Intravenous immune globulin (IVIg) therapy has been shown to be useful in a multitude of disorders. IVIg is produced from pooled human plasma; therefore, autoantibodies found in the general population are also present in IVIg and transferred to those being transfused. This can prove a particular hazard for screening and diagnostic tests based on autoantibodies. We present a patient who was found to have a positive antinuclear antibody (ANA) titer after multiple IVIg transfusions, resulting in diagnostic confusion and unnecessary workup. A 45-year-old gentleman was diagnosed with atypical CIDP, initiated on a course of IVIg, and sent for inpatient rehabilitation. However, recovery was complicated by multiple readmissions for recurrent weakness, and as part of the workup for other etiologies, an ANA was found to be positive. Sub-serologies and paraneoplastic autoantibody panel were negative. In the absence of clinical symptoms, we recommended continued monitoring and repeat ANA testing 6 months after the last dose of IVIg; as any drug needs 5 half-lives to be eliminated from the body. Clinicians should consider any recent IVIg treatments when evaluating the pre-test probability of detecting an underlying connective tissue disease with ANA screening. Indiscriminate ANA levels in patients recently given IVIg lead to unnecessary and expensive further testing and consultation.

Patient satisfaction has become one of the most important measures of performance in healthcare that affects valuebased purchasing. Many factors affect patient satisfaction, including effective communication by the physician, materials provided by the hospital, quality of the room and food, quietness and cleanliness of the hospital, understanding of the disease process and health literacy, and interaction with nursing and ancillary staff. It is incumbent on residents to understand what contributes to patients' satisfaction with their care -only then will they be able to have compassionate, therapeutic relationships with patients and engage them as partners, leading to better health outcomes and better compliance.METHODS: Pre-intervention data was collected with a survey that includes 13 questions related to physician's introduction, communication and experience. The survey questionnaire used was unique and is different from the HCAHPS or Press Ganey survey. A total of 50 patients were recruited from services run by resident physicians, including Cardiology, General Medical Service, Hospitalist Service and Nephrology. The pre-intervention data was analyzed, and a plan formulated that included peerdriven education and a guest lecture that focused on introduction of the resident and providing business cards to patients; discussion of different types of patient-physician interactions, including a mutualistic patient-centered relationship; communication, barriers, and effective ways to communicate; provision of written material on how to address patient concerns, and the importance of treating patients with courtesy and respect. Business cards were produced for the residents who did not have them.After the intervention, the survey was repeated. The aim was to improve the patient satisfaction rate by 5%. RESULTS:Post-Intervention data showed improvement in in-patient satisfaction scores from a mean of 4.1 to 4.74. Postintervention items that improved included patient recall of doctor's names, doctors giving cards, doctors taking time to explain the medical condition, doctors listening carefully, doctors explaining new medications, and patient expectations being met (pvalues 0.001-0.03). CONCLUSIONS:Patient satisfaction improved significantly after educating internal medicine residents on the importance of patient satisfaction, conducting lectures on communication skills, and providing relevant written material.CLINICAL IMPLICATIONS: Based on these results, residents should be educated routinely on the importance of patient satisfaction and should have workshops to improve their skills.