Within Normal Limits: Navigating Medical Risks

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 challenge in balancing the concerns of protecting your patient while protecting yourself from a medical liability lawsuit. In addition, we look at factors such as patient competency, reasons why patients may refuse care (including financial concerns), documentation guidelines, the difference of informed refusal versus “against medical advice,” and navigating the process of shared decision-making.

Podcast 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 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 prescribing opioids on a biennial basis (0.5 hours of which MUST cover Nebraska’s Prescription Drug Monitoring Program or PDMP). Dr. Zacharias outlines the details of meeting these requirements, including accessing a half-hour PDMP training video on the Nebraska Department of Health and Human Services’ website and upcoming online COPIC seminars that fulfill 2.0 hours of CME. There are two different COPIC seminars (each one is an hour) that provide risk management guidance around opioids, including the risks of addiction and overdose. The seminars are no-cost to attend, open to all Nebraska prescribers, and will be held on 9/28, 9/30, 10/12, and 10/14.

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.

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 how to approach these situations such as the idea of “developing a therapeutic alliance” as a framing point, inquisitive inquiries, and seeking first to understand why a patient is hesitant. In addition, the discussion touches on the benefit of highlighting the extensive research work done to develop mRNA vaccines and thoughts on what to say to younger patients who are anti-vaccine. 

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. 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 illustrate why errors occur and highlights steps physicians can take to proactively address these situations. The conversation also covers the importance of documenting your thought process when prescribing, the use of “read backs,” the “five rights” of medication use (right patient, right drug, right time, right dose, and right route), the challenges of drug monitoring.    

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 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 valuable insight into how our messages are being received and the patient’s state of mind. He also mentions the “golden minute” of when you first encounter a patient and have an opportunity to form a connection, how nonverbal communication may influence the likelihood of being sued, and the importance of nonverbal communication from other medical staff in a patient’s overall experience.

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.

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 he approaches his work by thinking about the ways broader decisions may impact medical providers, patients, and the overall health care system. Other topics on his mind include managing the challenges of physician burnout, the value of talking to peer physicians, and access to care and affordability. In addition, Dr. Diab emphasizes the importance of energizing other physicians about their role within health care and how to sustain joy in your medical practice while cultivating resilience.

Email the show with feedback or ideas 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.

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 that can lead to accusations of billing fraud, disciplinary proceedings, and governmental investigations. He also highlights common situations where these issues occur such as supervising other medical staff, serving as a medical director, or providing patient coverage for other physicians. Dr. Victoroff notes that well-intentioned favors and a desire to help can sometimes place good physicians in bad situations, and he provides some guidance that includes staying within your scope of practice—things you do on a regular basis. In addition, the discussion turns to EHRs, the challenges of automated templates, and being aware that your notes accurately reflect the care you provided.

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. 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 about the value of using tools such as a state’s prescription drug monitoring program, opioid risk assessment tools, and guidelines published by organizations such as the CDC. Dr. Sgambati also addresses alternatives to opioids that are being used, the challenges of having conversations with patients about opioids and how to document these, and the availability of naloxone to counter overdoses.

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 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 these interactions. Dr. Victoroff shares his thoughts about how the perspectives of providers, patients, and regulatory agencies have changed, the importance of reimbursement, and why “telehealth is one of the best things to happen to medicine.” In addition, he highlights considerations with technical platforms, privacy and security standards, documentation elements unique to telehealth, and concerns with providing telehealth care to patients in other states.

Podcast 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. 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 collaboration among all medical team members and a shared commitment to clearly defined patient safety goals. The conversation then focuses on the benefits of shifting away from a culture of blame to one that encourages reporting, continuous learning, and prevention. Dr. Keidan also talks about his experience with using a “systems perspective” to identify areas for improvement, making “the right thing the easiest to do” for staff, and ensuring that medical providers understand how to report incidents and that there is consistent follow up to explain how concerns are being addressed. 

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.