throckmortonsign

Specialities like Psychiatry, especially Psychiatry, have to document in such a way that makes using EMRs a huge waste of time. Where we (EM/IM docs) can use click boxes for a chest pain rule out and it ends up saving us time, explaining why a patient had a break (daughter was hit by a car, ran out of lithium, deep seated childhood fears) is a bit more complicated. There's no template that can be created easily (not saying its impossible but its difficult), meaning they have to type at somewhere between 20 WPM and 100 WPM, when they used to be able to dictate at 200 WPM. So by using this software they are now required to spend at least twice as long documenting as they used to.

This is coming from a huge technology nerd. I can type near 80-120 WPM depending on the day. I use Dragon dictation for all of my hospital notes and walk around with an Android cell phone, iPad mini or laptop every day. If I could get my hand on Google Glass I would use that too. But when I hear IT people say this (and I used to one that said it as well) it pains me. They are driving good docs out of the field because they can't type... they didn't sign up for that. And don't give me that "well the field changes, etc." I had an Attending that would read NEJM cover to cover every week, but couldn't type worth shit. If you asked him the best evidence for treating X, he could give you a hour long lecture and you would come out better for it. I would have him treat my entire family... which is something I wouldn't say for many other doctors I have interacted with, including the really "successful" ones that know all about documenting complexity and billing level 3's and CC time.

What was the cause of your ESRD?

This should probably be up top. A autoantibody does not an allergy make. Still a possibility though. A visit to an immunologist/allergist is probably in order.

Our study was designed to test the hypothesis that insulin autoantibodies, like cytoplasmic islet cell antibodies (ICAs), can identify individuals with ongoing autoimmune β-cell destruction and increased risk of IDDM development. Insulin autoantibodies detected by use of a radioligand-binding assay were found in 1.4% of normal controls, 4% of first-degree relatives of IDDM patients, and in 37% of newly diagnosed IDDM patients

http://diabetes.diabetesjournals.org/content/35/8/894.short

IM doc here. I always check B12 and TSH in suspected dementia patients. I often treat B12 if it's lower part of the reference range especially if they have other signs of B12 deficiency, but I've never seen a dramatic reversal of dementia symptoms after starting B12. I've only ever seen one case of reversible dementia in a hypothyroid patient. Can't blame other docs for not finding it because the patient had not seen a doctor in 20 years.