Internal Medicine

MAR 16, 2017
San Diego Death Diaries
Dr. Roneet Lev provides insights into the prescription opioid abuse epidemic.
From The Doctor’s Advocate

MAR 16, 2017
Analysis of Medication-Related Claims from The Doctors Company
Dr. David Troxel reviews 1,770 closed by The Doctors Company in which patient harm involved medication factors.
From The Doctor’s Advocate

MAR 01, 2017
Boost Patient Safety: How Doctors Can Reduce Risks with Vaccinations
Physicians should always be attentive to the importance of timely vaccines against infectious diseases for patients of all ages. Whether you’re seeing patients for back-to-school immunizations or preparing adult patients for travel abroad, this article can help you assess the vaccine administration protocol in your practice to reduce risks and enhance patient safety.

FEB 17, 2017
Up for Review: Five Keys to Managing Online Criticism
No matter how professional and caring a doctor you may be, eventually you will face criticism on the web. Here are five keys to managing that criticism.

JAN 24, 2017
Taking the Risks to Heart: Misdiagnosis of Heart Disease
Differences in the early symptoms and signs of an impending heart attack in women may make diagnosis more difficult compared to men.

NOV 29, 2016
Watch for the Signs: Screen All Patients for Suicidal Thoughts
Patients with suicidal thoughts or ideation appear occasionally in physician encounters. Any patient, no matter what issue is being treated and in any setting, could be at risk for suicide. A consistent and formal screening process, plus a response plan, will protect both the patient and the physician.

OCT 25, 2016
Optimize the EHR: Better Workflow Means Better Work-Life Balance
There are tools that can streamline patient care and payment workflows in the electronic health record (EHR). By dedicating time and effort up front to optimize the EHR, physicians can get relief from administrative tasks, reduce duplicate entry of data, and save time by not having to search for records in multiple places.

SEP 23, 2016
Internal Medicine Closed Claims: What Can We Learn?
Robin Diamond, JD, RN, and Julie Brightwell, JD, RN
Our analysis of closed internal medicine claims identifies top allegations and the most common factors that contribute to patient injury.
From The Doctor’s Advocate

Internal Medicine Closed Claims Study

SEP 21, 2016
Internal Medicine Closed Claims Study
This study of 1,180 internal medicine malpractice claims identified the most common patient allegations and the specific factors contributing to patient injury.

SEP 20, 2016
Money Talks: Discussing Cost with Patients Before Treatment Is a Win-Win
The physician needs to be involved in making sure that the patient is informed and educated about the financial burden of surgical and medical treatments. Doing this before proceeding with treatment can help lower the risk of a malpractice claim even when the medical outcome doesn’t meet the patient’s expectations.

AUG 09, 2016
What Doctors Need to Know About Zika
Dan Wright, JD, RN, vice president of patient safety, The Doctors Company
Physicians across the U.S. should practice vigilance to ensure patient safety and reduce risk of potential adverse events as we continue to learn more about the Zika virus.

AUG 01, 2016
Patient Safety Strategies for Gastroenterologists
Susan L. Marr, MSA, CPHRM
Gastroenterologists can reduce potential liability by taking risk management steps, such as following guidelines for moderate sedation (conscious sedation).

MAY 12, 2016
Obesity: A Common Comorbidity in Malpractice Claims
David B. Troxel, MD
This case study effectively illustrates the challenges of caring for morbidly obese patients.
From The Doctor’s Advocate

DEC 15, 2015
Challenges in Cultural Diversity: Protect Your Patients and Yourself
Susan Shepard, MSN, RN
Physicians are increasingly faced with providing care to a multicultural society complicated by literacy issues.

DEC 15, 2015
Analysis of Cerebral Vascular Accidents and Case Studies
Mary Lerch, RN
Physicians can improve patient prognosis by educating staff to recognize signs and symptoms of cerebral vascular accidents (CVAs).

OCT 19, 2015
Navigating Risks in Breast Cancer Diagnosis and Treatment: How Physicians Can Enhance Patient Safety
Patients diagnosed with breast cancer must navigate the complex healthcare system while dealing with the emotions of their diagnosis, relying on the expertise, communication, and empathy of caregivers who practice in environments with inherent risks. A study by The Doctors Company and CRICO Strategies reveals the top patient safety risks in breast cancer diagnosis and treatment, and how to reduce those risks.

AUG 04, 2015
On Alert: What All Doctors Need to Know About Alzheimer’s Disease
As the population ages, Alzheimer’s is becoming a more common cause of death. Early diagnosis of dementia, requiring the expertise of a neuropsychiatric physician who specializes in dementia, is essential to allow for maximum quality of life. Physicians of all specialties should become familiar with the early signs of this disease in order to refer patients with symptoms to a specialist for further testing.

JUL 08, 2015
Laboratory and Diagnostic Test Tracking in Ambulatory Practice
Dana Faber, RN, BS, Patient Safety Risk Manager
Inadequate clinical laboratory and diagnostic test tracking is a top factor leading to patient injury.

JUN 23, 2015
Employing Advanced Practice Providers: Balancing Benefits and Potential Malpractice Risks
Advanced practice providers (APPs), like physician assistants and nurse practitioners, perform both routine and complicated medical services for hospitals and medical practices across the country, improving patient access to healthcare. However, practices and hospitals that use APPs must also be aware of potential liability risks. Implementing effective risk management measures will help ensure that the benefits of using APPs are not at the expense of increased liability exposure.

APR 20, 2015
Mid-level Practitioner Liability—Preventive Action and Loss Reduction Plan
This booklet can help practitioners avoid liability risks when hiring or working with mid-level practitioners.

FEB 24, 2015
Rising Number of Measles Cases Creates Numerous Patient Safety Issues
New cases of measles (rubeola) are once again making national headlines. Physicians should implement effective screening protocols, infection control techniques, and patient education to reduce liability risks and promote patient safety.

JAN 21, 2015
Working with Patients Who Do Not Follow the Treatment Plan
Patients who do not follow the treatment plan may become high liability risks because their behavior often exacerbates existing health problems, which can lead to negative outcomes.

DEC 29, 2014
Tracking Referrals
An adequate referral tracking system can help reduce risks and help you provide safe, high-quality care.

DEC 15, 2014
Remote Patient Monitoring: Real-Time Patient Data, Real Liability Risks
Remote medical devices allow healthcare providers to closely monitor patients outside of the office, which can help improve patient health and contain healthcare costs. This article outlines the liability risks doctors face with using remote devices to monitor patients.

DEC 10, 2014
Editorial Comment on Maintenance of Certification
David B. Troxel, MD
Dr. Troxel suggests ways to restructure the MoC examination process to adapt it to changes in the healthcare delivery system.
From The Doctor’s Advocate

DEC 02, 2014
Diagnostic Error in Medical Practice by Specialty
David B. Troxel, MD
This closed claim review focuses on the variance between specialties in the incidence of diagnosis-related error.
From The Doctor’s Advocate

OCT 07, 2014
Communication Is Key to Improving Diabetic Patient Outcomes and Reducing Liability
It’s not uncommon for diabetic patients to file claims against their diabetes care team for failure to properly diagnose, supervise, monitor, and/or treat their disease. This article outlines ways physicians can have effective conversations with their patients to decrease malpractice risks.

SEP 04, 2014
Conflicting Guidelines on Mammograms Can Pose Risks
Breast cancer screening guidelines issued by national organizations and medical specialties have inconsistent recommendations about mammogram screening ages and intervals, which can create potential liability for delayed or missed diagnoses. Learn how to reduce these mammography risks.

JUN 25, 2014
Rising Number of Infectious Disease Cases Creates Patient Safety Issues
Infectious diseases and their inherent liability risks are becoming more common. This article highlights ways physicians can increase patient safety and reduce liability risks when outbreaks occur.

DEC 20, 2013
Interactive Guide to Patient Safety for Office Practices
This interactive guide is designed to help you uncover areas of potential malpractice exposure in your practice.

OCT 08, 2013
Tips for Preventing Misdiagnosis of Spinal Epidural Abscess
Spinal epidural abscess (SEA) requires prompt diagnosis and treatment to prevent serious neurological complications.

SEP 20, 2013
Avoid Missed or Delayed Diagnosis by Being Aware of Risks for BRCA-Based Breast Cancer
Physicians should be aware of the risk factors for BRCA gene-based cancer in order to identify those who need testing and to avoid delayed or missed diagnosis.

SEP 08, 2013
The Rising Tide: Perils of Opioid Use
Howard Marcus, MD, FACP
Dr. Howard Marcus discusses steps physicians should take when initiating opioid therapy.
From The Doctor’s Advocate

AUG 27, 2013
Be Aware of the Risk of Sudden Cardiac Arrest That Killed "Tony Soprano"
Healthcare providers need to be on alert for the risk factors of sudden cardiac arrest (SCA), including high blood pressure, obesity, use of illegal drugs, and nutritional imbalances.

AUG 20, 2013
Mid-level Practitioners: Shared Benefits, Shared Risks
Susan Shepard, MSN, RN
Doctors who work with physician extenders must be aware of their respective roles and the liability exposures that may result.

FEB 28, 2013
TIA Recognition and Management
David B. Troxel, MD
Failure to recognize subtle transient neurologic deficits as a transient ischemic attack or a harbinger of impending stroke can lead to a claim if a stroke subsequently occurs.
From The Doctor’s Advocate

NOV 27, 2012
REMS: Opioid-Related Patient Safety and Liability
David B. Troxel, MD
The FDA's Risk Evaluation and Mitigation Strategies (REMS) program addresses the epidemic of adverse events related to the inappropriate prescribing, misuse, and abuse of long-acting opioids.
From The Doctor’s Advocate

OCT 30, 2012
It Hurts: The Patient with Noncancer Pain
Susan Shepard, MSN, RN, and Howard Marcus, MD, FACP
Physicians who treat acute and chronic pain need to be comfortable and secure in their competency and cognizant of the correct dosing guidelines, which may have dramatically changed in the past decade.

APR 16, 2012
Medication-Related Errors and Liability: What Can You Do?
David B. Troxel, MD
This article outlines strategies for mitigation of medication-related errors.

JUL 26, 2011
Medicine Is an Open Book Exam
Howard Marcus, MD, FACP
Dr. Howard Marcus outlines a case of acute salicylate poisoning and how point-of-care knowledge tools could have improved the outcome.

JUL 20, 2011
Keys to Patient Safety for Dermatology
Susan L. Marr, MSA, CPHRM
Doctors can reduce potential liability in dermatology by taking risk management steps, such as avoiding verbal prescription orders.

JUN 22, 2010
An Analysis of Internal Medicine Malpractice Claims
David B. Troxel, MD
369 consecutive closed internal medicine claims were reviewed to identify events that place internists at risk for a malpractice claim.

JUN 22, 2010
Focusing on Missed or Delayed Diagnosis
Robin Diamond, JD, RN, and Susan Shepard, MSN, RN
This companion article to "An Analysis of Internal Medicine Malpractice Claims" focuses on the types of claims seen in the allegation of missed or delayed diagnosis.

JUN 22, 2010
Dilaudid-Related Morbidity and Mortality from Respiratory Depression
Howard Marcus, MD, FACP
Patient safety organizations and the FDA are focusing on ways to reduce patient harm from opioids.

JUN 01, 2010
Focusing on Selection and Management of Therapy
Robin Diamond, JD, RN, and Susan Shepard, MSN, RN
Claims dealing with selection and management of therapy illustrate how ineffective communication and lack of coordination of care play an important role in adverse events.

APR 07, 2010
Examining the Provider's Role
Arlene Luu, JD, RN, and William J. Oetgen, MD, MBA, FACC

MAY 01, 2003
When to Evaluate for a Hypercoagulable State
Richard Lanzerotti, MD and David B. Troxel, MD
This article discusses the increased risk for thromboembolic events as a result of genetic or acquired abnormalities.

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