Faster Might Not Be Better
Mark Sandoval, M.D.
I don’t know if you see daily trends in your practice, but in my ER, we seemed to have daily trends. One day might be psych day. Another day might be GI day. Another day might be trauma day, and so on. I remember one day in particular. It was tachydysrhythmia day. I had one patient in atrial fibrillation with rapid ventricular response, another was in atrial flutter, another had sinus tachycardia caused by thyroid storm, another had tachycardia secondary to urosepsis, and the last one had sustained ventricular tachycardia.
Each of these persons were in danger of dying, not of too much blood flow, but of too little. If you didn’t know better, you might conclude that as the heart rate increases, blood flow will increase proportionately, but if you draw such a conclusion, you will ultimately be wrong. Once the heart rate reaches a critically fast rate, as the heart rate increases further, blood flow actually decreases. Eventually, the heart can beat so fast that there is essentially no forward blood flow and one dies even while their heart is beating rapidly. This phenomenon occurs because the ventricles can only fill at a certain rate, and once that rate is superseded, they begin to fill less and less with each beat, and therefore the heart pumps less and less blood.
I would like to propose to you that the devil has inflicted our medical profession with two deadly tachydysrhythmias. These conditions are major causes of burnout and dysphoria with our profession. They are driving factors behind our ineffectiveness as healthcare providers. They are behind our patients’ frustration with the healthcare industry. And as these conditions remain unchecked in your practice, you will continue to be relatively ineffective in accomplishing lasting change in the lives of your patients.
I call the first tachydysrhythmia, too-busy-osis. This condition typically results from a combination of a desire to do good and a lack of vital connection with God. Because our lives are not surrendered and dependent upon God moment by moment, we accept too many good responsibilities and do too many good works to the point that the best gets drowned out by the good. We say yes to new responsibilities but lack the time to adequately accomplish them, which results in increasing ineffectiveness in most, if not all, of our varied responsibilities.
Symptoms of too-busy-osis include frustration, impatience, a rushed attitude, working late, insomnia secondary to trying to solve all of your problems before going to sleep, alienation from your family, anxiety about approaching deadlines, paradoxical procrastination, and a general dissatisfaction with life.
This all-too-familiar condition must be addressed and overcome in each of our lives, or we will continue to suffer from the uncomfortable symptoms above. It requires a moment-by-moment communion with our Lord, laying every plan and opportunity at His feet, to be taken up or left alone as He indicates. This was the reality of Jesus’ life, and it must become the reality of our lives. When this becomes the practice of our lives, we will say, “No” more often, and we will frequently review our lives to assess if we are maintaining priorities with maximum effectiveness.
I call the second tachydysrhythmia, consultus brevis, or short consult syndrome. This condition is the result of the medical and financial systems pushing for more patients to be seen in shorter periods of time, typically for less reimbursement. As hospital systems and physician groups push for greater revenues, insurance companies and the governments seek to decrease compensation, indebtedness from medical education and practice and personnel costs increase, and the disparity between the number of physicians available and the increasing health needs of patients increase, there is a shortening of the time available for consultations and an increase in the number of patients seen in a day.
Symptoms of consultus brevis in the patients include dissatisfaction with the healthcare industry as a whole, frustration with their healthcare provider and the quality of care provided, feeling that the provider has no time to listen to their needs beyond the superficial and immediate health complaint, and eventually seeking second opinions or alternative forms of healing where one is understood and cared for.
Symptoms of consultus brevis in the provider include a continual rushed sensation throughout the day, frustration at patients who come with a “long” list of complaints to be addressed, fear of opening “Pandora’s box” by addressing emotional or spiritual issues that result in a strong emotional responses such as crying and will take significant to resolve, exhaustion at the end of each day, and dissatisfaction with one’s purpose and practice which results in burnout. This second tachydysrhythmia will be the focus of the rest of this article.
Now that I have described these all-too-common conditions, let’s get serious. As Seventh-day Adventist healthcare professionals, God has entrusted us with a responsibility that is even greater than that of the minister. “Professional men, whatever their calling, need divine wisdom. But the physician is in special need of this wisdom in dealing with all classes of minds and diseases. He occupies a position even more responsible than that of the minister of the gospel. He is called to be a colaborer with Christ, and he needs stanch religious principles and a firm connection with the God of wisdom.” {5T 439.2}
What is our work? It is first and foremost the saving of souls. “The Redeemer expects our physicians to make the saving of souls their first work.” {MM 37.2} “Every medical practitioner, whether he acknowledges it or not, is responsible for the souls as well as the bodies of his patients…Every physician should be a devoted, intelligent gospel medical missionary, familiar with Heaven’s remedy for the sin-sick soul as well as with the science of healing bodily disease.” {MM 31.1}
We know this. We acknowledge this. We emphasize incorporating spiritual care, including praying with patients, into our medical practices. And there are wonderful testimonies of how the Lord has worked through us in these brief spiritual encounters to change the lives of our patients. But, does this constitute God’s vision for His last-day medical missionaries?
I fear that trying to inject spiritual care into a system that is plagued by consultus brevis is like giving a blood transfusion to an anemic with life-threatening tachycardia. The blood transfusion will increase forward blood flow a little, but if the transfusion is not combined with reverting the heart to a normal rhythm, it will ultimately accomplish little. Injecting spiritual care into a broken system will help a little, but how much more could be accomplished if we made the difficult decision to spend more time with each patient AND practiced spiritual care in our practices?
I was faced with this difficult decision nearly 10 years ago. As I read more and more of the Spirit of Prophecy, I was convicted that my practice needed to change. I was stuck in the typical round of complaint, diagnosis, prescription…complaint, diagnosis, prescription, and I read that I must, “educate, educate, educate.” {CD 256.2} I also read that, “A physician who has the moral courage to imperil his reputation in enlightening the understanding by plain facts, in showing the nature of disease and how to prevent it, and the dangerous practice of resorting to drugs, will have an uphill business, but he will live and let live…. He will, if a reformer, talk plainly in regard to the false appetites and ruinous self-indulgence, in dressing, in eating and drinking, in overtaxing to do a large amount of work in a given time, which has a ruinous influence upon the temper, the physical and mental powers.” {MM 222.1}
I realized that if I was going to practice as God called Seventh-day Adventist physicians to practice, I was going to need more time with each patient in order to meet their spiritual and emotional, as well as their physical, needs. If I was going to educate, educate, educate, I would need to have time in order to do so. Being convicted of the need, I pursued multiple ways that I could improve the impact that I had on the patients. Since I had a limited time myself to spend with each patient, I started developing handouts on common complaints (diabetes, hypertension, hypercholesterolemia, obesity, etc.) that I was dealing with in the clinic, providing more information and guidance than I had time to give in person. I would begin the conversation with the patient and then refer them to the materials I had produced for their continued education.
I realized that there was need of more education than this, so I started working on a website that could provide additional health information for them. This way, I could not only hand them a handout, but I could also refer them to my website for additional resources. I would pray with patients frequently, and I did make a difference in the lives of my patients. But I knew that there must be more. I was still unsatisfied with how many patients would simply bypass the information received and rely upon medication to “control” their condition. After a time, I realized that I needed a specialty lifestyle practice, where education, not medication, would be the center of the practice.
To make a long story short, I moved to Uchee Pines Institute to learn how to educate and treat my patients with lifestyle and nature’s remedies, as I was reading about in the Spirit of Prophecy. In this setting, I found myself able to spend a significant amount of time with each patient. This gave me the time not only to explore their medical history and understand their lifestyle, but also their traumas, relationship struggles, and spiritual journeys. I began to connect with my patients on a deeper level and entered into their lives more meaningfully. I was no longer afraid of opening “Pandora’s box,” because I now had time to address what would come spilling out.
I began to see that, while my patients were suffering from physical diseases, these diseases were not the problem. They were simply the manifestation of the problem. I began to see and understand the emotional and spiritual issues that were the cause of the physical diseases, and I began to prayerfully learn how to address these issues, as the Holy Spirit gave me wisdom and insight in various consultations. And something else marvelous began to happen. Patients started surrendering their lives to Christ in my office! Not only was I educating them how to practice healthy behaviors, but I was bringing them to the Savior who would heal the plague-spots in their souls and give them overcoming power to be successful in implementing and maintaining these health-preserving lifestyle principles.
It is not a rare occasion that patients surrender their lives to Christ in my office. There are frequently tears of pain and fear as we address the traumas of their past and fears for the future. And there are tears of joy as they see and believe the love God has for them and the freedom He offers them right now. This is as God would have our practices to be. The purpose is not so much the healing of the body as it is the healing of the soul. And that healing takes time!
I want to challenge you with this thought. If God has chosen us as His last-day medical missionaries to prepare a people for the soon coming of our Savior, and if our ability to truly accomplish the task in a patient’s life is dependent upon having sufficient time to address the issues of the heart and soul, in addition to the issues of the lifestyle and the diseases, what are you willing to do to make that time for your patients?
Are you willing to risk the censure of your hospital or physician group? Are you willing to risk the drop in revenue that will come from seeing fewer patients in a day? Are you willing to exit the system that encourages consultus brevis, and explore alternative forms of healthcare delivery that will allow you to adequately address the spiritual, emotional, and physical needs of your patients, bringing them to the foot of the cross and a saving relationship with Christ?
I know this is a scary thought. I remember when I was making this decision. It was as if I was standing on the edge of a canyon in the complete darkness, and God was asking me to jump. I couldn’t see how God would sustain me and my family of 6 (now 8) financially. I couldn’t see how I could pay of the remainder of my medical school loans. I couldn’t see what my life would look like. I feared what would happen to my skills and my reputation. But I can honestly tell you this: I have a practice that is absolutely satisfying. I make little money, but God provides for our needs. But I have a practice that is fulfilling, gratifying, and makes an eternal impact in the lives of my patients. I have successfully treated consultus brevis, and I am reaping the rewards.
Perhaps now is the time to apply the “cardioversion” of conversion, and successfully treat consultus brevis in your own practice, that you may be all that God calls you to be. May God bless you as you wrestle with this decision and what it will look like in your life and in your practice. You are in my prayers.
This is not to say that I believe all Adventists need to move to a lifestyle center and practice natural remedies. There is need of accurate diagnostics, expert acute care, and restorative surgical interventions. But we all, regardless of what type of practice we are in, need more time with our patients if