Within Normal Limits: Navigating Medical Risks

Dr. Zacharias welcomes Dr. Michael Victoroff, a COPIC consultant and health information technology expert, to talk about the increased use of telehealth driven by COVID-19 and how this has become a more permanent shift in health care. They discuss the applicable regulations and practical guidelines that are defining the telehealth environment and what physicians should know to effectively navigate...

Dr. Benjamin Keidan, Boulder Community Health's Chief Medical Officer, joins us to share his thoughts on how to implement and reinforce a culture of safety. Dr. Keidan talks about his personal journey and how an MBA gave him a better understanding of the financial, human resources, and legal perspectives that impact health care. He highlights the importance of creating a system that values collabo...

Dr. Zacharias is joined by Dr. Dennis Boyle, a COPIC physician risk manager, and Dr. Donald J. Lefkowits, the current president of the Colorado Medical Board. Dr. Lefkowits talks about his journey from working in emergency medicine to becoming part of the Board’s leadership. He then walks through the types of complaints the Board receives and how they manage the process of addressing these. This i...

Dr. Zacharias welcomes Dr. Alan Lembitz, COPIC’s chief medical officer, to talk about what we are seeing in terms of the medical liability issues that may come in the wake of COVID-19. Dr. Lembitz highlights what initial claims data and trends is telling us, and how, due to the “long-tail” of incident reporting, the full impact of COVID-19 will take some time to emerge and understand. The discussi...

In this episode, we look at medical education with two representatives from Pikes Peak Community College (PPCC)—Lisa James, Executive Director of PPCC’s Foundation, and Amber Lippincott, Associate Dean of Nursing. Their discussion explores health care trends that are influencing student programs in nursing and other allied health professional fields. In particular, they highlight simulation techno...

Dr. Sue Sgambati, a colorectal surgeon and COPIC’s medical director, discusses the recent recommendation from the U.S Preventive Services Task Force that colorectal cancer screening routinely begin at age 45, instead of age 50. This recommendation is in response to the sharp rise in the number of colorectal cancers in young adults. Dr. Sgambati draws upon her own experience to talk about considera...

Dr. Alan Lembitz joins us on this episode to talk about some of his key lessons learned over the years as COPIC’s chief medical officer. In particular, the conversation focuses on how and why COPIC developed its Practice Quality Reviews that help identify potential areas of risk. Dr. Lembitz discusses how claims data is distilled down to develop Level One Guidelines (best practices) about common a...

What is Candor? How does it benefit patients and providers? Dr. Zacharias is joined by Dr. Sue Sgambati, the medical director at COPIC, to answer these questions and provide some insight. In this context, Candor refers to a framework that emerged out of efforts by the Agency for Healthcare Research and Quality (AHRQ) to encourage an environment that supports open, honest conversations with patient...

Dr. Jeff Varnell, a surgeon and COPIC physician risk manager, is the guest for this episode that focuses on addressing adverse outcomes through COPIC’s 3Rs and CANDOR Programs. Dr. Varnell has managed the 3Rs (Recognize, Respond, and Resolve) process and highlights its origins and goals of maintaining the physician-patient relationship and improving the quality of medical care. He also talks about...

Dr. Zacharias welcomes Dr. Sophia Meharena, a pediatrician and member of COPIC’s Board of Directors, to talk about her personal journey into medicine and the transformative experience of doing her residency at Children’s Hospital Colorado. She also discusses her current role at a safety net clinic and highlights the value of integration that occurs with other specialists, health care navigators, a...

Dr. Zacharias’s brother, Alan, is our guest, not just because he is related to our host, but because he is a neurologist and expert in cognitive impairment. The two discuss having patient conversations about memory issues associated with “normal aging” and differentiating these from possible early indicators of Alzheimer's disease. Alan then does a deep dive into diagnosing Alzheimer’s; the role o...

Coming off the holidays, this episode taps into Dr. Zacharias’s knowledge as a published author on the benefits of the Mediterranean diet. In a conversation with Dr. Sue Sgambati, COPIC’s Medical Director, Dr. Zacharias talks about how a six-month sabbatical traveling across countries such as France, Italy, and Spain, enabled him to research how dietary habits can reduce coronary heart disease and...

As we get older, there is value in the wisdom and experience we gain. However, there is also a well-documented risk for cognitive and physical decline that accompanies aging. In this episode, Dr. Zacharias looks at the issue of assessing the skills of aging physicians with his guest, Dr, Jeffrey Varnell, a surgeon and COPIC physician risk manager. It’s a topic filled with gray areas (pun intended)...

In this episode, we hear from one of Dr. Zacharias’ patients who is doing well due to early recognition of an often-missed condition—epidural spinal lesion. The patient initially presented with symptoms that included back pain and mild saddle anesthesia. The episode provides an insightful perspective from the patient’s point-of-view and reinforces the importance of remaining hypervigilant to subtl...

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 necessary. Dr. Michael Victoroff, who is a firearms safety expert, addresses some scenarios associated with guns that can arise in the clinic...

While burnout is a long-standing issue in health care, the compounded impact of COVID-19 has heightened its prevalence and the importance of efforts to address the well-being of medical providers. In this episode, Dr. Zacharias talks to one of COPIC’s experts on physician burnout, Dr. Dennis Boyle. They dissect the root causes of burnout and three key diameters to consider—depersonalization, emoti...

Dr. Zacharias talks with Dr. Connor Graham, a frontline hospitalist at a critical care access hospital, about his direct experience in dealing with COVID-19. Dr. Graham discusses how patient cases have changed since March, the risk of exposure and the emotional strain medical providers face, and the ways treatment options have evolved. In addition, he addresses the challenging logistics of prolong...

Informed consent shouldn’t be viewed as just an obligation to get a signed form, but rather, an opportunity to engage patients in shared decision-making. Dr. Jeffrey Varnell, a surgeon and COPIC physician risk manager, joins Dr. Zacharias to talk about the process of disclosing essential information during the informed consent process so that patients understand the recommended treatment and indic...

Sepsis is a common syndrome, and although our knowledge of how to treat it has improved significantly, this bacterial infection can be very lethal if not caught early. Dr. Susan Sgambati, a colorectal surgeon and COPIC’s medical director, joins Dr. Zacharias to review some sepsis case studies and discuss why early recognition is critical, the value of clinical judgement and vital signs, and how pa...

Dr. Zacharias switches places with his peer, Dr. Boyle, who asks questions about a classic case study that involves…you guessed it—spinal epidural abscess. The conversation gets deep into the clinical aspects surrounding a patient who visits the emergency room several times in an eight-day period with complaints of a subjective fever and severe back pain. As Dr. Zacharias notes, this is a difficul...

Our first episode draws upon decades of medical liability experience to distill down the key areas where we consistently see malpractice lawsuits—heads (neurologic), hearts (chest pain), bellies (abdominal pain), and bugs (infections). We examine why physicians sometimes misdiagnose symptoms that seem obvious in hindsight, but in actual practice, are not so simple. Our guest is Dr. Dennis Boyle, a...