Anti-LKM antibody

So, you know, what's the evidence of ordering a B12 level in somebody that has delirium? What is the, you know, utility of ordering an x-ray in this patient with low back pain without red flag features? And then, you know, really this idea about celebrating restraint.

So, you know, I can't, you know, count the number of times where somebody gets admitted with a transaminitis and, you know, very clearly it's because, you know, they just took a bunch of Tylenol, but, you know, the resident has gone off and ordered an anti-LKM and they've ordered a ceruloplasmin, and they've ordered your whole huge differential diagnosis for transaminitis, and we really tend to applaud that, and we say, wow, look at you, that's awesome.

You know what your differential diagnosis for transaminitis is, but what if we could shift things so that we were equally laudatory of those trainees that actually didn't order the antibiotic for the patient with the viral infection, or they didn't order the imaging test for the patient that didn't need it? And so this idea really about celebrating restraint, I think, is another important thing that faculty members can do.

But supporting culture change is not just a one-way street.