Hospitalists - This Patient’s Take
Usually, I like keeping the really serious stuff off from the front of my blog. I’m a persistent comment dropper … especially when I think I can sneak in a word or two on someone else’s blog … particularly if they touched upon something I’m intensely interested in. Some pretty engaging conversations can take place in comments - virtually invisible to visitors unless they stick around and do a bit of exploring. Also, I don’t mind occasionally posting something that evokes a bit a thought on my own blog … but I generally try to keep the controversial stuff off from the front page. I’m going to break that rule today.
Earlier today, I posted a comment on Dr. R. Centor’s Medrants. Yesterday, he put up a post about hospitalists, and was asking for people’s input. I’ve commented on hospitalists before … and was really drawn to doing so again - but had decided to keep my distance. When the same post was still at the top of his blog this morning, it was more than I could bear, and like a moth is drawn to a flame, I fluttered in close enough to get a whiff of singed wings.
It seemed like only a few moments after I’d finished that my Bloglines warner beeped at me, and I checked to see who had just posted … it was Dr. Centor … and here was the title: “Listen to Moof comment on the hospitalist movement.” There was my entire comment - as a post. - Oh my. Caught! Red faced. - So much for a low profile.
Once my face stopped burning, I decided that he may actually have done me a favor … the ice is broken now, so why not write what I think about issues that concern me? Why not indeed. So - here goes. Those of you who only drop in for Bean Stories and light Musings can consider yourselves forewarned …
A few years ago, I was diagnosed with a chronic illness. It’s given me some ups and downs, and for a while, it seemed as if I spent more time as an inpatient than as an outpatient. Our hospital had just started using hospitalists, and on my second time as an inpatient, I was dismayed when I only saw my own doctor once - more as a “guest” than a physician. It was not at all comfortable dealing with this new fellow who’d been dropped on me seemingly out of nowhere, even if he was very nice, and seemed to be a good doctor. I didn’t know him.
Before I continue, just a bit about myself to set the atmosphere … I’m one of those people who is not comfortable with the physician/patient venue. In fact, before my chronic illness, I had seen one in 16 years … and if I had not gotten ill, it would now be over 18 years. After I was diagnosed, and it finally got through to me that life was simply not ever going to be the same again … that I was going to have to deal with these fellows in the white coats whether I wanted to or not, I tried to put a good face on it and do my best to be a “good patient.” I hope my PCP never sees this blog … he’d probably have an aneurysm from laughing so hard. But I did try … I still try. It took some major effort on my part to even begin being candid with these people whom I don’t know. With trial and error, I found that I did better with writing than I do nose to nose … but then I still had to overcome the obstacle of letting the dear man know that I had written something. *sigh* I know that not everyone faces the same problem with being forthcoming with their physicians, but in my own case, I had to work very hard at developing some sort of relationship with my PCP … and with the other specialists which I had to see. To more or less of a degree, I’m certain that most patients have to work hard to learn to be candid about intensely personal things with people they don’t know …
You can perhaps begin to get an inkling of how difficult it would be for someone like myself - and others who have similar difficulties, and even some who don’t - to cotton to the idea of hospitalists. Yes, I can understand the logistics behind the position … it really does free up the PCP for spending more time with his patients in his office … more time with his family … and the inpatient benefits from the promptness of the medical attention/decisions they need without having to wait until their own physician can get away for his hospital run.
That said - there are some other issues to consider. I will briefly touch upon some of them, in no particular order:
And now for a few more personal/quirky considerations:
For myself - once I realized that my own physician was always going to dump me on hospitalists, I stopped seeing him, too. Although it’s been more than a year, I haven’t begun hunting for a different one, because I’m afraid that no matter who I choose, it will end up the same way. I’d rather just not see anyone than expend the effort to be intimately open with someone when he’s going to pass me over to a stranger when I need that familiarity the most.
How many of you have lost your patients after a hospital stay … and you don’t know why? Did they end up seeing a hospitalist? Did you inquire if they would have preferred to see you? That sort of attrition is going to continue - because the very people who have a hard time dealing with hospitalists are the same ones who would rather vanish from your office, and either see someone else, or no one at all, than confront you. And if they don’t leave, has the trust between you been damaged? Have you asked how they felt about hospitalists? In fact, have any of you even considered asking patients their opinion on such a thing - considering they’re the ones who are going to be forced to deal with the experience?
Medicine is becoming so impersonal … from the point of view of a patient with a chronic illness, that’s pretty scary/uncomfortable/nightmarish. Hospitalists themselves are not the problem … I think that having doctors who are hospital based is a good thing … but I think that if ever a primary physician willingly turns the full care of his hospitalized patient over to another physician, then he needs to ensure that the patient isn’t lying through his teeth about how he feels just so he can get out of the hospital and away from a situation he may find is even more uncomfortable than his medical problem.
If I’m cultivating a relationship with a dear friend, and the minute I have a problem which calls for a shoulder to cry on, that friend fends me off on someone else they know (It’s ok! They have a lot of experience at being friends!) any previous trust engendered by the relationship is going to plummet.
Some of your patients don’t just see you as white jackets. Some of us see you as people - and we learn to relate to you as individuals. We are not just seeing you as what you are, we are also seeing you as who you are, and that part can’t be substituted by just any other white coat.
February 3rd, 2006 at 10:29 pm
I know what you mean about Docters and the trust factor. My PCP is very important part of how comfortable I feel in certain situations. She unfortunatly dosn’t see patients in the hospital. However, if I have to go to the hospital she sends me to the ones she has connections to and she gets all the information and updates and personally talks to whomever when needed. Im not one hundred percent comfortable with this but as busy as she is I understand it. She knows how I am with Docters and if I don’t like them I will not deal with them at all. So she is very careful who she sends me to and if she dosn’t know them well and how they deal with patients she wont send me to them. I was lucky when I had both of my children. My Obgyn works next to the hospital I stayed in, litterly down the hall so to speak, and he came to see me and check on my war wounds lol every morning. My OB is awesome and anytime I have anything done -which has been alot- he is always there to answer any questions even after surgery when most Dr’s take off. He knows I like to have answers as soon as I wake up and I don’t like to wait for two weeks afterwords to find out something. This is very comforting especially given his field. I would honestly feel better if my PCP did the same and fortnatly I have not run into a situation where she was needed like this.
February 3rd, 2006 at 11:43 pm
“Listen to Moof comment on the hospitalist movement.” I went, I read, and I left a comment. I am total agreement with the state of our health care, being a vet. I stoped going to the VA Hospital out of disgust with foriegn doctors.
February 4th, 2006 at 12:46 am
You said what I’m sure many, many patients feel. I myself am where you were before your illness; I haven’t seen a doctor since I was hospitalized for pericarditis before I moved to Illinois. And before that, I hadn’t seen one since I had my son, which was 1996.
I finally, though, have health insurance (no matter how temporary it may be due to the sale of Jewel to SuperValu), and I’m thinking it’s probably time to try to find a PCP and a GYN here in Illinois. I’m on the opposite pole from you, however, I much prefer a woman doctor, especially for a GYN. I’m not looking forward to this process of finding someone with whom I have to share intimate details about my physiology, though, and knowing myself as I do, I’m probably going to keep putting it off until either I am forced to do it as a result of an illness, or my health insurance gets terminated due to the change of ownership of the store I work in.
February 4th, 2006 at 8:48 am
[…] and for more from Moof on this issue - Hospitalists - This Patient’s Take […]
February 4th, 2006 at 9:19 am
Wolfbaby - thank you for your comments - it’s important to have physicians you can relate to, and it seems as if you mostly do. Have you considered talking to your GP and being open about what sort of response you’d like from her?
William … thanks for the comments dear. You wrote “I stoped going to the VA Hospital […]” … I hope that you’re still going someplace, though … right?
Shelly! The newly wed! Welcome back to my blog. Listen my friend - don’t wait until just before your insurance runs out to make an appointment - if something’s wrong with you, you’d find yourself in a real bind. *poke poke!*
February 5th, 2006 at 8:56 am
Hi Moof,
I think I want to get involved in this, but I need some definitional help. I almost hesitate to ask because it seems like such a stupid question.
What does “hosptialist” mean?
Is this just any doctor who works in hospital, so what we would call “a hospital doctor” of does it have a more special meaning? Is it something to do with “hospices” as opposed to hospitals?
As a PCP I would, predictably enough, very much sympathise with your position, but would you just help me with the definition first, please.
John
February 5th, 2006 at 9:12 am
Hi again Moof
Right it’s Sunday afternoon, and I have time, and I have been following your comments around. I guess a hospitalist is just a hospital doctor.
You said:
“I feel strongly enough about this subject that I will simply not see a PCP again … since when I need him most, I now know I’m going to end up with a stranger anyway. Over the last year or more, I’ve discovered that I’m not the only one who feels that way. Most of us haven’t said anything to our physicians, we’ve just stopped seeing them.”
Initial reaction from a PCP like me is one of sadness… but I see the point. In the UK the PCP is a gatekeeper and is not involved in hospital mangament. And frankly, we do not have the expertese to do hip replacemnts or mangae complex internal medicine cardiac problems.
BUT what happens to someone who gets a terminal illness? My own strong belief is that they are going to be better at home with family and friends and being managed by the PCP at home. Of course, GPs in the USA do not do home visits very often (or do they? they cerainly did NOT when I was doing family practice in Chicago) so what happens? How do you get medical support?
John
February 5th, 2006 at 6:30 pm
[…] Hospitalists - This Patient’s Take […]
February 5th, 2006 at 8:50 pm
Hello Moof,
Sorry to take so long to add your link to my blogroll, but I’ve done it.
Listen, I don’t like the hospitalist trend any more than you do.
1. Loss of control. I’m a control freak and I cannot abide what we call in our business “fragmentation of care”. Definition of this is basically two docs managing the same problem. It’s bound to create problems.
2. Loss of revenue. We get paid to take care of patients in the hospital. The payors seem to think our input is valuable enough to pay us well for it. Work done by hospitalists is money out of our pockets. [BTW, it needs to be said that, as a pediatrician, I rarely have patients in the hospital. When I do, I often send them to the big city hospital because that’s the only place that can provide the highly specialized services they need!]
One reason the hospitalist train is bearing down on us full steam is our fault (the PCPs, that is). It makes our lives easier - no getting up early and coming home late. No calls from the hospital at 2 AM.
Of course, all the payors and hospitals care about is that hospitalists tend to shorten stays. This is undeniable.
best,
Flea
February 5th, 2006 at 9:41 pm
Dr. Flea … thank you so much for your comment - and thank you for adding me to your blogroll - I’m honored!
Your comment is extremely interesting to me, because that’s how I see hospitalists too, when I try to see it from a PCP’s perspective.
The “fragmentation of care” … I didn’t say anything about that in my post, but I should have. I think I will try to post on that particular issue, if I can scrounge up enough courage to be adequately candid. At one point last year, I had 8 different doctors in two states … one was my PCP, and all the rest were specialists … 6 in NH, and 2 in MA. Honestly Flea, no one knew what the others were doing. The PCP was supposed to have a handle on it … but he really didn’t.
Looking back and reading the OR reports, and the tests and scans results which I carried back and forth between the home specialists and Lahey, I figured out what “the” central medical problem was … but I’ll make you any bet that none of my docs, PCP included, have any idea to this day.
At this time, I’ve trimmed it all back to seeing one physician: a nephrologist. Can’t do without him and keep blogging (or much else, for that matter. 0.o )
As far as “loss of revenue” goes … gee Flea … from what I keep seeing, others are saying that that they lose money seeing inpatients. Since I don’t know how finances work in the medical world yet - I’m still learning that as I work on my Medical Informatics degree - I can’t figure how some of you do better by seeing your own inpatients, and some do not. Is it perhaps the hospitals you belong to?
You said you’re in New England - well, I’m in the Dover, NH area. Locally, we have Wentworth-Douglass (Dover), Frisbie Memorial (Rochester), Porstmouth Regional (Portsmouth), Exeter Hospital (Exeter), and just across the line in Maine, York Hospital (York) and Goodall Hospital (Sanford). That’s all in a 25 mile radius … although, if you’re from NE, you realize that Dover/Portsmouth is not a “big city” area, it’s just a highly medical area. In Dover, nearly all of the generalists have offices which are “A Department of Wentworth-Douglass Hospital,” (I can think of only two who are not) and of those who are, all use hospitalists, and/or “on call” trade offs with each other. You’re almost guaranteed to not be cared for by your own physician as an inpatient.
Bad enough that the insurance companies have both sides of medicine (providers and patients) over a barrell, this wholesale “sell-out” by generalists is only making things worse.
I want to reiterate that I think hospital based physicians are a good idea. If my PCP is vacationing, or I don’t have a PCP, then a hospitalist would be quite nice. Also, if my own PCP is in his office seeing patients, or unable to be reached, or it’s 2 AM in the morning, and I’m an inpatient having some sort of medical crisis, then again, a hospitalist is a very nice commodity. But to have them completely take over my care as a matter of course is another thing altogether.
And now, on a different note - you’re in New England, you make house calls and also do not use hospitalists? Just how young do your pediatric patients need to be … ?
*blinks innocently!* ;-)
.
February 6th, 2006 at 5:27 am
LOL! If you can blog, you’re too old for me!
Good luck in your research Moof. I too would like to know how docs lose money on hospitalized patients.
best,
Flea
February 9th, 2006 at 1:49 pm
Doctors lose money by seeing inpatients because of the inefficiency of driving back and forth to the hosptial everyday (or even walking from their office to the hosptial each day). One of the people above explained she liked to have her doctor answer her questions “first thing in the morning!”. I would like for my lawyer and accountant to answer my questions in person at a place that is convenient to me, but not them, but they don’t. And no one else besides doctors do that. You go to where they are at. If you spend 7 minutes driving to the hospital and 7 minutes driving back that is 15 minutes driving. That is an extra patient you could see in the clinic. The price you get paid for a follow-up in the hospital is roughly equivalent to the price you get paid for a follow-up in the clinic.
Additionally, if you don’t take hospital call, you don’t get out of bed at 2Am when someone is dying in the ER. You can awake refreshed, get to work a little earlier, and see an extra clinic patient.
The other side to this is that patients are rational consumers. They want to see an “expert” for their problem at a low cost at a time that is convenient to them. Internists and family practioners are not experts. Hospitalists know more about acute illness than doctors who practice solely in clinics. Patients have asked for and recieved more specialized care, but in the process have to accept externalities. Dr. Welby will not be there in the morning to pat your hand. Welcome to reality.
b
February 9th, 2006 at 2:19 pm
Bruce, I can’t help but notice that you made that comment anonymously, but that you come from a medical center of some sort, and I find that rather interesting. Hospitalist, maybe?
You certainly have it very cut and dry … some physicians would rather save 14 minutes in driving rather than let the patients who’ve learned to trust them have the reassurance that at least in some way, someone they’re familiar with knows what’s going on.
And any physician who tells me that he’d rather wake up a bit earlier, refreshed, than see a patient who’s trusted him, and is dying in the ER … wow! I’m sure plenty of docs feel like you do, Bruce … I guess that’s perhaps one of the reasons why I’m no longer seeing any of you.
You know Bruce, medical emergencies almost never happen at a patient’s most “convenient time,” either. We don’t necessarily want to see an “expert” at a “low cost at a time that is convenient to us” … we want to be able to see a physician when an emergency arises. We know it will probably not be our PCP … under the circumstances - but being completely abandoned by a trusted PCP to the hands of strangers over a hospital stay is another thing altogether.
I don’t know what frame of mind some people go into medicine with … but I’ve met a lot of different kinds of doctors in the last few years. Those who are practicing medicine for the love of medicine, and yes, even for the love of those they take care of … can’t hide it. You can feel it when you’re with them, and it engenders an amazing trust. Those who see it as a business - resenting the time they’re giving to people - doing a job … also can’t hide it.
Most of us aren’t looking for Dr. Welby, dear heart … most of us are just looking for someone we can actually count on when we need them the most … even if they are not the ones administering the care at that time.
February 10th, 2006 at 3:06 pm
Thanks for an interesting post, Moof. There a pluses and minuses to the hospitalist issue, and I will try to visit them in the future here or on my site. Let me just say this: I have always seen my own patients in the hospital, but this is not easy. I usually think of myself as having two jobs, my hospital job and my office job. When I finish 8 hours in the clinic I then get to look forward to hours more of hospital work.
Also consider that hospital work is a 365 day proposition. I can close my office Christmas day. Can’t sent all my patients home Christmas eve. Hospital work means getting called at 4 am by the ER. It means getting phone calls all day in the office, which disrupts my office schedule.
Worst of all, there is nothing more frustrating than having to leave patients in the waiting room because you have to run to the hospital to take care of a hospital emergency. A few really sick hospital patients can wreak havoc on the best-planned day at the office.
I continue to hang with it but sometimes it can be overwhelming to handle both. Medicine has succeeded in keeping sick people alive longer and the result is that the acuity of illness among inpatients has greatly increased in the last few decades. If people keep getting sicker it may simply be impossible to keep doing both.
February 10th, 2006 at 4:45 pm
Dr. Hebert! Thank you kindly for dropping in!
You know, I believe you’ve probably expressed it best of all … and from that perspective, it makes a great deal of sense. I could almost hear myself saying the same things, under the circumstances you’ve just described. I can also “hear” your own regret as you assess the situation …
I believe that hospitalists are an inevitability, especially as more and more physicians are specializing, and generalists are becoming more and more overworked - not to mention underpaid by comparison.
I see the common sense in the fact that a physician trained in emergency medicine might do better in the ER … or that a hospitalist might be better at dealing with in-house crises and so on. I can also see that the dual juggling would also be very disruptive of the regular care of your out-patients.
Isn’t there a way to compromise?
Perhaps … let the ER deal with the emergencies, as long as they know to contact you when faced with something unnusual - which you, being familiar with the case, may be able to clarify.
Perhaps, while letting a hospitalist do the bulk of the inpatient care, involve yourself in the following ways whenever possible: seeing your inpatients when you can; remaining aware of what’s happening with them, and having a hand in the decisions surrounding their care … but most importantly, allowing them to know that you are aware of their situation, and are actually taking an active part in their care …
This wouldn’t be perfect for anyone, I know. Not for the patient, who would more than likely prefer to have you do all of it … not for the hospitalist, who would find himself working as more of a team member with each generalist, while still doing the bulk of the work … and not for you, since you’d still have to make time for more than just the clinic.
But - it would also be a better balanced approach than the impersonal “take it or leave it” it’s becoming now - or the all or nothing, “go it alone” … headed for burn-out … which seems to be the other side of the coin.
You know what really bothers me? The idea that medicine seems to be becoming a job instead of a calling.
When the pastor of a church takes on the “job” of “feeding his flock,” he knows that he’s going to be called out at all hours to deal with emergencies, and that he’s never going to have a week end off! He enters the ministry with the idea of “serving” as a “minister.”
When I went to nursing school, it was with altruistic motivations. I had no notions of easy hours, large paychecks … and since I’d already been working in a hospital for years before that, I had no rosy dreams about what I was facing. The fellows that I knew who went off to medical school went with the same ideas - to serve. To help alleviate pain. To try to make living better for those around them.
No, none of us were climbing up onto a sacrificial altar, but we knew what we were getting into - we each chose our own aspect of medicine, knowing what kind of job it would be.
Don’t those who go into medicine today do it for the same reasons? I can’t believe people have changed that much over the years.
Hang in there, Dr. Hebert … and do what you have to do to keep going. If you care for your patients, they’ll always know it. Even those of us who are really opposed to “one size fits all” medicine understand that there’s only so much you can do. Just don’t stop caring.
February 16th, 2006 at 10:48 pm
One partial solution that crosses my mind involves allowing the patient’s personal physician to see the patient, say, every 3 days, and then bill the insurance company for a “patient counseling fee.” This fee needn’t be large — even $20 will do — but enough to compensate the doctor for coming in.
It may seem like I am being greedy. Obviously I could admit a patient to a hosptialist and see the patient every day for free. But hospital care is like a tar baby. Once you get involved, you are in it all the way. I have made the mistake of making gratis courtesy calls on people in the hospital and been bombarded with questions and concerns about the plan of care. I hate to say it, but I have learned long ago that if you are not getting paid on the case, stay away! A simple hello can blossom into a full-scale, no-holds-barred battle over which doctor said what and when and who is responsible for this or for that. When people are very ill they are afraid and may not respect boundaries the way one would like them to.
For this reason, I think courtesy calls by the primary doc should be reimbursed, even if just nominally to say, “We understand that talking to patients is practicing medicine too.”
These creases in medicine can be worked out, but it requires a recognition that the human touch is important in therapeutics. So far, I have gotten little indication from the business side of medicine that this is so.
February 17th, 2006 at 9:09 am
Dr. Hebert … a few ideas on your comment:
“It may seem like I am being greedy. Obviously I could admit a patient to a hospital and see the patient every day for free.”
I don’t expect (and I don’t think anyone does) to see a physician in a hospital or his office for free. I agree that all calls should be reimbursed.
About the touch factor and talking in medicine … until the “powers that be” understand that, and medicine “works it into” the regular repertoire (practically and financially,) real medicine will continue to lose patients to alternative medicine - which is not only sad, it’s scary.
“When people are very ill they are afraid and may not respect boundaries the way one would like them to.”
Are you sure they understand the boundaries? The first time I was ever admitted by someone other than my own physician, it took me several days to figure out what was going on. He dropped in on me on day one, and I never saw him again. I had no idea why … or why I was being seen by someone I didn’t know. Would have been nice if someone had explained the new policy.
He didn’t stay away due to becoming embroiled in a morass of silliness either … the only question I ever ask when in that position is when they’re going to let me out. ;-)
But seriously, I think that if patients are made to understand by yourself ahead of time that you’re not going to be the one taking care of them in the hospital if ever they’re admitted, they’ll just be glad to see you … especially if the hospitalist also reminds the patient that the call you make will be a courtesy call, and that they should save their questions for him.
I would think that if there were a problem beyond that point, although the patient knows that you won’t be dealing with their care until their discharge, that there might be something that the hospitalist isn’t communicating to the patient, or that the patient feels the hospitalist isn’t understanding … your input might actually solve a problem that could be potentially more serious - be it with the hospitalist or the patient.
I think these things can work, but there needs to be a fair standard, and the patients need to understand what’s going to happen before they find themselves in the situation, whenever possible. It has to be worth the physician’s while, too … that’s simply common sense.
February 18th, 2006 at 1:58 am
My father used to do quality research for hospitals. He ended up getting out of the business because hospitals really do not want to know how they are doing. They just want data that shows that their patients loved them so they could say things like “We have a 95% satisfaction rate” in their ads.
But what he found consistently was that patients complained because they never knew who they were talking to. The door would open and someone in a white coat came in and started asking questions. Sometimes the invader was a doctor, sometimes a nurse, sometimes a physical therapist. But today a lot of doctors wear scrubs in the hospital and nurses and techs do also, so who knows who is who? Sometimes even I don’t.
That is why I never wear scrubs, and I usually wear a tie when I round. Neckties are on their way out these days, but at least when I wear one I know i will not be mistaken for anything other than a doctor. I always tell a patient why I am there and who I am. If I am covering for another doctor, I say, “Hi, I am Dr. Hebert. I am seeing you for Dr. Jones today.” That is common courtesy, and the reason for the confusion in the hospital is simply that doctors are not courteous.
I could go on and on about courtesy, and though I have many liberal views, on this subject Miss Manners and I are 100% in concordance. Etiquette tells us how to behave and lets others know what to expect. It is a form of communication. People who refuse to adhere to standards of etiquette are refusing to communicate with others. It is like talking to someone with sunglasses on. You cannot judge their expression, so you cannot really tell how they are responding to what you say. This is not fair.
I learned a related lesson from a professor in medical school. He was a psychiatrist, and he complained that sometimes he would walk into a hospital room to see a patient, and the patient would look at him and say, “My doctor doesn’t think I am crazy. He didn’t say he was calling a psychiatrist.” He asked us if in our future practice we would be courteous physicians and tell a patient that we intended to consult a psychiatrist before actually doing so.
I have expanded his advice by always telling patients which other doctors or specialists I intend to get to see them.
February 20th, 2006 at 9:53 pm
Dr. Hebert, if all of the doctors did things in the way you did, hospitalists, or “on call trade offs,” would be far better accepted by a majority of patients. I know that I would still not be comfortable with a stranger, however, I would do my best to be cooperative and understanding for the duration.
When you comment that you sometimes have no idea who you’re dealing with from their outer appearance - I hear you! Believe me, it’s even more confusing from the perspective of a patient. Triple that if you’re a patient in a teaching hospital. That’s a real nightmare!
Your father had a tough job, Dr. Hebert … you’re right, all the hospitals wanted to hear was the good stuff. People who have a complaint or a criticism usually don’t make out too well. I can’t imagine what it must be like for someone who was actually hired to do “quality research!” He would have to either be very self assured, or very self sacrificing!
About your “liberal views” … I’ve noticed that you do have a few more liberal ideas, but on the whole, I consider what I’ve seen in your blogs moderately conservative. The only really liberal idea I’ve run across so far is the fact that you would like to see socialized medicine. I still wish you’d do a few “discussion” posts with me regarding that … it would be interesting, informative, and a great topic for the Concordia Discors blog. :)
August 29th, 2007 at 11:24 am
[…] each and every nurse and LNA … and hospitalist (and that one’s really saying something, coming from me!) … I still am yearning for a shower with soap that doesn’t make me look like I poured […]