Lisa Rosenbaum, M .D.: Transitional Enduring or Chaos Damage? The EHR and the Disruption of Medicine A decade ago, a primary care physician We admired seemed to come undone. His effectiveness had derived not really from rushing between individuals but from knowing them so well that his charting was effortless and fast. But he became distracted abruptly, losing his grip on the details of his patients’ lives. He slumped around, shirt half-untucked, perpetually pulling a yellowed handkerchief from his pocket to wipe his perspiring forehead. Everyone concerned he was sick. His problem, however, turned out to be the electronic health record .

Nevertheless, such a system would describe the high incidence of adrenal vascular instability in medical patients with prolonged crucial illness38 and is backed by our observation that the individuals with the least response to corticotropin stimulation had the lowest cortisol production and the cheapest cortisol clearance, despite a similar baseline cortisol level, in comparison with the other patients. Although in isolation each one of the separate studies is suggestive, the corroboration of the findings by using multiple approaches is helpful for making conclusions. Urinary excretion of cortisol was elevated in the critically ill patients, but cortisol metabolite levels were low or normal, despite increased cortisol production; this pattern is fairly different from that in Cushing’s syndrome.