In my list of suggestions, I placed the patient representative last only because the subject of patient representation in the military merits a bit more discussion.

As I have talked to members of the military and doctors familiar with military medicine, I have been struck by the fact that many of its recent troubles seem to be the result of a clash of two cultures: medicine, where the patient should always come first, and the military, where the service comes first. Too often, it seems, the doctor-caregiver has been submerged by the doctor-officer.

Can a low-ranking officer or enlisted person truly be an effective patient representative in that kind of military setting? Can low-ranking patients always be heard? I don't know, but I know an interesting analogy. The editors of The Washington Post -- asking, "How can we make sure readers are heard?" -- appoint an independent ombudsman who is not part of the newspaper staff and will serve only a set term, then leave.

Why couldn't a military hospital have the same kind of independent patient's spokesman, perhaps a retired military or civilian doctor, to represent patients during a one- or two-year appointment? Many fine doctors would be willing.