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The Failure of Lifestyle

Mark Sandoval

Description

OBJECTIVES 1. Discuss the treatment benefit of lifestyle factors such as nutrition, exercise, water, sunshine, temperance, air, and rest as measured in Quality Adjusted Life Years (QALY’s). 2. Show how the typical approach to lifestyle interventions fails at securing the maximum treatment benefit as measured in QALY’s. 3. Discover a Biblical approach to lifestyle interventions that secures the maximum treatment benefit as measured in QALY’s. 4. Encourage participants to apply this Biblical approach in the treatment of their patients, regardless of their practice setting.

Presenter

Mark Sandoval

President and Medical Director of Uchee Pines Institute

Conference

Recorded

  • November 1, 2019
    3:00 PM
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I have my father we thank you for your loving mercies and we are grateful that you are a God who loves us so much and that you have created us in such a marvelous way and as we consider this topic this failure of life style we asked for you to be our teacher for you to bring sots and ideas home to our hearts that well Lord that we may make a change transformation that we may not stay. In the usual place but we may come out of our comfort zones and and enter into a different life. This we need and this we asked for and this we thank you for giving us and we pray this in Jesus' name amen. So we're going to look at the failure of lifestyle. You know my name is Mark Santa Paula President a medical director at u. pines Institute and the health ministry is director for the way the Gulf States Conference. And the founder and chair of health by the book in Trinidad and Tobago and there's a few other things that I have my fingers and. And God is good. Very good and we're going to look at the failure of lifestyle that there is a major failure in lifestyle and so we're going to look at that this is a continuing education. Opportunity and so I must tell you that I have no disclosures and there's some boring objection that you can look at in your hand out and otherwise we're just going to dive right in. So we have entered into the golden age of lifestyle it really is since 1903 Dean Ornish publishing studies that advocate for lifestyle interventions as part of the health care system he's met significant ridicule and resistance along the way but persevered in his pursuit lifestyle medicine as a component of our health care system and now the Dean Ornish lifestyle medicine per gram is reimbursed of all through Medicare and other insurance providers we have Caldwell Esselstyn who has pushed forward in his own arena pioneering lifestyle medicine work through the Cleveland Clinic and developing the cardiovascular disease prevention and reversal program ensuring that clearly lifestyle interventions can reverse even advance cardiovascular disease we have that 2011 documentary that just turned this world upside down forks over nines sure Mendis interest in the area of lifestyle and plant based diets I know of hundreds of people who changed to a plant based diet because of that documentary hundreds all over the place that that they have done so my personal journey in the change of diet was a little bit before forks and knives but. It was really neat when it came out and within the last 2 decades we've seen the rise of such organizations are going to zation as is the plantation project and the American College of lifestyle medicine with its. Offices on treating the cause right treating the cause and I just came there many of you actually have come right over from the a.c.l. am meeting this year 15th anniversary guess what 15th anniversary for a man both organizations same age but a c l m has 1500 says ish ans and other health care providers that are there at the meeting more than that that are members of the organization and they're all oh and you do you want to feel energy go to the a.c.l. I mean it's I mean there is all sorts of excitement and energy and people are just all interested in lifestyle and incorporating this and some of them are just kind of lost they're like well I want to but I'm not sure how and that's why I'm here but there's all sorts of people there it's just it's energy packed especially with the music. Those of you that were there know. But does the lifestyle really treat the cause does the lifestyle really treat the cause and is it really the answer that we're looking for or is the answer deeper than lifestyle. So let's look at some studies that show us the treatment of fact of certain lifestyle interventions in terms of quality adjusted life years quality adjusted life years ago water quality adjusted life years well it's a measure of health or disease burden that includes the quality and the quantity of life that's lived so so it assumes that health is a function of the length of life and the quality of life the 2 together and combines these values into a single and x. number so how is this calculated well to determine at you you you need to multiply utility value associated with a given state of health by the number of years that you live in that particular state for example perfect health is considered a utility value of one Das is the utility value of 0 so everything out says some where along the spectrum between 0 and one so for instance if you had a stroke with Henry precess you my be at a point for maybe just depending on how that works out and who's who's determining that and then when we look at quality adjusted life years well if you lived a whole year with perfect health then you would have a quality adjusted life year of one because you have one year at a utility value of one so one times one is one very good all right simple math right so a year of life lived at a situation where you had a utility value of 0.5 let's say or a bedridden for some reason for a year but you lived the whole year that way then you would have a quality adjusted life year of point 5.5 times one or if you had perfect elfin till you got killed by the vehicle halfway through that year. Well then you would have a quality adjusted life year of point 5 because you had perfect house for half a year so this is how you determine quality adjusted life years now let's throw that in the context of another scenario let's imagine that you have a group of people and they have a horrible lifestyle absolutely horrible lifestyle and they live relatively healthy for the 1st 20 years of their life you know it's the lease on life that they get and they have a utility value of point 9 So point 9 over 20 years and then boom they have a heart attack and their utility drop value drops to point 5 and they live at this level for the next 35 years well until they're 35 years of age and then they have a stroke at which point it drops down to point 4 and they remain that way until they're 65 years of age when they die in this situation they end up with about 37 and a half quality just in life years if you take all the utility values on the side multiply it by the number of years along with alongside there you have 37 and a half quality adjusted life years. Now let's add an intervention to this and see what happens so here we're going to teach them to eat a diet that reduces cholesterol and simple carbohydrates an increase is fiber so we're going to do a dietary intervention now this group lives for 40 years a good health with a utility value 0.9 then they have their heart attack and their utility utility value drops to point 7 drop quite as far when they have a heart attack and they live in that state until they're 80 years of age and at 80 boom they have their stroke drop their utility value down to point 5 and they live in that state or point 5 and they live in that state until they're 90 years of age when they finally die so this 2nd group has a quality adjusted life year of 69 so what is the treatment a fact while the treatment of factors are 69 quality adjusted life years minus year 37 and a half and that lends up with a treatment value of 31.5 which by the way is sheer. Imaginary but it's huge it's absolutely huge as far in as as an intervention is concerned so this whole red area here on the chart gives you an idea of the increase in quality adjusted life years that you can have with a certain behavior so let Now let's look at some real studies and what range quality adjusted life years might be in as we get along with our topic so here's the European perspective and of and best occasion in a cancer nutrition or epic Netherlands study the epic n.l. study and they followed 33066 people for 14 years and assigned them one point each for 4 healthy lifestyle factors so you received one point if you never smoked if you had a normal body mass index if you were physically. And if you had a high adherence to a Mediterranean diet so those are the 4 points for assignments that they gave to individuals and what they found is that after 14 years 33000 people that compared to those who had 0 points right so they weren't doing any any of those 4 things those who are doing all for the end up having 4 points they gain an additional 1.75 quality adjusted life years. Or so almost to good healthy years in addition if they were doing that compared to the others so. That's good that's good. What about smoking cessation there's a Danish study they looked at 25 year olds and calculated their quarterly quality adjusted life expectancy if they had certain lifestyle patterns that were negative for example 25 year olds who were have the smokers lost 10 to 11 quality adjusted life years compared to those who never smoked. Men who consumed high alcohol they lost about 5 and women lost about 3 quality adjusted life years if you were sedentary compared to physically active you lost 7 quality adjusted life years if you were obese men lost 3 and women lost 6 quality adjusted life years and so you see then there's certain benefits associated with particular behavioral patterns of lifestyle and interventions that one my enter into and looking a little bit more at smoking cessation another study looked at the effect of smoking Association on quality adjusted life years and looking at individuals that are older 65 and older and what they found is that if you'd never smoked by the time you got to 65 you hadn't expected 16 point one years longer to live quality adjusted life years not just years live but healthy years lived. At that point if you are a former smoker you only have 12.7 So obviously last if you had smoked in the past if your current smoker while you're only expecting about 7.3 quality adjusted life years at 65 if you began smoking before you were 18 you can only expect 6 but if you began smoking after you're 18 you can expect about 8 and a half quality adjusted life years and if you smoke last then a pack a day you're going to expect about 88 point one quality adjusted life years but if you smoke more than a pack a day only about 6.6 And finally if you quit you can gain potentially an additional 5.4 a quality adjusted life years so now it's about what we would expect. The more you smoke the earlier you start the worse it is and the research bears out that fact you know we look at it you know we look at him go wild dog but you know the research now tells us well. Right. Well we know so let's look at 2 different treatment options in this example you can see we've got 2 treatments we have treatment a treatment b. it's obvious that treatment b. is going to give you more quality adjusted life here right significantly more that read section on the chart is is much bigger in treatment b. And if you are looking at a particular condition or a life of your patient and you have the option of choice treatment they are treatment b. which one are you going to choose a lot of the Asli energy treat to choose treatment b. because that's going to give you the greatest benefit but what if it wasn't just treatment a and treatment be what if there is treatment. And treatments see. Well give you the same benefits as treatment b.. But it will also give you a turn a life with perfect health. Now which treatment would you choose. A b. or c.. Well that's right. You would choose treatments see the of course because it's infinitely better than treatment a our treatment being right so anything that you can do treatment wise that will all me impact that which is temporal is. Last effective then the smallest thing that you can do that will impact that which is eternal. Repeat that. Anything that you do that is temporal is an infinitely less effective than the smallest thing that you can do that is eternal because the eternal will have an everlasting eternal a fact and so we must take that into consideration when we are thinking of any treatment modality anything that we are involved in. And invent or intervention that can affect eternity and finitely more potent than the greatest intervention that can really affect this temporal life and so as wise practitioners we must understand the need to influence eternal interests we've got to see that we have to and we must be wise in applying mowed down ladies that impact those eternal interests and if we fail to impact eternity we fail of any real significance or success in our profession because we are choosing something that is infinitely law x.. Then knows what is what is available and what is an option right. We've got to see that goddess you gotta go there so some of us have been trained to be afraid of addressing spiritual issues of our patients. Part of our training so let me remind you that 70.6 percent of Americans are Christian. So the vast majority of patients coming to your practice they are Christian 22.8 percent are on affiliated. Only 7 point one percent or about atheists or agnostics it's a very low percentage but sometimes vocal 88 percent of people believe in God whether they're Christian or not 77 percent believe that religion is important to them 71 percent pray at least on a weekly basis and 35 percent have read scripture at least once a week or so so we find in our American population that our patients are predominantly religious they are whether they acknowledge it or not spiritual. It's that's not I mean it's like are you a human are you not well yes you are human well therefore your spiritual right just goes along with it but many of them are religious and they have knowledge that but what about physicians and their attitudes towards spirituality and religion and and so on when it comes to practice well physicians when it comes to addressing spirituality 91 percent thankfully think it's Ok to address spiritual issues on a patient brings it up. But that means that there's 9 percent. That believes it's not Ok to address spiritual issues even when the patient says Doc p.. I want to talk about this 9 percent of patients physicians out there are going to say I'm sorry. Not appropriate. 45 percent believe that it's not Ok for this is ition to bring up spiritual issues. Almost half it's not Ok for you as a as a provider to bring up spiritual issues part of it is because of our training and I talked about this in the last session ethics we've been taught as thinks that that there's such a gap between power between the patient and the provider that if the provider even mentions spiritual issues or brings up spiritual issues it's coersion a really. And fluence for sure coersion. 14 percent of physicians believe it is never Ok to talk about one's own religious beliefs with patients or even when the patients have come on Dr I want to know why you never. 53 percent believe that it's only Ok to pray with patients when the patient requests and 17 percent believe that it's never Ok to pray with patients ever so you see there is a disparity between the patience and the providers there's a disparity between the 2 and the providers are the ones that are Mauri religious and not interested in so on and so forth on the patients are the ones that are really wanting it so there's that disparity there. What if we only treat the body. What if our practice is dealing with allergies and anesthesia and. Autoimmune conditions and. Diabetes and hypertension and high cholesterol and so on and so what if that is our practice those are the things we focus on those are the things we look at that the stuff we deal with from day to day and so on if that is our abject if that is our an aim if that is our purpose then we're going to be monkeying around between a and b. and we're never going to go to c. and c. will slip away from us into eternity. If we don't address the whole person and their real need well we have the example of Jesus. Now asking for 23 well familiar with this I know but I'm going to read it anyways that's read it again it's good to review God's word and Jesus went about all Galilee doing what teaching in their synagogues and what preaching the gospel of the Came in doing what he's doing all kinds of sickness and all kinds of disease among the people. It was not a one sided ministry it was a complete ministry of teaching and preaching and handling there was never a divorce between the gospel and his healing work there were always integrating So what about us councils and health page 544 Christ has given us an example he was the greatest physician this world ever knew and yet he combined with his Healy work the imparting of souls saving truth and thus should our physicians labor how like Jesus did. They are doing the lord's work when they labor as evangelists I have ever thought of your job as an evangelist if they did they do to evangelism class and evangelism training in medical school. Well I skipped a lot of classes and that must have been one of the ones that I skipped. I seriously did skip a lot of class and I think it was a few years after I went through they finally got the idea and they started making everybody go to class and. This crazy idea that I could learn more just studying on my own than going to class if I did it over again I'd go to class but. At least I made it through. Sometimes people ask well how did you make it through I made it through as the top. Of the bottom 3rd. Of the class. Top of the bottom 3rd of the class was like 33rd percentile at last you know so yeah. Praise God He got me through so he could change me. So. Thus our physician should labor they are doing the lord's work when they labor as if Angeles. I missed that one I missed that one give you an instruction as to how this all may be healed by the Lord Jesus every physician how many physicians. A 3rd of them 2 thirds most almost all average the average physicians should know how to pray and faith for this. Now it's one thing to pray for the sick. It's it's one thing to pray for the sick we can say words it's easy to say words do you know how to pray and see for the sick. So that when you are done praying they are believing. Because they have caught the fever of faith from you. Or is it dry and tasteless and whatever and and they're just as unbelieving afterwards because it's just a formal thing it's different to pray and to pray in face they're not the same thing do you every physician should know how to pray and face for the sick as well as to administer the proper treatment at the same time he said Labor is one of God's ministers to teach repentance and conversion and the salvation of soul and body but if you have not repented if you have not been converted if you if you only have a form of godliness about g. dying the power there are of and your soul and what's that going to the soul in the body it's going to be. It's an official term. It's not going to work such a combination of Lady Labor will broaden his experience and greatly enlarged his influence one thing I know the greatest work of our physicians is to get access to the people of the world in the right way the right way there is a world perishing Insan and who will take up the work of the cities the greatest physician is the one who walks in the footsteps of Jesus Christ and let me tell you it's not an easy pathway. Because it'll cross cut right across the world in the way the world operates and guess what most of us are operating that way too. So when we follow in his footsteps it's going to cut right across our way to. What is the physicians 1st work the re Damer expects our physicians to make the saving of souls their 1st work. The 1st work out their 3rd work not their last work not their their 1st work. So let's on packages a little bit because we need to we must we've got to go here and some of you were in the last session and so we kind of went there together and we'll just go through there again. If the salvation of souls is your what work 1st work right then that's the aim that's the purpose that's the reason for your practice is the salvation of souls and if that is the case which it is because we're told this is not just any god is telling us it's our 1st work if that's the case then how are we going to design a practice so that it meets that 1st work how are we going to do that. When you you know and architecture can have a part to play just like Mark family was talking about yesterday evening All right what is this. Theme of textures something like Barry where I remember the term Disney thing you know it's. It with a theme in mind you build the whole thing even the architectural around that thing right so if you were starting a whole new practice how would you how would you envision this whole thing setting up where how would the flow be where would you put the waiting room what would be the seating arrangements be like what would you have on the walls what would you have on the tables What would how would you have all of this stuff interacting but it's not just the location in the position and so on and so forth but what about the people the people that work in the practice who would you hire to be your staff. Nice people that know how to smile and and interact in a nice. Accommodating way with the patients and so on so forth sure customers you know people that have good customer service sure but no that's not what we need we need people that have that yes but they have to have the gospel experience themselves because they can't give what they don't. And if we haven't we hire staff that don't have that personal experience with cries that don't have that transform relational relationship with them they can't share it with the people. All they can give them is a theory but not a reality. And our business nowadays as specially a 7th Day Adventist Christian health workers arm our business is still the 3 messages. Right it's still the 3 angels message and that's still our business even as physicians that's our business and so if you have individuals that might be a good Christian otherwise but don't have a clue about the 3 and those messages and don't have an experience in the 3 engines messages that's not. We must have those that are in our living experience of the messages that we're trying to share with the patients because only then can they communicated to them and you want the whole team to be on board not just some because your team provides a protecting hedge for the patients it provides the environment that they walk into it is important in order to have all of that right so it's it's you it's your staff it's the the even the layout of the place and and it's the flow through it it's the literature that you have the pictures that you have all know all the things that are playing on the t.v. if you have one and so on all of that much to be thought out with the purpose of salvation. But another really hard part and we kind of dug into that in the last session it's also the schedule. The schedule. This Gadgil has a significant impact on salvation. Significance and the enemy knows that he knows that he knows if you have 2 little time. You will take only that which is superficial and accomplish it because you don't have time to go deeper. And so he he he he directs the system into overdrive. So that there's not the opportunity of addressing spiritual issues emotional issues heart issues with patients because if you open Pandora's box you are lost for the rest of the day. Because now you are far behind. Because now you are far behind the. Time and everybody else is running late and so on and so forth and and so so we just don't go there because we don't have time to go there and so on but it's our business to go there it's our purpose to go there. So we've got to consider whether what we're going to do about that have to we have to consider what we're going to do about that are we going to continue on the same way that we have been are we going to continue on with the same practice in the same partners in the same whatever and all that kind of stuff and doing things the same way or are we going to stamp out in the way of God's choosing the focus being salvation of souls and divine design everything in the practice that fits around that or if you're mid-level providers some like that and you have to be working under somebody else that finding that one that does. So what's the physicians responsibility and every medical practitioner whether head knowledge is in or not is responsible for the souls as well as the bodies of his patients the Lord expects of us much more than we often do for him every physician should be a devoted intelligent gospel medical missionary. Some Melia with Heaven's remedy for the Sensex soul as well as with the science of healing bodily disease we should be as well versed and dealing with hurting soul and helping them to heal as we are with our physical treatments of whatever conditions they were dealing with and whatever specialty they were in. I should be able to as easily and search a chest tube. And I should as easily be able to insert the gospel for a patient and to show them. The solution right to their hurts to their heart issues coming as he does in daily contact with disease and death his mind should be filled with the knowledge of the scriptures that from this treasure house he may draw words of consolation and hope and drop them as good seed into hearts ready to receive them he should encourage the dying to trust in Christ as the 2nd part means Savior and should prepare them to meet their Lord in peace. How many patients have you have that slipped through your hands. Without preparing them to meet their Lord and. Well in some situations it's difficult. Especially when you're dealing with trauma and so on and so forth and I've had plenty of patients that have died in my hands on I'm trying to keep them alive. Not in lifestyle any are they don't die is often a lifestyle. But yeah they are and you know I mean I it's hard you know I'm sure all of us have been there to wonder very or another I've had I don't know how many patients die in my hands while I'm trying to save them. But sometimes you get to them just a little bit earlier than you know they're circling the drain you can see it right you can see it in them you can see it in the numbers and so on so far they haven't they haven't gone they haven't been flushed down yet but they're right on the verge. How many of those have we prepared to meet the Lord in peace I am not asking that for you to be guilty I'm just we need to have honest questions and honest answers with ourselves in regards to our practice are we following the great master in his work or are we not we've got to look at it we've got to see it we've got to see whether we're doing that are we doing a. American cause of lifestyle medicine lifestyle intervention but not really get into salvation. Are we new stars without new starts. You know without trust in God or or what how how is it going with us as issues need a double portion of religion man in any calling physicians or most in need of clearness in mind purity of spirit or how do you get purity of spirit Well you can't have purity of spirit without purity of mine and you can't have purity of mind without purity of eyes and ears and so on and so forth so so that means we've got to we've got to watch what we're watching. We've got to listen to what we're listening to we've got to pay attention to the avenues of the soul and those things that are coming and we can't just be playing around with the trash trouble and trivia of the world we can't just be watching everything that Hollywood puts out and so on and so forth and have periods spirit it cannot work. So it has to enter into every area of our lives. I can ask the question oh let's imagine that in the last 7 days there is this special equipment that was following around you following you around. And there's special equipment that you know it's like a drone and it sees where you're go in and it's got video of this and that and it's even has special equipment so you can tell what you're looking at where you're you know where your vision is is at and so on and so forth and it can tell what you're thinking. And it records it all. And and I have the file on my computer and I can just hit play me and see the last 7 days anybody here would pay me not to play that video. Might pay me a whole lot of money not to play that video. Some might be comfortable with it some might be a Ok well that's fine I'm not perfect and you'll find out that I'm not perfect but it's you know it's not like whoa. You know. Where we have that. Physicians need a double portion of religion right we need a clearness of mind a purity of spirit of faith which works by love and purifies us all that they may make the right impression on all who come within the sphere of their influence we're told of Jesus no man spoke as this man spake. Because no man live does this man live if you are not living in it you they it will not have us an atmosphere along with it that will be transformational. I was just down in Brazil and I was I was talking to a young lady and I asked her just a few question and she just burst into tears you know I love it when that happens I do I love it when that happens because I know that we're getting to something of worth a value we're getting somewhere with that and she's crying issues that are you know why I've cried I don't usually cry with it but in you just as like one or 2 guys. You know and I get that a lot from patients and from you know on others and whatever why there's an atmosphere but the atmosphere is not just created with the patient it's created with the life it's you know it's the time that you spend on your knees it's a time that you spend with a lot of the time you spend in his words it's a time you spend not with the television but with the teacher you know and so that makes the right impression upon all who come within the sphere of their influence a physician should not only give as much physical relief as possible to those who are assumed to lie in the grave but she should also relieve their burden souls present before them the uplifted Savior let them Behold the Lamb of God it taketh away the sin of the world those who understand the science of Christianity have a personal religious experience he who acts as a guardian of the health of the body should have tact to work for the salvation of the soul so we're called to we must do until the Savior is indeed the savior of his own soul the physician will not know how to respond to the question What shall I do to be saved so we must spend that time with the Lord we must enter into that experience with him we must be transformed by the grace of God that we have that living experience ourselves. If you can't give what you don't have. Through the efforts of a Christian physician they accumulated light of the past and present is to produce its effect not only as a physician to give instruction from the Word of God That's part of it and if you don't know the Word of God you can give instruction in it so we must know it before we can instruct it but that's part of it line upon line precept upon precept here is to moisten this instruction with his tears and make it strong with his prayers that souls may be saved from death when the last time you cried for your patients. When When's the last time that that that that that their situation that their desperation that they're that they're lost in this. Word in your eyes. That that bad just brought you to tears and you cried to the Lord for them that he might save them somehow and if you might be a medium of that salvation God let it be me. Wait when you have when you have that and you cry over your patience. You can't just then skim over things you can't help but dig you gotta get to the heart you're concerned about them and their lives and what they need and what they really need is eternity not this temporal stuff. So when you cry for them you cut to go there. And we have such a privilege sought to privilege not even the minister has the privilege of the physician. The physician who ministers and the homes of the sick people watching at their bedside of the sick relieving their distress bringing them back from the borders of the grave speaking hope to the dying winds a place in their confidence and affection such as the grant of the few others not even the ministers of the gospel are committed with possibilities so great is an inflow and an influence so far reaching. And and the enemy knows this in so he must try to divorce the gospel from our work because he knows that we are the most of it agents that God can you. And so he must take away the tools of our agency so that we can continue doing the work and never accomplish the purpose. That's the danger that's the reality. Oh God help us. So what are some signs of poor spiritual health you have a patient that's coming and they're there they're struggling you know what's going on that can give you an idea that things are not going on spiritually will pretty well well they get frustrated right and maybe frequently they might be anger angry they might be better they have guilt that they're dealing with maybe they have got some self-hatred maybe a pick up a few phrases here and there I'm not worthy of or I don't deserve or or something I want to hear any of those phrases you know here we are right what's going on they have a low self value there might be jealousy or suspicion that's going on there might be addictions that they're dealing with they got anxiety or depression and they're they're caught in the cycle of self-pity and you know it's navel gazing it's like oh poor me poor me poor me you know of course you know the phrase a goes a long after that poor me poor me poor me another drink. So. Self pity usually leads to then the addictions in trying to get out of that selfishness desk and Tant impatience hopelessness right all of these things give you an idea that oh spiritually things are not going well. Dear just not doing well even though they might have a smile on their face but you hear some of these comments that have come out and you go all radars up there's a problem here right there's an issue. What are some signs of good spiritual health because it's out there warily So they're joyful they're patient you know you get to an hour later and it's Ok dark and. They're content with what they have even though they might not have much they're hopeful and they're trusting in others they're at peace regardless of what's going on around them they're connected to others there's significance in their life they their understanding of others and their situations and they're helpful they're there and these are these are signs that they're doing well right things are going well spiritually but it's like with all of them if they're all there they're doing well film I have a few components while they might be doing so well. So what if we're looking at spiritual care and spiritual care of our period patients then we can look at a few different things one is we can look at a hopeful approach to spiritual care and say we're going to use the acronym hope h.-o. p.-e. age has to do with hope aren't so that's what we're talking about 1st and so we can ask them what gives you hope. Right what do you hope and what's there that's there what gives you meaning in the life right why do you live is what keeps you going what comforts you and difficult circumstances are situations what is it that you latch on to right and what gives you strength to keep going because you know there's others that have given up by now but you're still going why are you still going. What is it that's doing that for you what gives you peace and I What makes you call men when things are chaotic and what what gives you love and connection right so we can ask all these questions we can we can enter into that hope that personal spirituality and by the way I am and I'm going to give my email address at the end so if anybody wants the slides or seen mail me and I can e-mail them to you. And so they can have all this as well. So we've got 8 hope oh is for organized religion so this is where you know we're going into the church stuff so do you belong to a face group that's you know simple question usually on a questionnaire somewhere how often do you attend religious services does that have any thing to do with anything. Absolutely the Nurses Health Study just was you know looking at that in the differences in attendance of religious services and and the more often you go to church the last often you die from everything so my my my takeaway point from that study was just stay at church you never know I. Write seems to be the trend. So do you feel connected with other members of your face group so you might be along to a faith group you might go to religious services but you might still feel alone and not connected you know I might be a big mega church or something like that and you know it's you just don't have anybody that really connects with you that could be a problem does your religion positively impact your daily life and if it does how. And if it doesn't that's a problem it's a problem. So h. hope oh organized religion p. stands for personal spirituality and practices personal spirituality and practices and a question I like to ask individuals is on a scale of 0 to 0 to 100 zeros not at all hundreds of best it's ever been in your life how would you rate your relationship with God right now right just it's almost like a Likert scale so you know a Likert scale for their relationship with gone you know and some of them look our hearts 101 that's growing it's the best it's ever been excellent What do you do to foster that relationship right what are the practices that you're involved in the time that you're spending that you know is it prayers and scriptures a meditation or are you going to religious services what are you doing to foster that relationship and when was the last time that you were at 100 because you know the scale means 100 was the best that it's ever been got to be 100 back there somewhere or right now so when was it and what were you doing at that time to make it that way and what would it take to improve that number now most people when you ask these questions they will give you the answers right they'll give you the answers because they know. Rarely do they not give you the answers. Right and then it's a time of working with them and educating and encouraging them along and coaching them and so on but most of them will give you give you the answers and then he what are the effects on medical care because there can be. You know so how do your beliefs impact your health do they prevent you from accepting some forms of medical care like blood transfusions or vaccinations or life support or you know what are those beliefs doing it in relation to your health care and how would you like your spiritual needs addressed during your medical visits. So just being open an end up front with them about it everybody has got spiritual needs so how would you like them to be addressed when when we work together and all of this can be done in a questionnaire if you don't have as much time and you can breeze through it and see what their answers are and see kind of where they're at or it can be done in a face to face face to face is much more productive. It's much more time consuming but when it comes to eternity face to face is much more productive much more effective. And then what are some principles of spiritual care well one in need to maintain an active devotional life yourself you can't give what you don't have you got to foster that relationship with God yourself you've got to have that personal thing going on and then ask the Lord to send you patients who need him and who will be open to hearing about Him God will make divine appointments he's all about divine appointments and I am just waiting for heaven one day when I can look and I can see all these rewind tapes about the angels and how they did this and how they can you know somebody driving here and somebody driving there and they make this one stops this one goes through in this one over here and then this interaction on that side and how they all actually got everything to come together so that there's the interaction. I mean heaven is all busy trying to make all this stuff happen pray about it recognize that nobody who comes to your practice is by accident they didn't fall in your practice they're there on purpose right. Well if they did they're probably so human. So before and while you're seeing the patient pray you know what I found out I can pray and I can talk of the same time. I can talk with a patient and I can have a conversation at the same time I can be praying and going aren't Lord I don't have a clue what's going on right now I need you to help me write s.o.s.. Lord help me out with this one I'm not sure what their issue is I can tell that there is an issue it's very clear that I don't know what it is and I'm not sure exactly how to get there and so Lord I need you to help me right now to ask the right question to say the right thing to whatever or just let it come bursting out so I can see it I'm dull right now so Lord make it really obvious for my dog mind so I can see it and God answers those prayers asked the patient would be helpful for you if I prayed with you before again and if they say yes then at the end you can say well let's pray before you go just make a sandwich a prayer prayer be it in prayer at the end rarely will they say no sometimes they do but rarely. So look for the underlying reasons why they're sick and coming to you. The physical issues are just the effect to see a fact there is a cause and a cause almost all the time is an emotional or spiritual issue so recognize that and go looking for it ask questions to find out what's the underlying emotional and spiritual issues address those underlying emotional spiritual issues and you're probably asking wow how do I do that. Well it took me years of praying wall I'm with the patients and Lord I don't have a clue what I'm doing you've got to teach me and God gives me something in that in that interaction and then I'm praying in another interaction and I'm praying and I'm asking Lord you've got to help me with this one and he gives me something and that one and he gives me something in this one and he gives me something and that one and then somebody comes back that has the same issue as that one and now I've got the key for it already and then and then so on and so forth and so the Lord has taught me over the last 7 years or so how to counsel with individuals find out what the issues are and then help them resolve it it's not because I learned in class or anything like that the Lord has taught me while I'm dealing with individuals and praying to and so be a conduit of God's love to them. And I have time to tell you Steve story a bit. Well. He was converted. He was converted before he died also carcinoma met a static. And after his wife had been after him she was Adventists he was Catholic she had been trying to work on him for year. Decades and after he came in and saw things from a Christian physician's perspective and we prayed with him and we worked with him and so on he finally surrendered his heart to Christ went home studied with her pastor was baptized about 2 months before he passed away. Praise God right lifestyle is becoming very popular. And I'm happy for that because I work in a lifestyle center I'm a lifestyle physician I do lifestyle full time. But in the application of lifestyle interventions regardless of how they good they are in Germany in terms of quality adjusted life years. If we don't impact eternity it is worthless meaningless. And that is the failure of lifestyle that is the failure of lifestyles that lifestyle is focusing on the temporal and they're leaving out the eternal and those of you they were at a sale am and listening to the messages and so on and so forth oh oh oh oh oh. And some of those presentation so oh. And then went down a different pathway. Yeah so we can't do that we've got to be doing differently. If you're looking for more resources that you can use in counseling with your patients and helping them to see and understand their spiritual issues and look at resolving those and so on and so forth I have a bias suggestion happen to be. Happens to be a book. About hailing from disease depression and damage relationships and it gives a lot of. What should I say it gives a lot of analogy so it gives a lot of concepts that one can use of the patient whether they are Christian or whether they're not in order to help them to see their need and to see the love of God and to and to help them in that walk in that practice and that's part of what I've been learning over the last number of years in regards to providing that spiritual care for patients and so it's the law of life by Marks and of all it's available on Amazon. For anyone who wants and also if you're interested in more lifestyle resources than you cheap pines Institute has a website at. Pine start or g. and on there there is a section called counseling sheets we have over 500 different counseling sheets for various different conditions that you can look up with natural remedies and lifestyle interventions for those and then we also have a You Tube channel that has hundreds of hours of video on a whole ton of different topics and so you can look that up as well and if you want the slides or any other things that my e-mail address is right there m. sand of all the pines orgy and you can get ahold of me I need to pray because I'm taking up somebody else's time and we need to switch So let's pray. Dear Heavenly Father we thank you for your abundant last scenes in your great mercies thank you that you're a God who knows better than we do. And why we've been challenged we have been. And each of us must answer for ourselves the question Will we follow you all the way and what does that look like we don't know but we know who's there and we want to be with you and like you and so Lord may we may we enter Great into our practices may we transform our practices mean we design our practices with eternity and view that the salvation of souls may truly be our 1st work and we are following the pathway of our savior Jesus we pray in Jesus name and. This media was brought to you by audio 1st a website dedicated to spreading God's word through free sermon audio and much more if you would like to know more about audio verse or if you would like to listen to more servant leader visit w w w audio verse or.

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