General Surgery

Professional Education
Patient Relations: Spotlight on Challenging Situations
The Doctors Company’s dedicated patient safety risk managers deliver a wide range of expert services and resources to our members—including personal telephone consultations to help guide members through challenging situations. A recent review of our call data shows that “patient relations” and “patient termination” consistently appear as the top reasons that members request assistance. The following strategies can help prevent challenging patient situations and provide guidance if one occurs.
0.5 credit

Professional Education
Pathologists and Surgeons Can Collaborate to Reduce Diagnostic Error
The Doctors Company has updated the claims filed against pathologists between the years 2015 and 2020. The information provides quantitative and qualitative data that a pathologist and surgeon would find meaningful in reducing diagnostic error. This program provides a breakdown of where patient injuries occur involving pathologists and surgeons and how collaboration between the two disciplines can improve patient outcomes.
1.0 credit

Professional Education
Patient Safety in Spine Surgery
Spine surgery requires a series of best practice patient safety interventions to reduce the frequency and severity of patient harm while giving the care team the resources to mitigate such harm. Evidence-based clinical methods, pathways, and tools coupled with an evolving culture of patient safety through effective communication, teams, and teamwork has shown to reduce patient harm exponentially. Patient and clinical team experiences are enhanced while ensuring a learning culture is built that approaches surgery from both a technical and nontechnical approach alike.
1.3 credits

Professional Education
Risky Practices: Hidden Liabilities Identified by Medical Office Assessments
Office practice assessments by The Doctors Company's patient safety risk managers uncover hidden liability risks, often exposing areas where patients can "fall through the cracks" and leave the practice vulnerable to a malpractice claim. Our Practice Risk INSIGHT, an assessment tool customized by specialty, zeros in on problematic areas. The assessments have been completed across a range of practice environments around the country—from small offices to practices that are part of large integrated delivery systems. In this course, we analyze the results of the Practice Risk INSIGHT assessments, highlight problem-prone areas and offer strategies to minimize liability.
1.3 credits

Jun 11, 2021
Conflicting Guidelines on Screening Mammography Can Pose Risks
David B. Troxel, MD, Medical Consultant to The Doctors Company
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.

Professional Education
Telehealth: Review Your Service Components
Many practices implemented telehealth overnight in response to pandemic restrictions on elective care. Practices already using telehealth saw huge increases in volume. This program presents a roadmap for practices to evaluate their telehealth implementation using the best practice tips identified herein and their own lessons learned.
0.8 credit

Professional Education
Breast Cancer Claims – A Review in Gynecology
Breast cancer medical negligence claims are reviewed over a ten-year period to identify the major case types in which the gynecologist is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense physician experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
1.0 credit

Apr 02, 2021
Pre-Procedural Screening and Testing During COVID-19
Throughout the pandemic, surgeons have faced many challenges in adapting to new situations. Now that facilities have resumed elective surgeries, surgeons are facing additional challenges in evaluating and scheduling patients who have recovered from COVID-19. The strategies highlighted here can help ensure a consistent approach in keeping both patients and providers safe.

Mar 24, 2021
Patient Selection for Elective Cosmetic Procedures
James E. Vogel, MD, FACS, Associate Professor of Plastic Surgery, The Johns Hopkins Hospital and School of Medicine, and Susan Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education, The Doctors Company
The patient selection process is a valuable tool that can help you reduce risks when you assess prospective patients for elective cosmetic procedures.

Mar 23, 2021
Prescribing Opioids Safely: How to Have Difficult Patient Conversations
Roneet Lev, MD, Chief of Scripps Mercy Emergency Department, Chair of Prescription Drug Abuse Medical Task Force, and President of Independent Emergency Physicians Consortium
Drug overdose is the leading cause of accidental death in the U.S., and opioids account for over 60 percent of those deaths. Building a strong doctor-patient rapport can help facilitate tough conversations with patients about opioid prescriptions and reduce risks that could lead to malpractice suits.

Mar 08, 2021
Patient Safety Strategies for Dermatology
Susan Shepard, MSN, CPHRM, Senior Director, Patient Safety and Risk Management Education, The Doctors Company
Take steps to reduce risks in dermatology by reviewing your practices and systems and implementing these strategies.

Feb 26, 2021
Resources for Elective Procedures During COVID-19
Kim Hathaway, MSN, CPHRM, Patient Safety Healthcare Quality and Risk Management Consultant, and Julie Ritzman, MBA, CPHRM, Vice President, Department of Patient Safety and Risk Management
Your patients most likely want to know about the safety of surgery during the pandemic and what occurs if they contract COVID-19 post-procedure. You may have questions about keeping your staff and patients safe, informing patients about new risks the pandemic has created, and potential liability risks you may be facing.

Professional Education
TeamSTEPPS® Teamwork Training in the Office Practice
This course provides an overview of the evidence-based TeamSTEPPS® concepts, tools, and strategies based on the four areas of 1) leadership, 2) mutual support, 3) situation monitoring, and 4) communication. TeamSTEPPS training provides teachable/learnable skills that improve communication and teamwork among healthcare professionals in both acute care and ambulatory care environments.
1.5 credits

Jan 26, 2021
Laparoscopic Lysis of Adhesions Leads to Missed Bowel Perforation: Case Study
David B. Troxel, MD, Medical Consultant to The Doctors Company
Experts opine on the case of a patient who suffered a bowel injury during laparoscopic surgery. The discussion includes strategies for recognizing patients who might be at increased risk.

Professional Education
HIPAA Fundamentals: 2021 Edition
This on-demand program provides an orientation to the basic requirements of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA gives patients many rights with respect to their health information.
1.0 credit

Professional Education
HIPAA for Managers: The High-Level View
The program explores and defines HIPAA policies and procedures, business associate agreements, security assessment and analysis, training requirements, HIPAA compliance requirements, breach events, and informed consent.
1.0 credit

Professional Education
Prevention of Diagnostic Error in Primary Care
Diagnostic errors occur often in primary care settings and can impact over 12 million outpatients annually. This is a top patient safety concern and a global burden. Significant patient harm can occur due to treatment delay, testing, or misdiagnosis. This course is an opportunity to promote awareness and visibility by identifying where these errors occur most often in the diagnostic process of care framework.
1.0 credit

Professional Education
It's the Little Things: An Introduction to Enhancing Patient Relations and Reducing Risks
It's the Little Things is designed to assist medical practices with improvements in patient interactions by looking at how incorporating hospitality as a focus makes a difference. It has been developed to improve multiple facets of patient interaction.
1.3 credits

Professional Education
Spotlight on Diagnosing PE/DVT
The overall incidence of venous thromboembolism (VTE) —including both deep vein thrombosis (DVT) and pulmonary embolism (PE) —is one case per 1000 patient years. Accurate and timely diagnosis of VTE can be improved with the use of diagnostic guidelines such as Wells criteria and scoring for both DVT and PE.
0.5 credit

Professional Education
Lessons Learned – Plastic Surgery Closed Claims Study: An Expert Analysis of Medical Malpractice Allegations
This course is based on the findings of a study conducted by The Doctors Company that analyzed 415 claims that closed against plastic surgeons (from July 2015–December 2018).
1.3 credits

Professional Education
Medical Error Prevention
The purpose of this monograph and continuing medical education activity is to provide physicians with the most current information regarding the prevention of common performance and diagnostic errors.
2.0 credits

Professional Education
Safe and Effective Opioid Prescribing – Florida Edition
The Doctors Company recognizes the opioid epidemic in this country. This course provides insights into the risks of opioid usage, as shown by malpractice claims, and how to reduce those risks both for your patient and for your practice. Approved by the Florida Board of Medicine—Controlled Substance Prescribing.
2.0 credits

Professional Education
Prevention of Medical Errors: CME Risk Management Course for Florida Practices
This activity is specific to Florida statutes and reflects regulations effective February 2020. Few medical errors are attributed to faulty medical judgment. More commonly, they are attributed to system failures inherent in healthcare delivery. By drawing on our professional liability closed claims data, we have identified common performance and diagnostic errors that reflect on the most common issues identified by Florida—wrong site surgery, surgery complications, cancer, Ob/Gyn related conditions, gastroenterology conditions, cardiology issues, neurological issues, and adverse drug events—that will serve as the focal point of this patient safety and risk management course.
2.0 credits

Professional Education
Cauda Equina Syndrome: A Failure to Diagnose
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when patient assessments are incomplete, having a narrow diagnostic focus, or diagnostic test issues. Other factors that hinder timely diagnoses include failure to appreciate signs and symptoms, lack of consults, and failure to respond to repeated patient concerns/symptoms.
0.5 credit

Professional Education
Telemedicine to Telehealth: Trends and Emerging Risks
This course explores challenges and risks such as privacy and security, licensure, and technology concerns that might instigate a malpractice claim. The risks overlay the inherent challenge of replicating the interaction of a traditional, in-person encounter between a provider and a patient, without compromising the standard of care. It also provides resources for clinicians and practice managers to consider when making decisions about deploying telehealth services or to improve existing services.
1.3 credits

Aug 25, 2020
Distracting Devices in Healthcare: Malpractice Implications
Shelley Rizzo, MSN, CPHRM, Senior Patient Safety Risk Manager
Digital distraction in healthcare is a threat to patient safety and physician well-being. Personal electronic devices can create a digital distraction so engaging that it consumes awareness, potentially preventing healthcare providers from focusing on the primary task at hand—caring for and interacting with patients.

Professional Education
Making an Informed Consent an Informed Choice: Training for Healthcare Leaders
This activity is designed for healthcare professionals in leadership positions. It covers the principles of informed consent, crafting and disseminating an informed consent policy, and building systems to improve the informed consent process.
2.0 credits

Professional Education
Making an Informed Consent an Informed Choice: Training for Healthcare Professionals
This activity, designed for doctors, nurses, and other providers, examines problems with the process of healthcare informed consent. It describes the principles of informed consent and highlights the benefits gained from a good informed consent process.
2.3 credits

Jun 29, 2020
Why Medical Clearance Is Really a Preoperative Evaluation
Debra Davidson, MJ, CPHRM, Senior Patient Safety Risk Manager, Department of Patient Safety and Risk Management, and David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company and Healthcare Risk Advisors
The goals of the preoperative evaluation are to determine the patient's level of risk and to identify opportunities to mitigate it.

Jun 18, 2020
Moderate or Conscious Sedation in the Office Setting
Julie Brightwell, JD, RN, Director, Healthcare System Patient Safety, Department of Patient Safety and Risk Management
Prevent patient injury when providing moderate sedation in the office by incorporating these patient safety and practice improvement strategies.

Jun 15, 2020
Safely Caring for the Hospitalized Patient with Obesity
Paul Nagle, ARM, CPHRM, Director, Department of Patient Safety and Risk Management, and Shelley Rizzo, MSN, CPHRM, Senior Patient Safety Risk Manager, Department of Patient Safety and Risk Management
Obesity is viewed as a chronic health condition, and patients with obesity pose patient safety issues.

Professional Education
Physician-Patient Relationship: When Does it Begin and When Does it End?
This enduring program will assist the participant in understanding the principles which form the establishment of a physician-patient relationship, as well as the concerns which may result in the need for the physician to consider terminating the physician-patient relationship. Additionally, the concepts of providing patient centered care will be presented for the learner’s consideration.
1.0 credit

May 01, 2020
Informed Consent for COVID-19 Risks: Frequently Asked Questions
To support our members and the entire medical profession during this unprecedented time, the following are answers to some frequently asked questions regarding informed consent for COVID-19 risks.

Professional Education
General Surgery: Miscommunication and Inaccurate Documentation
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when documentation is inconsistent or not thoroughly read. Other factors that hinder timely diagnosis include inadequate hand-offs or referrals.
0.5 credit

Professional Education
Neurosurgery: Communications and System Failure Leading to Diagnostic Error (Claims Corner CME)
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when needed equipment isn’t available or when access to a patient is difficult. System failures may result when there is a lack of coordination of appropriate care among providers, or when poor communication among providers leads to missed and delayed diagnoses.
0.5 credit

Professional Education
Analysis of Medical Oncology Claims
An analysis of The Doctors Company's closed oncology claims reveals drivers related to diagnosis, care management, and medication management. In addition, the analysis identifies related drivers that are often the underlying reasons that patients file claims.
1.0 credit

Professional Education
Internal Medicine: When Personal Relationships Interfere with the Standard of Care
Physicians and dentists are often faced with the decision whether to treat friends and families without realizing the inherent risks in doing so. A review of one case will highlight some common circumstances and risks associated with the treatment of friends and family members.
0.8 credit

Dec 12, 2019
Making Further Advancements in Anesthesia Care Safety
Susan K. Palmer, MD; Darrell Ranum, JD, CPHRM, Vice President, Patient Safety and Risk Management; and Susan Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education
We analyzed 459 claims for new trends in anesthesia care.
From The Doctor’s Advocate

Professional Education
Spotlight on Anesthesia Claims: Moving the Needle
In this course we will show how comorbidities complicated the delivery of good anesthesia care. And we will share how important a thorough history and physical is to identifying potential problems that occur in the administration of anesthesia care.
1.0 credit

Professional Education
Safe and Effective Opioid Prescribing - Georgia Edition
This three-hour learning activity provides instruction on controlled substance prescribing guidelines, recognizing signs of abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management, as delineated in Georgia Rule 360-15-.01. It also provides tools and resources to assist in educating staff and informing patients.
3.0 credits

Professional Education
Prescribing Opioids Safely
Faced with an opioid-related epidemic that continues to bring addiction and deaths, it is important to define the role of opioids for both acute and chronic pain management. This activity spotlights the epidemic and presents the Centers for Disease Control and Prevention (CDC) guidelines, regulations, studies, and emerging solutions to address the epidemic and allow for effective and appropriate use of these drugs.
2.5 credits

Professional Education
Safe and Effective Opioid Prescribing - Michigan Edition
This three-hour learning activity provides instruction on controlled substance prescribing guidelines, recognizing signs of abuse or misuse of controlled substances, and requirements delineated in Michigan’s law. It also provides tools and resources to assist in educating staff and informing patients.
3.0 credits

Dec 01, 2019
Dilaudid-Related Morbidity and Mortality from Respiratory Depression
Howard Marcus, MD, FACP, Chairman, Texas Alliance for Patient Access
Patient safety organizations and the FDA are focusing on ways to reduce patient harm from opioids.

Nov 05, 2019
When Treating Kids, Learn from the Emergency Department
Phyllis L. Hendry, MD, FAAP, FACEP
To prevent communication gaps when treating kids, all specialties can benefit from lessons learned in the Emergency Department, where conversations are rushed, stakes are high, teams are assembled ad hoc, and physicians seldom have relationships with the patient.

Sep 05, 2019
Advanced Practice Provider Closed Claims: What Can We Learn?
Howard Marcus, MD, FACP, and Susan Shepard, MSN, RN, Senior Director, Patient Safety Staff Education
Top allegations in our claims analysis involving advanced practice providers centered on diagnosis.
From The Doctor’s Advocate

Aug 27, 2019
Electronic Health Records Continue to Lead to Medical Malpractice Suits
Darrell Ranum, JD, Vice President of Patient Safety and Risk Management
We analyzed 216 medical malpractice claims that closed from 2010 to 2018 in which EHRs contributed to patient injury. The pace of these claims grew, from a low of seven cases in 2010 to an average of 22.5 cases per year in 2017 and 2018. As EHRs approach near-universal adoption, they may become a more prevalent source of patient safety risk.

Professional Education
Advanced Practice Providers Closed Claims: What Can We Learn?
A recent study by the Association of American Medical Colleges predicts that the U.S. would need an additional 95,900 doctors, 22,700 NPs, and 12,800 PAs immediately if healthcare use patterns were equalized across race, insurance coverage, and geographic location. More understanding of the liability associated with APPs can help provide insight on the current situation and identify strategies that decrease risk, improve patient safety, and advance patient care.
1.0 credit

Jun 13, 2019
An Analysis of Malpractice Claims by Physician Gender
David B. Troxel, MD, Medical Consultant to The Doctors Company
A gender-specific analysis of 5,897 claims from six medical specialties.
From The Doctor’s Advocate

Professional Education
Physical Examination and Its Impact on Outcomes
Advancements in technology improve the timeliness and accuracy of many diagnoses but the technology does not replace a thorough physical examination. For some diseases, such as Parkinson’s disease, herpes zoster, cellulitis, and Bell’s palsy the PE is the only diagnostic tool available. This short course makes the case for reversing the downward trend for physical examinations.
0.8 credit

Professional Education
Neurological Case Study: Management of the Surgical Patient
This Claims Corner examines a neurosurgical case that alleges several failures to assess and treat a patient in a timely manner. It also highlights the importance of communicating with physicians and advanced practice providers involved with post-surgical care.
0.5 credit

Professional Education
Oral-Maxillofacial Surgery Informed Consent
Informed consent involves more than a patient signing a form. This activity explains how to enact an informed consent process based on best practices in dentistry and oral surgery.
1.0 credit

Professional Education
Ob/Gyn: Telephone Communications
The most frequent inconsistent practice found in the Practice Risk INSIGHT assessments was telephone communication (22 percent not met). When appropriate and adequate systems are in place, the physician is less at risk for having a suit filed. This case-based study provides insights and risk management techniques to lessen the frequency and severity of such a claim.
0.5 credit

Video Apr 09, 2019
Study of Malpractice Claims Involving Children
Patient safety risks when treating children vary depending on the patient’s age—but communication breakdowns between doctors and patients/families occur in malpractice claims for pediatric patients of ALL ages. Watch this important case study to learn more.

Mar 20, 2019
Study of Malpractice Claims Involving Children
Darrell Ranum, JD, CPHRM, Vice President, Patient Safety and Risk Management
The Doctors Company analyzed 1,215 claims filed on behalf of pediatric patients that closed from 2008 through 2017. The study is based on the claims filed against physicians in 52 specialties and subspecialties and includes an overview of the most common types of claims, expert insights into the specific elements that led to patient injury, and risk mitigation strategies.

Professional Education
Opioid Pain Management and Appropriate Prescribing for Older Adults
This activity includes five video segments on effective pain management and appropriate prescribing of opioid medication for older adult patients. Presenters include a family practice physician, orthopedic surgeon, palliative care physician, and a pain management specialist provider.
1.5 credits

Video Oct 31, 2018
Fighting the Opioid Epidemic: Progress Report from Surgeon General
Programs for combatting the opioid epidemic, reducing overdose rates, and addressing other addiction epidemic issues (including heroin and fentanyl) are explored by U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH. His comments were made to attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Surgeon General's Priority: Partnering for Public Health
Community health and economic prosperity are connected, and healthcare professionals can partner with the business community to improve public health. This priority for public health was shared by U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH, with attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Threat of Global Epidemics: Surgeon General Speaks
There is a growing threat of global epidemics, including Ebola and Zika, and U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH, is working to address this threat and promote health through better community partnerships. He made his comments to attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Naloxone to Fight the Opioid Epidemic: Surgeon General's Perspective
Co-prescribing naloxone can help turn around opioid overdose rates and is an important first step in fighting the opioid epidemic, says U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH. His comments were made to attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Surgeon General Addresses E-Cigarettes and Vaping
Vaping and e-cigarettes present a significant healthcare challenge for physicians today. U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH, addresses this issue and the fact that young people are susceptible to developmental delays and effects on the brain from vaping and e-cigarettes, which prime them for addiction up to age 26. His comments were made to attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Surgeon General's Strategies for the Opioid Epidemic
U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH, detailed some of the strategies, plans, and programs that can be effective in combating today's opioid epidemic when addressing attendees at The Doctors Company's 2018 Executive Advisory Board meeting. Topics include prescription drug monitoring programs, reasonable alternatives to opioids for acute and chronic pain management, medication-assisted treatment for those in recovery, and co-prescribing naloxone for those at risk of opioid overdose.

Oct 30, 2018
U.S. Surgeon General Discusses Public Health Issues
United States Surgeon General Vice Admiral Jerome Adams, MD, MPH, discusses how vaping and e-cigarettes present a significant healthcare challenge for physicians, as well as how changes in healthcare payment models are increasing the focus on public health.

Oct 30, 2018
U.S. Surgeon General Discusses the Opioid Epidemic
United States Surgeon General Vice Admiral Jerome Adams, MD, MPH, discusses the opioid epidemic’s huge impact and strategies to combat it, including prescription drug monitoring programs, medication-assisted treatment for those in recovery, and co-prescribing naloxone for those who are at risk of opioid overdose.

Video Sep 27, 2018
Future of Healthcare: Physicians Won't Recommend Their Profession
The Future of Healthcare Survey of over 3,400 doctors shows physicians are disenchanted with practicing medicine, largely because of technologies and payment models they say are interfering with the doctor-patient relationship and their ability to provide quality care. Despite continuing volatility in the industry and resulting dissatisfaction, one of the predominant themes captured in this survey is the concern physicians share for their patients and the quality of the care they receive.

Dec 07, 2017
Teamwork Saves Lives in Bronx-Lebanon Hospital Shooting
Shelley Rizzo, MSN, CPHRM, Patient Safety Risk Manager, The Doctors Company, and Steven J. Weintraub, MD, Chief of Risk Management, North American Partners in Anesthesia
Teams pull together to save lives and provide support during a deadly hospital shooting.
From The Doctor’s Advocate

Jun 06, 2017
Prescribing Opioids Safely
Howard Marcus, MD, FACP
Dr. Howard Marcus discusses guidelines and recommendations for preventing opioid misuse and addiction in patients with acute or chronic pain.
From The Doctor’s Advocate

Mar 16, 2017
San Diego Death Diaries
Roneet Lev, MD
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
David B. Troxel, MD, Medical Director, Board of Governors
Dr. David Troxel reviews 1,770 closed by The Doctors Company in which patient harm involved medication factors.
From The Doctor’s Advocate

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