    One doctor’s road from being a closet Christian to medical evangelist.    Objectives:  Describe friendship evangelism Give examples of Christ’s method Provide specific tools that can be useful to coworkers    

AMEN 2015: CrossTraining

<div> <div> <div> <div> <p>One doctor’s road from being a closet Christian to medical evangelist. </p> <p> </p> <p>Objectives:</p> <p></p> Describe friendship evangelism Give examples of Christ’s method Provide specific tools that can be useful to coworkers </div> </div> </div> </div>

<p>Free sharing permitted under the Creative Commons <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/us/">BY-NC-ND 3.0 (US)</a> license.</p>

Adventist Medical Evangelism Network (AMEN)

Breakout Sessions A

Harvey Hahn

So You Want Me To Be an Expert Witness?

Now, for the sake of time, we're really going to start going.

This course is called, so you want to be an expert witness, please focus on the question mark at the end.

The other title for this talk is, How to evangelize without losing patience or patience, which happens to us a lot in the office here.

So I have a couple of disclosures I want to go over.

First is I'm really not an expert witness.

I'm just a regular person like most of us.

Okay, I'm just a regular SDA, kind of like all of you guys.

And finally, I'm not an expert witness, but I'm going to share what I've learned, what I've thought about, and how it's impacted myself and my practice.

So this is kind of my step-by-step journey here to kind of go over this real quickly.

For those who don't know me, I was born in S.K.

I went to P.U.C., Loma Linda Medical School.

And the first part of my medical career, I had prayed 5 times with any patient for the whole 15 years.

I wanted to do high-tech cardiology, et cetera.

Then 1 of my friends kind of kind of slowly chided me into starting to pray of patience And so I started and basically I was scared to death when I started doing this All right, And I'll talk about some of those experiences.

Finally, joined AMN, started doing some more passive witnessing, praying to more patients.

But let's be honest, not very comfortable.

I'm actually in a patient's prayer chain, email chain with them, which is a lot of fun.

What's really been great though, we have morning prayer for our staff, which has been phenomenal.

I work at Kettering Health Network, which is an Adventist hospital, all the administrative meetings, they all have prayer devotion, but the doctor meetings, we don't start with prayer.

So we're slowly working that in, starting with prayer, and it's actually been received very well, basically building a habit on how to do this.

The point being here, it doesn't matter where you are on the spectrum.

Some of these people, you're probably EFDZ because some people are actually doing real medical missionary work.

But no matter where you are, it depends on where you want to eventually get to.

I'm not going to go through this, but this is obviously the Great Commission that Jesus said before he took off back to heaven.

There's something else that's even more compelling to me.

All right, he is a famous outspoken atheist.

He has this very powerful quote when he talks about Christians.

I always said that I don't, do not respect people who do not proselytize.

If you believe there's a heaven and a hell and people are going to hell and not getting eternal life and you think it's not really worth telling them because it would make it socially awkward, how much do you have to hate that person not to tell them about that?

How much do you have to hate somebody to believe that there really is everlasting life, but you're not going to tell them.

Then he goes on and says this, I mean if I believe beyond a shadow of a doubt a truck was going to come and hit you, there's a certain point where I'm going to tackle you.

So besides the Great Commission, the world, the atheists, they're calling us to do what we're supposed to do.

These slides will be available if you want them afterwards, so you don't have to take copious notes.

OK, now here's the present state of medical affairs.

This just came out last week in Journal of JAMA Internal Medicine.

And they looked and they videotaped end of care life discussions with families and doctors.

1 third of doctors are now atheist or agnostic.

This is probably the most important thing here in the bottom.

77% of Families view religion as being very important or fairly important.

After they analyzed all the video data, this is what they found.

Only 16% of end-of-life care discussions had any mention of religion or spirituality.

65% of the time, it was brought up by the family or their surrogates.

Only 5.6% of the time was any spirituality interjected by the doc.

The rest was chaplains, nurses, social workers.

So 77, 78% of families think this is important, but we're only bringing up 5% of the time.

Now here's the real scope of the problem.

As a metaphor of life, who are we in this picture?

Okay, we're saved, we have the life preservers, and we have room in the boat, right?

The People who, the unbelievers, they're these guys here drowning.

Are we going to throw in the life preserver or are we just going to be too timid and too scared to upset people and let them drown?

So It'll get lighter as the talk goes on, I know it's getting pretty serious.

But the thing I want you to think about is we have the opportunity to be part of the greatest life-saving operation in history.

I love Proverbs, makes you think about what you're doing for life.

Proverbs says, rescued those being led away to death, hold back those staggering towards slaughter.

If you say we know nothing about this, does not he who weighs the heart perceive it?

Tim Arakawa

Lifestyle Intervention and Its Impact on Diabetes Treatment & Outcomes

All right, we gave you just a little time to finish lunch and then come in so I think it worked out okay but we do have a lot to cover so Just by way of an introduction though, we're going to be talking a little bit about diabetes Lifestyle intervention how many of you?

Well, you watched the beginning part, or I don't know, maybe it was partly in the middle.

I found it interesting that it was the non-physicians that actually brought up the fact that if we really want to address the health care crisis in this country, we need to address the health crisis that we're facing.

We're going to be talking about that today.

But I missed a little bit of an introduction here, so I haven't been here for a couple years to amen, so some of you may not know me as well.

I'm currently an endocrinologist working on the island of Guam There's an STA mission clinic there and I practice there.

I would say 70 80% of my practice is diabetes type 2 There's very little type 1 actually in Guam Because that's a lot of it is in a Caucasian demographic.

But we also have a wellness center there.

We have lifestyle classes and the whole bit there.

You may have seen my wife and kids running around here.

He was 3 years old at the time of this picture.

You can stop them if you see them in the hall and say hi.

Before we go into learning objectives, let's bow our heads for a word of prayer.

Dear Father in heaven, we thank you for the privilege we have of knowing so much about healthy living, and we pray that as we now go over the evidence in the medical literature and as we apply it to our situation as Adventists, May you give us a special portion of your spirit to both understand and to learn how we can be a part of spreading this important message.

Alright, so today we're going to have 3 main objectives.

The first 1 is to look at some of the recent medical literature that really has proven that diabetes can be prevented and treated and that can be done through lifestyle intervention.

And then the second part of it is going to be looking at how lifestyle intervention works or potentially how it could work and how it affects the progression of diabetes.

And then the final part, we're going to touch briefly on some things perhaps that we can do to help people sustain their healthy lifestyle choices, and that is a big dilemma nowadays.

So before we begin that, you probably are aware of the current diabetes epidemic.

But just to review and to reinforce in our minds where we're at now, the most current statistics as of 2015 show that over 50% of the American public either has prediabetes or diabetes.

That's 12% to 14% with diabetes and about 40% with prediabetes.

So you walk out on the street, 1 out of 2 people has pre-diabetes or diabetes, and I include pre-diabetes because that's almost as important as diabetes, especially when we talk about lifestyle intervention.

115 million people in the United States with diabetes and 387 million currently worldwide.

And just to underscore how quickly this is growing, realize that in 1985 there were only 30 million diagnosed cases of diabetes at that time.

Since then, of course, we know we're in the 300s, 300 millions currently.

And it's projected that by 2030, we'll have about 552 million people diagnosed with diabetes.

The latest number that I've seen is a projection for 2035, and they're estimating almost 600 million people with diabetes.

That's a tremendous amount of morbidity and mortality, as well as health care costs.

However, a lot of the medical societies now are recommending lifestyle intervention for prediabetes and diabetes.

And in fact, just 3 days ago, the United States Preventive Services Task Force recommended diabetes screening for certain groups of people.

And you can see here, this just came out a few days ago, that it says that they recommend screening for abnormal blood glucose as part of a cardiovascular risk assessment in adults between 40 to 70 years who are overweight or obese.

As an endocrinologist and as a diabetologist, I would say we probably aren't going far enough with this.

You're missing a lot of potential diabetes cases by not going lower than 40, by not paying attention to high-risk populations and women with gestational diabetes and all these type of other categories.

It says, clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity.

So this is the most recent recommendations out there.

And if you look at the other medical societies, you'll see a similar recommendation.

So here's the American Diabetes Association, 1 of the preeminent medical societies for diabetes.

And in their guidelines, this is what they say.

Patients with impaired glucose tolerance, impaired fasting glucose, or an A1c between 5.7 and 6.4, All of those groups would be considered pre-diabetes, correct?

Should be referred to an intensive diet and physical activity behavioral counseling program targeting loss of 7% of body weight and increasing moderate intensity physical activity, brisk walking, to at least 150 minutes per week.

So that is the current guidelines from the American Diabetes Association.

And then, of course, there's the American Association of Clinical Endocrinologists, which is the society that I belong to, and they also have the recommendations for prediabetes and diabetes.

This is the algorithm for prediabetes, and you can see here that lifestyle modification is the first line treatment.

And if you look at the algorithm for diabetes treatment, again, we all know this.

Lifestyle modification is the first thing that we should recommend to our patients.

There were 3 landmark clinical trials that were done around the turn of the millennium that really proved eloquently and convincingly that lifestyle intervention is very important in the progression of diabetes.

And we're going to go through each 1 of those now.

It was called the Daqing IGT and Diabetes Study.

The second 1 was published about 4 years later in 2001, and it was called the Finnish Diabetes Prevention Study.

And the last 1 that we're going to talk about was published just a year later in 2002, called the Diabetes Prevention Program.

It's maybe the most famous 1, and it was done in the United States.

This study looked at 110, 660 adults from 33 clinics in Dacheng, China.

This is back in 1986, probably before China was as westernized as it is now.

But they were looking for individuals with IGT, or impaired glucose tolerance, or diabetes type 2.

And of those 110, 000 people, they were only able to find 577 people with prediabetes.

That's pretty amazing actually, isn't it?

If you were to do that same screening process in the United States right now, okay, with the known rates of prediabetes, you'd probably find about 44, 000 people with prediabetes.

That just gives you a little idea of where China was and maybe that demographic at that time in 1986.

That was prior to the boom in diabetes, at least on the early stages of it, especially in China.

Anyway, they randomized these 577 people to either control or 3 different intervention arms.

1 was a diet only arm, 1 was an exercise only, and then 1 was combined together.

And I'll show you what they did for each of those in a moment.

They followed these individuals at two-year intervals for 6 years, and they were trying to identify those who developed diabetes.

Here's what the different interventions were.

Of course, control was just general advice, brochures, things of that nature that you would normally give in a primary care setting.

They had dieticians that helped advise patients on a diet that was supposed to consist of 55-65% carbs, 10-15% protein, and 25-30% fat.

And if you kind of know these proportions, it wasn't that aggressive, okay?

You know, the fat levels are pretty high, and there's a lot of things that we could do probably to make this stricter But that's what they chose to use for their study.

They were encouraged to eat more vegetables drink less alcohol and Less simple sugars There was a calorie restriction for those who were overweight or obese and that was to encourage them to lose weight.

And then in terms of the actual counseling, there was individual counseling with physicians as well as small group sessions that continued throughout the active intervention.

With the exercise only arm, it's a little bit more complicated, but they basically were asked to increase their exercise level from whatever they were at baseline up by 1 or 2 levels or so.

And so it wasn't specifically, there wasn't a goal for a certain amount of minutes or a certain level of intensity.

The results of this study did show a decreased incidence of diabetes in the intervention arms, whether it was diet, exercise, or the combined diet and exercise, you can see that the cumulative incidence of diabetes dropped from about 68% down to the 40s.

And that correlated to a risk reduction, especially for the combined arm, of about 42%.

Franklin Cobos

Establishing Home Sanitariums: A Sanctioned, Scalable, Sustained Plan

And let's begin with a word of prayer together as everybody comes in to get settled down for the presentation.

Father in heaven, we're grateful for this opportunity to come and meet together at the Amen Conference here.

And we pray that your spirit would be here to bless our interaction and our our discussions our thinking and our our desires may we be guided with your word and inspiration to know how to navigate these tough challenging times in Earth's history we are privileged and humbled to be used by you in these hours and ask only that you would sharpen us as iron on iron to make us better tools as the days pass and time ticks out.

What if I told you that today, or say by the end of the year, the Seventh-day Adventist Church could bring online and operate a global health institution for evangelism that could serve the needs of 4 to 5000000 people per day year round.

And that would it be done in a sustainable manner, scalable up or down depending on financial conditions, whether or not you could buy or sell, whether or not you had debt or credit wouldn't matter.

It would be done in a fashion that was totally lacking any questionable or harmful practices.

It would be so safe that God himself could refer, do a clinical referral to any of these locations because it was so safe that he himself would sanction it for any of his sin-sick children to go and stay there.

So before I outline the plan I think that we could do to make that happen, I'm going to tell you about the unsustainable, unsanctioned, unscalable system of medicine that I and I think most of you perhaps are familiar with.

I would caution to say that I can only speak for myself.

I do not want to convey the idea that I'm accusing anyone here of doing anything wrong, but you must yourself decide whether or not today You are practicing the style of medical missionary work that you believe God has called you to do.

So right now I am, as a way of introduction, they asked me to do an introduction.

Right now I'm Director of Anesthesiology at a small Community Hospital in Crossville, Tennessee.

We're lucky to have 30 people spend the night.

At this point, we're $1 million year to date in the hole.

Last year, we were $3 million in the hole.

The AHA website that I looked at, American Hospital Association, indicates that in this nation, there are 915, 000 registered beds, And that it costs us $859 billion a year to operate those beds.

That comes out to just under $1 million per bed per day.

The same website, American Hospital Association, indicated on a chart that in the years 1992 to 2012, patient margins were all negative except for 1 year, 2012, and the margin was .7 percent.

If you don't go to your staff meetings at your facilities, you need to go because that's where the financial reports are given.

And it'll give you a sense of just how close you are to the precipice of not having employment.

The patient margin is the number of dollars that come in for giving patient care.

If you divide that by the expenses of the hospital and then divide that by the revenue, you get your patient margin.

That is, if patients come in and pay you a dollar to take care of them and you spent 99 cents to do that, you're plus 1%.

But if your patients come in and pay you 99 cents and it costs you a dollar to take care of them, you're negative 1%.

You can't, You can't do that without borrowing money, existing on credit, until some credit financial crisis occurs like it already has in 2008.

And then you're going to go down, like many hospitals already are.

So that's what I would describe as unsustainable.

By the way, we talked about the prophetic importance of where we are.

And I really appreciate some of the comments that other speakers have done in their presentations And how obvious it is that we're nearing the end of time and the event or flow of events that we watch happening around us.

Have any of you thought how would you operate the typical Seventh Day Adventist institution, tertiary health care facility, if you can't buy or sell?

Will they even exist long enough to make it where the CEOs have to say, well, you know, we can't buy or sell.

How will you operate medical missionary work when you cannot buy or sell?

Has anybody got that in their business meetings, talking about that as an agenda item?

Well, If you think that's unsustainable, try this.

CDC website indicates that $20 billion a year are attributed to antibiotic resistant infection complications alone.

Can Florida Hospital do that for very much longer?

Loma Linda, Porter Healthcare, all the Adventist Healthcare Systems, nothing against them.

I trained at Loma Linda, very thankful for that institution.

But I'm not entirely convinced it's going to be very sustainable for much longer given conditions that we know and expect and are watching unfold.

Is the institution where you work going to last another credit crisis like 2008?

So no, I don't think right now the present model is sustainable.

Sometimes I wonder if some of the things we do are even sanctioned.

Let me draw your attention to a quote that I think I first discussed with John Kelly right here on the front row in the lawn in front of the basic science building near where we used to play hacky sack.

I mean, that was a longstanding tradition, everything, because we played it after micro at the basic science building.

John and I talked about this quote from 5th volume of the testimony 443 paragraph 1.

There are many ways of practicing the healing art, but there is only 1 way that heaven approves.

God's remedies are simple agencies of nature that will not tax or debilitate the system through their powerful properties.

Pure air, water, cleanliness, a proper diet, purity of life, And a firm trust in God are remedies for the wonder of which thousands are dying.

I'll give you some numbers here in a little bit.

Yet these remedies are going out of date because their skillful use requires work that people do not appreciate.

Fresh air, exercise, pure water, clean, sweet premises are within the reach of how many?

You may have family members who are growing broke because they are on prescription medications.

Drugs are expensive, both in the outlay of means and the effect produced upon the system.

Fifth volume of testimony, page 443, paragraph 1.

Actually this was the quote I think John and I talked about.

John and I, I remember we were on call in the VA hospital, third floor, and I was reading the Merck Manual, studying, and John pointed out, you know, the Merck Manual never has a section on cure.

The ONC tab, ONC Oncology, you can see cures in that section, but nowhere else in the Merck Manual are cures discussed.

When drugs are introduced into the system, for a time, they seem to have a beneficial effect.

We have many publications that indicate beneficial effects.

A change may take place, but the disease is not cured.

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Series

Breakout Sessions A

So You Want Me To Be an Expert Witness?

Transcript

Description

Parent Series

Parent Conference

Sponsor

Recorded

Attachments

Parts

So You Want Me To Be an Expert Witness?

56m

Lifestyle Intervention and Its Impact on Diabetes Treatment & Outcomes

52m

Establishing Home Sanitariums: A Sanctioned, Scalable, Sustained Plan

57m

The Christian Dental Practice a Center of Influence!: Keys to Making Your Dental Practice Thrive

55m

AMEN Orientation

36m

Sound Doctrine