Within Normal Limits: Navigating Medical Risks

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 her background in pulmonary care and why her desire to better educate patients (and other physicians) on lung health led to writing Breathing Lessons. The discussion also touches on research data insights, measuring lung function as people age, the use of spirometry testing, and advocating for improved public policy on lung health. In addition, Dr. Han highlights the importance of expanding patient conversations beyond just addressing complaints to also focusing on awareness of environmental and socioeconomic factors that contribute to lung disease as well as practical, preventative steps patients can take to reduce risks.

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Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.

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 recovery plan. Dr. Varnell then talks about preoperative screening processes, from nutritional screening to pain management, and the importance of using a team/systematic approach to improve outcomes and reduce risk. 

Show email [email protected]

Feedback or episode ideas email the show at [email protected]

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.

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 disease. In responding to this type of situation, Dr. Zacharias highlights the importance of differentiating consumer-grade devices from approved medical diagnostic devices, explains how the data may inform a careful evaluation focused on the patient’s concerns, and how to handle documentation of this data in the medical record.

Show email: [email protected]

Feedback or episode ideas email the show at [email protected]

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.

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 touches on the concerns with ketamine (diversion and addiction), the duration of benefit, “rule outs” to consider, and the influence of Michael Pollan’s book, How to Change Your Mind, on the renewed interest in psychedelics as therapeutic tools. Based on his experience, Dr. Van Derveer also talks about creating the optimal setting and preparing patients for this type of treatment as well as taking an integrative approach that looks at underlying issues, such as diet and lifestyle habits, that contribute to depression.

Feedback or episode ideas email the show at [email protected]

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.

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 at key factors that contribute to these types of incidents—from the risk of a laser igniting oxygen to miscommunication between a surgeon and an anesthesiologist. Dr. Vogel then highlights the importance of “putting the patient first,” assessing the situational risks, and understanding the safety protocols relevant to the procedure you are performing. She also reinforces the value of training that covers the basic physics associated with electrical surgical units such as cut mode settings and how this awareness can impact patient safety.

Feedback or episode ideas email the show at [email protected]

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.

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 injuries (BDIs). Dr. Sgambati focuses on guidelines developed from a multi-society consensus that identify optimal strategies for the prevention of BDIs. In particular, she highlights five key guidelines to consider, provides some real-life context from her experience as a surgeon, and reinforces the importance of documenting your thought process with any type of medical procedure.  

Email comments and suggestions to [email protected]

Feedback or episode ideas email the show at [email protected]

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.

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 legal advice in these situations) starting with a thoughtful analysis of “why do you want to terminate a patient? what is the core issue?” We look at assessing the timing of a termination, how to draft a formal letter that is brief and objective (without letting emotions seep in), and other aspects that include transferring medical records and referrals to other providers. BONUS CONTENT: Dr. Zacharias highlights the news around using monoclonal antibodies in the treatment of COVID.

https://www.covid19treatmentguidelines.nih.gov/therapies/anti-sars-cov-2-antibody-products/anti-sars-cov-2-monoclonal-antibodies/

Email the show at [email protected]

Feedback or episode ideas email the show at [email protected]

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.

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 about “triple rule out,” diagnosing acute coronary syndrome, and considerations when evaluating major risk factors. Dr. Trujillo also talks about prevention and intervention strategies—from adopting a Mediterranean diet to the threshold between benefits and risks with exercise, and the ongoing debate about the impact of alcohol. In addition, he highlights some of the promising research and ideas that may change how we predict coronary disease and improve outcomes.

For comments, suggestions or topics you would like to see us cover you can email the show at  [email protected]

Feedback or episode ideas email the show at [email protected]

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.

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 health fair reports, results of self-authorized tests, or records from external providers. Such information, once received, can present an information management dilemma and potential liability exposure. We walk through considerations such as evaluating if there is an existing provider-patient relationship, was the information sent in error, how clinically urgent the information is, and documentation steps to take.

Show email for ideas or comments [email protected]

Feedback or episode ideas email the show at [email protected]

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.

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 cases cover topics such as “normalized deviance” that occurs with system workarounds; empowering medical staff to voice concerns; common diagnostic errors associated with heads, hearts, bellies, bugs, and cancer; the importance of checking vital signs; subtle symptoms that can turn into severe issues; paying attention to pain out of proportion; and more. In addition, the physicians talk about the art of disclosure along with burnout prevention and wellness strategies.

Show email: [email protected]

Feedback or episode ideas email the show at [email protected]

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient’s specific condition.