosis
impact of medical decisions on quality of life.
Access to affordable healthcare, adequate healthcare resources & access to health insurance
Formularies
Understanding risks and benefits of various medical decisions
Having a dependable social support system
Influence of family members, friends, mentors
Weighing advice from one's healthcare provider.
and more.
At times people make medical decisions simply based on statements from influential public figures such as political or religious leaders, “influencers”, or statements based on ideology and misinformation that often directly conflict with established scientific evidence. Such statements cause further confusion in the medical decision-making process. The Covid-19 crisis is a prime example of leading figures in government, medicine, and religion making erroneous claims about the nature of the virus or the viability of specific treatments leading to tremendous suffering and death. It caused global confusion on a scale not seen for years.
Let’s face it, medical decision-making is challenging under the best of circumstances. The Baháʼí community is by no means exempt the challenges I’ve outlined above. We are fortunate, however, that the Baháʼí Teachings do offer a wealth of wisdom and insight on a broad range of medical issues. We have many valuable insights in the Writings to draw upon addressing:
physical, mental, and spiritual health,
general advice on healing, nutrition, sickness and disease, cleanliness,
laws regarding avoidance of harmful & addictive substances,
to name a few.
Perhaps the most consequential is the powerful obligation in the Sacred Text cited at the beginning of this article that we must seek guidance from a competent physician, alongside the critical principle of harmony of science between religion. Additionally, we have benefitted greatly from a host of questions posed to Bahá'u'lláh, ʻAbdu'l-Bahá, the Guardian, and the Universal House of Justice that explore such subjects, and we also benefit from papers and compilations written by Baháʼí scholars on health topics.
A Baháʼí System of Healing?
What the Baháʼí Teachings do not offer is a recommendation of any specific system of medical practice the believers should turn to. In a June 6, 1948, letter to an individual believer written on behalf of Shoghi Effendi, Guardian of the Baháʼí Faith from 1921-57, his secretary writes on his behalf, "There is no such thing as Baha'i Healers or a Baha'i Type of Healing. In His Most Holy Book (The Aqdas) Baha'u'llah says to consult the best physicians, in other words, doctors who have studied a scientific system of medicine..." (Directives of the Guardian p. 36)
The Universal House of Justice reiterated this in a January 24, 1977, letter to an individual believer stating, "No specific school of nutrition or medicine has been associated with the Baha'i Teachings. What we have are certain guidelines, indications and principles which will be carefully studied by experts and will, in the years ahead, undoubtedly prove to be invaluable sources of guidance and inspiration in the development of these medical sciences. Moreover, in this connection the Guardian's secretary has stated on his behalf that 'It is premature to try and elaborate on the few general references to health and medicine made in our Holy Scriptures.’ The believers must guard against seizing upon any particular text which may appeal to them and which they may only partially or even incorrectly understand..." (Lights of Guidance #1015 р. 298)
There is much to unpack in these two quotes. A logical place to begin is to acknowledge what both the Guardian and the Universal House of Justice have stated: There is no Baháʼí system of medicine or identified Baháʼí healers. An example of a religious community that does have designated healers is Christian Science. Christian Science practitioners offer healing through prayer and turning to the teachings of Christian Science founder Mary Baker Eddy.
While the Baháʼí Faith does not have a recognized system of medicine or designated Bahai healers, we have access, as illuminated in the quotes above, to "certain guidelines, indications and principles which will be carefully studied by experts and will, in the years ahead, undoubtedly prove to be invaluable sources of guidance and inspiration in the development of these medical sciences." We must remember that the Baháʼí Faith is still in its infancy and as the Faith evolves and develops over the course of decades and centuries, Baháʼís trained in medical science will make important contributions to the field of medicine and healthcare. The beginnings of this are already evident in the Baháʼí experience over the past few decades. In time, more and more Baháʼí medical providers will deeply study the Bahai Writings on health and healing and engage in medical science research inspired by them, contributing to the discourse on health and healing and making important contributions to the field of medicine. This will go a long way towards providing assurance to the friends as they make important decisions about their health and wellbeing.
To give an example of the diversity of training pursued by various Baháʼís there are many Baháʼís who have received training as medical providers from a variety of systems of healing (both scientific and traditional knowledge systems) including, but not limited to, western conventional medicine (also known as ‘biomedicine’), Naturopathy, Homeopathy, Traditional Chinese Medicine (TCM), Ayurveda, Unani, among many others. Certainly, in the many countries and territories around the world where Baháʼís are found and the medical systems referenced above are still practiced, there will be Baháʼís trained in those systems or who seek advice from practitioners in those diverse traditions of medicine (sometimes understood via the anthropological moniker ‘ethnomedicines’). The Guardian reminds us in the passage above of Bahá'u'lláh’s injunction to seek the advice of a competent physician when we are ill. This refers to the verse found in the Kitab-i-Aqdas found at the beginning of this article, which states, "Resort ye, in times of sickness, to competent physicians..." (KA, K113, p. 60) ʻAbdu'l-Bahá, the Guardian, and the Universal House of Justice have all restated this teaching.
Bahá'u'lláh’s statement above warrants deeper exploration, especially in today's medical environment of intersecting medical systems where there are medical providers in many disciplines who do not have the title of "physician" yet are highly competent and considered experts in their fields of medical practice. Clarification on this point can go a long way towards alleviating some of the confusion for the Baháʼí friends as they make decisions about which direction to turn and who they should believe when making important decisions about their health.
Accreditation
In our society, a provider's training, licensure, certification are all important considerations when determining a provider's competency. For example, the provider's medical training program allows you to determine if that center of medical training is accredited. Accreditation information is public knowledge and easily accessed online at the training center's website. A medical practitioner from an unaccredited or "accreditation pending" medical institution, while not conclusive of incompetence, should raise yellow or red flags about the quality of training the provider has received. A medical training program that is accredited denotes that the school has attained a standard of training competence expected of all similar training programs.
Licensure and Professionalization
Licensure and professionalization refer to the provider keeping current with professional continuing medical education (CME) requirements for the state in which they practice. This is critical in assessing a practitioner's competency. This means that they are keeping up with current medical knowledge which they can then apply to their practice of medicine. In making important medical decisions, one would be putting themselves at risk by choosing to be treated by an unlicensed medical provider. We may think this to be rare; however, it is not impossible. The practitioner will usually have their medical license posted in their office for the public to view. You can always ask to view the medical provider's medical license or go to the state medical board website to determine if a provider is licensed.
Obviously, there are highly competent healers from traditional indigenous healing systems where licensure and accreditation are not part of the training. A person seeking healthcare in such a system would need to be familiar with the system and the competency of the practitioner when making important medical decisions.
Certifications
Certification is important because it demonstrates the practitioner having passed periodic rigorous medical board examinations demonstrating proficiency in their medical discipline. As a family medicine PA, I was required to pass an initial comprehensive national medical board exam upon graduation followed by similar recertification examinations every ten years thereafter. Physicians have a similar requirement. Many Physicians, PAs, and Nurse Practitioners (NPs) take advanced training courses and get certifications in areas such as Advanced Cardiac Life Support (ACLS), Advanced Trauma Life Support (ATLS), Advanced Life Support Obstetrics (ALSO), Pediatric Advanced Life Support (PALS), among others, to specialize their expertise. Practitioners often have their various certificates hanging on a wall in their office or waiting room for the patients to view. This can be reassuring when making important medical decisions knowing that the medical providers have the general required certification of their profession and demonstrating competence in additional advanced training certifications. It also provides the patient with reassurance that such medical provider can effectively make referral to competent “specialists” when more advanced assessment is required that is out of the scope of practice of the general practitioner.
Medical Boards and Regulations
It can be reassuring for people to know that each state in the U.S. has a medical board whose role is to determine practice regulations for all recognized medical providers (MD, DO, PA, NP, Chiropractor, ND, Licensed Acupuncturists, others) and ensure provider compliance to those regulations. The medical boards carefully vet each applicant to make sure they are qualified to practice medicine according to their professional standards. You can explore the state medical board website of your state to learn more.
Transdisciplinary Teams
Medicine in the U.S. has adopted a patient-centered model of care where the person's needs, values, and preferences are considered front and center in all facets of medical decision making. This commonly includes a transdisciplinary team of medical professionals that might include a physician, PA, NP, Behavioral Health provider, Occupational and/or Physical Therapist, Psychologist, Pharmacologist, Medical Social Worker, among others. In many settings, it is not unusual to see such a transdisciplinary team additionally including a Naturopath, Licensed Acupuncturist, Chiropractor, Massage Therapist, among others. Involvement of such diverse providers in the medical decision-making can be a great source of reassurance to the patient.
Medicine is often provided by a professionally diverse team of competent practitioners and not one practitioner or modality alone. This proceeds from the recognition that any one type of practice has a range of validity and types of health situations they are best equipped to address. A well-trained naturopath with extensive training in nutrition and ample time devoted to personalized care and follow-up may be more equipped for certain chronic and nutritional health conditions than an emergency physician, who would be better suited than the naturopath for emergency procedures or hospital care, for instance.
Indeed, there are many practitioners of the holistic medical systems above who have attained the highest levels of competence in their fields and may not be designated as "physicians” yet can be considered highly qualified practitioners. While this offers the Baháʼí friends a wealth of options to choose from, it can also lead to further confusion especially if the friends are unfamiliar with those holistic medical systems and the practitioners. In the passage above the Guardian's advice to the individual believer was inclusive of "...doctors who have studied a scientific system of medicine..." (Directives of the Guardian p. 36) While individual interpretations may vary, this is a fairly broad statement that leaves a range of options available to the friends, but it requires diligence in investigating the various systems of medicine before committing to receiving care from one of their providers.
What makes a ‘doctor’?
The word doctor originates from the Latin word docere, which means "to teach." The title was initially used in the 14th century to identify highly educated Catholic theologians and later scholars more generally. Only later, during the 17th century and the emergence of contemporary western biomedicine, some medical schools adopted the word to denote a medical physician specifically, and this has become the widely adopted use of the term today. Today, the term doctor or physician is used to describe those with extensive postgraduate training in fields of medicine but still refers to such training in fields such as law, education, philosophy, and other fields (PhD).
When one hears the word doctor, it may often register in their mind as a medical doctor, however, the word doctor also usefully describes specialists such as naturopaths (ND-Naturopathic Doctor), osteopaths (DO-Doctor of Osteopathy), optometry (OD-Doctor of Optometry), occupational therapy (OTD-Occupational Therapy Doctorate), physical therapy (DPT-Doctor of Physical Therapy), audiology (Au.D-Doctor of Audiology), and the list goes on. The point I am making with this discussion is that the term doctor has many professional designations and the training for each varies in length and obviously in content. So, what do we make of this diversity of training pathways for making medical decisions?
My personal feeling is, in today's world with a wide diversity of highly trained medical providers, the important take home message is to seek out competent medical practitioners with the demonstrated expertise, credibility, and training suitable to help you make important healthcare decisions, while appreciating that these providers most often do not work alone but are engaged with other medical professionals as part of a diverse transdisciplinary healthcare team. This opens the door for the friends to seek out qualified practitioners from among the systems of medicine referenced above with confidence, knowing that they need not rely only on one stream of expertise to resolve their health needs.
Confusion can arise if one's primary medical provider is unfamiliar with other holistic practitioners and the services they provide. A patient may decide they would like to see a licensed acupuncturist for treatment of pain. For years, western conventional medical providers resisted referring patients to a licensed acupuncturist because not much was known about such treatment in the west and the service was not covered by health insurance. Now, however, western conventional medical providers have been educated about the utility of acupuncture, many have taken acupuncture training themselves, most state medical boards have regulations for and now license acupuncturists, and acupuncture referrals are now common.
The same can be said for chiropractors. They are licensed to practice in most, if not all, states, their practice is regulated, and referrals are common and often covered by health insurance. From there we can assess the competence, track record, and demonstrated expertise of a particular chiropractor for our health condition, and in consultation with other trusted health providers, our families and others in our community make an informed decision. While there is obviously more to our understanding of medical competence than just the factors I’ve identified, these are a few of the factors we can weigh to determine which path or modality of treatment we wish to pursue for our specific health needs.
Challenges persist, however, when a patient asks their western conventional medicine provider for information about, for example, Ayurveda or Traditional Chinese Medicine and if those holistic systems of medical practice might be beneficial for them. These and other holistic systems of medical practice are still not as well known in the west. However, those cross-trained in western medicine and the holistic systems of medicine referenced above and those who have studied “Integrative Medicine” are all familiar with such holistic systems of medical practice and may be better equipped to make specific recommendations about when those systems of medicine may be beneficial or not. As scientific understanding about these systems of knowledge and how they may be best put to use evolves, our understanding of human health advances, and disciplines refine their methods and training accordingly. I believe it is here we will find further confirmation of the transdisciplinary approach mentioned above that draws on diverse modes of care.
Conclusion
The Baháʼí community is fortunate to have a wealth of resources to turn to on matters of health and medical science to assist the friends in making important decisions about their health and wellness. We have scant Writings of the Bab on this theme available in English and in the future will have translations of the Writings of the Bab that address this theme in greater detail.
Bahá'u'lláh has provided us with Writings on health and healing, the most well-known being His Lawh-i-Tibb (Tablet on Medicine) which offers the believer insight into several health topics such as nutrition, exercise, avoidance of harmful habits, the importance of purity and cleanliness, among other topics. The tablet also is the source of the "short healing prayer" found in the Baháʼí prayer book that begins with the words "Thy Name is my healing..." The Lawh-i-Tibb has not yet been authoritatively translated into English, however, there are provisional translations and studies of it available online which offer the believer a glimpse into the topics above and Bahá'u'lláh’s recommendations. Portions of the Lawh-i-Tibb can also be found in the Baháʼí periodical from the early 20" century, Star of the West, and in Dr. John Esslemont's introduction to the Baháʼí Faith, Bahá'u'lláh, and the New Era. As noted earlier, Helen Hornby’s compilation Lights of Guidance is also a great source of information.
The Writings of ʻAbdu'l-Bahá contain numerous tablets to individual believers on health and healing topics as do the letters from the Guardian and the Universal House of Justice. The best sources for ʻAbdu'l-Bahá’s Writings include Selections from the Writings of ʻAbdu'l-Bahá, Some Answered Questions, the 3-volume set Tablets of ʻAbdu'l-Bahá, Star of the West, and Lights of Guidance (all available via www.bahaireferencelibrary.org; www.bahai-library.com) As mentioned above, a great source for references to health and healing topics from the Guardian and the Universal House of Justice is the compilation Lights of Guidance, and the House of Justice's compilation on Health and Healing. There are also compilations by individual authors such as ‘The Throne of the Inner Temple’ compiled by Elias Zohoori, and ‘Prescription for Health-A Comprehensive Guide on Health Issues’ by Dr. Manouchehr N. Nadimi.
It is my hope that this general discussion has been enlightening and will set the stage for the medical decision-making tips I will share in Part II of this article.
Dear Aaron,
I really enjoyed reading this well written piece. You may want to have a look at the below paper that discusses the Tablet of Medicine of Bahaullah.
https://bahai-library.com/ziaei_lawh_tibb_health