What is about ethics that tend to cause mass confusion, riots, and nuclear annihilation? When you consider that not one person I have asked today can provide me with a direct answer should begin to give you an understanding why this occurs: people fear what they do not understand. As a result of this misunderstanding, ethics can generally be defined as many different things to many different people. Often, ethics are confused with morality leading many highly educated professionals or "Joe six-packs" to make unethical decisions. Sometimes I find myself questioning what is ethics? I also tend to try and convince myself in true "Law and Order" style as to why something is ethical or unethical. This is never a very effective or efficient manner as talking to yourself is consider a faux pas by many of my co-workers. However, throughout these years I have come up with one simple understanding of ethics: ethics is the weak minded, timid brother of morality.
Morality is a robust and easy to understand "feeling". Often, morality tends to give us a clear direction as to where we are headed and how we are going to get there. Unfortunately, morality also tends to step on others' morality in it pursuit of global domination. In many ways morality means well, but like a bull in a china shop tends to destroy and fracture many items around it. Ethics, on the other hand, is the much more timid, scientific (if you will) brother of morality. Both are the offspring of social and cultural rules established through the hilarious trial and error process of our relatives. Both have been examined and re-examined by scholarly geniuses and the not so scholarly. However, ethics tends to take a much more scientific and worldly view of society and its actions as opposed to morality's local and finite understanding of the world around it. The constant quest of ethics isn't necessarily to be right, but rather to be fair.
So what exactly is ethics? For me, ethics is a way of combining the general aspects of morality, social norms, evidence based practices, the law, and common sense. Ethics is also a long term solution to a social dilemma. For many, ethics can be a painful decision to make, but it is usually the wise decision leading to successful longevity for both the individual or organization. However, as society evolves, ethics evolve. This means that professionals and organizations must be willing to invest both time and resources into continually evaluating, examining and, if needed, re-writing their own ethical backgrounds. This agreement is critical if ethics is to continue to evolve and our understanding to increase.
In summary, ethics is something that no one person or organization can define. On an organizational or individual level, ethics tend to vary greatly. However, ethics can be viewed as a combination of morality, social norms, evidence based practices, the law, and good ole' common sense. While we may never truly understand what it means to be ethical, we can agree that it is ever changing and evolving. At minimum, I know that I am 75% right all the time.
Friday, July 15, 2011
Saturday, June 25, 2011
The Ultimate Healthcare Employee
What exactly is the best qualities in a healthcare employee? Is tact, compassion, competence, high work ethic, or diligence the most important? In many ways these qualities tend to boil down to three aspects (not in order of importance): 1. Passion for their profession, 2. The ability to use intelligence in an efficient and effective manner, and 3. The ability to work together.
One of the most important qualities for any potential candidate is not only the ability to work well and cooperate, but also have the desire to do so. Cooperation is the benchmark of any well organized, efficient, and effective healthcare organization as many departments tend to overlap and are heavily dependent on one another. This quality has become so important that many hiring managers have begun to examine beyond the professional and academic qualities of an individual to see if they can become part of the "team" (Bowen et al, 1991). The ability to cooperate and act in a professional manner at all times, while seemingly a simple request, can have a significant effect on the overall efficiency, clinical efficacy, and financial stability of the organization. In summary, the faster the work is processed the more inexpensive the product becomes.
While the ability to cooperate can be look upon as the foundation of any "team", it is also important that each member of the team be well informed, well educated, and continually updated on any pertinent information. Generally, this does not mean that the individual has the potential to be intelligent, but rather that they have the continued ability to gain further knowledge and insight into new techniques, tools, etc. in the ever changing healthcare field (Ganzach, 1998). The ability to have new information and in turn apply it in an effective and efficient manner can not only improve the overall quality of the organization, but also have significant impact on improving employee moral.
Finally, a healthcare employee must have a passion for their work. The healthcare industry is similar in many ways to other industries, but is also incredibly different at the same time. The reason behind this is simple: every action each employee takes directly or indirectly affect the livelihood of an individual. It is critical that each employee or potential employee have the desire to work as many hours as possible, work as hard as possible, or learn as much as possible to help improve the lives of others around them. In the end, while organizations must remain financially solvent it is even more critical that they also remain passionately solvent.
References:
Bowen, D., Ledford, G., Nathan, B. (1991). Hiring for the Organization, Not the Job. The Executive, 5(4), pp. 35-51.
Ganzach, Y. (1998). Intelligence and Job Satisfaction. The Academy of Management Journal, 41(5), pp. 526-539.
One of the most important qualities for any potential candidate is not only the ability to work well and cooperate, but also have the desire to do so. Cooperation is the benchmark of any well organized, efficient, and effective healthcare organization as many departments tend to overlap and are heavily dependent on one another. This quality has become so important that many hiring managers have begun to examine beyond the professional and academic qualities of an individual to see if they can become part of the "team" (Bowen et al, 1991). The ability to cooperate and act in a professional manner at all times, while seemingly a simple request, can have a significant effect on the overall efficiency, clinical efficacy, and financial stability of the organization. In summary, the faster the work is processed the more inexpensive the product becomes.
While the ability to cooperate can be look upon as the foundation of any "team", it is also important that each member of the team be well informed, well educated, and continually updated on any pertinent information. Generally, this does not mean that the individual has the potential to be intelligent, but rather that they have the continued ability to gain further knowledge and insight into new techniques, tools, etc. in the ever changing healthcare field (Ganzach, 1998). The ability to have new information and in turn apply it in an effective and efficient manner can not only improve the overall quality of the organization, but also have significant impact on improving employee moral.
Finally, a healthcare employee must have a passion for their work. The healthcare industry is similar in many ways to other industries, but is also incredibly different at the same time. The reason behind this is simple: every action each employee takes directly or indirectly affect the livelihood of an individual. It is critical that each employee or potential employee have the desire to work as many hours as possible, work as hard as possible, or learn as much as possible to help improve the lives of others around them. In the end, while organizations must remain financially solvent it is even more critical that they also remain passionately solvent.
References:
Bowen, D., Ledford, G., Nathan, B. (1991). Hiring for the Organization, Not the Job. The Executive, 5(4), pp. 35-51.
Ganzach, Y. (1998). Intelligence and Job Satisfaction. The Academy of Management Journal, 41(5), pp. 526-539.
Monday, June 20, 2011
"I Perform Surgery Better when I've had a Few!": and Other Phrases You should never Hear from a Surgeon.
I have often find myself wondering what exactly would posses an individual from becoming a physician. The only one that I know by name is my father, there are no physician trading cards, and for the most part each of them are not "rolling in dough". I have often found myself asking friends or peers who are in medical school or planning to attend medical school why they would put themselves through such torture? Not surprisingly many give the same answer: "because it is the ultimate sacrifice I can make to help my fellow man". With such a valiant belief it's not hard to see why so many within our society respect and admire physicians.
While I will be the first in line to congratulate and thank any physician for making this sacrifice the reality is simple: they are still people. This means they are going to make mistakes, act rude, say weird things, or even wear weird clothing. Some physicians are pretty normal, some are eccentric, some are boring, and some are very interesting. However, when they day begins they "put their pants on one leg at a time" like everyone else. This means that while a talented physician may be desired by many different healthcare organizations, they still must be willing or at least able to adhere to the culture of the organization they are joining (Valentine, Godkin, and Lucero, 2002). This means that while they are highly valued, they must be disciplined in the same manner as anyone else.
Recently, I have encountered a case study where a respected doctor fails to keep to his commitment as the on call surgeon and shows up intoxicated to surgery. This, in my opinion, is unacceptable for a variety of reasons. First and foremost, doctors are people and this surgeon could have easily "called in sick" allowing the facility to call another surgeon to replace him. Secondly, the surgeon has gone directly against the Hippocratic Oath by putting himself, others, and the patient due to his drunk driving and possible treatment of the patient while impaired. At the end of the case study the text asks simply: what would you do? The answer is simple: release him immediately. It's one thing to make a mistake, but to act so bold is simply unacceptable. No one individual is greater than the organization and a doctor, by this point, should realize that.
References:
Valentine, S., Godkin, L., and Lucero, M. (2002). Ethical Context, Organizational Commitment, and Person-Organization Fit. Journal of Business Ethics, 41(4), pp. 349-360.
While I will be the first in line to congratulate and thank any physician for making this sacrifice the reality is simple: they are still people. This means they are going to make mistakes, act rude, say weird things, or even wear weird clothing. Some physicians are pretty normal, some are eccentric, some are boring, and some are very interesting. However, when they day begins they "put their pants on one leg at a time" like everyone else. This means that while a talented physician may be desired by many different healthcare organizations, they still must be willing or at least able to adhere to the culture of the organization they are joining (Valentine, Godkin, and Lucero, 2002). This means that while they are highly valued, they must be disciplined in the same manner as anyone else.
Recently, I have encountered a case study where a respected doctor fails to keep to his commitment as the on call surgeon and shows up intoxicated to surgery. This, in my opinion, is unacceptable for a variety of reasons. First and foremost, doctors are people and this surgeon could have easily "called in sick" allowing the facility to call another surgeon to replace him. Secondly, the surgeon has gone directly against the Hippocratic Oath by putting himself, others, and the patient due to his drunk driving and possible treatment of the patient while impaired. At the end of the case study the text asks simply: what would you do? The answer is simple: release him immediately. It's one thing to make a mistake, but to act so bold is simply unacceptable. No one individual is greater than the organization and a doctor, by this point, should realize that.
References:
Valentine, S., Godkin, L., and Lucero, M. (2002). Ethical Context, Organizational Commitment, and Person-Organization Fit. Journal of Business Ethics, 41(4), pp. 349-360.
Wednesday, June 15, 2011
The Unsteady Hand of the Stark Act
From its inception in 1989 Stark (the Act), officially known as the Federal Physician Self-referral Law, has allowed an "ethical background" from which healthcare organization can build and maintain their own ethical regulations and protocols. In many ways, the Act has improved the quality of care available much in the way that antitrust laws have improved quality in the private business sector through the creation of competition. However, the Act is not without its own faults. For example, the Act basically covers Medicare issues in reference to financial relationships between physicians - their immediate family members - and the facilities which they refer Medicare patients (Gosfield, 2009).
This seems simple enough to understand, but many consider the Act to be outdated, very difficult to interpret, and follow (Sutton, 2011). Though the Act is written in very narrow and defined terms, difficulty is created due to its constant evolution and change. For this reason, many organizations have continued to create and apply their own version of the Act within their own organization. This has resulted in a general across the board "bench line" for each of employee of not accepting any freebies or kickbacks whatsoever from any vendor while under the employment of said employer. Sometimes even writing about the Act can be a bit of a mind twister!
This confusion has also led many to believe that the Act is also detrimental in many ways to the business of healthcare. As previously cited, the fear of violating the Act and as a result losing funding through Medicare and other government sources has created a tremendous fear amongst facilities. This, in turn, has created a very regimented business atmosphere that has significantly hurts a healthcare facility's ability to grow (Taylor, 1999).
Though the healthcare industry is not a business in the same sense as companies like Apple or Nike, it is still critical to remain as financially stable as possible. The Act like many other government regulations imposed on the healthcare industry has created a virtual mine field that organizations and administrators must navigate on a constant basis. Ethically, the Act has created a culture that strives to continually evolve ethically, but it should not stand in the way of creation, evolution, and ingenuity. If so, the healthcare industry at best will not perform to its abilities or at worst continually regress.
References:
Gosfield, A. (2009). Stark Law Covers a Narrow Corridor of Actions (Malpractice Consult). Medical Economics, 86(17), 38.
Sutton, P. (2011). The Stark Law in Retrospect. Annals of Health Law/Loyola University Chicago, School of Law, Institute for Health Law, 20(1), 15.
Taylor, M. (1999). Healthcare Struggles with Stark Reality. Modern Healthcare, 29(27), 30.
This seems simple enough to understand, but many consider the Act to be outdated, very difficult to interpret, and follow (Sutton, 2011). Though the Act is written in very narrow and defined terms, difficulty is created due to its constant evolution and change. For this reason, many organizations have continued to create and apply their own version of the Act within their own organization. This has resulted in a general across the board "bench line" for each of employee of not accepting any freebies or kickbacks whatsoever from any vendor while under the employment of said employer. Sometimes even writing about the Act can be a bit of a mind twister!
This confusion has also led many to believe that the Act is also detrimental in many ways to the business of healthcare. As previously cited, the fear of violating the Act and as a result losing funding through Medicare and other government sources has created a tremendous fear amongst facilities. This, in turn, has created a very regimented business atmosphere that has significantly hurts a healthcare facility's ability to grow (Taylor, 1999).
Though the healthcare industry is not a business in the same sense as companies like Apple or Nike, it is still critical to remain as financially stable as possible. The Act like many other government regulations imposed on the healthcare industry has created a virtual mine field that organizations and administrators must navigate on a constant basis. Ethically, the Act has created a culture that strives to continually evolve ethically, but it should not stand in the way of creation, evolution, and ingenuity. If so, the healthcare industry at best will not perform to its abilities or at worst continually regress.
References:
Gosfield, A. (2009). Stark Law Covers a Narrow Corridor of Actions (Malpractice Consult). Medical Economics, 86(17), 38.
Sutton, P. (2011). The Stark Law in Retrospect. Annals of Health Law/Loyola University Chicago, School of Law, Institute for Health Law, 20(1), 15.
Taylor, M. (1999). Healthcare Struggles with Stark Reality. Modern Healthcare, 29(27), 30.
Monday, June 6, 2011
Ethical Tools for All
What exactly is the Healthcare Industry? Who works in the healthcare industry? Does it only constitute doctors, nurses, allied healthcare staff, hospitals, clinics, and the first aid station? For many, the healthcare industry is composed of the staff and facilities that provide direct patient care. However, those who support the healthcare industry have begun to be included, in the author's opinion, in this most important of all social clubs. For example, the individual billing clerk may not provide direct patient care, but their ability to properly (and ethically) code and bill insurance companies can have massive influence when compounded. Multiply their actions by as many billing clerks currently employed today, it is easy to see how billions of dollars and as an effect the quality of healthcare delivery can be seriously augmented by support staff.
While significant cost concerns support staff can create or alleviate is of vital importance to any healthcare facility, what can be said about the human cost? To an extent, support staff can create an environment conducive to increasing the quality of healthcare delivery while maintaining costs. Though nurses are very much considered an integral part of the "staff" of any hospital or related facility, they were considered for many years "support staff" to the all-mighty physician. As a result, more and more studies where conducted to see what affect, if any, nurses had on the health of the patient and finances. The result was not only the elevation of nurses to the level of physicians, but also the need for specialized nurses (Czaplinski, 1998).
With the obvious need for highly trained support staff continues to increase, have we done enough to also give these individuals the tools to act as professionals? Though the level of education is not indicative of one's level of professionalism, it is easy to assume that similar individuals may simply not understand or posses the knowledge to understand the intricacies of what makes a healthcare professional. More specifically, the need to understand and follow the highest ethical standards. Though high ethical standards within traditional healthcare facilities (like hospitals) have become the norm for all staff, many "support staff" operating in non-traditional facilities do not received the same amount (if any) of ethical training required of healthcare professionals. Though we expect support staff to function at the level of any healthcare professional, why do we not provide them with the same tools and expectations?
References:
Czaplinski, C. , et al. (1998). The Effect of Staff Nursing on Length of Stay and Mortality. Medical Care. V36:12. pp. 1626-1638.
While significant cost concerns support staff can create or alleviate is of vital importance to any healthcare facility, what can be said about the human cost? To an extent, support staff can create an environment conducive to increasing the quality of healthcare delivery while maintaining costs. Though nurses are very much considered an integral part of the "staff" of any hospital or related facility, they were considered for many years "support staff" to the all-mighty physician. As a result, more and more studies where conducted to see what affect, if any, nurses had on the health of the patient and finances. The result was not only the elevation of nurses to the level of physicians, but also the need for specialized nurses (Czaplinski, 1998).
With the obvious need for highly trained support staff continues to increase, have we done enough to also give these individuals the tools to act as professionals? Though the level of education is not indicative of one's level of professionalism, it is easy to assume that similar individuals may simply not understand or posses the knowledge to understand the intricacies of what makes a healthcare professional. More specifically, the need to understand and follow the highest ethical standards. Though high ethical standards within traditional healthcare facilities (like hospitals) have become the norm for all staff, many "support staff" operating in non-traditional facilities do not received the same amount (if any) of ethical training required of healthcare professionals. Though we expect support staff to function at the level of any healthcare professional, why do we not provide them with the same tools and expectations?
References:
Czaplinski, C. , et al. (1998). The Effect of Staff Nursing on Length of Stay and Mortality. Medical Care. V36:12. pp. 1626-1638.
Sunday, May 29, 2011
Doing what is right at the RIGHT time
As a future healthcare executive I often think about what is most important when running a healthcare organization. Obviously, it would be to my benefit to provide the highest quality services and access while maintaining a spotless reputation within my respective community. Many believe that maintaining a spotless reputation naturally entails making absolutely no medical errors. This is simply not the case. I have to vehemently disagree with this notion for a variety of reasons. No matter how high the caliber of your staff or how clean or up to date your facilities and equipment are there will always be medical errors. Healthcare executives must acknowledge that they and their staff are imperfect in nature. We should not and cannot expect anyone not to make mistakes. However, we also cannot allow for the trust we have created with our respective communities to be diminished.
Trust between a healthcare organization and the community is paramount. In many ways it is the "Alamo" of all requirements that constitute a quality healthcare organization. In other words, we as healthcare executives must guard this trust with all the power and tools that we have at our disposal. This requires that healthcare executives and healthcare organizations remain as transparent as possible in reference to its shareholders and the community in general. As painful as it may be, this also means that sharing information such as medical errors must be as thorough and as open as possible. For us to maintain our trust we must understand that "human relationships depend on communication of information; without an honest sharing of information there can be no trust. (Perry, 2002)"
Though healthcare executives are willing to share information of medical error with the community (they have to by law), I often wonder if they share this information quickly or thoroughly enough with those in the community. I recently ran across an article that details how a staff member at Emory University Hospital exposed almost 800 individual staff and patients to the potentially life threatening bacterial infection tuberculosis, known as TB (Moisse, 2011). The article briefly details how the community and those affected were made aware and then went on to describe TB. This information is important, but when did these infections occur? Did the executives in charge not only do the right thing, but did they do it at the right time? Generally, TB is very rare and can be completely eradicated if treated early enough. However, how are we to know if the people exposed were treated in an efficient and effective manner so as to avoid any permanent damage?
The healthcare industry continues to make significant strides in preventing medical error. This strides directly affect how organizations ethically treat situations when medical errors to arise. Though we have done a good job of preventing errors and following ethical guidelines we still need to create a culture that accepts the fact that medical errors will continue. We should embrace these situations as an opportunity to display that while we will make mistakes, our communities can always have trust that we will always do the right thing at the right time.
References:
1. F. Perry. (2002). Medical Errors: Paradise Hills Medical Center. The Tracks We Leave: Ethics in Healthcare Management. p. 1-15.
2. K. Moisse. (May 27, 2011). Atlanta Hospital Employee Exposed Hundreds to Tuberculosis. Retrieved May 29, 2011 from: abcnews.go.com/Health/Wellness/atlanta-hospital-notifies-700-patients-tuberculosis-exposure/story?id=13702727
Trust between a healthcare organization and the community is paramount. In many ways it is the "Alamo" of all requirements that constitute a quality healthcare organization. In other words, we as healthcare executives must guard this trust with all the power and tools that we have at our disposal. This requires that healthcare executives and healthcare organizations remain as transparent as possible in reference to its shareholders and the community in general. As painful as it may be, this also means that sharing information such as medical errors must be as thorough and as open as possible. For us to maintain our trust we must understand that "human relationships depend on communication of information; without an honest sharing of information there can be no trust. (Perry, 2002)"
Though healthcare executives are willing to share information of medical error with the community (they have to by law), I often wonder if they share this information quickly or thoroughly enough with those in the community. I recently ran across an article that details how a staff member at Emory University Hospital exposed almost 800 individual staff and patients to the potentially life threatening bacterial infection tuberculosis, known as TB (Moisse, 2011). The article briefly details how the community and those affected were made aware and then went on to describe TB. This information is important, but when did these infections occur? Did the executives in charge not only do the right thing, but did they do it at the right time? Generally, TB is very rare and can be completely eradicated if treated early enough. However, how are we to know if the people exposed were treated in an efficient and effective manner so as to avoid any permanent damage?
The healthcare industry continues to make significant strides in preventing medical error. This strides directly affect how organizations ethically treat situations when medical errors to arise. Though we have done a good job of preventing errors and following ethical guidelines we still need to create a culture that accepts the fact that medical errors will continue. We should embrace these situations as an opportunity to display that while we will make mistakes, our communities can always have trust that we will always do the right thing at the right time.
References:
1. F. Perry. (2002). Medical Errors: Paradise Hills Medical Center. The Tracks We Leave: Ethics in Healthcare Management. p. 1-15.
2. K. Moisse. (May 27, 2011). Atlanta Hospital Employee Exposed Hundreds to Tuberculosis. Retrieved May 29, 2011 from: abcnews.go.com/Health/Wellness/atlanta-hospital-notifies-700-patients-tuberculosis-exposure/story?id=13702727
Monday, May 23, 2011
Healthcare on Your Iphone
The marriage of technology and health care has been one of wedded bliss for some time now. It is hard to imagine a more perfect union that exists at any point throughout the ages. Often, the results are significant and important milestones in the continuous drive to improve the quality of life for all individuals. However, sometimes this marriage can create moral and ethical gray areas, even if the original intentions where noble .
As society continues to its technology march, I often stop to think of the advances we have made throughout my life. I can still remember the day when my 8th grade teacher explained how one day we will have computers small enough to carry in our hands and more powerful than the one we were currently using. This was less then 15 years ago and the arrival of the iPhone (along with other similar smart phones) continues to amaze me to this day. As a result, many technologies continue to be designed among the lines of smaller, cheaper, and more mobile. It isn't much of a surprise that the technology used in health care today follows those same guidelines. One example is the Vscan portable ultrasound device. This small device that resembles a mobile phone both in size and shape has the capability of recording and viewing the same images captured on traditional ultrasound machines with the added mobility of file sharing and email.
It's incredible to imagine the ability such a device has. For example, this breakthrough in technology allows physicians to visit patients in any setting without having to visit the doctors office. Such technology will allow physicians to visit patients in rural areas that do not have access to such technology. It's no wonder that such innovation not only improves the quality of life, but also greatly reduces the cost as the Vscan only costs roughly $8,000. These positives are very significant and important as we continue to struggle with providing quality health care to all individuals no matter their location or income level. However, what happens to all this information once it is gathered?
Though technology such as this has the ability to provide a quality service at low cost, do the companies that create such technologies invest time and effort into creating some kind of protocol to protect such sensitive information? What happens if the Vscan is lost or stolen? Is it possible that an individual could obtain sensitive information simply by just turning on the device? As an individual I fully embrace and welcome any form of technology that can improve the quality and access of health care, but as a future health care administrator I have to be cautious as to what information and who may use sensitive information against my clients. In the end we all have to acknowledge that even the best marriages have their problems.
References:
Simon, S. (2011, March 28). Medicine on the Move: Mobile Devices Help Improve Treatment. The Wall Street Journal. Retrieved from: online.wsj.com/article/SB10001424052748703559604576174842490398186.html
As society continues to its technology march, I often stop to think of the advances we have made throughout my life. I can still remember the day when my 8th grade teacher explained how one day we will have computers small enough to carry in our hands and more powerful than the one we were currently using. This was less then 15 years ago and the arrival of the iPhone (along with other similar smart phones) continues to amaze me to this day. As a result, many technologies continue to be designed among the lines of smaller, cheaper, and more mobile. It isn't much of a surprise that the technology used in health care today follows those same guidelines. One example is the Vscan portable ultrasound device. This small device that resembles a mobile phone both in size and shape has the capability of recording and viewing the same images captured on traditional ultrasound machines with the added mobility of file sharing and email.
It's incredible to imagine the ability such a device has. For example, this breakthrough in technology allows physicians to visit patients in any setting without having to visit the doctors office. Such technology will allow physicians to visit patients in rural areas that do not have access to such technology. It's no wonder that such innovation not only improves the quality of life, but also greatly reduces the cost as the Vscan only costs roughly $8,000. These positives are very significant and important as we continue to struggle with providing quality health care to all individuals no matter their location or income level. However, what happens to all this information once it is gathered?
Though technology such as this has the ability to provide a quality service at low cost, do the companies that create such technologies invest time and effort into creating some kind of protocol to protect such sensitive information? What happens if the Vscan is lost or stolen? Is it possible that an individual could obtain sensitive information simply by just turning on the device? As an individual I fully embrace and welcome any form of technology that can improve the quality and access of health care, but as a future health care administrator I have to be cautious as to what information and who may use sensitive information against my clients. In the end we all have to acknowledge that even the best marriages have their problems.
References:
Simon, S. (2011, March 28). Medicine on the Move: Mobile Devices Help Improve Treatment. The Wall Street Journal. Retrieved from: online.wsj.com/article/SB10001424052748703559604576174842490398186.html
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