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Stepwise Success

Do You Still Email at Work?
October 7, 2015 7:04 AM by Scott Warner

In 2008 I blogged “Big Brother Has Mail,” about justified paranoia that employers may be reading the emails of employees. I didn’t read email then, since, or now. It’s a waste of time when a manager is doing a good job.

But hospital environments are changing. In the interim I saw four security cameras turn into thirty two cameras, keyloggers installed on servers, and other tracking software. While this could protect employees and the interests of the organization, it also sends a chilling message.

I stopped using email except as a last resort. We were reminded too often of how “discoverable” and thus dangerous it is. I wouldn’t be surprised if greater surveillance or its mere threat leads to similar changes in behavior.

The legal web site NOLO tells us that some email systems make copies of emails that are sent or received, so deleting them doesn’t matter. Courts have ruled that employers are free to read emails as long as there is a valid business reason for doing so.

If this hasn’t happened at your workplace, it will. All it takes is one virus or piece of malware to get through the system to change a policy. I don’t blame employers for protecting sensitive information, but reading emails is a bit creepy for my taste.

Email is a tool to foster relationships and business communication, and as such it should contain a lot of non-business related information. Our telephone conversations, after all, contain pleasantries about weather, family, sports, and other topics not related to the subject. Is this personal? If all phone calls were recorded, the message sent to employees would surely change what people say.

Email is also quick, efficient, and doesn’t interrupt the other party like a phone call does. Email can be addressed and answered on the terms of the receiver, increasing productivity. It can be pondered and answered with deliberation, unlike the first thing we might think of saying. How is all this affected when we know our emails are being read? I wonder.

How about your workplace? Do you still email at work?

NEXT: Package Inserts or Procedures?

Sensitivity and Specificity
October 2, 2015 7:08 AM by Scott Warner

I hope I’m not the only one who gets confused about sensitivity and specificity. Every now and then I have to rethink this.

Sensitivity defines the true positive rate, or the number of people correctly identified as having a disease. A highly sensitive test has few false negatives. Here’s the formula:

           # of true positives
# of true positives + # false negatives

A highly sensitive test may have false positives, but since it identifies more people with disease that’s not the point. The value of sensitivity is in a desired low number of false negatives. A positive test may not prove disease, but a negative test rules it out.

Specificity is yin to this yang. It defines the true negative rate, or number of patients without disease. Here’s the formula:

           # of true negatives
# of true negatives + # false positives

In other words, a highly specific test rarely gives a positive result in those patients without disease. A negative test does not necessarily rule out disease.

Typically screening tests such as RSV, influenza, and other rapid kits are sensitive. They are used to rule out disease. Confirmatory tests such as antigen and toxin testing are used to rule in disease and weed out false positives. But this oversimplification doesn’t consider how sensitivity and specificity interact or are affected by the prevalence of disease. Here things get really confusing.

Sensitive tests are not only useful to rule out disease, they are often inexpensive, fast, and simple. They make sense in an emergent setting. If your test correctly identifies patients without a condition that gives a doc very good information.

While it sounds great to have tests with high sensitivity and specificity, that isn’t always practical or needed. A D-dimer, for example, has high sensitivity and low specificity. A negative test can rule out a deep venous thrombosis or a pulmonary embolism, but a positive test means a clot has formed and been lysed.

Sensitivity and specificity choices depend on the laboratory, too. I suspect small hospital labs use more rapid screening tests, for example. Our experience with these tests vary with the focus of our careers.

NEXT: Do You Still Email at Work?

Ace That Phone Interview
September 28, 2015 6:10 AM by Scott Warner

Our plumber Bob once confessed he refuses to answer his cell phone in the bathroom. Ironic or not that’s not so obvious in this age of instant communication and social media trivia. It also makes me wonder who does.

CNN describes a candidate who flushed the toilet during a telephone interview. You can’t make this stuff up. While the person on the other end doesn’t know what you’re doing or what you look like, that doesn’t mean it doesn’t matter. Knowing the difference can make, break, or flush a telephone interview.

Telephone interviews are now common. These include a screening call to check credentials and other requirements before setting up a telephone interview. It’s a cheap way to weed out candidates, and if the applicant carries a cell phone it’s fast. It also means you have to be prepared.

The big trap here is one of informality. We are so conditioned to answer the phone doing everything (unless it’s Bob) that we become casual about interruptions in grocery lines, at the dinner table, or in bed. We ignore where we are, what we’re doing, and how we are dressed. But these things matter. Monster offers these great tips:

  • Treat it like a face-to-face interview. Prepare, act professional, and realize that you need to convince the interviewer that you are a serious candidate.
  • Keep your resume and cover letter in front of you. One advantage of the telephone interview is having information in front of you on paper or computer screen. You should also have the organization’s website and job description handy.
  • Make a cheat sheet. Prepare a list of answers to common questions, examples of things you have done or problems you have solved, and other points.
  • Look the part. Shower and dress in clothing appropriate for the interview. It can’t hurt, and it will make you feel and sound more professional if you look the part.

Make sure your phone is charged and background noise is minimized. An interviewer will imagine you by sound alone, so you’ll want only your voice. And definitely no plumbing.

NEXT: Sensitivity and Specificity

Please and Thank You
September 23, 2015 2:12 PM by Scott Warner

The Ghostbusters reboot has me chuckling over the original. There’s a scene where an EPA official asks Bill Murray’s character to see the ghost storage facility, and Murray refuses explaining, “Because you did not use the magic word.” In an expression typifying bureaucratic obsequiousness for the ages the EPA man asks what that is. Murray replies, somewhat surprised, “Please.”

How often are we surprised with courtesies like please and thank you?

According to Jeremy Sherman, PhD, blogging on Psychology Today, “please” and “thank you” help stabilize accountability in relationships by signalling a favor requested and debt paid. Although he admits these are vague concepts, the point is valid. If you work in a lab where people routinely use please and thank you you can safely conclude that relationships matter.

This is much more than politeness, as Sherman points out. It is a matter of acknowledging an indebtedness and interconnection that builds a team. Consider these examples.

Sue and Dave are working a weekend together, and she draws an outpatient. It is a STAT request for a potassium, and she drops it off in Chemistry telling Dave, “That’s STAT,” and walks off. Dave performs the test. Dave feels he’s stuck performing the work in the middle of everything else he is doing, and Sue feels the same.

Sue and Dave are working the weekend, and when she draws a STAT potassium on an outpatient she brings it back to Dave and says, “Hey, Dave, I know you’re busy, but would you please run this STAT potassium? The doctor is waiting in the office for the results.” Later, after Dave has completed the test Sue tells Dave, “Thank you for running that potassium. I was swamped!”

The former happens all the time. It’s work, get used to it, etc. The latter happens when people realize that success is about good relationships. We have to care about how the other person works to improve the way that we work. It’s the foundation for all successful business. It still amazes me how few people grasp this simple truth, abbreviated by please and thank you.

NEXT: Ace That Phone Interview

What to Ask a Salesperson
September 18, 2015 8:25 AM by Scott Warner

I once stopped at a local Dodge dealer to buy a truck. No matter how direct I was the salesperson insisted on steering me toward a different vehicle. I even said, “Look, you’re not the only game in town. I want that truck,” pointing to one. Inexplicably he ignored me, so I left and bought a Chevy.

We all have those stories of frustrating salespeople, but just as often customer service exceeds our expectations. The trick in the lab, as in life, is to sense the latter and not waste time on the former. To do this, you need the right information from a salesperson who will always try to head you off at the pitch.

Example: “This new kit uses revolutionary technology, and I’ve just signed several big clients. A lot of big hospitals are interested in it. It has great pricing and a great shelf life. And if you order by the end of this month I can get you an evaluation kit at half price. I just need to know your volumes for a two year contract.”

Maybe this is a good deal, maybe not. Here are a few questions to ask:

  • Is this kit on our Group Purchasing Contract? Always good to know, if your hospital has a GPO.
  • Would you mind sending me a package insert to review? Salespeople usually aren’t lab people. A package insert will reveal a wealth of information.
  • Do you have any literature to support your claims? Data-based decisions are always best.
  • Are you the sole distributor of this product? Freight costs between distributors or direct shipment costs can add up, so this is a good detail to consider.
  • Are controls included in the kit? Controls and calibration verification materials can be expensive, adding cost.

I’ve heard the “new and improved” pitch a thousand times. It is what all good salespeople do, and it’s a great way to get word out about new products. But a laboratory doesn’t have to evaluate every kit, try every new method, or believe every deal. We’re always in the driver seat.

NEXT: Please and Thank You

Making the Deal
September 14, 2015 6:09 AM by Scott Warner

I was going to blog about handling sales people, but it’s complicated by both parties wanting the best deal. And making the deal is harder than it looks.

As a bench tech many years ago I enjoyed booths at trade shows, but I was only a shopper. No matter how keen my interest, once a salesperson knew I wasn’t the person in charge they didn’t want to talk to me. The line was always the same: “Talk to your manager.”

As a manager I attended one trade show with different results. At one booth several sales people offhandedly ignored me until I told them who I was, and then there was immediate interest from all of them. Funny, but I understand where they were coming from. Their job was to sell product, and it’s a waste of time to talk to anyone who can’t make the deal.

I don’t think it is uncommon in small hospitals for the lab manager to negotiate pricing with or without a materials manager, while the latter negotiates the bulk of pricing for the rest of the hospital. Depending on the organization, lab managers will also be concerned with contract compliance, freight cost, contract language, interest rates, and even presenting capital purchases to a finance board for approval. Our industry is too specialized to expect otherwise.

A manager should know an accurate cost per test, expected life of the instrument, maintenance costs, proximity and reputation of technical support, expected shelf life of reagents, expandability of methods, and other factors. Beware of end of life products, instrument deals with expensive reagents, no-maintenance claims, and new methods sold with promises of this or that added in the future.

The laboratory is in many ways a business within a business. Laboratories have a large, proprietary inventory with many items not shared with other departments. This is true for other clinical departments such as nuclear medicine but to a lesser degree. The amount of expertise and knowledge needed to shop, negotiate, manage these items is considerable. How it is done means big bucks in one direction or the other.

NEXT: What to Ask a Salesperson

Why Do You Switch Methods?
September 9, 2015 6:10 AM by Scott Warner

One of the challenges in laboratory medicine is keeping up with technology while reducing cost or keeping budget neutral. This isn’t easy, since the amount of information grows daily from emails, websites, trade magazines, scientific magazines, physician requests, colleagues, and sales hucksters.

Newer technology is often cool - smaller, faster, less sample, no maintenance, and incentivized - and more expensive. What’s great for a laboratory may not add value for physicians. A more sensitive Clostridium difficile assay that increases a positive rate when no problem was perceived is one example.

On the flip side, a method that is better for the docs may add work and headache on the bench. We’ve all run those tests that we can’t wait to replace with something better. It’s part of a job where the product has to be a reliable result. The physician sees sensitivity and specificity, but bench techs see maintenance, repeat rate, quality control, calibration, and rates of random and systematic error. Some pains are worth the headache, others are not.

Beyond all this are bean counters that are concerned with contract maintenance and compliance issues. A laboratory may be forced to adopt a problematic method or instrument because it is on a GPO (Group Purchasing Organization) contract. A better method may be available, but contract compliance varies.

Then there is the issue of “Do I make it or buy it?” If a test is already in house, is a better method available or is it cheaper to send it to a reference laboratory? If the test is not needed on a STAT basis, pricing is negotiable. But if a test is sent out, physicians may order it more if brought in house. The once paradigm of bringing in tests to justify hours has long disappeared. Laboratory business is rapidly moving toward a centralized model.

All are valid, and all affect how, why, and when a method is switched. The trick to success is to understand what is important to each party affected by the switch. Next I’ll consider how to handle the most vocal proselytizer - the salesperson.

Why do you switch methods?

NEXT: Making the Deal

Working With Nursing
September 4, 2015 1:08 PM by Scott Warner

The current Advance opinion poll question, “What is your laboratory’s relationship with your facility’s nursing staff?” has me thinking. As fellow Advance blogger Stephanie Noblit points out, medical laboratory professionals don’t often have a positive opinion of nurses.

This is an unfounded opinion for any laboratorian. Nurses are wonderful, and I learned to love working with them. They do a difficult job with grace and dignity under pressure.

Here’s perspective on the issue: as a computer consultant I was often tasked with duplicating a manual process that was completely unfamiliar to me in software. At times, I was asked to fix a problem in the software that created problems that hadn’t existed in the manual process. This was a case of two worlds colliding - both with jargon-laden cultural assumptions - and it meant sitting, observing, listening, and understanding. My perspective had to become the client’s in order for the relationship to be successful. The reverse was not true.

And this is the essential problem with lab techs and nurses. We think they should understand quality control, regulations, specimen collection, order of draw, and many other issues that live in our universe.

I solved this problem by going directly to the nurses every morning with concerns, questions, and requests. This daily rounding included looking at charts, talking to hospitalists, and talking to the nurses. It’s one thing to reject a contaminated sputum from the lab for the third time in a row and quite another to go directly to the patient’s nurse and have a discussion about what’s best for the patient.

Success in all forms is based on relationships, hospitals included. All relationships are a matter of compromise and meeting people halfway. In my case I took lab issues directly to them in person. After several years I was invited to be a part of their morning safety huddle. Usually, this involved myself and one of the techs. It was always a great chance to see how what we do directly affects the patients.

None of this involved asking nurses to understand the lab. They have enough to worry about.

NEXT: Why Do You Switch Methods?

What Are Your Skills?
August 31, 2015 6:11 AM by Scott Warner

Like most managers with experience, I’ve seen a lot of resumes. Most are chronological, listing jobs worked in order from flipping burgers to working in a lab. Take it from me, it gets boring seeing so many timelines. I have never - repeat never - seen a resume that highlights what skills a person brings to the job.

Resumes that highlight skills are functional and are highly useful when there is a gap in employment. Let’s say, for example, you worked in a lab in your 20s, decided to have a family, and took a few years off. A chronological resume would show a gaping hole in your employment history. You can make up for this by listing relevant skills.

It’s a great idea to list skills anyway, even without gaps in employment. Known as a combination resume, this gives employers the best of both worlds.

Remember that employers may not choose to interview you based on your experience alone. They want skills that fit the job. Relevant work history gives them an indication of loyalty and time served, nothing else. Many applicants don’t get this idea and treat a resume like a legal record that has to be strictly accurate, leaving employers to infer skills.

But the whole purpose of a resume is to make you stand out. That’s it. If you’ve worked at one place 30 years that means something. But otherwise what makes you unique? What makes you the candidate an employer looks at and thinks, “Wow! I have to interview this person!” That’s what you want.

You’ll be surprised how many valuable skills you can list, too. (“Hard worker” is not a skill, it’s an opinion.) Examples that lab managers find interesting: age-specific phlebotomy skills, analytical and critical thinking skills, advanced training on instruments, generalist and non-generalist e.g. antibody identification, procedure writing, process development, vendor negotiation, any specific work-related computer skills. It’s easy to assume that all experienced techs offer about the same skills, but you’d be surprised. You also often don’t know what an employer is looking for.

What are your skills?

NEXT: Working With Nurses

Your Facebook Face
August 26, 2015 7:43 AM by Scott Warner

As long as I’m on a how-to-find-a-job jag, it’s only fair to mention Facebook. According to the website Statista, as of the second quarter of this year there are 1.49 billion active members on Facebook, a number that has steadily climbed since 2008.

Facebook and other social media allow people to connect across states and even time as we create a living diary of our lives. We post where we’re going, what we’re doing, what excites us, and what upsets us. Facebook can reveal if we’re optimists, pessimists, complainers, helpers, bookworms, party animals, how much time we spend playing online games, and even what our sense of character is in choosing friends. Good, bad, or ugly, our Facebook face tells the world (at least our friends) who we are.

Rachel Ryan writes on the Huffington Post site that she caught her bosses Facebook stalking a potential hire. (One way around it is to change your name.) Kashmir Hill sums this up in Forbes with, “those who don’t want employers looking them up on Facebook pages are fighting a losing battle.” Indeed. As far back as 2009, 45 percent of employers screened using social media sites, and Facebook is the most common. An incredible 35 percent of employers did not hire based on content uncovered.

Think about that a moment. It used to be that work was work and play was play. But now lines are blurred. Employers use sites such as Facebook to find out what kind of people they have hired or applied. And why not?

It may seem unfair, but if in the 1980s you and your friends wrote comments on a bulletin board posted in a hallway at a local mall for everyone to see, it would not have been outrageous for employers to troll the comments. That’s what Facebook is, a public declaration of who you are, what you like, and whom you associate with.

This isn’t a freedom of speech issue. An employer has every right to protect its interests, especially when considering the financial wisdom of hiring you to do the same.

NEXT: What Are Your Skills?

Plain Text Your Resume
August 21, 2015 8:16 AM by Scott Warner

In a paper world, a resume is a one-page flier tacked on a pole along the highway of your career, part lost puppy notice and part Call Me! for this or that. Since paper is an ideal medium for display purposes, a resume can be dressed up with different colors, textures, and layouts to get you noticed.

In a virtual world, a resume is still written for paper. Fonts styles and sizes are carefully chosen and white space judiciously used to make it look just so. Saved as a PDF, it still looks exactly like a paper page, which is the point of Adobe’s format.

But as Lisa Vaas writes on the career advice site The Ladders, “job seekers must create an alternate, plain-text, internet-ready version of their resumes for those occasions when it is requested, and it often is.”

Great advice!

It’s common to register at a job portal and fill out an application with text boxes to paste a cover letter and resume. Sometimes you can attach a PDF, too. Since these text boxes accept text without any formatting other than spaces, you’ll need a copy of your resume saved as a plain text document using Notepad or a similar editor.

Open your resume in Word, right click and choose “Select All,” then copy and paste the text into Notepad. You can use keyboard shortcuts or the Edit menu. The lack of formatting makes all text look the same and left justified, but once in Notepad add spaces, carriage returns, and bullets using dashes or periods. When filling out an application, the process is reversed: open your text resume in Notepad, Select All, and copy and paste into the text box in your browser.

I’ve wondered, “Isn’t the point of a resume to get me noticed? How does boring text do that?”

It doesn’t, but content does. It embeds your resume in the middle of your job application. It’s nice to make it look pretty, but it’s better for employers to see everything in one place. And if you don’t, your competition will. Why take the chance?

NEXT: Your Facebook Face

Job Search Tips
August 17, 2015 6:11 AM by Scott Warner

Don’t you love business buzz phrases like low hanging fruit, thrown under the bus, thinking outside the box, and take home message? I recently attended a jobs workshop and received a great take home message. In fact I got several. If only business meetings were all so productive.

Here are two:

Create a master application. A resume contains some of the information that goes on a job application but not everything. The purpose of a resume, after all, is to get you the all-important interview. It’s a tool to market yourself, highlighting whatever aspects of your career make you stand out. But a master application contains everything in detail you need to copy and paste into an online job application. It can save a lot of time looking up addresses, telephone numbers, supervisor contact information, and other details. An online search can find PDF applications where you fill in the blanks. Your master application should be regularly updated alongside your resume.

Create a professional email. Giving a potential employer a cutesy, obscure, silly, or sophomoric email address tells them right up front you don’t want to be taken seriously. This one is so obvious I’m sure most people miss it or just don’t want to create a second, third, or fourth account.

Fortunately there are two really easy alternatives to creating extra email accounts:

  • Yahoo - Yahoo mail allows “disposable” email addresses that can be used to route emails to your account. It’s easy to create a basename (you are only allowed one) and keywords for your search (up to 500 keywords are allowed). This is a great way to create a professional email address without the hassle of another account.
  • Outlook - Microsoft Outlook (formerly Hotmail) is even easier. You can create an email alias. As far as I know, you can create as many as you want. This is more versatile than Yahoo, because you can delete an alias and even make it your primary email address, changing the character of the account.

These are outside the box take home messages. At the end of the day it’s a win-win.

NEXT: Plain Text Your Resume

Are You Good or Great?
August 12, 2015 6:54 AM by Scott Warner

Some time ago I read Good to Great: Why Some Companies Make the Leap... and Others Don’t by leadership guru Jim Collins. The book describes why some companies are good and others are great. It’s a worthwhile read. It turns out that being great isn’t a huge leap, luck, or circumstance. It’s a choice.

It fascinates me to consider two businesses that are identical on the surface: same service area, same customers, same services, etc. Yet one is just Ok to work at and the other is great. One complains about a lack of good help and the other attracts talent. One has customers who treat it as a second choice and the other loyal followers. One is criticized and the other praised. One is avoided and the other loved. And one has no idea why the other is great, because it can’t see the real difference. Worse, it can’t imagine what the difference could be.

Customers experience the difference. I know I do.

There’s nothing wrong with “good,” but it amounts to settling for average. Don’t we all want to work for great hospitals, great labs, great bosses? Do we see “bad” as the only alternative?

Too often we’ll say, “My boss is Ok” or “this lab is a good lab.” There isn’t anything wrong with that per se - it beats working for a jerk or in terrible conditions with poor quality - but is that really a benchmark? If we settle for good because it’s better than bad, we won’t be great. We won’t even think it’s possible.

“The good-to-great companies made a habit of putting their best people on their best opportunities, not their biggest problems. The comparison companies had a penchant for doing just the opposite, failing to grasp the fact that managing your problems can only make you good, whereas building your opportunities is the only way to become great,” writes Collins.

Maybe I’m making too much of semantics but think about it. If someone asked you, “How is work?” what would your answer be? What do you want it to be?

NEXT: Job Search Tips

Arbitrary Rules
August 7, 2015 6:44 AM by Scott Warner

Since the laboratory is a mystery to many in your organization, it’s a good idea to use any arbitrary rules as teachable moments. You might be surprised how many of these exist.

  • Specimen labeling rules
  • Specimen rejection rules
  • Wristband protocols
  • Compatible blood types
  • Reporting microscopic values

To an outsider, many of these seem subjective. A nurse in the ED with only one patient is reasonable when she asks, “What do you mean, I have to recollect that throat swab because it’s unlabeled? I only have one patient!” A laboratory is correct in rejecting an unlabeled specimen that is retrievable, but the rule can seem arbitrary in the sense that it doesn’t take circumstances into account.

In other cases, technical knowledge is lacking to understand the fine rules. For example, not every nurse transfusing a unit of packed cells will know what types are compatible; this can be even more confusing when giving multiple component types. I once dealt with a physician who didn’t want to switch a bleeder from O Negative to O Positive because she was sure it would kill the patient.

If your rules are consistently enforced, it’s possible that everyone will learn and no longer question them, but that doesn’t imply understanding or agreement. It’s likely that a nurse might think, “Not again!” and get frustrated (or angry).

It’s worthwhile to identify these rules that seem arbitrary to outsiders and ask if there is a way to be proactive, change a process, or use each instance as a chance to educate. This can be difficult in the moment, since someone asked to recollect a sample or accept an unusual value may not have the time or be in the mood to hear why.

But there are opportunities to be proactive: a newsletter, a standing slot in the nursing department meetings, daily rounding, regular check-ins with physicians, etc. There are always chances to explain why we do things. It’s always been my experience that people appreciate understanding why.

NEXT: Are You Good or Great?

The Problem with Windows XP
August 3, 2015 7:54 AM by Scott Warner

Now that Windows 10 is here (it’s free if you have Windows 7 or higher) laboratories should worry about computers still running Windows XP. These include desktops in offices, laptops, and data managers attached to an instrument.

The problem with Windows XP is more than being old (it was released in 2001), ugly (the “Teletubbies” theme is outdated, to say the least), and limited (it can’t recognize more than 4 GB). Windows XP is a big security risk and getting bigger every day.

Microsoft ended official support for Windows XP in 2014, which means there are no more automatic security patches. About 17% of computers are running XP (the Windows 10 upgrade won’t affect this) as reported by CNET. That’s still a sweet target for hackers, especially since this percentage varies by industry. Public utilities still run largely on XP. As reported by Forbes, the reason could be that IT departments pay more attention to business and office systems than manufacturing and industrial applications.

This might be true in your hospital, too. Business and administration offices tend to get newer computers and operating systems, while data managers are upgraded with new instrumentation. IT departments tend to stay away from proprietary systems with separate service contracts.

It isn’t just operating system patches that have ended. Gradually, support for all software on XP will end or has ended already, such as Microsoft’s Security Essentials. That means XP is even more vulnerable to attack.

What can you do about XP?

  • Ask your IT department about an upgrade schedule for any standalone PCs such as an office desktop. If there are no plans to upgrade, ask about more secure access such as a remote desktop connection. They may have alternatives in place.
  • Inventory operating systems in your laboratory, including data managers attached to large analyzers. Anything older than five years might be running XP.
  • Check with instrument manufacturers to determine the cost of upgrading any data managers. It might be time to upgrade the instrument, too.

Fortunately, the problem with XP is simple to fix: it’s got to go.

NEXT: Arbitrary Rules



About this Blog

    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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