Within Normal Limits: Navigating Medical Risks

This episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes Olivia Soutullo, a psychologist and Director of Parent-Child Interaction Therapy Services at Children’s National (Washington, D.C.). Olivia highlights how gr...

Dr. Dennis Boyle, a COPIC physician consultant and rheumatologist, is the guest on this episode which looks at the issue of treating friends, family, and staff as patients. The discussion looks at the ethical, legal, and other considerations in these types of situations using some case studies and highlighting the American Medical Association’s guidance. In particular, there is the issue of how yo...

This episode examines patients who present with chest pain and how this can run the full spectrum of being a minor irritation to a more serious condition that requires immediate attention. Dr. Zacharias draws upon his experience in internal medicine to talk about using clinical judgment to work through an assessment. He delves into using a differential diagnosis approach, addressing emergency situ...

Due to recent active shooter situations and a renewed focus on the safety of health care providers, COPIC is re-releasing this past episode . Some providers may draw a strict boundary about discussing guns with their patients (or not think about it). But research has shown there are situations when access to firearms is a potential risk factor and raising this issue can be not only appropriate but...

This episode’s guest is Jody Thomas, PhD, Founder/Chief Executive Officer of The Meg Foundation, a nonprofit whose mission is to empower families with the pain management strategies, skills, and support they need to prevent and reduce pain. The discussion examines how “fear of needles” and health care avoidance can develop in early childhood, and what strategies can be implemented—by parents and m...

Our guest for this episode is Dr. Dan Rosenquist, a family medicine physician in Nebraska and risk manager for COPIC. The focus is on Stevens-Johnson syndrome and toxic epidermal necrolysis, which are commonly caused by medications or infections and typically present as skin reactions. Dr. Rosenquist walks through the causes and symptoms to be aware of, the role of certain medications in this cond...

Dr. Zacharias reexamines the issues that lead to spinal epidural abscess, a rare condition that can result in severe adverse outcomes and allegations of negligent care. We start with a clear definition of spinal epidural abscess, why it occurs, and some notable contributing factors. From there, Dr. Zacharias examines risk factors with patients and some suggestions on being highly vigilant about ce...

This special episode features Dr. MeiLan Han, a Professor of Medicine and Chief of Pulmonary and Critical Care at the University of Michigan and author of the book Breathing Lessons: A Doctor’s Guide to Lung Health . Dr. Han shares her perspective on the impact of COVID-related respiratory issues and how this emphasized the importance of healthy lungs and the vital role they play. She talks about...

This episode features Dr. Jeff Varnell, a surgeon and COPIC physician risk manager, who offers some insight about the phrase of “clearing a patient for surgery,” and how this has evolved over time. The discussion starts on the idea of evaluating patients prior to surgery with a focus on maximizing their condition and ability to get through surgery safely, and how this informs the post-surgery reco...

Dr. Zacharias tackles the subject of managing patients who come armed with data from wearable devices (e.g., Fitbits, Apple Watches) believing that this information is valuable for their medical care. He uses the case study of a patient who is a trail runner and has concerns about elevated heart rates (as indicated by device data) and how this may connect with a family history of early heart disea...

This episode’s guest is Dr. Will Van Derveer, a recognized leader in integrative psychiatry, who shares his insight about using ketamine to treat depression and the different schools of thought about how it should be used. He provides some background about the origins of ketamine use in medicine and research studies that demonstrated positive results for patients with depression. The discussion to...

Dr. Rebecca Vogel, a general surgeon and COPIC board member, is the guest for this episode that explores key areas of risk management associated with certain surgical injuries. Dr. Vogel talks about her involvement with surgical residency programs and integrating a focus on “maintaining your passion and humanism” throughout your career in medicine. Using a case study about a surgical fire, we look...

Dr. Sue Sgambati, COPIC’s Medical Director and a colorectal surgeon, returns to the podcast to discuss risks and guidelines associated with laparoscopic cholecystectomy. Dr. Sgambati talks about the background behind utilizing this approach and how a reduced recovery time led to improved patient and provider satisfaction. However, one of the concerns that has emerged is the risk of bile duct injur...

Dr. Zacharias is joined by Dr. Sue Sgambati, COPIC’s Medical Director, to discuss situations where a physician is thinking about terminating a patient from their practice. Common issues that we see include multiple missed appointments, rude behavior, or non-compliance with medication. The conversation focuses on considerations from a physician’s perspective (disclaimer: consult an attorney for leg...

This episode’s guest is Dr. Nelson Trujillo, a cardiologist out of Boulder, Colorado, who also has a background in biomedical engineering and nuclear medicine. Dr. Trujillo shares his personal journey, the influence of prominent mentors, why he gravitated toward the prevention of cardiovascular disease, and the notable paradigm shifts he has observed during his career. He shares some insights abou...

This episode focuses on the issue of what medical practices should do when they receive clinical information (often test results) about an individual who is not a recognized patient, or which did not originate from an order or request from the practice. This situation increases as patients have more options to self-refer for tests, and more ways to deliver results to providers. Examples include he...

Taped live at the annual Patient Safety & Risk Management Forum, this episode features a panel discussion with Dr. Zacharias, Dr. Alan Lembitz, COPIC’s Chief Medical Officer, and Dr. Sue Sgambati, COPIC’s Medical Director. Using a series of real case studies, the panel highlights key patient safety and risk management principles based on where we consistently see medical liability issues. The case...

Dr. Alan Lembitz, COPIC’s Chief Medical Officer, joins us to talk about managing situations where patients make decisions about their care that you don’t believe is in their best interest. Using a case study review, we analyze a scenario that illustrates the importance of using an informed refusal form to document a patient’s choice that goes against your recommended care. This presents a challeng...

This episode focuses on Nebraska legislation that outlines rules for prescribing and continuing education around opioids and controlled substances. The legislation was passed in 2018, but its implementation was delayed because of COVID. However, these requirements are now in effect starting in October 2021. Among the requirements are that prescribers must obtain 3.0 hours of CME regarding prescrib...

It’s an issue that many physicians are facing and something that continues to be a focus in public discourse—people who don’t want to take the COVID vaccine. The conversations providers are having on this topic can be emotionally charged, full of confusion and disinformation, and difficult to navigate. This episode’s guest, Dr. Dennis Boyle, is an expert on communication and shares some insight on...

Dr. Dennis Boyle, COPIC physician risk manager, joins the podcast again to talk with Dr. Zacharias about ongoing issues we see with medication errors. These include drug-to-drug interactions, medications that are most prevalent in medical liability lawsuits (antibiotics, pain medicine, and anticoagulants), and awareness about black box warnings. Dr. Boyle walks through some case studies to illustr...

Dr. Zacharias is joined by Dr. Dennis Boyle, a COPIC physician risk manager, to talk about key elements of nonverbal communication that occur during physician-patient interactions such as touch, facial expressions, posture as well as the speed and tone of your voice. Dr. Boyle talks about nonverbal cues in both how we sent messages to patients and how “micro expressions” from patients can provide...

In this episode, we are proud to have Dr. Sami Diab, the president of the Colorado Medical Society (CMS). Dr. Diab describes his journey into medicine, from growing up in Syria to finding his calling as an oncologist to joining the leadership team at CMS. He talks about how his medical background is applied in his current role when dealing with public policy and state legislative issues, and how h...

Dr. Michael Victoroff joins the podcast again to talk about administrative or conduct issues that can create legal concerns for physicians. Many of these relate to the authority a medical license grants and the power of a physician’s signature (i.e., prescribing medications, signing off on medical charts, etc.). Dr. Victoroff makes the distinction between willful misconduct and inadvertent actions...

Dr. Sue Sgambati, COPIC’s medical director and a colorectal surgeon, joins Dr. Zacharias to talk about her personal experience in balancing the professional responsibility to treat pain with concerns over opioid addiction. Dr. Sgambati reviews the historical background of key factors that contributed to the overprescribing of opioids and what she saw and learned in her own practice. She then talks...