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Spiritual Mission and Medical Institutions

George Guthrie


George Guthrie

Faculty at Florida Hospital Family Practice Residency Program



  • October 28, 2011
    4:00 PM
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you have concept of a medical missionary is one that I think we all have a grasp of it I'm not sure that it's really clear in our minds and maybe there's some room to grow I when I was early in my career I had someone tell me that unless I was working in a lifestyle center I was not following the Lord 's plan and and I think that was a and incorrect if you will a statement and as I've kind of gone through life and matured I have come to see that health ministry helping people is really reflecting of God 's character and I am privileged as a position to be able to have hard to make a living doing something that really is helping people are reflecting God 's character my family has been involved with Seventh-day Adventist institutions health institutions for a long time my grandfather had the opportunity of building two of them he was a administrator he built Castle Memorial in Hawaii and the other why don't remember managed several hospitals have my father went as a missionary to Youngberg Memorial Hospital and Singapore and I grew its growing up there and I was of course the mission hospital and of course medical school and since then has left me first and Guam clinic van backfill Loma Linda University Doctor Sonora and then at the lifestyle Center of America are now finally at Florida Hospital it's been an interesting journey RF focused today has to do with their information and medical institutions and so sometimes understood a bit affront to the end may be even that inappropriate to speak to people about spiritual things the science is beginning to help us with these things maybe you've heard the term whole person care becoming more and more popular family medicine has had this is a part of their and in the universe for quite some time so we talk about whole person care that includes a spiritual does it not I sent it interesting and reviewing for this particular talkback I found an interesting article that simply reviewed the number of articles in scientific literature on spirituality and health and then they see a significant increase through time and so that's that's kind of interesting read by religion spirituality and biomedical journals a number of those articles is increasing rather quickly we see churches addressing health issues with those of us here in a row know that this seven Dennis had done that four hundred years plus but other churches are now finding this an important part of their ministry and so that's another overlap if you will between spiritual care and healthcare knife mentioned here the American Academy of family physicians and and their encouragement now the strongest that is as it is fascinating to me as I was researching this the strongest correlation from that of this spiritual arena is that decrease risk of dying from church attendance and church attendance seems to be fairly strong weekly attendance at religious heiresses increase the risk of dying I would it was five thousand patients over twenty eight years that relative risk was thirty six percent reduction in you can see the confidence interval intervals there when they adjusted for social support and health practices it was still a quite a significant drop of around twenty five percent if elected women it was even stronger there are thirty four percent reduction knowledge they get this right decrease risk of dying a decreased risk in diet several studies have have look at this just simply going to church so I suppose that makes it a legitimate part of our history doesn't do you go to church our services on a regular basis simply going to church makes a different survey of twenty thousand Americans by the way in this area of religious nests and health there are no double-blind randomized controlled studies that obvious meat does or impossible to do right so we would have to deal more with observations to understand this this is a religious involvement in the US adult mortality report in nineteen ninety nine 's was not new the survey of twenty thousand Americans huge on seven years longer with regular church attendance and in blacks fourteen years longer the church is making a significant difference now in those that never attend church the risk of dying was increased fifty percent so there's there is a spiritual dimension that affects health and again this regular worship is the strongest one older worshipers five hundred and fifty seven adults over six years I reduce risk of seventy eight percent odds ratio you're compared to non- attendance and it seemed to be at least a significant portion of it those who went to church on a regular basis had decreased serum interleukin six levels so looking for kind of biological mechanisms if you will and and not that necessary knowing for sure but at least getting some clues related to involvement helps this is a cut of every a review of the literature I done by Koenig and some others mental health and substance abuse seems to be better in people who have religious involvement social health and quality of life positive health behaviors that is not smoking not that drinking too much more disease screening and people who go to church on a regular basis or areola involved religiously continuity of care is better regular follow-up there are fewer surgical complications and go to those who go to church regularly and use of health services and I as I said this is a regular use of health services improve endocrine and immune function lower blood pressure less coronary artery obstruction less carotid atherosclerosis improves survival rates and increasing positive human traits forgiveness gratitude meaning purpose optimism hope all truism that all of these associated with so we had permission to talk to our patients about spiritual things now religious beliefs influence a lot of things that we do in medicine I chemotherapy decisions about what arena do about this cancer treatment a person 's spiritual perspective comes into play with that so that is a legitimate place to bring it up do not resuscitate status how your patient feels about end-of-life issues ends up being really important a lot of spirituality and that advance directives got them in the same realm and then really end-of-life care all of these have spiritual religious influences now related is not good for everything religion tends to worsen in this abuser from the literature there are many fewer of these in their is that benefits but that those who are religious have a worse problem with obsessive-compulsive disorder if they live in Italy and that was that was a interesting group risk of breast cancer among women raised a religious homes in California tended to be a little higher like arguing it's okay I got control of diabetes is worse in those who go to church regularly Muslims and lead that's in the United Kingdom and in survival rates after hospital discharge in patients without a religious struggles are known with religious struggles in North Carolina and in an apparently simpler religious struggle in the life and make things a little bit worse so again religion is a part of our health so when we come to the hospital setting to the even outpatient clinical setting but in this and in organizational structure how do we go about addressing the spiritual dimensions of the folks my interest has been in lifestyle medicine how do I help people will change their lifestyle in order to improve their health I appreciated that Tim your discussion this morning about how that healing comes from my cell medicine is a picture if you will fuss the salvation process it allows I like to say it allows people to experience salvation without religious baggage that's kind of the way I like to put it and so life cell medicine has been an important part of that focus in its least in my practice and I discovered how to do it on an individual basis that is one on one of the officer remember the first fellow that had had came in with diabetes and hypertension metabolic syndrome as I talk to about this is whose years ago in the in the eighties I was working in the Guam clinic Italian business man came in with this metabolic syndrome we can even have that name for in those days we just thought they were for different diseases he had them all Aston Villa cell changes that you made a lifestyle changes and a year later things were really completely normalized that was incredible and the NIH could change the course or energy or focus of my life towards the lifestyle intervention yes it's nice to be able to help people now what's my attitude towards people who don't want to make those changes well what's God 's attitude towards people who don't want to make changes without you continue to love them and the truth is I've got some medications that may be able to help them live a little longer they don't want to make those changes but at least I've given the choice so I call my pills grace but I say the best thing to do is to change your lifestyle so that's been helpful the one clinic introduced me to the one-on-one against some group lecturing and type does that type of thing then went to Loma Linda University where I got some more information if you UL experience with lifestyle changes then you then I moved to Northern California where she was born as a nurse practitioner with nothing to do an amount home so she took up the chip program corner health improvement project I've added it fascinating experience with this interaction in a community setting with the whole group of people in the group dynamic brought a whole new energies a lifestyle change for America lifestyle Center of America where people were paying money to come a long distance and when they landed most of them if I said jump they would say how high on the way out we had a high compliance rate if you will and saw the miraculous things happen each time in each circumstance there is a spiritual dimension that ended up being at least for us a financial challenge and it was hard to make bets that way of doing things work and when the opportunity came for me to go to Florida Hospital and and work in Florida Hospital it began to make sense to me as a place where there could be spirituality and lifestyle and if all mixed up together why do people make changes in their lifestyle sometimes it simply information they didn't know when they hear they'll do it some people and I would say most people it takes a crisis are marketing people at lifestyle Center of America tried to find people in crisis on the phone and talk them into it they didn't have a lot of credibility you know they had a glossy they had what someone had said by word-of-mouth and actually change people 's understanding was a bit of a challenge the suit care hospital that's where crises happen they're all concentrated so it makes sense that that's when people 's lives are best touched for this example if you will of the healing process of the salvation process within that mode of healing it's a wonderful place in Florida Hospital had in it when I went to interview I found very focused and interested in addressing the spiritual part of people number one and number two and having the whole Seventh-day Adventist health ministry to the forefront is a big challenge when you run a hospital that is huge as I understand it's the largest admitting hospital in the United States certainly the largest Medicare bill are in the United States I was lamenting to the one of the administrators I about have a lack of Adventists working in this institution and I was told we work hard to get address last year we hired all we could get a course to a competent people write all of all confident we can get we hired annually said two hundred and fifty something like that and are percentage of Adventists fell behind again it's a big job and so the administration has worked hard to try to keep Seventh-day Adventists upfront health Ministry if you will and I really like thereby line extending the healing ministry of Christ my plan is to share a further rest of our time I think we've done a little bit with the science is to share with you what I see happening in Florida Hospital for one and the benefits that I see coming from that it's not all perfect it never is it's always a work in process and that I have some interaction with you over things that have worked in your hospital some of you may work in non- admin as hospitals some of you work in administrations are connected with them and things are always a little bit different but I think we may have some things to share with each other the things that we've tried and it worked or things that we've noted and have been helpful in promoting if you will this interaction with the spirituality of our patients to bring the total healing that really needs to happen well let me share with you what I have and not let cell go from there Florida Hospital has a chaplaincy program at chaplain to the wondrous Bostock about spiritual things correct one of the things it said nice in our particular pride I work in a residency were one of the large family medicine residencies in the country we have a chaplain assigned to our residency she comes and spends time in the office of the resident has a patient with a spiritual issue she will talk to the patient herself or go in with the resident and interact over the this spiritual issues and great essay on support if you will of this hall of spiritual connection there is a chaplaincy training program as well and not everyone who comes to the chaplaincy program is not even a Christian I note several years ago they had a Moslem who came through I heard him speak he's quite excited about being a certified chaplain as a Moslem and get a news included course chaplains are taught how to meet a patient's spiritual need without that applying how would one say this denominational screws and I think that's very consistent with the recommendations given to us another program called spiritual ambassadors where employees who come to help extend the healing ministry of Christ no matter what faith there from meet together with a team which trains them to be spiritual and fasteners there's a little pen anywhere that says that that they are spiritual ambassadors and their taught how to appropriately pray with patients so that's for really any of his staff and I I just think that that is an excellent move as well then there's a little concept of parish nursing and Florida Hospital has been forwarded reaching out into the community and interacting with churches I am not as aware of the details on this but I have interacted with the lady who runs this a know it's an active program involving spiritual with the church in a Florida hospital has a department of health care and spirituality and there is a physician that's the head of this activity Doctor Guarneri is not a Seventh-day Adventist views are very committed Christian is an OB/GYN specialist his office is just down half a block from my and that I appreciate actually this weekend there is a conference physicians who are interested in getting together and talk about how to interact with the spiritual with patients over spiritual things so these are things encouraged by the hospital administration and that the course physicians are involved with in the residency we have whole person care rounds where we talk about these types of thinkers that's an educational setting storytelling activities storytelling is extremely important I mentioned that in my short remark this morning how storytelling tends to provide hope to people and I think is much more powerful and that changing behaviors there's a lot of storytelling that goes on purposefully at Florida hospital it's it's it's really sent out essentially in many of the different organs of communication there's a story that comes out most every week from the president Lars and other have tools at where stories are Taliban told of people who are involved in healing in dealing with the spiritual dimension that these are things that help and create an environment where we're extending the healing ministry of Christ high at appreciate this concept of healthy one hundred it's Florida Hospital 's new kind of marketing push I is Cummings is stepped into the back here I think he's the guru behind this innovation he can fill us in on all the details but the idea is this we can help you live the healthy one hundred and you have a heart attack will help you with that if you if you need a vascular if you break your hip will help you with that but we also want help you with your lifestyle change so to try to incorporate that whole business it in such a way that it's part of marketing to the community does say something about the result is really all rooms are his health care reform minded basically it was producing a medicine is an value whenever extending life I is in one morning I was seventy eight year Time magazine the greatest benefit is there were Nobel prize economist said it was the extension of life for the average American citizen in your life extension begins in five thousand two thousand projections from a number of sources and then they are down because of obesity and so forth we said that the individual is the division of health in America look at what is happening is helpful you heard from you eleven years longer the age of eighty nine dollars seventy eight years life in two thousand and eleven eighty nine where you are allowing use of eleven years so I is eleven euros ninety and you have an eleven year heartedly say we live on a three half helping hundreds was that what we really have a crisis presenting one that actually you were spending more and get the same number of years reply to the third reason is that in your iPhone or more you are skyrocketing while he spends expectancy is skyrocketing enabling all verses does a rotating all you will so we want to help you is able to the lifespan lifespan was home as we said when we got all your belongings are a world leader in we ran is not usually this week by-and-by is a nasty home now is not how he has values diversity I was reviewed as the enraged evil science and health office as your e-mail we imagine now because our love is the new Asian bovine easy as well you are the first profile is and you know is what I see as my roses star life expectancy was twelve there was the older children may find that is not as you will actively and I that is in a hospital administrator in one of our hospitals Johnson is his name by John and he was the oldest living American CHF CSS and CF is that I want now is his you know this is also a so that point is all what happens is and it is guaranteed that you will now like most other ways is to diet exercise as you purpose purpose is the greatest thing that drives a person is in formation while the cancer that you will not have personal motivation and lifestyle changes as we start and then we may see what is able to use you as you know is a school zone result in community or is that I want to do that is why I believe I'll thought balloons more on why we were warning health reform is a new user you will perform as a credible answer is a incredible vision and is not saying the answer is in you are all a very wrong here are we in the harbor is how long the answer is less a revolver and breakfast in the days and John Kellogg probably somewhere in the knowledge of evil is that you only one is on Israel are stable you know products services careers lifestyle and made America a nose that is all first-place leaders as small as ten thousand and two hospitals in twenty years by the Wales hospitals have a staff style week age is is is an island we gave your savings rate we work in the him and tell you what all this is in Louisiana and you'll always and only when everything are careers our life savings on God 's ideas as an artwork artwork and these behaviors you with tools and services when you expect to lose well expect a problem as far as leadership problem having the understand how lighting is the daily life and is a daily life popularizing of actually marketing those in my life I believe where you lose value my will that leave you as jurors and crazy guy should be really as worldly as best I live in a used mouse want to live area here you will not directly address those areas you simply over and I and is healthier people who have been described as a pass nowhere going on a we had a society to do is learn Wednesday as dangerous as a whole I will service her craters in a very long and so and her knees and working with business owner is as an incredible opportunity right on very excited and will you and is I believe you are we're also pretty now with his schools is a healthy school certified he is a great help he is a school around the users out there values in a little is the way it will happen in a given the opportunity to live a thank you guys as I appreciate that passion that as I work in Adventist Hospital as a personal physician I have noted over him it is my path I shared with you my own path but I've noticed that at Seventh-day Adventist hospital administrators have a passion for the lifestyle and the mission but they often haven't known how to scratch it and it sure is there but I sent an energy and a focus year that's making it happen most of us in the room are individual clinicians we go from room to room and we see patient to patient and this is good and we made difference there and administer hospitals need positions like you and me could do that but there's also this bigger vision there is a marketing piece that there it's so big that as individuals we don't handle it all so I did we need to look for ways to help those who are thinking within the big picture the mission has mentioned that creation health schools also had the privilege of working with Robin Edgerton in mission development and where beginning the project we will be able to roll out next year and a man which will provide a set of creation health pamphlets that express those kind of a natural laws within the concept of creation for doctors offices hypertension diabetes and those types of things to to bring it to that level for us used to fit into this larger really nationwide needy worldwide marketing I kind of campaign to help strengthen Adventist health missions I appreciate what's happening there the creation health CR facility you are acquainted with the CRE API land stands for C's for Joyce I love that it starts with that this is like the eight natural laws you know the West Coast noticed new start of a new thing out of Florida now is that creation help C is for joints it's your choice great place to start and the program starts with a focus on what you do to improve your frontal lobe function right on the diet and exercise his right there's all overlap are is for rest and yes not just physical resolute vacations and a weekly rest eat is for environment the environment you live in and work in I is for activity teams were trust and in particular trust in God and God who loves us and heavenly father I is for interpersonal relationships how we get along with each other the social VO is for Outlook is are you an optimist or pessimist makes a big difference and then and this one at the end the nutrition language tends to get stuck in people 's crock if you hit it too soon but they learn the benefits are extended through the programs that is a nice creation health program that can be done in churches and offices in all kinds of places with set of videos and a bunch of materials you want at some else is saved basically are you crazy and increasing story the reason we use pretty all in her role as shareholders is on I is a corporation and in two I only actually build a hospital sitting to his already said we were interested in what you have to offer we like your industry is no but we want to know what your help we believe your healing ministry is you Mister Christ shows us his version for your help history and we basically a study and looking at many many ideas and visitors and I and all are as health minister industry firstly Elizabeth Bernstein which is the creation story so we basically said the festival was first no brown humans live my whole law is offering pain and disease in the second time he will so we had is gone help you and you so he walked them through a guy is in the gentleman was there in his orders as you started started with this was the idea is you is is only two weeks as a is worth in a wall is is is is that we all alarm words that someone is in you is that you always and at this message you are a member of your people is is is basically you are made below in one creation stories as you will and will and will and in fact there is a staff is in a one is says to me in early and is only as this is the most long and not so I myself is that power is a city half-life is a story that way you live you live in young people you resort is a a you are a spy he is Rooney Barbara Ray you are basically it is wrong choice we want to live in a inspiration is ready to review as a cost all parties got in resilience I have is circumstances not your happenstance for your sewing top of that is the whole idea is in your life is pretty sorry all have a worse three first version is the first in a sad free phrases such as you and God as long as first-time as so as easy as all you made will let you in on a you know there is very worse and on my phone I said that is a song is sung the song are all while in person was pretty low and was the long time was as so you have the opportunity using love and why have the disease will only in his review and call it here in you as you leave this is why he will will and is the root word is so as to form really a pretty sorry healing I talk to people is on his cellular failures you have posted I found Star is a university letters are so is Joyce's desire guard he is a familiar and is all all of the various sources is off and leave you alone Mister is first and foremost a guiding getting Joyce isn't it was yesterday what you believe in God and prayer we believe in you and is a is a is the earth and in Sony and is he is why I will be told in so I be a standalone is really true love and when he joins these are not a choice between food is as small as being you is or is you is called there are more rest will you say he lasted a day I think I felt that her finish the story is a result of years ago working as possible as you know you will a Saudi town is pretty rebuilt it we go to war as one who is a order is a you this hospital is now the most successful is made by Wall Street Journal as a junior when he is offered as a panel on God and is a you are you and is so I know you will eventually really asked how long you have a history as a pontificating and related and then you express so you is you should produce solid as a will you carry your question is that to Mark explaining to the board member and usually more remember all creation model of ennui or health ministry came from her own ideas and how is he hurting so the ministry of Christ you may respect the file that you may use Seth Jesus is the model for a head injuries you are in dollars for our one for you you see she really is Rabbi is you is is is is is is is is Rabbi what a trivial ministry of Christ is run as a senior and a private concert there's nobody I is there is a and they don't have problem with Jesus Christ will save your yes as I said overall and basically is a long one in his visions used the Sabbath practices we as all of our all of our service management is for managing the service will set three words across a rest and blessing segregation of three words and in those three is set in creation is translated will work in the trust will you and you are home early with people 's lives that is in relationship we view as to serve the show a way and satisfaction is our leader is in so we may live focusing on is our satisfaction or anyone is in the size is small sizes you a you a worse time for loss of what to follow your philosophy is held as in everything you do not just is no religious slogans on the walls and better hardest work very very any other questions that needed her comments thank you I guess it's your explanation is always such an encouragement to me I've appreciate her lifestyle medicine focus as well I will tell you that getting this to work in a related mind and the same time is bit of a challenge and now that something were working on we are able now that coronary health improvement project the chip program being run in Florida Hospital as I know it is you that Melinda as well and I'm doing this wellspring diabetes program it's still in its tinnitus and it needs no praise at present we're looking for ways to make it grow and go as was pointed out so well this morning my doctor how it's very hard so tell someone to quit smoking if you are smoking yourself and so as I'm teaching these young residents about lifestyle I got to get a big hurdle by contagion the science that's fairly easy this party is to get them to change their own livestock it has to be their choice can be forced down on them they have to say yes I want to do that and see that it's neat to see that happen that the unfortunate thing is for my standpoint but it's a blessing they finish they graduated and they go so I I lose the victories in Iraq doing their practices but encouraging to see those types of things happen but what have you seen happen in your hospital you have any questions it is says at least one administrator and I call and as the senior vice president for dreams okay that's that's what I call I appreciate that that vision that he puts out and not it really does permeate in the organization any concepts are experiences that you have had a video of him in spirit and will he he he will is as well as I said it had a very interesting question we of course all know that I will disease is can increase the risk of heart disease and so what I generally do as I tell her residences using evidence of periodontal disease need to happen Doctor dentist right it's not usually an inpatient in a process that is certainly something that we understand I think that would be true most all the cardiologists so now yes we would we would like to deal with that party yes and you will oh and then increases and provisions are as bad as you as the abuses were all initially and I have a huge following things that are probably realizes that he especially is a product that is as long as all the is a burden as well and there saw my say Lincoln general has an SSI she is a scientist can happen demonstrating his horse will and is on a whole was the process causes lung you will not carry I guess I'm assuming here and talk about how to work with individuals to get them to change and I share that I've been using elevator the group process the kind of help with that that is I'm still learning that process what I see happening is that we have a group of people coming together to interact over a disease process and there many times they'll come there they're not ready to make a full change and the thought for example of a hundred percent plant based diet is and a difficult one for them to grasp are generally present you don't have to become a vegetarian is a you do have to have a whole plant them eat a lot of whole plants I'm together in a girl and then others in the group begin to tell what happened to them when they made their choices or they'll begin to share recipes or an essence they are helping I know each other at that process is very good at getting people to make choices and those that say is that I now pointed out this morning that he would send the patient said I'm never quit eating meat somebody said that you guys right is right and and though they'll come back and no I've actually done it while I tried and yes I feel better and ongoing to continue to so that group processes is really powerful and bring about change now having this group process attached to the backend of an acute care facility because that's further crises are so you can gather those with crises and then funnel went into that type at least that's my dream into that type of experience that can then be ongoing that's over trying to build with the Chip program for example although there is organizational inertia in the top is that the wheels are spinning fast but a little further down the channels that wheels are spinning a little slower dealership to bring people along you can't force it down their throats need understanding and embracing as I have opinions and leaders in the hospital a lot more people were in it are a lot more work in you is small and there is an old innovator but he ideas on how we now that you are not heading that's an excellent point and one that I wrestled with it has a employee of you our one of them are the leadership of lady myself in America I I really I think the answer lies in what is presented this concept of really reaching out and got to get it throughout the organization can figure out how to apply the principles all away on the organization but once you get it and you market it the world is enmity doorstep and of the monies can be a problem I really agree with you joint the obvious is basically one of the law is that really a menace we used to doing things to and that was in your situation you say something is in you prescribe something in you that some system or your own way in a situation it really means that they have to be actually doing eighty nine percent of here cells so your consultants so years that he is often in areas that your switches in the hospital your an old culture and you draw all your design on how society and our culture this is probably an hour he is however is this original is always on the human side spiritual as part of his prayer for God to intervene on this for you to view and hear the moment and will serve as a health size off the wall the difference is transmitted as sense that it is a spiritual investment subsidy wife Laura Hospital Oxford are now in our room they be a larger means we met as version one going on he is those people who are volunteers are not going to organization in the spirit of that organization you are lazy and energized and all energy is processed in the heat in the house when my we all believe it's all said no more margin on me you really as bad as the users of the organization organization makes money over here as he was working that I and you say your harmony mission is staying in and and long-term downstate value and sustainability our mission will not survive his business stressful to amaze our business as else's work over time that means you have to incrementally draw down is as warm as easy as creating all entities you are is making me out make it a magnet for you and I are held in fact his whole life is reversed it is no marginal mission is a mission of March as you can our most mission driven organized as possible should be our most financially stable on an area market where there is financial stability of hospitals and services in places where people weren't as important as what you are that we will provide those services without saying service is the early returns are trivial people will pay those funds to so I think the key thing yes categories are drawn from the holster or when using the browser your prescription pad is always a religious body he is in prescription is a is a you you and your spirit is really more of a time for the be highly motivated to lodging is uses for this version one of problems that were very vivid moving patients by disease but they live my family circle and change them as a support system I don't have a Palmer says if you eat healthy on your best to help your partner is likely your best friend exercise your arms are as one is we got to move from grooming people in and in disease grooves teaching in here and send it back to the situation that has created one of their homes the process that help you create a movement at the is will will have a social life and need that's what is wrong without spiritual teaching you cannot please you motivation for change motivation Virginia from my beer or medical facts and were as everybody only and are not medical information or is not information is motivation so maybe the answer to that spurs row to be in the core even some of Reverend you will become every time thank you I appreciate that your time is up I hated this time is up and I think we need to let people go I appreciate the involvement in everybody's interaction I personally am thankful for seventh address medical institutions they give me a place where it's safe to pray for my patients it's safe to reach out and learn his lesson he learned in medical school right or even use that I have five more minutes as well and network this gave me the that's okay we have five more minutes of cake okay Tim shared Sharon's comment your use is as real as an and most important thing you can say what you will you and doesn't make any difference I will use you in error and will be a still a good job because some of the video don't you see it so I you you you and many times you know you are a business my office is twenty years and is on his family and friends will send you a thank you are you one of my reader to a house that you are the general home is more about how viewing there really views on the time he has a home and you will you will eat you I is and I as I look at it I have that what if I have an appendix and easy cut out hi I need late on the table at the doctor work diabetes hypertension heart disease the doctor is fooling himself if he thinks he's got a management that disease by giving a pill is really a lifestyle disease and so in order for me to change my behavior I need somebody as as Doctor house pointing out here not just to tell me what to do but to create an environment of home if you will wear eye and encouraged and nurtured in that change I I doctors or dictators that's the culture right any week dictate we dictate matters there's dictation it happens but what we need to do is to become coaches we do recognizably below ready to change the advance is to get to the point where we can bring people to the point of a crisis so they willing to change and of course tell them the right thing to do to tell them cut back in your red meat exercise a little bit doesn't work really well if you tell people the wrong thing to do for several Mediterranean diet site really isn't there no often said as I heard one research thank you another you don't solve problems by doing the wrong thing better we really need to give the right answer the correct answer and it really administer have the advantage on okay I hope that was good nothing was missed in the users will have a and the and you and you will you know when you finally settled in Israel and is a is a will you write if you change again which outed obesity you can just deal with the kid you have to change the whole family Millie which is aggregate it's an extremely difficult thing to do network node with us view you as you are all in your Wii and all her because her moments child in going over and these the moments you will poorly in and start country and I believe place to deliver to our church because of church it is sustained by you or your office can be a stimulating location is in an involved process as well and only half of the parole is is why most American medicine will just go back and look as American as hospitals when one direction when history and hotels when the direction the direction hospitals prisons the language we use is the language of incarceration you go to a website and prisons we call people under when there is admission they call me we only take shape indication in on inmate behavior enclosed in an action plan and that social worker we are now a case manager when we are in a way leaving on the yard when God is charged when a novel dual resenting all gone then on you cannot call people the wrong hands in the hell is your romance in England in the journal personality incarceration is absolutely diametrically opposed the direction you saw the people to have fun and is is why you said many people I thought there is not an show how to live a happy life in Ohio danger is so were talking about the view that it things that you've been training for years and years that you have she is going to his time in all that's it that's what let's close with a word of prayer that's okay our father in heaven we have been challenged with the opportunity the vision and we need your spirit to guide us as we go back to our practices help us to incorporate what we need to into our practices teaches how to reach out to the administrators in our hospitals and work together as a team to extend your in the thing you this weekend was using my audio verse four amen to that it is better if you would like to learn more about me then please visit www. a manner that I will like there was more free online service please visit www. online universe on a


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