In the first instance your thoughts may be that this chap, who is otherwise well and rarely attends the surgery, is unlikely to have any physical and psychological problems. However, even if your gut feeling is that this is a purely spiritual problem, it is wise to explore wider issues in your history taking. Among other things I would be keen to find out a bit about his relationships and social structures. When a similar case came into my surgery I found that I just had to listen and the story poured out without much prompting.

It is not imperative but you ought to set this story in context. Does he claim this is just a one-off, or is it a persistent problem with pornography that has been going on for some time? If so, then how long, and how does he feel about it? If he is married, does his wife know? If she doesn’t, is he going to be able to admit this episode to her? How does he feel about being caught today? Does he know what the consequences of his actions are likely to be? Is he suspended pending further investigation? Has he been sent away to get help? Establish if you can whether this may involve child pornography. In UK law this a more serious offence and it is likely to be dealt with by the courts. Allow him time to express his feelings. It is very likely that he has feelings of anger mixed up with guilt. And guilt may be your best means of addressing his sin!

It may be that you feel a certain amount of distaste for this gentleman: an ‘upright pillar of the community’ who has let everyone down with his sordid behaviour. These feelings will not help you to help this man. If they are welling up inside you then you need to ask God quietly for help to show this man his love.

The bottom line is finding the reason for his attendance so you can try to help him. He may be looking for a medical excuse note – a sick note citing stress or something similar. This is an overused mechanism by some patients in an attempt to take the pressure off certain situations, especially where work or the courts are concerned. How are you going to deal with that if it is asked for and you deem it to be inappropriate? As a Christian doctor I have to be careful that being patient centred does not compromise my God-centredness. I would therefore avoid writing any documentation that I know not to be true. You can negotiate quite effectively with most patients.

The consequences for a CEO of being found with porn accessed via the net could be severe. His job may well be on the line. Society can also be very judgmental of those in positions of responsibility even if their actions are ‘no worse than Joe Bloggs’. How does he feel about this? He could soon be suffering from stress, even if he wasn’t before!

When I asked my patient why he had come, he replied, ‘Well doctor, it was either the parish priest or you.’ That was a carrot and a half for seeking a spiritual dimension to this consultation. At the same time it should also strike you that, as doctors, we are generally still held in high esteem by society at large. Our patients believe that we are trustworthy people – over and over again surveys show us at the top of the pile, with politicians near the bottom.

As church attendance has declined in the UK, society’s spiritual needs have not. Have you thought what a harvest field your surgery may become if you allow God to guide you? At the same time we must be careful not to abuse our patients’ trust. A good way round this is to ask permission when dealing with these issues. Gentleness and respect are key. There are resources to help us develop in this area.[3]

Next I asked him if he had any faith. He didn’t seem too sure so we talked about guilt and how we all fall short of God’s standards. Even if we say sorry and sort things out with God we may often have to face the human consequences of our failings. He observed that I seemed to have strong beliefs, so I then asked his permission to share the gospel with him. He consented and afterwards he agreed for me to pray with him. He commented that he felt it had been worth coming and I made it clear he was welcome to come back at any point.

Some might say that I abused my position as a doctor in this case. If you are tugged by the Holy Spirit to explore spiritual issues with a patient, then that is a great opportunity for the Kingdom. I encourage you to take them.