By Bob Coates, M.Div., LMFT

President and CEO, the SyMedica Network

Assessing a physician’s attitude about the legal responsibility for healthcare practitioner rule of “Intent to Comply” with U.S. healthcare statues, regulations and rules is the first step of any healthcare compliance initiative, whether in a private practice or institutional setting. Compliance begins to identify factors that predict physicians’ intent to comply. The ethical guidelines governing any licensed activity by physicians, mid-levels, or support staff are the result of dedication to statutory, regulatory, and rule compliance. We begin our discussion by establishing a theoretical framework from social psychology to assess and understand better the attitudes of physicians towards following their practice jurisdiction’s initiatives to protect the public trust and predict the success of a compliance mentality. What are the identified factors that influenced physicians’ intent to comply with these multiple regulatory and ethical guidelines?

When a practitioner adheres to “Intent to Comply”, there are significant benefits to physicians:

  • When intent to comply is clearly demonstrated by the practitioner, criminal penalties are most likely abate when and if a significant non-compliance event occurs.
  • While civil monetary or monitoring may occur, the result of non compliance allows for factual compliance efforts;
  • “Intent to Comply” MUST be demonstrated rather than just lip service to the concept. Practitioners must establish a clear demonstration of intent to comply. Compliance is evidenced by practitioner integrity programs implemented within the day-to-day operational, clinical, and fiscal landscape of patient adherence, and employee behavior as the result of employer mandate.
  • Implementing intent to comply has a positive revenue enhancement end result as well. In SyMedica’s implementation of compliance programs, we discover that approximately 60% of patients in even high watermark licensed pain management clinics have significant issues with adhering to the physician’s plan of care. Thus, the clinic can implement a “disease management program” which increases patient compliance, with increased patient requirements to comply.
  • Intent to comply programs is physician practice results in the identification and screening of patients at a higher risk of non compliance, yet leads to counseling interventions which allows the patient to remain in guided treatment as opposed to traditional discharge. Thus patient lives are turned around in a win-win situation for practitioner and patient.
  • Patients spread the word that this clinic does not tolerate drug seeking behavior, but requires positive results due to compliance initiatives as a bridge to better health.

Physicians traditionally in real life practice have a responsibility to self-govern their credibility and professional image as being the most important aspects of following all clinical, operational, and fiscal practice guidelines. For the most part, physicians live moment by moment with the responsibility that it was important for them to increase their credibility as a profession and also to improve their professional image. Physicians are asked in professional compliance audits whether following the established professional guidelines would decrease the possibility of feeling obligated to the various commercial pressures, mainly financial related pressures. Almost half have indicated to SyMedica that following the guidelines was likely to decrease the possibility of feeling obligated to the commercial industries, and approximately 62% of practitioners in AMA studies stated that decreasing the possibility of fiscal related commercial pressure obligations was important to them, a finding which could seem to affect the judgment of individual practicing physicians.

Self‐serving bias is unintentional, unconscious and affects choices indirectly by changing the way individuals seek out and weigh information on which they later base their choices when they have a stake in the outcomes. Since more than half of the physicians stated that their satisfaction in following their ethical guidelines in practice was important to them, it might be useful to use this reasoning to promote the ethical guidelines.

Physicians as well identify closely with their colleagues as the most important determinate as to practice behavior as opposed to patient or commercial pressures. Study findings indicate that physicians peer pressure is the best incentive for adherence with guidelines. Although a number of studies indicate that physicians depend on sales representatives for information, the findings from SyMedica’s experience indicate that, with regard to ethical guidelines, physicians see sales representatives in a different light. There is significant perception among physicians that imply that physicians perceive commercial and patient pressures as not wanting them (physicians) to strictly comply with the guidelines. Physicians might think that the feeling of obligation imposed by patient demands on physician care planning and financial pressures to survive in a convoluted industry competition for patient volume might have led physicians to believe that patient demands and financial pressures may incentivize non compliance, resulting in a practitioner not following the ethical guidelines; thus patients in many sub-specialties such as pain management may not want physicians to follow the guidelines established by regulations and rules governing the clinic, it’s employees, and practitioners.

Pretesting by the SyMedica Network in its continuing education events, particularly pain management compliance events in the presentation of pain management seminars indicate approximately 50% of the physicians in our experience had read the guidelines governing pain management with complete understanding, but only approximately 30% of the physicians agreed that they could follow practice guidelines because they knew the guidelines very well. As stated by a physician in the one‐on‐one interviews, physicians are busy professionals.

A potential method to assist physicians in reading the guidelines could be by providing these guidelines for some form of continuing education credit or through education at a professional or a national meeting. It is possible that physicians might have read the guidelines, but not being educated to use them in specific situations might have led to their belief of not knowing the guidelines very well. State imposed regulations to the epidemic of prescribing pressures from patients in pain management indicate it is imperative time to now call for a mandatory approach on pain management compliance. The Pulido Coates Pain Patient Compliance Protocol and Rating Scale (PPCP-S) does just that; it requires patients to demonstrate compliance in the physician’s plan of care rather than subject the physician to dealing constantly, and often blindly, to patient non compliance behavior

Precedents support the theory that self‐regulation is often more effectively used and adopted than applied standards. It is important to note that, although these physicians might not want to follow the suggestions of strict pain management regimens devised by well intentioned regulators, it is possible that their own policies might still be ethical in nature and might conform to ethical standards. Patient self imposed compliance presents a severe conflict.

In all, 6o% of the patients Pulido Coates have assessed using the PPCP-S protocol (n=3200) have scored at some level of non-compliance, indicating patients went against their physician’s individualized plan of care guideline. When physicians were provided with the results, responses varied, but generally 90% of physician responses per case relied upon the PPCP-S to alter patient’s plan of care or discharge the patient. This indicates that most physicians changed their prior decisions about patient’s intent to comply when presented with the PPCP-S results. This finding further corroborates the fact that physicians who want to follow the guidelines do so voluntarily. For future promotion of the PPCP-S guidelines, Pulido Coates has found it helpful to present physicians with scenarios from practice settings, along with the guidelines. It takes a strong ethical position to follow the intent to comply.

The interaction between attitude and subjective norms suggests that if a physician believed that positive outcomes would result from following the guidelines and was convinced that his colleagues want him to follow the guidelines, it is likely that he would do what his colleagues want him to do irrespective of his attitude towards financial or commercial gain, and as opposed to compliance with ethical and regulatory guidelines. The implication of this finding is of great importance, since it sheds light on the fact that attitudes and subjective norms work together in influencing physicians’ intent to comply with the ethical guidelines. Bearing this in mind, it would be easy for rule makers to switch their focus from trying to change physicians’ attitudes to trying to concentrate on the opinions of important referents such as physicians’ professional organization, colleagues and patients. For this reason, Pulido Coates as aligned itself with the SyMedica Network, an accountable practitioner initiative.

To learn more about the benefits of “Intent to Comply”, our Disease Management Program, the Pulido Coates Pain Patient Compliance Protocol and Scale, or the SyMedica Network, contact us at http://symedica.net/pain-management-solutions/, or call us at 888-508-1859.

Posted by: SyMedica | January 19, 2017

America’s Agitated Depression

Its very real. Although not being familiar with the symptoms of this behavioral health syndrome, you may well confuse the clinical nature of this “diagnosis” of the American state of mind. Developed among Americans during the 2016 Presidential election with concomitant outright righteous indignation for our country’s emotional plight, your friends, and neighbors have expressed with the limited choices for presidential candidates the fact of America is suffering from a base behavioral condition which rather does not find its etiology in politics, but the American Public Trust. Take for example the following.

Today during the Senate hearings for the nomination of Treasury Secretary nominee Sten Mnuchin, Senator Pat Roberts (R-Kansas) actually offered Senator Ron Wyden “a valium” during the volatile hearings itself. Valium, a benzodiazepine so the panel could probably get through the Senate confirmation hearings on  Mr. Mnuchin.

It doesn’t get any better than that to demonstrate both Congress and most certainly the American public is symptomatic of what is well-known in my profession as a behavioral psychotherapist as “agitated depression”. Agitated depression is an older term in my field to describe a person tho has a combination behavioral mixture of Anxiety-that feeling you have to do something about an impossible situation- and Depression, which by definition is “a form of internal temper tantrum” that things aren’t going right in one’s life and emotional and physical symptoms occur.

America is a victim; we feel out of control. We are trying to figure out the old “whose on first” question as we go about our daily routine hearing allegations between political parties, arguments between the President elect between, well, virtually everybody. These fights we witness will soon find a logical course to impeachment or demise. Learn from history this is rare, but isn’t anything new, just exacerbated in that it hits your ears within seconds with modern communication, rather than weeks. According to communication psychologists, each day we are hit with 49,00 subliminal and overt messages, mostly negative, each 24 hour day. Yes, we often dream out what we lst heard before hitting the bed.

The real question now isn’t  “what is the big elephant in the room”, but “what is that little twitter-bird in the room”? Let me confess I don’t know and that is what is driving me and possibly the American Trust, a slow grade level of anxiety and depression.

Call it what it is: we are sad for America and we are anxious about America.

My suggestion as a psychotherapist is NOT to grab an anxiolytic or antidepressant; but stay way from the cable news, turn off twitter, hug your spouse over a simple and quiet candle light dinner, turn the television off-better yet remove from the bedroom, take your children to the park, say the Pledge of Allegiance, sing in the shower, go to church-one without a political mandate, and remember who you are. Remember you are an American with one vote. Remember the promises and follow the day to day experiences to actually watch the clock start ticking at noon January 20, 2017, and then watch your paycheck, your quality of life, your safety in the streets, and your freedoms to move about without restrictions in this get land.Go vote your insight at each election.

Forget about taking valium or an SSRI. They are gifts from God when things really begin to change your body’s neurons and cells. Lets not allow the American Agitated Depression get that far.

If you are a news reporter reading this, my sincerest apologies, but America has enough on its plate to listen any further to your knee jerk reaction to each tweet. Please respect America’s plight by remaining truthful and aspire to honor Edward R. Murrow.

Now, don’t you feel better already? No charge.

Bob Coates is a theologian, and licensed clinical psychotherapist in Virginia and Tennessee, practicing since 1978

 

 

 

Posted by: SyMedica | October 17, 2016

HIPAA:I Cant Believe My Ears

Sitting in a prominent Safety  Harbor, Florida physician’s lobby, along with four other individuals, I am waiting for a dear friend to finish his physician’s visit.

Apparently, this physician’s receptionist hasn’t heard of the HIPAA Omnibus Act of 2013, much less the HIPAA Act of 1996. 

Sitting here, the receptionist is going over the “new” patients’, an elderly couple, complete medical history, their Protected Health Information, including their d.o.b., their insurance information, and at least 8 additional PHI data specifics.

I am literally appalled. Any OIG agent would have a $45,000 field day. I literally became nauseous… Should I have stepped up and quietly interceded?

As a physician, have you checked your front offices’ compliance with HIPAA and 42 C.F.R., Part II’s requirements to keep your patient’s PHI confidential? Apparently, by the ease this office person’s demeanor, this is an ongoing travesty.

SyMedica can help. We teach your staff with simple, but comprehensive, courses approved by the Florida Division of Medical Quality Assurance as a continuing education provider, how to keep you out of trouble. Give us a call, 1-888-508-1859, and we will be most certainly be pleased to help you AND your patients’ privacy.

Posted by: SyMedica | September 11, 2015

Has the Florida Pain Management Initiative Worked?

The recent JAMA for Internal Medicine study regarding the success of Florida’s initiative. The study cites a 1.4% decline in the aggregate amount of prescribed opioid medicatins.As an objective professional in both teaching the Florida Pain Management Law and Regulations for the past five years , and consulting with numerous pain physicians and clinics in evaluating their patient’s compliance with the Pulido Coates Pain Patient Compliance Protocol and Scale, I have determined that while the Florida legislation has reduced the number of illegal pill mills, the Legislation has rather increased patient NONCOMPLIANCE in even the finest of legitimate pain management clinics and prescriber. In essence, patients are duping the docs! The average clinic level of non compliance including all 5 scale levels we scored in 3200 administrations using the PPCP-S is 60% NON COMPLIANCE. We routinely ask each physician medical director before we begin assessing their patient’s compliance how they think their facility rates as to compliance. The response is almost universally even among the most cautious physician, “my patients are 90-95% compliant”. Upon showing empiricle evidence of the easily scored PPCP-S, which is a billable procedure, that even many of their most perceived compliant patients are non compliant, the physicians are shocked.

It is one thing to close down a Pill Mill or make access difficult in pharmacies; its a totally different nightmare to know 60% of non-malignant chronic pain patients are either not educated or diagnosed properly, or the patient has become accustomed and skilled to serve to their reptilian pleasure seeker mentality. Its high time to protect the physician AND their patients from patient non compliance. its just the right and good thing to do.

I never intended myself to be immersed in the “pill Mill” controversy. In somewhat of a paradox I am. Rather a career in politics and law in the early ’70’s, I became a psychotherapist by choice because my best friend committed suicide after unbeknownst to him, he becoming high on amphetamines and vodka mixed together and taunted to drink. I made a choice to make a difference. But my solo training in family practice clinics in Appalachia hours away from substance abuse and mental health professionals brought me face to face with the Oxycontin abuse in  2000.

One of my clinics was targeted for the prescribing of Oxycontin by the physicians who worked for me. Over 6,000 patient charts were reviewed by the federal task force for two years. It cost me $58,000 in legal and copying fees. After the investigation, my lawyer received a call from the Assistant U.S. Attorney who said “you can have Coates come get his charts. We didn’t find one case of prescription abuse.”My attorney convinced the AUSA to deliver them to me at her cost.

How did it happen that not one  non compliant prescriptive case could not be found? It is simple.Fifteen years ago  my physicians were audited by my compliance staff. We had mandated enforceable protocols in the clinic and one of the protocols was the physician had to state on the record by signature he/she examined the patient and the medication was necessary and required. All other means of treatment had demonstrably failed. The audits confirmed independent evidence of failed treatments. The physician also was required to state on his timesheet compliance with all laws and rules governing their practice. Each pay period the docs had to attest compliance.

We had a second layer of safety which protected the physician. We protected the physician from the patient. Every patient was evaluated by a licensed behavioral practitioner as to the need for narcotics and even psychotropic medication, including benzodiazepines and anti depressant medication. We had on site a confirmation moderate complexity clinical laboratory which tested urine and blood for toxicology. We tested for alcohol abuse. Point of service cups have a 40% error rate; 20% false positive and 20% false negative. We confirmed testing to protect the physician.

After teaching about 150 physicians and staff in Florida regarding compliance with the Florida Legislation the past five years, evaluating personally almost 2,000 individual patients for compliance, and averaging the reading of approximately 6 news articles about “pill mills” daily, I can readily make the observation neither the physicians or patients are safe in this country when it comes to narcotic prescribing. Our good physicians are frightened to the point of fear of being prosecuted; most deserving patients are not even  sure that they will have their script filled, and those patients working the system wont stop at anything to try scamming the physician. I have not informed you of anything new.

But maybe there is a solution so obvious it may be automatically rejected. The tools necessary are available in every clinic that has a computer. Just add required compliance audits similar to JCAHO or CARF. Audit the Physician AND the patient on multiple levels a minimum of once a year. Would it surprise the reader to hear that even in the best pain management clinics 60% of the patients are currently NOT following the physicians plan of care for prescription narcotics? That is the number Pulido Coates and Associates has discovered to both the shock and dismay of their physician clients. Wait just a minute before you make a deduction. It isn’t hard to fix. the disease of pain must be managed. And compliance with the plan of care requires education. Enter the Advanced Nurse Practitioner. Florida is one of the few states preventing prescriptive authority to the one group of healthcare professionals that are trained to take the time, expertise, and hard-line questioning to “audit” the patient’s compliance, AND to watch the doctors back.

I believe pain management clinics ought to treat non malignant chronic pain as a course of “disease management”. The protocol needs that skilled professional, the Advanced Registered Nurse Practitioner,  to audit the patient, which by the way, is a five step reimbursed procedure, paid for by Medicare, Medicaid, and most commercial insurance plans. I have seen this work. I know it works. In those clinics Pulido Coates has instituted the disease management protocol we call the Pain Patient Compliance Protocol two things are objectively reported: Doctors sleep better at night, and patients begin to get the mandate to follow strictly the physicians pan of care. The rate of non compliance drops like a rock to less than five percent. Doc’s, protect your ticket to practice. Patients, try wanting to get well.

Those interested in finding out more about this approach can review the pain management page of the SyMedica Network.

By Bob Coates, M.Div., LMFT

President and CEO, the SyMedica Network

Assessing a physician’s attitude about the legal responsibility for healthcare practitioner rule of “Intent to Comply” with U.S. healthcare statues, regulations and rules is the first step of any healthcare compliance initiative, whether in a private practice or institutional setting. Compliance begins to identify factors that predict physicians’ intent to comply. The ethical guidelines governing any licensed activity by physicians, mid-levels, or support staff are the result of dedication to statutory, regulatory, and rule compliance. We begin our discussion by establishing a theoretical framework from social psychology to assess and understand better the attitudes of physicians towards following their practice jurisdiction’s initiatives to protect the public trust and predict the success of a compliance mentality. What are the identified factors that influenced physicians’ intent to comply with these multiple regulatory and ethical guidelines?

When a practitioner adheres to “Intent to Comply”, there are significant benefits to physicians:

  • When intent to comply is clearly demonstrated by the practitioner, criminal penalties are most likely abate when and if a significant non-compliance event occurs.
  • While civil monetary or monitoring may occur, the result of non compliance allows for factual compliance efforts;
  • “Intent to Comply” MUST be demonstrated rather than just lip service to the concept. Practitioners must establish a clear demonstration of intent to comply. Compliance is evidenced by practitioner integrity programs implemented within the day-to-day operational, clinical, and fiscal landscape of patient adherence, and employee behavior as the result of employer mandate.
  • Implementing intent to comply has a positive revenue enhancement end result as well. In SyMedica’s implementation of compliance programs, we discover that approximately 60% of patients in even high watermark licensed pain management clinics have significant issues with adhering to the physician’s plan of care. Thus, the clinic can implement a “disease management program” which increases patient compliance, with increased patient requirements to comply.
  • Intent to comply programs is physician practice results in the identification and screening of patients at a higher risk of non compliance, yet leads to counseling interventions which allows the patient to remain in guided treatment as opposed to traditional discharge. Thus patient lives are turned around in a win-win situation for practitioner and patient.
  • Patients spread the word that this clinic does not tolerate drug seeking behavior, but requires positive results due to compliance initiatives as a bridge to better health.

Physicians traditionally in real life practice have a responsibility to self-govern their credibility and professional image as being the most important aspects of following all clinical, operational, and fiscal practice guidelines. For the most part, physicians live moment by moment with the responsibility that it was important for them to increase their credibility as a profession and also to improve their professional image. Physicians are asked in professional compliance audits whether following the established professional guidelines would decrease the possibility of feeling obligated to the various commercial pressures, mainly financial related pressures. Almost half have indicated to SyMedica that following the guidelines was likely to decrease the possibility of feeling obligated to the commercial industries, and approximately 62% of practitioners in AMA studies stated that decreasing the possibility of fiscal related commercial pressure obligations was important to them, a finding which could seem to affect the judgment of individual practicing physicians.

Self‐serving bias is unintentional, unconscious and affects choices indirectly by changing the way individuals seek out and weigh information on which they later base their choices when they have a stake in the outcomes. Since more than half of the physicians stated that their satisfaction in following their ethical guidelines in practice was important to them, it might be useful to use this reasoning to promote the ethical guidelines.

Physicians as well identify closely with their colleagues as the most important determinate as to practice behavior as opposed to patient or commercial pressures. Study findings indicate that physicians peer pressure is the best incentive for adherence with guidelines. Although a number of studies indicate that physicians depend on sales representatives for information, the findings from SyMedica’s experience indicate that, with regard to ethical guidelines, physicians see sales representatives in a different light. There is significant perception among physicians that imply that physicians perceive commercial and patient pressures as not wanting them (physicians) to strictly comply with the guidelines. Physicians might think that the feeling of obligation imposed by patient demands on physician care planning and financial pressures to survive in a convoluted industry competition for patient volume might have led physicians to believe that patient demands and financial pressures may incentivize non compliance, resulting in a practitioner not following the ethical guidelines; thus patients in many sub-specialties such as pain management may not want physicians to follow the guidelines established by regulations and rules governing the clinic, it’s employees, and practitioners.

Pretesting by the SyMedica Network in its continuing education events, particularly pain management compliance events in the presentation of pain management seminars indicate approximately 50% of the physicians in our experience had read the guidelines governing pain management with complete understanding, but only approximately 30% of the physicians agreed that they could follow practice guidelines because they knew the guidelines very well. As stated by a physician in the one‐on‐one interviews, physicians are busy professionals.

A potential method to assist physicians in reading the guidelines could be by providing these guidelines for some form of continuing education credit or through education at a professional or a national meeting. It is possible that physicians might have read the guidelines, but not being educated to use them in specific situations might have led to their belief of not knowing the guidelines very well. State imposed regulations to the epidemic of prescribing pressures from patients in pain management indicate it is imperative time to now call for a mandatory approach on pain management compliance. The Pulido Coates Pain Patient Compliance Protocol and Rating Scale (PPCP-S) does just that; it requires patients to demonstrate compliance in the physician’s plan of care rather than subject the physician to dealing constantly, and often blindly, to patient non compliance behavior

Precedents support the theory that self‐regulation is often more effectively used and adopted than applied standards. It is important to note that, although these physicians might not want to follow the suggestions of strict pain management regimens devised by well intentioned regulators, it is possible that their own policies might still be ethical in nature and might conform to ethical standards. Patient self imposed compliance presents a severe conflict.

In all, 6o% of the patients Pulido Coates have assessed using the PPCP-S protocol (n=3200) have scored at some level of non-compliance, indicating patients went against their physician’s individualized plan of care guideline. When physicians were provided with the results, responses varied, but generally 90% of physician responses per case relied upon the PPCP-S to alter patient’s plan of care or discharge the patient. This indicates that most physicians changed their prior decisions about patient’s intent to comply when presented with the PPCP-S results. This finding further corroborates the fact that physicians who want to follow the guidelines do so voluntarily. For future promotion of the PPCP-S guidelines, Pulido Coates has found it helpful to present physicians with scenarios from practice settings, along with the guidelines. It takes a strong ethical position to follow the intent to comply.

The interaction between attitude and subjective norms suggests that if a physician believed that positive outcomes would result from following the guidelines and was convinced that his colleagues want him to follow the guidelines, it is likely that he would do what his colleagues want him to do irrespective of his attitude towards financial or commercial gain, and as opposed to compliance with ethical and regulatory guidelines. The implication of this finding is of great importance, since it sheds light on the fact that attitudes and subjective norms work together in influencing physicians’ intent to comply with the ethical guidelines. Bearing this in mind, it would be easy for rule makers to switch their focus from trying to change physicians’ attitudes to trying to concentrate on the opinions of important referents such as physicians’ professional organization, colleagues and patients. For this reason, Pulido Coates as aligned itself with the SyMedica Network, an accountable practitioner initiative.

To learn more about the benefits of “Intent to Comply”, our Disease Management Program, the Pulido Coates Pain Patient Compliance Protocol and Scale, or the SyMedica Network, contact us at http://symedica.net/pain-management-solutions/, or call us at 888-508-1859.

Adolescents in turmoil after the school day …Chronic Pain Patients needing support without leaving home…Licensed health professionals needing a Caduceus Group…Families who can’t meet for family therapy because of tough family schedules. What they now have in common is I offer these group therapy, individual therapy , and family therapy as online  interventions by secure tele-medicine. After years of doing Caduceus Groups for medical professionals online, even Intensive Outpatient Therapy, I have been encouraged by my colleagues to offer the groups prime time for those who have a difficult time traveling to therapy or who are in need of an emotional support.

If you know of someone who you would refer my services online, I would greatly appreciate your sharing the word. This is something I have been doing since 1999, after a few years working as a member of the American Telemedicine Association as a member of the behavioral health strategy planning committee.

Online therapy is so very effective, and less costly by a long shot from traditional methods. What studies have shown is online therapy is the most beneficial modality of care for adolescents and children. I teach courses in the method to other healthcare professionals, so with their encouragement, here goes! Find out more by going to my page on Psychology Today...

As always, I’m available for you and those whom you care for and love.

Bob

Posted by: SyMedica | October 17, 2014

The Sacrament and Ordinance of Tears

THE THIRD ORDINANCE… The Eighth Sacrament

What I am thrusting into your mind I hope will not be looked upon as sacrilegious, but a new slant on an aging theology. Believe me, its taken a lot of thought to write this for publication. Read and weep…for the right reason of course.

I have come to believe there is a third Ordinance for Protestants, the eighth for Catholics.

I Believe it is the Ordinance/Sacrament of Tears.

The inception of the idea was benign. Wednesday a couple of weeks ago I discovered 9 leaks from my Florida home’s ceiling. Five complete strangers came within 30 minutes from a disaster recovery company sent by my insurance company. One gentleman about 40 looked around and saw that I lived alone. He spotted though numerous pictures.”Mr. Coates, you don’t get a lot of visitors”. My occasional housekeeper had not been gone long, so I took it that the abundance of work product on tables was the dead give away.

I began to weep.

He was right. My pain levels do keep me at home more these days. But there was evidence of unfinished tasks of a person with limited physical abilities. There I stood and streams of tears began to flow from my eyes. No, I wasn’t tired, or forlorn about the stained ceiling. I just began to cry. A near 61-year-old-man crying because a guy told me he saw I was very much alone. I don’t see my children very much anymore because of life. Much , much more, I don’t see my grandchildren nor my father as much anymore. It’s a huge house; and, I have a huge heart. I want it filled.

Yes, there is more. Much , much more, I have now realized I’m on borrowed time so to speak. I have to get with it. I have so many ideas and dreams yet unfilled. There is this one project I’m starting….

Well, lets just say I am happy to say I don’t have time to go to my funeral yet.
H
But there is more. I was at first embarrassed that I was in
tears, but then after several days, yes days, the embarrassment confirmed to my theological bending that there is a third Ordinance for Protestants, the eighth for Catholics.

The shortest verse in scripture is “Jesus Wept.”

He just received news of the death he might have prevented. Eventually He did a miracle after He wept.

I believe when a normal,sane, but sensitive person spontaneously begins to weep, it is sacred. The a miracle can happen. Once you come to as some would say, “to the end of yourself”, you might be humble enough to allow God, heh, even YOU, to allow something magnificent to happen. I believe sacred tears bring sacred messages to the conscience. The Holy Spirit works for eternity this side of Heaven to bring you to a Place.

That Place may be the thought of a recent lost loved one. It may well be that news out of the blue blew you over and you just began to weep. Possibly you became angry and out of an enormity of emotion came forth tears, and then a solitude. for whatever reason, the tears can be theologically from God. Then after a shivering of arms, face, hands, knees,and cold chills come a peace that, well, just can’t be understood; a peace that passes understanding.

The gentleman asked me after he saw I was in a distant distress, “Mr. Coates, apart from this crisis, may I come by and talk?”, he asked. I said, of course. Its been a few weeks. He may never come. People often are heroic in the moment and we say the most spiritual things…”I’m praying for you”….”God bless you”….”What can I do”.

Forget them. Yes, take it for a grain of salt. Just take a reasonable risk when the possible Sacrament of Tears happens and go somewhere inside of your self. Get with God. Not a minister, not a spouse, at first. Get within. Try remembering the taste of tears when you lost your first anything or anyone that meant the world to you. Remember that warm feeling that flooded you moments after you wept.

The do as Jesus did. Accomplish Something. Something miraculous. Something that would necessarily be unlike you. Accomplish the capital “S” Something. Stand up and notice you have just been in the Presence of the Almighty and He has chosen to use you. You of all people.

One more thing. Try to remember telling someone SILENTLY weeks, months,  later that you know something about the sacred Ordinance or Sacrament of Tears….”You wept” will be the shortest verse that need to be quoted. You just might find yourself weeping with someone instead of promising them this Something is that God wants for and with you..

 

Posted by: SyMedica | August 22, 2014

Life Needs a Pillow…Revisited

Here is an update to “life Needs a Pillow” which was published in February, 2014…

I am a frequent flier. I cannot remember ever flying on a busy day that I didn’t see a teen age girl carrying a pillow through the airport. This last trip by air to Tri Cities I say what looked like a senior adult lady carrying a pillow tucked and clutched under both arms in the front of her chest trapsing through ATL D concourse.

I was insidious envious. You see, I was on my way to see my dad in ICU in Kingsport, Tn.,  and I was anxious, out of my gourd. I needed a pillow.

Think about it. We spend more time with our pillow and any other device in our world. It knows our tears. Our sleeplessness is well known to its constitution. It hears our sobs. 8 more or less hours
a a day if knows where we are and what is our condition….

I did a word search in scripture and the word “pillow” as translated is found only once in scripture, Mark 4:38. Jesus  was sleeping on a pillow during a horrific storm that caused fear among his followers. He had not one worry in the world.

Sometimes life just needs that close, abiding, comforting pillow, especially when life raises its ugly head, like those  sweet girls and  ladies flying in uncertain airplanes.

Laura bought me a gift about a month ago….a pillow. Its supposed to be awaiting me when I get home. Its supposed to be one of those really nice bamboo jobs because my neck hurts all the time, especially when I sleep. Yet didn’t/wont wait. The uncertainty of my dad’s illness, this twilight he is suffering between life and death caused me to ask one of the nurses for a pillow…

It hides my weary eyes, my fear, and with ease I pray into the pillow, as if it a prayer closet.

Where is your piilow? Find it; be good to it; keep it clean. Don’t give it to someone else to use. You need it.

Its just because sometimes life needs a pillow….Need one? Write me and I’ll tell you where to go find just the right one.

Vividly the other day in ICU I had a familiar sight. As a child, I used to sneak in Dad’s bed room after school to see if Dad was home from working graveyard shift. There he would be, dressed in his tee shirt, both arms wrapped around his pillow, nudging his face into it’s comfort. He still does. In ICU, it was as if the Lord was saying all is well. There he was, face in s somber nudging that pillow. Thank you, Lord, for pillows.

The update? Here is Dad’s recent pictures after surviving his ordeal…

Life just needs a “pillow”.

IMG_1044.JPG

IMG_1055.JPG

Posted by: SyMedica | August 22, 2014

Supporting Health Professional Friends with Addictions

 

Caduceus Recovery Foundation, Inc. (CRF) is hosting its 1st Annual Recovery Month 5K Walk/Run September 13, 2014 in Nashville, TN. Caduceus Recovery Foundation, Inc. (CRF) is a public not for profit organization (501(c)3 status pending). This event will contribute to community awareness of addiction, recovery and mental health in support of Recovery Month 2014. All proceeds from this event will go directly to support our scholarship fund for Tennessee health professionals with drug addiction, abuse and use disorders as well as co-occurring mental health issues. These scholarships aid in full or partial payment for needed services for an individual’s recovery; such as, inpatient and outpatient treatment, individual and group counseling, continuing education courses in support of recovery, and many others. Our goal is to generate as much as we can to help offset the cost of treatment and recovery for those Tennessee health professionals and their families in recovery.

If you or someone you know has ever dealt or is dealing with depression, mood disorders, substance abuse or use disorders please join in supporting Recovery Month and help us reach our goal!

 Event Details:

When: Saturday September 13, 2014

Time: 9:00 am – 11:30 am

Where: 4700 Franklin Pike, Nashville, TN 37220 (Track at Franklin Road Academy)

Registration: Early Individual Registration: $30, Early Team Registration: $25 per person:

…minimum of 4 people per team, Late Registration Individual: $35, Late Registration Team: $30 per person – minimum of 4 people per team, Virtual Donation $25.00 – can’t make it but still want to make a donation

(Please note: minimum of 4 people per team)

Virtual Event: If you are unable to attend the event in Nashville but still want to help generate funds for the cause submit registration packet for you or your team and walk for Recovery in your local neighborhood.

Challenge – Each team region can challenge another for the most raised donations, East-Middle-West, TN…Consider One organization against another

 HOW TO REGISTER:  http://www.eventbrite.com/o/caduceus-recovery-foundation-6880106967?s=27044375

 

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