TCD Article

Efficient Care & Spiritual Care: Can You Do Both?

September 6, 2017

It was bound to happen. And it did, on a Thursday morning. But let me give you some background first. My best friend and practice partner, John Hartman, MD, and I were seeing patients in our family medicine practice from, as they say, conception to cremation. We had been working to introduce a variety of simple spiritual interventions that allowed us to practice not just as healthcare professionals who were Christians, but as Christians who happened to be healthcare professionals.

In other words, our practice was becoming a ministry as we took a spiritual assessment with most patients; utilized faith flags, faith stories and faith prescriptions; and prayed for and with patients when indicated. Christ was central to who we were and what we did professionally. We took great joy in what the Lord was doing in and through each of us. Then came that auspicious Thursday.

Paul Brennan (not his real name) was a grouchy senior who continually ignored or resisted anything to do with God, Christ, the Bible or church, and he didn’t mind letting me know about it. During the years I had known him, I had raised countless faith flags and explained the health benefits of faith. He was on my daily prayer list for more than a year. He had even allowed me to pray for him once about a difficult medical decision he needed to make and then once again before a minor procedure in the office. All of these were interventions that took virtually no time. And all were seemingly to no avail.

Then, on the morning of an appointment to hear a biopsy report, something changed. Unfortunately, it was peak flu season and I knew the schedule was double-booked, a patient was waiting for me in the ER and I was already running terribly behind. When I walked into Mr. Brennan’s exam room, instead of receiving the verbal beating I expected from this crabby, cantankerous old fellow, I sensed that my patient’s heart had softened.

“What’s the word, Doc?” he asked quietly.

I sighed and replied, “Paul, I’ve got bad news. It’s cancer.”

He stared out the window and then came the unexpected: “Doc, I think I’m going to need that God you’ve been trying to tell me about for this one.”

On the one hand, I was excited. I sensed we were on the edge of an amazing spiritual breakthrough. 1 Peter 3:15 says, “In your hearts honor Christ the Lord as holy, always being prepared to make a defense to anyone who asks you for a reason for the hope that is in you; yet do it with gentleness and respect” (ESV, emphasis mine). And here was Paul, asking—seriously asking. And I was prepared. But, on the other hand, I was behind for the day—terribly behind.


I was slapped in the face that day with the all-to-familiar bucket-of-cold-water realization that Christian healthcare professionals who begin utilizing spiritual interventions quite quickly will find themselves, as I was, being caught in a time crunch by a patient or family member who wants to know more.

If I took time to talk with Paul, I knew I’d run even more behind. But if I failed to take time to meet Paul’s spiritual needs, something that is a passion for me, would I put Paul’s spiritual health at risk? Would I risk being disobedient to God and His call for me in healthcare? Would I miss an opportunity to join the Holy Spirit where He was already at work? Did I really believe God was sovereign even over my schedule?

Add to this conundrum the pressure-cooker of modern healthcare systems where healthcare professionals are required to do more and more in less and less time. When most of us have less time with patients than ever, it’s no wonder many question how they’ll ever meet the spiritual needs of their patients—and many don’t even try.

What’s the answer? It’s actually stunningly simple. It’s no different for Christian healthcare professionals than it is for the church. We are not designed nor called to do ministry in the workplace alone. There are no lone rangers at the frontline of evangelism. We are designed and called to be part of the body of Christ in worship and work. In fact, I believe our work as followers of Jesus is to be an act of worship.

We each know God has called and commissioned us to be competent healthcare professionals who practice with Christ-like compassion while being draped in Christ-honoring character. And most of us in healthcare know God can speak very loudly with His megaphone of pain, disease, disorder or disaster (to use a C. S. Lewis metaphor).

But God simply has not given most of us the time or the impossible call to “do it all” ourselves with everyone we see. Rather, He has given each of us the call and commission to “do ministry” with others. But how?

[We] have a matchless, wonderful opportunity to meet people at times of their real need when they are ready to open up their hearts and expose their fears and worries and concerns. They will talk about their families and about eternity and the other things that are bottled up inside them. They are broken and afraid when they face a medical situation. They often are very willing to express these things, and this gives us the opportunity to present the grace of our Lord Jesus Christ. In the active practice of our profession, we need to know and have available to us, on call as it were, other people who can participate with us in the great work of witnessing to the love of God. I believe we should know people in our church and in our hospital—nurses, mothers, people who have been bereaved, people who have suffered, people who know how to sympathize and comfort—so that in our busyness, when we cannot give as much time as we ought to give, we can call on someone else to help. It would be wise to have a list of other members of the body of Christ who could help us in this great work.”
—Paul Brand, MD



After having more and more spiritual crises pop up in our day-to-day care and talking to other Christians wrestling with the same issue, we decided to utilize a Spiritual Care Team in our practice. Emmer and Brown first described Spiritual Care Teams in healthcare literature in 1984. They defined a Spiritual Care Team as a group of health professionals and staff who seek to integrate spirituality into patient care in a way that enhances their ability to provide “whole-person” healthcare that includes “spiritual care.”

For us it meant organizing two of our staff nurses into what we called our Spiritual Care Coordinators. Their role was to be sure spiritual assessments were recorded when indicated. And when spiritual needs arose that the physicians didn’t have the time or training to handle, their role was to coordinate this care with Spiritual Care Providers.

In our practice, the Spiritual Care Provider took two forms:

  1. We could have used chaplains, but none were based in our town’s hospitals. So we approached pastoral professionals and Christian counselors in our area to see if they’d be available for referrals or consults, and not a single person turned us down. Their biggest complaint over the years was that we didn’t use them enough!
  2. The second type came from our patients and close friends—Christians who were mature in their walk with Christ and had successfully wrestled with (or were wrestling with) a specific health crisis or problem. People in this group were more than delighted to join us, and we called them our “lay ministers.”

John and I were now able to utilize spiritual interventions without the worry of a spiritual crisis, for we were now quarterbacking a team—the body of Christ—in providing whole-person care. Practice became a joy. It was not overwork but overflow. We actually became both more fruitful and more efficient.


Dr. Sherry O’Donnell followed a path similar to our practice. She developed a consult and referral network with pastoral professionals in her one-doctor clinic in Southern Michigan, plus she developed a training program for lay ministers and was able to have a lay minister in her clinic every day she was open. Most would serve a half-day at a time. Some would be in the waiting room visiting, while others would stay in the staff lounge praying for and over the clinic. All were available to be called into a patient room at a moment’s notice to listen, to share, to pray.

A hospitalist physician worked with one of his administrators to authorize a Christian nurse manager to be his Spiritual Care Coordinator. She worked with the doctor to coordinate spiritual needs with the hospital chaplains and several local pastoral professionals as Spiritual Care Providers.

A group of Christian anesthesiologists who wanted their work to become a ministry in their academic center worked with administration to have a Christian nurse manager become their Spiritual Care Coordinator, and then they coordinated with local prayer warriors who would be at the hospital chapel each day to pray for folks in surgery who desired prayer and with hospital chaplains who could be called in when indicated.

A group of Christian medical students met with a Christian faculty member to brainstorm how to incorporate their faith into their clinical rotations. Two Christian emergency room physicians developed a small Spiritual Care Team in a large inner-city hospital and their personal ministry bore incredible fruit. A Christian dentist worked with her hygienists to add a spiritual assessment to their dental intake form. One of the hygienists volunteered to be the practice Spiritual Care Coordinator, and as a team they began to

pray for and with patients and developed a small group of Spiritual Care Providers for referral when indicated. She told me, “I never imagined my dental practice could be a thriving ministry—but it is.”

The members of the Spiritual Care Team and their roles will vary depending on whether the setting of care is outpatient or inpatient. For outpatient settings, the Spiritual Care Team is headed by a healthcare professional and a Spiritual Care Coordinator (a nurse or clinic manager assisted by the nursing and administrative staff), as well as chaplains, community pastoral professionals and/or lay ministers. In inpatient settings, the Spiritual Care Team can have the same basic makeup, but could also include a social worker or case manager, behavioral health professionals and even the patient transport, food service, maintenance and cleaning staff.HEALTHCARE PROFESSIONAL
The healthcare professional’s responsibility is to be the coach of the Spiritual Care Team—to help form it and supervise it. The Spiritual Care Team can be as small as the healthcare professional and the Spiritual Care Coordinator. After that, the healthcare professional’s major role, other than undergirding the entire ministry with prayer, is to conduct a brief spiritual assessment with most or all patients in order to identify spiritual needs. The healthcare professional needs to know about factors that could affect the patient’s health and their compliance with the medical care. Thus, it’s highly advantageous to both the healthcare professional and the patient to take this history. Once spiritual needs are identified, the healthcare professional can then work with the Spiritual Care Coordinator to ensure these needs are addressed.

The Spiritual Care Coordinator is most likely to be a nurse or a clinic manager, but it could also be the healthcare professional’s spouse or pastor. If the physician is the coach of the Spiritual Care Team, the Spiritual Care Coordinator is the quarterback of the team. The Spiritual Care Coordinator has a number of roles, and the first duty is to hold the healthcare professional accountable for conducting and recording spiritual assessments. Then, they can review the results of the healthcare professional’s spiritual assessment and identify and prioritize the spiritual needs that require addressing. The Spiritual Care Coordinator does not conduct the assessment. The healthcare professional’s assessment cannot be deferred to the Spiritual Care Coordinator, since the healthcare professional needs to collect this information first hand. Next, the Spiritual Care Coordinator manages each step to ensure the patients’ spiritual needs are addressed, providing resources as needed (for example, information on local faith communities, spiritual reading materials, information on pastoral care services and so forth).

Chaplains, pastoral professionals and/or lay ministers are a critical component of any Spiritual Care Team. They are responsible for conducting a more comprehensive spiritual assessment to clarify spiritual needs and develop a spiritual care plan to address them along with the healthcare professional and Spiritual Care Coordinator. If a Spiritual Care Provider is necessary, the Spiritual Care Coordinator can prepare the patient to see the person, explain the reason for the referral, describe the training or qualifications the person has and discuss what the person will do. The Spiritual Care Coordinator can also prepare the Spiritual Care Provider for the patient, informing about the spiritual needs identified and why the patient is being referred.



Why should I take the time to form a Spiritual Care Team to assess and address the spiritual needs of my patients? Shouldn’t this be someone else’s job? The chaplain? A pastoral professional? Someone in administration who has the time? 

In short, no! This is our job as healthcare professionals, and it allows us to take back our rightful position as the patient’s healthcare advocate and coach. The major goal of the Spiritual Care Team is to help you provide spiritual care to all of your patients who desire it.

But I don’t have time to add one more responsibility to my day. I barely have enough time to perform my currently required duties and then document the results. If I open Pandora’s box by taking a spiritual assessment, there’s no way I will have adequate time to address the issues uncovered. 

I understand completely. In fact, in the 25 years I’ve been teaching CMDA’s Saline Solution and Grace Prescriptions courses with Bill Peel, the major obstacle most healthcare professionals have raised to incorporating faith into their profession was the reality of time. But consider this—isn’t the provision of spiritual care one of the reasons you were called and commissioned into healthcare?

By making a short spiritual assessment a cornerstone of your practice’s social history on each patient and also make addressing those needs a priority for the Spiritual Care Team, you will be taking the first steps into providing true whole-person healthcare. And you will be turning your patient care into a body-of-Christ ministry, whether you are in a solo practice, a multispecialty practice or a healthcare institution.

Dr. Harold G. Koenig, the Director of the Center for Spirituality, Theology, and Health at Duke University, writes, “Doing a brief spiritual assessment must be a priority for the physician and addressing those needs a priority for the spiritual care team. This is not an optional activity, but central to providing ‘whole-person’ medical care. Furthermore, the spiritual assessment can actually save time, improve the relationship with the patient, improve compliance, and make the physician’s work more rewarding.1” After John and I began utilizing a Spiritual Care Team, we found our efficiency, spiritual ministry and satisfaction with practice all increased. In addition, our practice was named “The Most Efficient Medical Practice in America” by Medical Economics.

“You are the salt of the earth. But if the salt loses its saltiness, how can it be made salty again? It is no longer good for anything, except to be thrown out and trampled by men.”
—Matthew 5:13

Could working with a Spiritual Care Team potentially increase the quality of your patient care, your personal and professional satisfaction, and your efficiency in caring for patients? Could a Spiritual Care Team allow you as whole person to provide whole-person care—the call and commission the Bible gives each Christian healer—and allow you to bring all of who you are to all of what your patient needs? Could it be within your reach?

Let me encourage you to prayerfully consider studying more about setting up a Spiritual Care Team (Dr. Koenig’s article explaining exactly how to do this and how to address the many objections you may face can be found at Begin praying for God to provide a Spiritual Care Coordinator to work alongside you, and then present a proposal to pilot a Spiritual Care Team where you practice. You and your Spiritual Care Coordinator can begin recruiting Spiritual Care Providers to be available.

I pray this information will allow you to efficiently and effectively begin providing the whole-person and spiritual care to which you have been called and commissioned. Who of us would not want to be able to practice as a healthcare professional, in the power of the Holy Spirit, undergirded with fervent prayer, and leave the results to God? To experience our

work as worship? To see healthcare as ministry that involves the body of Christ? To become salt that is flavorful and light that is attractive to the patients we see each day? To see God work in and through us each day in patient care?

There can be no higher calling—even in the midst of terribly busy and demanding days—of finding where the Spirit is at work and being able to briefly, but effectively, fan the flame of His work in the hearts of the hurting people He is calling to come into their Father’s eternal embrace.


What in the world did I do with Paul, my patient who was having a spiritual crisis when I didn’t have a Spiritual Care Coordinator to help? I quickly asked the four questions I normally ask in a potential emergency—spiritual, physical, emotional or relational:

  1. Is it an actual emergency? Or can the situation actually wait?
  2. Am I the best one to handle this? Or can I refer this to someone else?
  3. How will my decision affect others? Other patients who are waiting? My work colleagues?
  4. Is this the best time? Or can I schedule this later?

“For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.”
—Ephesians 2:10

In Paul’s case, since we as a practice had prayed for him for so long, and since I felt I was the one who should answer his questions even though we were so behind, I excused myself from the room. My partner John was in the hall talking with two of the nurses. I quickly explained the situation. John gave me permission to take all the time I needed. The nurses would let the patients who were waiting know the situation. They would give them the option to continue to wait, see John or reschedule. And the front office staff began letting patients who were on their way know we had hit a snag so they could reschedule if they desired.

I then had the freedom to spend some quality time with Paul. I answered his questions and then briefly shared the gospel. With tears in his eyes, we held hands and he asked the Lord to become his Lord and Savior. He was changed, but so was I. I left the room and, with Paul’s permission, called Bob, a Christian businessman who had recovered from the same type of cancer. Bob came to pick up Paul, took him to lunch and began discipling him that very day.

By the way, it will likely be no surprise to you that the schedule “miraculously” took care of itself. Some folks canceled. Some no showed. Others were happy to reschedule. Another Christian physician “just happened” to be in the ER and was happy to see the patient waiting for me there. Obviously, God was sovereign, even over my crazy schedule, and He was working in more ways than one—to show me how He would work in and through His body to draw my patients to Himself. What a joy!


  • Grace Prescriptions: Incorporating Spiritual Care in Your Practice by Walt Larimore, MD, and William C. Peel, DMin is available at
  • Workplace chaplains may be available in your area to help with your practice. Check with Marketplace Chaplains at or Corporate Chaplains of Americas at
  • Helping Hurting People: Lay Minister Training includes 29 one-hour training videos for training lay ministers for your practice. Contact Dr. O’Donnell at
  • Stephen Ministries equips and empowers lay caregivers—called Stephen Ministers—to provide high-quality, confidential, Christ-centered care to people who are hurting. For more information, visit


  • Identify the spiritual needs of patients related to illness.
  • Competently address those spiritual needs.
  • Create an atmosphere where patients feel comfortable talking about their spiritual needs with the healthcare professional and other team members.
  • Provide whole-person spiritual care to all patients they serve.



1 Harold G. Koenig. The Spiritual Care Team: Enabling the Practice of Whole Person Medicine. Religions 2014, 5, 1161– 1174. Also available at

Walt Larimore Image

About Walt Larimore, MD

Colorado, UNITED STATES OF AMERICA Award-winning Family Physician and Best-Selling Author Walt Larimore, MD Nationally-Recognized Family Physician and Educator Dr. Larimore has been a practicing family physician for over 30 years (delivering over 1,500 babies). Besides seeing patients, part time, and volunteering for Mission Medical Clinic, a free, faith-based health clinic for the poor sponsored by over 100 churches and religious organizations in Colorado Springs, Dr. Larimore teaches family medicine part-time, holding adjunct clinical academic appointments at the In His Image Family Medicine Residency Program in Tulsa, OK and the University of Colorado Family Medicine Residency Program in Denver, CO. Dr. Larimore has been listed in Distinguished Physicians of America, The Best Doctors in America, Who's Who in America, Who's Who in Medicine and Healthcare, Who's Who in Science and Engineering, International Health Professionals of the Year, and International Health Scientists of the Year. In addition, Dr. Larimore has been listed in the Guide to America's Top Family Doctors, America's Registry of Outstanding Professionals, and The 2000 Intellectuals of the 21st Century. In 1996, Dr. Larimore was named America's Outstanding Family Physician Educator (Thomas W. Johnson Award) by the American Academy of Family Physicians and in 1999, he and his wife, Barb, were named National Educators of the Year by the Christian Medical Association. Dr. Larimore was listed as an inaugural member of the Leading Educators of the World (in the field of family medicine), by the International Biographical Centre of Cambridge, England. Dr. Larimore served as Medical Director of Mission Medical Clinic from 2008-2012 and as Vice President and Family Physician in Residence at Focus on the Family from 2001 through 2004. Prior to moving to Colorado in 2001, Dr. Larimore practiced family medicine in Kissimmee, Florida for 16 years. During this time he served over a decade as a volunteer physician for the U.S. Olympic Committee and was named to the Great Florida Shootout Basketball Tournament Hall of Fame. From 1981 to 1985, Dr. Larimore practiced in the small town of Bryson City in the rural Smoky Mountains of North Carolina. Dr. Larimore completed his Residency in Family Medicine at Duke University Medical Center in 1981 and completed a General Practice Teaching Fellowship at Queen's Hospital in Nottingham, England in 1978. His M.D. degree, with AOA honors, was from Louisiana State University School of Medicine in 1977; and his B.S. degree was from Louisiana State University in 1974. Dr. Larimore is Board Certified and re-certified (four times) by the American Board of Family Medicine and has been awarded the Certificate of Added Qualification in Sports Medicine by the ABFM. Dr. Larimore and his childhood sweetheart, Barb, live in Colorado and have been married over 38 years, have two adult children, two beautiful granddaughters, and a cat named Jack. Best-Selling, Award-Winning Author Dr. Larimore is a prolific author and has written, co-written, or edited thirty books, thirty medical textbook chapters, and nearly 700 articles in a variety of medical journals and lay magazines. His best-selling books include Bryson City Tales, Bryson City Seasons, and Alternative Medicine: The Christian Handbook. His books have garnered a number of national awards, including three Gold Medallion Award nominations, three Christy Award nominations, a Retailer’s Choice Award, and a Book of the Year Award from ECPA. Dr. Larimore currently posts a twice-a-day topical devotional ( and since 2007 has written a health column, Ask Dr. Walt, for Significant Living magazine. From 2007-2012, Dr. Larimore posted a medical and health news blog (, for which he posted nearly 3500 articles. Dr. Larimore co-wrote, with Barb, his childhood sweetheart and wife of over 38 years, His Brain, Her Brain: How divinely designed differences can strengthen your marriage. He also wrote the health chapter for Coach Joe Gibb’s best-selling book Game Plan for Life. Dr. Larimore’s most recent health book is 10 Essentials of Happy, Healthy People. He’s also recently written two books for kids going through puberty (and their parents). The Ultimate Guys' Body Book: Not-so-stupid questions about your body was published in 2012 and The Ultimate Girls' Body Book: Not-so-stupid questions about your body will be published in 2014. Since 2010, Dr. Larimore has published four novels. The first two, The Gabon Virus and The Influenza Bomb, were written with his dear friend Paul McCusker. His first two solo novels, Hazel Creek, and its sequel, Sugar Fork were released in 2012. His best-selling books, about his first years in practice as a family physician in the Great Smoky Mountains of North Carolina, includesBryson City Tales, Bryson City Seasons, and Bryson City Secrets. In 2012, Dr. Larimore wrote the introductions to two books: a devotional, Walking with Jesus in Healthcare and a book on nutrition, Alive! A Physician's Biblical and Scientific Guide to Nutrition. He was also featured in Miracles & Moments of Grace: Inspiring Stories from Doctors. Dr. Larimore was the General Editor for Updates in Maternity Care (2000) and served as a contributing author for the Mayo Clinic's Complete Book of Pregnancy and Baby's First Year, Focus on the Family's Complete Book of Baby and Child Care, and Focus on the Family's Caring for Your Aging Loved Ones. His thirty medical textbook chapters have been on topics ranging from maternity care, prenatal care, sports injuries, endoscopy, rural health economics, and ethics. Award-Winning Medical Journalist Dr. Larimore was a medical journalist from 1995 to 2012. From 1995-200, he hosted over 850 live daily episodes of the National Cable TV Show Ask the Family Doctor on America's Health Network and later on Fox's Health Network. While with Fox, Dr. Larimore was awarded the prestigious "Gracie" Award in 2000 by the American Women in Radio and Television for his work on a program about breast cancer and reconstructive surgery for Fox News' Health Network. Besides hosting the show in-studio, he also performed investigative and fieldwork. At its peak, his show was available in over 28 million American homes. Joe Maddox, the past President and COO of America's Health Network, said that Dr. Larimore had more "... actual on-air TV experience than any physician in the history of television." Dr. Larimore also hosted a medical news minute on The Health Network and the Apple a Day segment on The Health Network and later on Discovery Health TV Network. On Ask the Family Doctor, Dr. Larimore hosted several of the nation's first live televised medical procedures. He conceived and hosted the first worldwide live Internet and TV birth in June 1998 – a then innovative approach to reality TV that was covered by most large media outlets. Of his hosting, the international edition of Time Magazine said, "Dr. Walt Larimore, a distinguished private physician conducted the exercise like a veteran 60 Minutes reporter." Dr. Larimore appeared in interviews on NBC's "The Today Show;" "CBS Good Morning;" "CNN Headline News;" CNN's "Anderson Cooper 360," CNBC's "The Abrams Report;" PBS' "Family Works;" and several Fox News shows. He has also been interviewed on Bill O'Reilly and Sean Hannity's shows. Dr. Larimore served as an on-air Medical Consultant for many radio stations, including WDBO in Orlando; WMBI, Chicago; WISG, Indianapolis; KNKT, Albuquerque; WBCL, Ft. Wayne and the Indiana State Network; WOCL, Baltimore; Kim Jeffries’ Along the Way, Northwest Radio Network; KFSH, Los Angeles; WKES, Tampa, Lakeland, Orlando, FL; WSOR, Naples, Ft. Myers, Cape Coral, FL; WHGN, Crystal River, Inverness, Ocala, FL; WKZM, Sarasota, Bradenton, FL; Life Perspectives, American Family Radio; KTIS, Minneapolis; WRMB Boynton Beach, Okeechobee, Stuart, and Ft. Pierce, FL. Dr. Larimore has also served as a medical consultant for the Total Living Television Network, CCN (Christian Communications Network),, and Dr. Larimore hosted the nationally syndicated Focus on Your Family's Health from 2001 to 2004. These 90-second daily news features were in as many as 75 radio and 37 TV markets across the U.S. Dr. Larimore also provided live on-air interviews to local TV affiliates and national cable TV outlets about breaking medical news. As a family health and medical expert, Dr. Larimore has been sought for print interviews with dozens of newspapers: including the Wall Street Journal, New York Times, LA Times, Boston Globe, Boston Herald, Chicago Tribune, Washington Times, Orlando Sentinel, National Catholic Register, Malaysia Strait Times, South China Post, and the UPI. Dr. Larimore has been interviewed by a number of national magazines including Redbook, In Touch Weekly, Life & Style, Significant Living, Today’s Christian, Home Life, Family Life, Stand Firm, First for Women, Today’s Christian Physician, My Family Doctor, AMA News, Family Practice News, and Pediatric News. Contact Dr. Larimore by email.

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