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The 6th Competency: Systems-Based (Spiritual) Practice

Eric Nelson Rachel Nelson
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  • October 31, 2014
    9:45 AM


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rates are very privileged to be sharing this time with you this morning as you can see from the screen the title of our presentation is the next competency and most of you are unsure familiar with the ACG any and their six competencies things such as professionalism patient care medical knowledge in the sixth one is systems -based practice the Bible says in Luke sixteen verse eight the children of this world are in their generation wiser than the children of light and your member that comes from the parable that Jesus told about the unjust steward and the point he was making is that worldly people spend more time more energy more thoughts on worldly matters temporary things than Christians do on internal matters and it might be true that's true even for medical missionary work and we don't want the ACG me to be smarter than we are about things that really matter and so are going to talk about today is systems based spiritual practice and try to learn some lessons that hopefully will be healthy each one of us in our individual lives and our individual practice situations in spiritual care my car has a prayer once more before we begin dear God I ask that your Holy Spirit we present here and that we will learn lessons perhaps even lessons from the ACG any about how we can more effectively win souls for you being an influence for Heather analyzes each one of our patients in Jesus name amen anyone know what that picture is the painting there's got to be someone here who knows the name of the painting famous painting iconic vegans in the eighteen seventy five he painted a picture of a seven -year-old professor of surgery at Jefferson medical College this painting is called the Gross clinic some of you and Gross clinic for more than one reason that is Doctor Sando the gross he was probably the most influential surgeon of his generation he was twentieth president of the American Medical Association he was the father and one of the founders of the American surgical Association and here problem exactly at a systems -based problem about forty five percent of the patients that he operated on die down forty five percent of patients I operated on dive idea breathing problem with my licensee no can anybody CS systems based problem from the pictures little bit dark and they see a problem there no glove anything else no mask okay a health note down L in fact he does have a codon and that's probably the same code that he worn off the street okay exactly Doctor Gross had a systems problem he was well aware of the work of Joseph Lister who had been preaching in Europe for over twenty years by the time this painting was commissioned about Lister is using carbolic acid to sterilize instruments wash your hands wash the new area the vision and he specifically rejected that in fact he wrote in the Journal of the American Medical Association that no one on the side of the electrical service very seriously and lest you think this distance -based problems were limited the eighteen seventies Rachel is going to give you specific examples that she is familiar with that it happened very recently I think the pediatric emergency department when he was then shot the unknown adrenocorticotropic corticotropin hormone deficiency if yes I cannot tell it was immediately contacted admitted the child and ordinary stress does Solu-Medrol multiple nations involved in the care multiple physicians I was ported to the pediatric ward continued to deteriorate and eventually had to go to the pediatric idea at the time was admitted at about eleven p.m. a.m. it was discovered that the stress does the Solu-Medrol had never been administered the strength had a Solu-Medrol was subsequently given child immediately improved and was actually able to be discharged that evening what is this an issue well it turns out that it wasn't actually that there were multiple positions multiple nurses although I'm certain that continued into the problem turned out that a computer that the division used to order the medication I automatically scheduled stress that is volume agile to begin at six a.m. that morning as opposed to eleven p.m. when it was order the defendant issue was the computer automatically scheduling the medication for the wrong time second example nurse Anna baby nine thirds unit chapter tomorrow at about twelve p.m. to verify the medications ordered she notices that the physician has order hydralazine to begin in prison Valley blood pressure greater than one fifty two p.m. definition from my cancel the order at three p.m. at the new regime I know and respect is probably one pressure in what he gone I think I'm the victim and then administered that he is not as shining the medications are listed in the order with you about one hour prior what inherent well you get about communication I think that the bottom line is that the defendant medication that had been discontinued what were the outcome and Kate Middleton in the EMR that in the case the nurse what I was ironing the nurse in the issue now and then Eric continued to occur so what is this practice was a straight from the AVG immediately ability to use the resources to optimize medical care is visited and that you're within to improve care and those of you who work with EMR systems know how that can be used for instance you can put together words that make sure you don't forget critical parts of a postoperative orders you can put hard stops and so you can't order to medication that have severe drug drug interactions on his clinical pathways you can put in place one particular example that I like insurgent those of you who know surgeons know all of us think we can operate faster than really can and so when you scheduling his sometimes that leads to action in the Kaiser system California in California I where I worked as a resident if I schedule the laparoscopic cholecystectomy the computer system would look at my last ten cases average the time and well not so much time in the operating arm I got back all of those arguments were eliminated so is it just few examples of systems what about spiritual practice however one of what is the latest practice when it comes to spiritual care for patients well I guess the ability to use system resources optimize spiritual care but here's the problem how do you know when you optimize your care we think I think we've taken one step back if you're a family practice doctor trying to evaluate your care for diabetes maybe a look at inability once the levels if your surgeon looking at your outcomes for surgery made you look at the surgical site infections if you're an oncologist maybe a look at five year disease specific survival were familiar with outcomes for medical care what about spiritual care Rachel actually going to take a microphone around and I'm like I like to hear from at least two or three maybe four people from the audience what are some goals that you have even thought about or maybe you have set for yourself for providing spiritual care medical missionary work were some gold that you have set for yourself in providing spiritual care for your patients Rachel has a microphone please raise your hand don't be shy Roger Lindgren 's great you cannot contain it but share so as to be in constant prayer okay but the Lord opens the amendment just gives me divine appointment I think he provides the right towards the right approach limitations and it's amazing what he's doing the patient was becoming totally higher rate that she has martini before and I never ever before she turned totally crazy and the news that she only gets sheets typically the whole bill S him and wouldn't you just build far Medicare you may find my pants down when the needs of the instrument piquancy still she's crazy moneymaking directions is crazy I think we've heard twenty percent she's hurting I have to meter and after I met her and she was again given that I'm just will will will protect the pecan to be conceded to hurting she said yes so sorry I can tell you want me to tell you Jesus Matthew he's at least getting some recovery time and I told her my face of the sun in my life until she sucks and to mislead anything that she goes and from the office manager if he can deliver what you need to have to price of it all I think that example of how to calm down somewhat what other goals that you affect for yourself right on the back there some goals that you set for yourself and medical missionary care anions and so on of the best clinic at Stanford we're a lucrative practice of medicine and basically what goals he set is in the patient will not relieve you of the expense optimal health without an introduction to the creator the giver of life and health and so were the kind of integrator delivered and then Tyrone the entire spectrum of care whether the index and health education programs we do always speaking the creationist view and the fact that you know you're an obligation to creator as the one who needed you and held as a necklace George and so essentially if you try to get into good and everything that we do whether the print edition which is obviously a part of it but also this doesn't mention the creator and the fact that you create a cynical part of its because of our culture guitar practice thank you great culture change one more so okay yes fairly quick for my practice it is about taking the focus away from the problems and issues that patients are having and having them look to the one who is able to solve all the issues so that in the end of the encounter when they leave and they speak and say thank you God that is Michael and so every single patient record I sort of someone more root record my name is Donna Cooper Dockery from McAllen Texas amending China's so my goal is to intentionally exposing the patient's my beliefs to Christ so what we're doing we have a spiritual healing class at the office voting Spanish and English to three per week the patients are invited to join we have patients that have visited our church and are ready for baptism wonderful thank you for all of you who shared those are some very good goals what I would like to share with you is again straight from the idea of systems based active and quality improvement if you are thinking about a goal for medical practice they are going to set for yourself in providing care for a patient you need that goal to be smart in error and a lot of other acronyms you could come up with this is straight out of the quality improvement work that we do it at UTC University of Tennessee Chattanooga needs to be specific Kathy pretty bag needs to be very specific needs the measurable attainable not attainable you'll give up anything relevant to what it is you're trying to do and finally I believe very strongly needs to be time now you know that a specific time you think you're going to sit out of the view met your goal you'll never know if you may notice keep going and going and you'll never send thinking maybe a morning doing is really working for the gold I'm trying to upset so what rates are going to do for the rest of our time together organized soccer for different practice settings Rachel is going to speak about her time at the hospital is that her current job is it working at urgent care I'm going to talk about my office side of my practice and also surgery and will share a few examples of singles except for ourselves and share successes hopefully in all fishers and failures and our hope is that each one of you in many different practice settings will be able to take something away the you can apply to your own practice setting a very unique I think I can set for the centenary four-hour the seven-day stretch and depending on the invitation my impatience I went in from one to seven days at least in pediatric patient you I never see again in your teaching not that you may work with residents which actually decreased even further your patient interaction there are some advantages of being a good father you have a lot more contact with foreigners you have face time with consultants from other specialty that you don't get in the outpatient world you also have an opportunity whether it's positive or negative and interacting more closely with hospital administration the people I believe are often neglected in our vandalism and sharing right that they need Christ just as much as our patient one example of the mark goal for outreach the patient could be to provide a verbal and written invitation to community health program sponsored by your local church that any patient with the white tile issue I like pressure obesity high cholesterol in Bengal can be the at least one patient and understanding and even then made during the wedding an example of the Margolin fellow currently could be threatened by at least one subspecialist over for dinner every two months with the goal of finding at least one person with his spiritual entry and three-year period that you actually are able to start my writing now I worked in the hospital is for five years and I read we had met I miserably failed in the gold like that you are going and I reevaluated my then I realized that because I was working very part-time I'd like to sit here and sit there I had no continuity fairly difficult to establish a relationship with anybody I have remedied that I now work in the urgent care setting but while I was working in the hospital it I thought I needed to be involved in evangelism and how health outreach sites rose to get involved with my community outside of the hospital and side effect that I think those of us in to have an office in working office-based practices specially primary care physicians have probably the greatest opportunities for medical missionary work is at least two reasons for that one is longitudinal care I have can count the number of family practice doctors are taught with whom taking care of at least four generations in one family for different generations of patients that incredible opportunity to build a lot of trust within a family group also if you happen to be in private practice for your small group you have near complete control over your systems of care and set up to talk about some of those Teresa and I were among land about two years ago and Leon Jackson similar lectures to this talk about single we were letting ourselves I was just starting out practical needed some goals I set myself maybe they are very idealistic but anyway I hope they were smart goals in any case I wanted to have a devotional or a prayer for every single clinic with my staff I wanted to screen one hundred percent of patients for lifestyle spiritual issues I wanted to invite every single patient did have a lifestyle issue to a dinner with the doctor you'll hear Rachel I reference that allotted monthly lifestyle program at our church and my goal was that five percent of those I invited would actually attend I finally I wanted to start some sort of home Bible study and the goal was that five percent of those came the lifestyle program couple times and I form a relationship with them and then they would in turn come to some sort of home Bible study that original and I would start those are my goals and we'll see how that worked out for me let's start with the office-based setting I know almost all of you who do this already if you work in an office I'm sure most of you in your waiting room magazines out there on spiritual matters and some of you probably enough paintings on the walls maybe Nathan freezeout paint the combined spiritual themes with the medical care and efficiency along those lines I know I set up a custom music for my dad 's office many years ago on Greenville Tennessee and how many do you have never heard of life and health network anybody never heard of it a couple people okay those are all needed to raise your hands the type copyright afterwards and down get educated about life and health network this is an excellent opportunity if possible to put on a television out in your awaiting area and get patients thing about spiritual themes that's easy that's all basic below we need to do is think systems based and taken to the next level rather than random alkali spiritual magazines in the waiting area think about what interventions you have available in your community for your patience and I'll give you an example from my from my setting those of you who are familiar in Wildwood know that the health and healing of the Journal Wildwood without Wildwood is right down the road for me so I have several different journals and in any Asian pick up one of those journals get information about while the lifestyle center especially if they have any sort of lifestyle concerns any case you think that the stop smoking magazine goes down a pathway to show you in just a moment in the pathway of care for patients were smoking I put something about that out there rates are right now or piloting a Dave Ramsey 's financial peace University seminar with a young couple in our church and the goalie and the future will have our church do some financial planning seminars that will then invite our patient service and one picks up one of those magazines and finally there's several magazines about fighting cancer losing weight etc. and all of those patients get an invitation to dinner with Doctor so think of your systems that you have in place to care for patients and make sure that the magazines are putting out there correspond to those and make sure you're following up if you happen to see which one the patients pick up those of you who are in private practice probably have the ability to change your intake forms I know all of us have writing intake forms to screen for smoking diet psychiatric relationship neither spiritual needs and my thing I can't modify the forms I have to make that up in other ways when the MAR and is rooming the patient for you again I I came into practice where there are already several MAs who have been doing colorectal work for quite some time they can tell me before I walk in the room this patient has a vision for the last two weeks regarding failed fiber therapy operation Michael K sign them up like a winner talk with themselves they already know all that what about spiritual care how many of us are trained earners that RMA is specifically to inquire about spiritual matters so that when they come out of the running occasion they can tell us this patient is suffering from depression because they just lost their child a year ago and was the anniversary of her death they wonder if God exists and a Benzedrine these different churches over the last few I mean how many of us are doing I know I'm not the best example of what we should be doing this in place systems of spiritual care I will say the minor 's dozen excellent job of this I didn't trainer she was already good at and she comes out of the room and said and consulting of this patient came to see specifically because they hurt you pray with your patients another twenty one see you and we need to think about leaving systems based to have our MAs are nurses trained to identify these needs before we walked in the room my observation about physicians as we all develop halfway the charity will for any common disease that you see in your clinic you develop a short needle thirty seconds one minutes spiel you give that goes through briefly in a simple manner the pathophysiology the disease talk about the treatment finally if you have any questions for me we all do that we need to think systems based on how we can use these pathways of care steer patients into spiritual discussions on the new couple examples on for my practice are not very easy for me and one regarding it it just so happens that pretty much every single disease that I see commonly diverticular disease hemorrhoids legal incontinence are cancer they're all costs are not enough fiber and this is very useful how many of you know what kind of food has vibrant what kind of food is vibrant it turns out half fibrinogen and how much how much fibers in any animal product determining zero so every single patient I see pretty much the thirty second lecture on the advantages of a plant -based diet and we extend the younger hemorrhoids also talk about the diabetes high blood pressure etc. doesn't take long but then I'm even to further discussion this is the fiber forming in the minute I do ask mother Bristol stool scale is half of every single times I know if they're getting enough fiber they think it's hilarious about smoking cessation every single patient comes into my office after they want to quit smoking it is a smoke and a half and it turns out the only way and so the next question is great in your cigarettes and then you find out who really wants and it's not all of them but those who are willing to need a cigarette lighter right then and there I have a specific pathway to accurately go down all I do is print off the PDF of the whole find a plan to quit smoking out the Internet I got it from University of Wisconsin health care system they still use it as their preferred system print out and we go over with the patient and I have a secret weapon it was the you can hear that Amy and Michael and I think cigarettes home with me and the lighter and we alternated its throw away what they are give up a little bit and elitist through a lighter Michael Mister Winston cigarettes and then we pray that Jesus will help a person quit smoking debate catsuit videos them throwing it away and then the expectations and one patient that was set to that idea she got all her three kids tomato videos well and all throughout the first several days is watching videos on a long mom quit smoking mom quit smoking it works really well finally dinner with the doctor this is the just example flyer this goes every month in every single patient who had any lifestyle concern I don't have time to get an entire lecture on diabetes during a North Shore offices up for hemorrhoids of your something of that nature but they all get a flyer and I encourage all and commonly talk about that in just a moment here finally follow up again which to learn goals and if you don't document you have no idea whether or not you met your goals is important to do that I'll give you an example of the failure and that there was a doctor remembering all of it how many of my patients would go to five percent I probably seem not to know nine hundred patients my first year of practice I sat down and looked at my numbers and I probably invited about two hundred fifty of those to dinner with the doctor so first of all that the problem that numbers low zero of those patients actually came to the event so I felt bad about that and I evaluated my system of care there were a variety of reasons for that first I didn't always have a flyer to give them so I've worked with with those who are actually running that advance to make sure half-lives earlier second if at a distance for my office any patients probably don't want to drive there for some patients I forgot to ask and forth it's not always needed and electric regally at another physician and may not have something to do with why is actually seeing me and so I changed my system of care now my MA when the room the patient is going to give every single patient flyer make sure we all have them available in the future I need to run a program myself probably from within my clinic actually get patients to come in so those are some of the changes that I've made internal failure though I'm really happy with friendly staff Rachel talk about this in a moment because she's done a better job and taken to the next level but from the staff is very powerful and become a a very meaningful time because several of my MAs and had serious Sears life events parents are having strokes and struggling with addiction and that nature and sows become a very meaningful time for us and I do think it were prime one hundred percent of the time and smoking cessation I'm actually pretty excited about that I don't give any drugs I don't do any intensive white self-help like you couldn't get within a more intense soft smoking environment only doing in the PDF document talk with them for five to ten minutes and take the cigarettes home and drove away and pray and currently anyway about fifty to sixty percent of my patients are able to stop smoking and sustain at least offer to three months I have not measured long-term outcomes but pretty good for a minimal amount of effort okay rituals and talk about urgent care is working efficiently and her take care and the reason I'm now working in the hospital it then existed and it was too chaotic for our family much as I enjoyed at Simmons and consistent adult and very passionate with the consistent work environment it allowed me access to keep the marble outlet parroting here it should work if you care I don't control and even if acute-care and you don't have control over my office setting I'm an employee I also have minimal long-term follow-up the patient there and they're out in a follow-up with their pediatrician but I do have very consistent interaction with me that so I actually made it my goal to reach me that the first goal was to provide an indication to check event that for me as a nurse and a secretary with the goal of at least one intending one event and pigment my goal was to pray before every step with me that that will number one I now actually remind when my secretary attended than what the doctor with her boyfriend and really enjoyed it and that's it going to continue attending the Olympics that after one notable and unregulated gravy I work for a Christian organization I think earnings you to pray with you that before were even among the legality that evidently think I enter the president that I've met Michael now so what idea what little story I see different one and did not backtrack and he got dramatically been Friday I get there he met a remind me right away the one human being to really care any season anything I did add that I think Houston really didn't need to be considering window to see what the Christians you like but anything really and recognizing one night nurse came to work and she looked completely now legally a lot of reason to be stressed she has three children she and her husband just foreclosed on and how they now live with her and live in financial things are getting fed identity declaring bankruptcy is a long agency and Doctor Nelson I am all and I got given out and think about journaling and you will enter the next fifteen minutes I completely went off about how wonderful journaling and handling and then we got in the patient that night as I was praying it then we had me that I admit it great opportunity to meet her needs and when it am bad and loan it to talk about journaling what I elect I think I don't want to turn her on my talk about praying Chicago in the intervening is useful in the United Nations then everyone and her argument last few days later they intimate friends immediately had an analog patient somehow I know that I wanted how you actually really care what I got to hang my recommendation is really like to learn how to pray and fast acting up when he was completely out and we certainly well on my way to work that night I was still sad and I remembered how you pray before Clinton how little better after you pray I think that my bears for prayer on my way to work at night I felt about this they untangled ideally an opportunity to redeem himself I'm beside myself reading the time that I realized I needed to carry the ball the next level and make another goal now I'm happy to advise you that I'm able to survival story CDs with this nursery painted about the Bible is scanning them financial peace in the night with her and in and in my back I think that maybe it will lead this private lending weight opportunity to share we've been reading fondling all ninety one with all the discussions about what you have been able to actually share things with them they can learn about my book apathy Britain fell and really adding about taking the next level and what they were both good for something to another surgery on the value in the audience do surgery in the operating room okay well this will be the short part of the talk but I guess not too many don't need to do know you're very limited control over the system there's so many systems of care around you did you just come and go along all that was a prey with one hundred percent of the patients wanted before surgery and brings a kind of a funny story I'll tell on myself I guess it's a little humiliating retrospect I suppose but I'm so memorable is gold I had last time that I sent just starting out in practice all this is one of them I want to pray with one hundred percent of my patients to him before surgery wanted in the first week I store my very first patient came in he had hemorrhoids just like all of my patients have family and down so I examined in that they had stepped valid address and coming back in to tell him that he needs an operation first hemorrhoids because they're so big all fiber in the world manager so I know now in retrospect it I'm sure this is the way it came across to him I I walked back into the room and you have hemorrhoids let us pray him and him and he politely decline eating leader and down well the rest that week my next patient hemorrhoids do and they declined prayers well and this now my first week was site I changed my system will put it that way what works a lot better I discovered through trial and error if I have up rehabilitation sheet for surgery any patient is going to have an elective operation especially big abdominal operations on the whole shoot I give them talk about optimizing their outcomes talk about diet exercise using incentives barometer preop try to decrease the risk of a nosocomial pneumonia is we talk about us do other things and then we talk about stress reduction and one of the things I offer them as far as stress reduction goes is on young happy to pray with you before surgery that's something that would be helpful for you I believe in prayer at night and most of my patients in Tennessee your Christian they are very happy to have me pray with them on in the operating room for patients asleep well I come and see Kennerly witnessed the patient are known as the doctor who only listens to classical music in the arm I don't know what that makes people that I dislike can handle from the music that goes on in their and it's a great time at spiritual discussions with staff this is also kind of funny what recipients out of school right now book of James that's right so it's just recently here that we are starting on the book of James about letting patients have her perfect work that ye may be perfect and entire wanting nothing and low rates until you maybe that's a challenge my uncle she can speak for me against and down I'd highly discern without mindless drone attack in the the circulator that you know I assured them I will text you want to be more patient person becomes funny look in their eyes really Doctor Nelson we can help you with him and with a van and down the great time for spiritual discussions with staff this is an area I need to work on I need to develop pathways of spiritual care more I have pathways for physical care for the vast majority of my patients but I know that I have aired room for improvement here even patients identified to quit smoking if they have a major normal operation are stuck in the hospital for five days they just quit smoking why not help them continue to quit smoking for the rest of their life I need to improve spiritual interventions that I give my patients in the immediate postoperative period and in my case clinical follow-up is fairly limited especially for anorectal patients I see them pre-op I see them in the operating room and I usually see them only once but that a chance to reinforce whatever changes they've made we reinforced the need for them to come to dinner with a doctor or any other interventions that we gone over with them as you probably gathered Rachel I've been sharing the way our practices are set up our goal is to extend our friendship and our relationship with our patient outside of our clinical practice because their clinical practices fairly brief what we need to do is invite them to programs like financial planning seminars like dinner with the doctor other programs outside of our clinical setting so we can form longer-term relations ships with them and so that's our goal at dinner with the doctor and Bible studies or two of those finally in conclusion on there was a wise surgeon and I know you've all heard this in a planets room settings who was once asked how was he always seemed to make the good decision the right decision weather was in the office or in the operating room he made the wrong decision and his answer was experience while in the next question is how you get experience then how do you get experience by making lots of bad decisions are records to produce at Yahoo messenger and Rachel and I've done the same thing rituals that are briefly share our story and some of the complications that we found cattle on the way I will tarry to be the first last night and two thousand twelve I can actually color of authority and achingly dishes very typical and language standard Time and why it revealed out I stated Eric has written yet I guess the medical mission community we were actually getting to see if we were sharing that needs to you we were doing a great job of witnessing her major live and we didn't like me when we had been ailing for medical event alae Internet archive and wanted to rally CI one and dermatology and think that they were doing great then neither not at all and then I did my backup plan would be acting Eric had a backup plan in the light for urology again at the Max again and announced that I really depressing time for both of us and me being the worst we both started getting that evaluation about our interpersonal guilt now the first view in isolation sleep allowing getting persecuted right thing I had when you get three or five different people are saying to maintain we begin to realize maybe we weren't a problem not the evaluator so we'll be depressing we may like we had them in a interpersonal guilt to develop a so we started reading administrative yelling and crying others at the great chapter we read it many many times we had a few that I we had been trusted friend Ellie Tweet ten hours in prayer that God and we slowly begin to see our major wine we drink the congregation will teach you if you're willing to learn from them I pray we get and I pray we continue to everyone in the half and complicate him him him once I finish my story might happen about the healthcare those of you who are familiar with the two areas human Institute of medicine report never came out in nineteen ninety nine this is the first paragraph from it healthcare in the United States is not of faith as it should be at least forty four thousand people and perhaps as many as ninety eight thousand people die in hospital each year as a result of medical errors that could have been prevented preventable medical errors in hospitals exceeded traditional depth of that Spears records motor vehicle records breast cancer and AIDS I'm sure most remember the big public outcry that came along with the Institute of medicine report in those of you who remember and remember the main point of this report was the reason that patients unnecessarily dying hospitals had nothing to do with that doctors poor training for facilities purposely abusive physicians were trying to help their patients I nodded that the whole reason the patient unnecessarily die is systems issues poorly designed systems of care that could be improved well at Cinematical about spiritual there are thousands upon thousands dead in trespasses and sins thousands are dying unwarranted unconverted who will render an account for these souls God calls for workers who will labor for those who know not the truth who will rescue those who are out of the full thousands passed through our office every day who are unwarranted unconverted and it is a systems issue that needs to be addressed I hope that we can learn lessons from the AZ DNA we need to approach this in a systematic manner sometimes I think that in the name of waiting for the Holy Spirit to speak to us we just kind of ignore the patient and sellers wanted so obviously yet we have to pray with them or we have to reach out to them friends we need to put in place systems of care that encourage the healthcare providers to do the right thing every single time I know we want to but we haven't put the time and is systematically planning to our challenge today is very simple put as much time and effort into your systems of spiritual care as he did to you and your systems of medical care the stakes are higher is much higher is how to pioneer and the rewards are much greater as much greater as an eternal reward is compared to anything at this earth has to offer systems of care spiritual systems of care let's pray together you got I ask that each person here will a very practical way consider what the world the children of this generation have to teach us about spiritual care help us to put more time and effort into things that really matter compared to those who don't really understand what really matters and how much time and effort they put into their systems of medical care authorized to be opened to see things as urban as they really are help us to set very clear goals for ourselves help us to evaluate ourselves do we really have a level of confidence that you expect for us as medical missionaries we thank you for this time together and we thank you the conference they can give us time to think about these matters and I need your person here will because of our time to gather make changes to resolve only reacting to this union was using my audio verse four amen medical management never you mind to learn more about the man please visit www. anodyne and I will like more free online service please visit www. online universe


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