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Changing Behavior in the Clinic Setting

Tim Howe


Tim Howe

Medical Director of Wellness and Diabetes Education at Parkview Adventist Medical Center



  • October 29, 2010
    3:15 PM
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changing behavior in the clinic setting that wasn't the topic you are given but the topic you are given said something to do about the entering when and changing the entering wedge I think has to do with the right arm in knowing for the gospel and so I thought what was just changed the title and changing behavior in the clinic setting how many of you here are in primary care medicine are right so you know what I put up with for the last twenty one years actually longer than that for twenty one years I've been in Brunswick Maine and I've been a general internist which means I see patients in my office like most of you do Monday Tuesday Wednesday unveiled a half a day Friday and Thursday I do other things like visit I can use a microphone if I'm given one about that this insists the one you want me to use okay Arkansas clout or whichever you prefer okay I can do above if you're hard of hearing I don't know of as I was saying for the last twenty one years I practice in Brunswick Maine and today is like a warm summer day in Maine we get about three of these I was on a plane going to remain before I decided to move there and I sat by a Maynard who now can you hear a better song now there we go you want me to slide it up okay will we can do lots of things you there I don't want audio verse to feel cheated so why would Verizon it was all there was I was flying and then I talked to the guys to tell me what summers are like rain he said while last summer was absolutely gorgeous you can't believe what a beautiful summer we had Caesar Yahoo was on Wednesday so that's that's how things are that the trouble that we haven't primary care medicine is we've got ten to fifteen minutes right that's what you've got to interface with the patient how are you ever going to change behavior intended fifteen minutes while I as I often do I asked several people here in what what they would recommend and the most common answer that I got was you need to pray for the right patients and and I would submit to you that that is an answer but it's not the right answer so with with that let's begin with the word of prayer our father we are thankful to be together on this beautiful day we pray that you will be among us today that you will minister to us that we may see things clearly in Jesus name amen the first statement on on the and out is as follows when it comes to health you have to apply it to sell down real estate that's not true right you can sell somebody else's property they do it all the time that's how they make their money but when it comes to health you have to buy it this salad modeling a healthy lifestyle is the best sales pitch it's really difficult to tell my patients to lose weight when I need to know if I've struggled with that that's even better because you know I'm right along with them and my patients look at me and they say you don't understand when I say well what you don't know is my brother weighs two hundred sixty pounds oriented and you know the smell of food I can gain weight on the smell anybody else here like the Amiga smell especially certain types of food interestingly the next thing to remember is this every change for the better is a gift from God every change for the better 's a gift from God it's not from you it's a gift from God and you know that from the test every good and perfect gift comes down from the father of lights or father about ministry of healing has a similar here or one that tells us the same think we usually read this paragraph and this is on page one forty three of ministry of healing Christ's method alone we know all that but how about the paragraph before and you know what that one says it says this it is only through the grace of Christ that the work of restoration physical mental and spiritual can be accomplished it is only through the grace of Christ so when I say well I have to pray for the right patient that is the answer is our next point change for the better without God may bring evil instead of good and tax there is Christ talking to Pharisees he said you compassed land and sea to make one convert and you make him twice the sun felt we were before those are his words what have you seen the health message makes someone harder their stronger they feel better and so they send harder it change for the wrong reason can be good but remember taking credit for the change that God gives will always bring evil and you know it's so easy as physicians in the patient's command thank you Doctor can you say while you know I am very skilled about God is the own it is the grace of Christ alone that brings restoration alone that brings restoration and I think this is so important when you're in that room with that patient how much time does God need to change a life while a lifetime but he can change the direction like that can a lot what about song he was on the way to Damascus and an godsend while this is going take me a long time so what he said about Anne and if that's what were working with then when were in the clinic who do we depend God and here's another point pray for and whenever possible with your patients encouraging them to look to God for help in making changes for the better this is why often do for talking to a patient with their new to me although I don't have a lot of hard didn't have a lot of new patients until recently because my practices been closed for about twenty years most of my patients I've had for twenty one years that's the way things work in me through their Intel now you have that celestial transfer its lets what were all hoping for eventually but now I'm taking new patients as I have sent among doing more consulting work and lifestyle medicine and when I have a new patient did that I don't know well often I'll say when were talking about a change you know we have a prayer list here in this office would you like me to put your name on that list and if they're little hesitant I say well up on will do that but if the sale yes that would mean so much to me that I say would you like a prayer right now and you know it's the rare patient this is now an and I gives you you know give some little freedom in what respect for their their belief system and yet it always gives you the opportunity to bring up prayer now there's something in desire of ages several speakers and mention the ministry of healing in the two chapters physician as an educator and teaching and healing they're very good but I would also recommend the chapter and desire of ages that I'm a quote from now read from now and it's go teach all nations if you haven't read it recently I would encourage you to read it particularly page eight twenty four and I think this is very very important for a assist health professionals to keep in mind saw this read you a paragraph for the sick we should use the remedies which God has provided in nature we should point them to him who alone can restore it is our work to present the sick and suffering to Christ in the arms of our faith noted to get that it is up how much faith do they have to have died insane thing of their faith that is in the arms of whose faith our faith it and that's our work it was says it says it is our work to present the sick and suffering to Christ in the arms of our faith we should teach them to believe in the great healer we should lay hold on his promise and pray for the manifestation of his power and then the next sentences is very critical but before I read it I want to ask you what is the essence of the gospel anybody with the essence of the gospel notetakers God loves us okay listen to what she says the very essence of the gospel is restoration now we just read an ministry of healing who alone one alone is responsible for restoration right the grace of Christ the very essence of the gospel is restoration and restoration may take place when you lift up your patient it's in your arms of faith and ask for God 's healing power so change in the office setting takes on a whole new aspect doesn't and you know what we really are is conduits for the grace of Christ and you know what you may not even know that a person is change from interacting with a gun doesn't always tell us what wonderful people we are instead in fact what is a lifesaver closer we come to Jesus how we appear in our own eyes they're worse but don't despair because this next this next thing is equally important recognize your need of help and if you don't take anything else from the talk today I want you to take these next two sentences there from the chapter the sermon on the Mount she's talking about the poor in spirit from the soul that feels his need nothing is hell can you wrap your arms a lot it was picture something okay we are looking around and haven't we been granted an opportunity go up there and there is God any set of the conferences get Gabriel and discussed the chair Vincent Seraphim 's new know their rule in the universe and they got this big deal or working on it but a lot of problems down there and in the earth and in plus they got all the stars there taken an end Gabriel says on sorry God but there's persistent person out there and they're not there not in time shall I tell them to go away and got says who is all of that said Tim Hal God Wisconsin oh nine him again noticing our letting me he really needs help so they interrupt everything they said I come right into insert unit you going there you or me and and dirty water right with God and Gabriel interviews check this watch is that it's been it's been a while him I don't think we ought to get back to business Internet that is not what is saying and Gus is also now he has one access on limited access that's what it says from the soul it feels his need nothing is without he has unrestricted access to him in who all can you beat that and so when you go your patience you don't have much time but who do you see you have power well you know you have to assess change readiness right winger now what Prochaska low said yesterday Wallace 's patient ready for change and you go through the precontemplation would come do you do in fifteen minutes I mean no you sent it it's a godsend the man if they want to pick it up fine if they don't okay yes I think it's somewhat helpful when I'm talking with smokers particularly along no nowhere are they on this scale have a thought of everybody stopped about smoking cessation I mean no one today does not think so that's good form that might happen twenty thirty years ago but not today they all know it's bad so they've all contemplated that but in other somewhere on that list you know I tell him I said listen but I really appreciate smoking I just want to write up front because there are many people who give their bodies so that I can have something to do it up there I guess that you helped put my children through college and I really appreciate it but but since you've done your job and because I paid the last one through college if you ever want to quit let me know and I give him a little handout on five days to stop smoking that Agatha thrash it it's a great little thing we've adapted it for our practice and I said listen when you want to quit just call us just call us and we'll put you on a prayer list and in my office I have this sheet of paper on the door and I write patients names on you know we change it periodically but we have remains unsettled someone calls up can you start praying for me honest quit smoking all you we can do that and we put up there and and we pray for you who is doing the changing visit me know and I know it's not me they know where the powers coming from and isn't that what you want to convey to your patients it is so that they get this idea that a if they feel in need they can go the same place that you go so much assessing change readiness is important but God is the one who removes them from one step to another and I think that's important to keep in mind Ellen White in many ways says the following she says expressions strengthens impression and I think this is very important when were talking the patient's about change she says those who talk faith will have faith those who talk discouragement school have discouragements how many of you fret the book motivational interviewing by Miller and rolling it's a great book I heartily recommend that you at least read the first chapter or two and then think about what they're really saying and then what I'd recommend is that you read Christ's interview with Nicodemus and his interview with the woman at the well and his interview with the rich young ruler and then read in desire of ages about those same interviews and pick up some of your tips from the way Christ interview it's really interesting if you think about what he did with Nicodemus no Nicodemus comes and says good master and Jesus goes and cuts right to equipment and syndicate would be born again and Nicodemus he's he's he's off balance he seems like a minute and so he supported it can't really be born when -year-old cannula and in crisis nails him again and energies this is really good at keeping his people little off balance when they need to be kept off balance look what he did to the woman at the well she said anyone she said well you know that you say they should worship here and we were worshiping here and try to get him into that mess and he just said no were not going there and then he said go call your husband he knew felt full well that she had had five what was he doing she was off balance inches away in a minute who am I talking to and sometimes keeping your patience just a little off-balance when future range when here's the set really study know when you're off balance us why use a lifesaver that I think of my patients when their need to quit smoking I say I really thank you for smoking consistent where's he going with this their off-balance in your thinking a new way humor will do that and use humor with your patients they don't expect it from you use a little humor changeups things get them off balance and then there more you willing to change very helpful the other thing about motivational interviewing that relates to this is Miller and Rolex say never argue with your patient Nicodemus came in he want have a discussion in Jesus and know where I'm going to discussion were going to the heart of the matter and you don't want to argue with your patients because if they express resistance they become more resistant so you want to draw them out you don't want get into a fight with them as one person and expressive it's sort of like martial arts where you don't really resist the punch you kind it is in L Leedom right thrown into her role in a cell like that you sell well let me help you an end really you do that when you're wanting to change people you roll with it if they if they get defensive use side a little bit and then get them off balance again and that type of interviewing really helps train we see that Jesus did that and got that Miller enrolling say don't confront him about sometimes you need confrontation it's sort of like the fellow that had the mules would be sold you may heard the story PE sold to Samuel to the farmer down the road this is this is a great mule he works hard he works all day and never had any problems with them and so does a great mistress kind even so I took him home hooked him up to his plow the next thing you wouldn't go he just wouldn't go so I called the guy N you sold me a bomb you'll perform or so think so and so he came down and the there was a one move in any picked up a two by four pages from the mule over the head just as hard as he could me will stand up and start plowing he said there's nothing wrong with me we've is going to get his attention first and sometimes you have to get your patient's attention and and I do this to mean we all do is with the diagnosis I had a patient that I've been after for a while he needs to cut back on his alcohol read eliminate and he needs to change his diet so anyone is having trouble getting his attention his mother died of dementia small vessel disease you've all heard about while I sent lawmen get a CT scan because I know he's got the same he just doesn't know and I got a CT scan and sure enough he had small vessel disease not as bad as his mother what I do to get his attention I laid his mother 's scansion now deceased on the deck in his scam just like that person I want you to read those you think I got his attention are you unsure to because his mother then you know who requirements based on one ago and so sometimes you need that confrontation but remember this the gospel comforts the afflicted and afflict the comfortable and you've got to do that in your practice to because if there's someone that's really afflicted they need comfort him hard you want to say you can do it you can check range with God 's help you can change no enrollment talk about self efficacy there is no such thing the only efficacy various is the divine human connection is not its you can do it without God every impulse to good comments from a bath every good and perfect gift comes down from the father of lights and they need to understand that and so the you Johnson misquoting Christ without me you can do nothing and Paul said I can do all things through Christ who strengthens me they need to understand that well how about some settings for change in our few minutes left here the one that's most common is one-on-one and a several speakers of our dimension I think Neil Natalie on Thursday night mentioned this Christ used one-on-one all the time it's the most effective physically change one person you've changed a lot more than one because of all the people that they're going to never forget that that is the most effective way to change people one-on-one in your office I do I don't know another area it in the world where you can sit down in an exam room of the total stranger asked him any question under on you know under the earth under the sun and they'll answer you most of the time honestly you can ask them to take their close often they will and and you know and then I walked out and pay for I mean is there another profession that gives you got much touch with you smell there is it is an incredible privilege and honor but not one that should be taken lightly or ever confused dreams and never forget that the power of change is is not in your hands unless has been placed there by God and on my way to work I used to listen to the news I drive about eighteen minutes to work depending on how the traffic goes if I get called an emergent way I can make it thirteen but that's a watch out but I used to listen to the news on only for myself that God can use me and for my patients that need to change Mister God you're the one it's only your grace it's not me remember so-and-so remember so-and-so I'd encourage you to do that if you have to listen to the news you know okay do it on the way home or you might find it trained both ways is good the thing that you'll find is your busy to write anybody here have free time or time to kill no none of us do so you got to gather up the fragments of time don't let any slip through your fingers and then when you're driving the car is a wonderful time to pray and if you have five minutes to work well that means that you have ten minutes or else if you drive a half an hour let's wonderful time to prepare yourself for God to use you for the day one-on-one change is very important I in my free time I volunteer at a clinic that we call the oasis clinic and I had worked all day I was tired it was a Wednesday and oasis clinic starts in the six o'clock I usually make it on time by six thirty and now and then one of those days where everything goes wrong you say why me God but he never really says in his thing other than that I'm still here keep hanging on and I thought on my way over now these are these patients that now their smoke and remain me know what Medicaid patients are likely ever had any allows I said no God may be maybe it's help someone tonight so I get over there to diabetic clinic and I have two patients and the first one comes in his heavyset guy smoker on disability for God said to me talk to the sky and so I confronted my sister know your smoker your overweight you get type two diabetes your enemy on insulin soon he was already on the sulfonylureas and metformin and in all the other stuff maxed out his A-1 C was ten disaster and I said you know you don't have to be this way God can help you change he said I think this was a divine appointment the patient told me it's so I said listen we run a diabetes reversal clinic you come for free but on one condition you have to go on our diabetes reversal diet for two weeks before you come in so what drives so I told and it's not fun acting in November regular US citizen smoke and drink in the media no heat in the four-legged creatures and it out I I said in a no go by such and such a book and you know if you don't apply at all to see so I don't want by outsiders routing menu and it was rather plain he said I'll do it I said God will help you and you need to sell to two weeks later he shows up in it he said now I'm happen all kinds of trouble if so what's really says I'm feeling we as a wine with the Prime Minister Doctor Madison midwinter or diabetes their reversal of class it's only four nights is on his off of three of his nine diabetic medicines only on metformin now I had to stop his blood pressure medicine but he couldn't quit smoking behaviors the beauty about a group visit how many of you do group visits anybody here yet but they can be really effective what we do is we have both diabetes and heart disease reversal run the same class and we prepare a supper for them so they get a meal on its tasty I don't prepare that's why it's tasty and they love that food they just love it may all eat and they talk together and encourage them to exchange names if they want to and I have a great time he came to that and one of the ladies that was there had been a smoker and had quit and she said to the sky she said listen I want your number he said okay here's my number and she said on the call you every day and encourage you to quit smoking as she did and you know he quit these people they support each other it's a wonderful opportunity for change and if you're not doing group visits to group visits it it's a little bit of work but you know my nurse practitioner takes the afternoon off and goes home and cooks and then we come together and she gets out this food in and they help each other in then I talked to them for about forty five minutes to an hour and then we course measure their blood pressure and a few things to make it legitimate for insurance purposes but you see ten people twelve people fourteen fifteen sixteen and altogether in an hour and a half two hours and then you have to chart on them but you still get a whole afternoon in two hours so it's it's financially doable it just requires a little different thinking in a different setting we did it for a while in our home but now the hospital where I work is provided a room force that works very nicely and has a little kitchenette and that's a wonderful setting for change because now the patients are ministering to each other like this ladies and gentlemen did and this gentleman who got off now is off of all of his medications and he's quit smoking his wife came along to and she had terrible fibromyalgia let's gone to and she came up afterwards after she comes all the classes and she said you don't remember me but said no I'm sorry I was your patient fifteen years ago and you talk to me about this stuff and I listened but I plan on looking at doing just that I've suffered for fifteen years because I haven't listened to God 's voice and what happened I've set up the first time but I hadn't introduce the other stuff the important thing like the grace of Christ is the only thing that will change now she heard the right way and God was able to make happen the change happen and it worked because fibromyalgia much of an issue as I'm sure you've experience will go away if you get people on a good guy and get them living that and I'll tell you it's a very rewarding to see these changes another change setting this seminar is one thing that we do it Parkview I started Parkview Hospital was hot what I worked on in Brunswick it was started as an Adventist hospital and still is although it has a management contract now with central Maine medical Center I often say somewhat tongue-in-cheek Israel was taken to map one but they still have a ministry and that's the sort of where we are but nonetheless we have a lifestyle choices program that was started in nineteen ninety five it's the same type of thing that they do it we mark only on an outpatient setting and the way it works is that patients come for ten days every evening from five o'clock till eight o'clock they didn't suffer a takeout breakfast and lunch we give them my period of exercise and an hour to an hour and a half of lecture testing before and testing afterwards that's another change settings very very effective we just have to struggle to get people and anointed it twice a year because in Maine in the winter it's hard to get people to come out of there in a leave the fireplace and from January through February and in the summer no one comes indoors they all say outside you know so we have in the spring and fall but recently we've had so many people coming that we've had to do two sessions we just finished one with forty people were doing another forty in November when I get back last spring we did seventy we can only have one class that was a bit big but the Lord blesses and made the changes amazingness these people eat differently and they listen and interact with each other and exchange names and they call each other up really encourage your patients and that type of the setting to help each other that's very powerful as well the last one that I have there is a public lectures I've done them for a lot of years in Brunswick about Sears at five years ago now we started partnering with a local cable channel to do a series called healthy living and we've done about thirty thirty five lectures now and they just play them over and over on the cable channels and I was at the dump one day a few years ago and you know when you go to the dump you don't want to look like a doctor I had my hat pulled down the list and really scrappy closing I was unloading some old culverts that my father-in-law drug home and should have brought them home and worrying good anyway and I was so upset that I had tumbled off the truck and time and filthy dirty and the Skype network of the dump came out and looked at me savagely Doctor is in I didn't say yeah what is that to you by I said yes he said I want you to know that I watched your talk on diabetes and it changed my life now my talk didn't change his life God changed his life he set off my medication he said I've never felt better no God can use even the electronic media to change lives and that the wonderful thing about those programs now is that there is a fully other person in Maine that has made them available to all local channels across the cable channels across the country for free and were now available the forty percent of the homes in the US and/or the top twenty for downloads and that's just the Lord 's doing it's amazing what God will do if we allow you to and that's just another setting for change never met this is an opportunity to to speak for health and don't be afraid to mention where the power comes that's so very very important because when you do then other doors open one of my patients have squamous cell carcinoma the long he was supposed to die but didn't about ten years later he came up to me soon when you married me not me Mary and you will you marry me to sell himself and I got to provide it I got to perform the ceremony for the sky to get married his wife died and he was remarrying I have the wonderful opportunity to speak at several my patients funerals and and even gives several with you never miss an opportunity to get into the community make yourself available to your patients nearly so he can keep a strict no-no you know did Christ will he he met the people where we were he was often seen in all celebrating with them so much so the Pharisees calling one along the river Rhine so be seen with the people be there Christ's method alone is the one that works he mingled among them any really cared about and that's what work to do to everyone to change things right any questions think our time now I will thank you very much this weekend was produced by audio verse four amen this Pentagon analyst network if you'd like to learn more about me then please visit www. .ie manner than I thought I might as more free online service in WW online 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