Mar 01, 2022
With Medical Implants, Hope and Plan for the Best, but Talk About the Worst
Even with common implant procedures, variability among human systems creates risks and uncertainties. Dr. David L. Feldman discusses the importance of a true informed consent process using shared decision making.
The Doctor’s Advocate
Feb 03, 2022
Documenting a patient’s refusal of test or treatment options is key to minimizing risk exposure.
Feb 02, 2022
Informed Consent: Substance and Signature
True informed consent is a process of managing a patient’s expectations. Every healthcare provider should develop an individual style and system, making it easier to avoid omissions and ensure consistency of application.
Jan 05, 2022
Communicating with COVID-19 Vaccine-Hesitant Patients: Top Tips
As the number of Delta and Omicron variant cases increases alarmingly across the United States, more individuals are considering vaccination against COVID. It is important for physicians to be prepared to answer questions from patients about the various vaccines—particularly since some patients remain hesitant about receiving the vaccination.
Safe Opioid Prescribing for Physicians and Dentists
Opioids play an important role in pain management—both in the acute and the chronic setting, but a variety of causes have contributed to an opioid-related epidemic leading to addiction and death. There has also been substantial misuse of opioids by prescription and by diversion.
Clinical Presentations Cause Delays: Failure to Diagnose Myocardial Infarction
In reviewing closed malpractice claims, The Doctors Company identified missed or delayed diagnosis of myocardial infarction (MI) in the ambulatory internal medicine setting as a reoccurring problem. This course highlights the importance of recognizing the varying clinical
presentations of MI and contributing factors associated with failure to diagnose and treat. Assumptions, lack of a thorough history and physical, communication failures, and failure to recognizing atypical signs and symptoms are highlighted in this case study.
Nov 04, 2021
Reduce Patient Safety Risks with Vaccinations, Including COVID-19
Vaccine administration is usually regarded as a simple office procedure, often performed without the direct supervision of the physician or a licensed professional. Although vaccinations are a routine procedure, physicians and staff should remain vigilant about patient safety considerations. Whether you’re seeing children for COVID-19 vaccinations or adults for travel abroad or general disease prevention, take time now to assess the vaccine administration protocol in your practice.
Delayed Diagnosis of Stroke
In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients. The following highlights the importance of recognizing the signs and symptoms of a stroke.
Cervical Cancer Claims: A Review in Gynecology
Cervical 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.
Alzheimer's – 4 Addressing Patients' and Families' Needs through the Disease Stages of Dementia
This activity includes seven video lectures and is the fourth in a series of four courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. This fourth course covers life planning through disease stages, assessing and assisting caregivers, improving communications, utilizing community resources, and end of life decision-making. These sensitive conversations with patients. The course finishes with a focus on dementia resources, effective communication strategies, and understanding when it is time to make a referral to a specialist.
Alzheimer's – 2 Evaluation and Diagnosis of Alzheimer’s Disease and Related Dementias
This activity includes eight video lectures and is the second in a series of four courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. This second course introduces the Alzheimer’s project evaluation algorithm and evaluation instruments and focuses on differential diagnoses. Finally, the course discusses how to prepare and engage in a sensitive dementia diagnosis disclosure with patients and caregivers.
Alzheimer's – 3 Addressing and Managing Behavioral and Environmental Symptoms of Dementia
This activity includes eight video lectures and is the third in a series of four courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. This third course focuses on using the DICE method to assess behavioral symptoms of dementia and create and evaluation treatment plans. This course also covers the careful use of medication during disease management as wells as common behavioral issues with dementia patients including tools for management of these behaviors.
Alzheimer's – 1 Screening for Dementia Among Adults with Cognitive Decline
This activity includes eight video lectures and is the first in a series of four courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer’s disease and related dementias. This first course focuses on introducing the Alzheimer’s Project and highlighting the increasingly important role of primary care providers in dementia care. This course also introduces the Alzheimer’s Project cognitive impairment screening algorithm and screening instruments and covers addressing reversible conditions that may present similar symptoms to cognitive impairment.
Prevention of Dental Errors for Dental Practices
Few dental errors are attributed to faulty 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:
wrong-site surgery, improper performance of dental procedure, wrong or unnecessary treatment or procedure, retention of foreign body during treatment, and diagnosis related. We analyzed loss prevention measures in tandem with the elements necessary to conduct a credible and thorough root cause analysis (RCA) to reduce system failures, respond to sentinel events, prevent dental errors, and improve patient safety. The purpose of this continuing dental education activity is to provide dentists with the most current information regarding the prevention of common performance and diagnostic errors.
The course covers:
• Identification of the most common quality-of-care violations.
• Illustrative case studies detailing prevalent diagnostic and performance errors.
• The necessary elements of an RCA.
• Safety systems in healthcare organizations.
• Risk management measures designed to prevent dental errors and increase patient safety.
Prevention of Dental Errors
for Florida Dental Practices
The purpose of this continuing dental education activity is to provide
dentists with the most current information regarding the prevention of
common performance and diagnostic errors. The course covers:
• Identification of the most common quality-of-care violations.
• Illustrative case studies detailing prevalent diagnostic and
• The necessary elements of an RCA.
• Safety systems in healthcare organizations.
• Risk management measures designed to prevent dental errors and
increase patient safety.
This course is specific to Florida statutes and reflects regulations
effective in February 2018 for dentists licensed by the Florida Board of
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.
Aducanumab for Treatment of Alzheimer's Disease – Controversy and Appropriate Communications
Panel discussion among neurologists and geriatric psychiatrists to clarify controversial issues surrounding the FDA’s recent approval of Aducanumab for treatment of Alzheimer's disease, and appropriate messaging to patients and family members. Following their presentations, the panel experts will conduct a question-and-answer session.
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.
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.
The Need for Close Monitoring in Hyponatremia: Osmotic Demyelination Syndrome
In reviewing closed malpractice claims, The Doctors Company identified mismanagement of sodium levels during correction of severe hyponatremia as a serious problem that can result in catastrophic permanent neurological injury due to osmotic demyelination syndrome (also known as central pontine myelinolysis). This article highlights the importance of close monitoring of sodium levels during correction of severe hyponatremia, with a slow and controlled pace of sodium correction. Contributing factors discussed include clinical judgment with regard to rate of rise of sodium levels, patient monitoring, choice of practice setting, and communication between providers, especially at points of transition in care.
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.
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.
Dictation Errors in the Emergency Department
The Doctors Company identified dictation errors as a significant patient
safety risk factor. The following case highlights the importance of timely
recognition of dictation errors to ensure accuracy of the permanent
electronic health record (EHR). This is particularly important when using
a voice recognition program to document encounters in the busy
emergency department. In this case, the voice recognition system was
Dragon Direct Voice Recognition Program.
Pain Management - A Closed Claim Analysis Looking at Risks and Lessons Learned
For the first time, The Doctors Company has published an analysis of lawsuits and claims filed against pain management physicians. This study completed in 2020 provides quantitative and qualitative information that a physician who practices pain management, including interventional approaches to treatment would find useful in mitigating the risks of unintended outcomes or harms. This study breaks down where most patient injuries occur, what those injuries are, and the lessons learned from those claims.
Apr 15, 2021
Best Practices in Patient-Centered Care and Shared Decision Making
Using a patient-centered approach with shared decision making benefits patients by incorporating their needs and priorities into the treatment plan.
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.
Interventional Radiology: Analysis of Closed Malpractice Claims
Studying interventional radiology malpractice claims provides an understanding of drivers of lawsuits and patient injuries that result. By analyzing these claims and identifying the contributing factors involved, risk mitigation strategies can be developed and implemented reducing adverse patient outcomes and increasing patient safety.
Feb 26, 2021
Resources for Elective Procedures During COVID-19
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.
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.
Diagnostic Radiology: A Failure to Diagnose
In reviewing closed malpractice claims, The Doctors Company identified delayed diagnosis of a malignancy as a reoccurring problem. The following highlights the importance of recognizing a spinal abnormality and recommending further follow up of a lesion seen on imaging. Contributing factors include misinterpretation of radiologic studies, narrow diagnostic focus, lack of communication and failure to establish a differential diagnosis.
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.
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.
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.
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.
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).
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.
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.
Oct 05, 2020
Orthopedics: Informed Consent
Inadequate informed consent communication between the surgeon and the patient/family is a top factor contributing to claims against orthopedists.
Sep 30, 2020
Otolaryngology: Inadequate Informed Consent Can Lead to Malpractice Claims
Our analysis of otolaryngology claims revealed that inadequate informed consent is a frequent contributing factor in malpractice claims.
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.
Sep 21, 2020
Obtaining Informed Consent in Teaching Institutions
Given the nature of teaching institutions—where individuals in training participate in patient care to varying degrees—the informed consent process is more complex and can present additional liability risks.
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.
Jul 29, 2020
Physicians Can Be at Risk When Homebound Patients Refuse Help
Physicians face potential liability when patients refuse help that is offered or neglect to follow up as instructed.
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.
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.
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.
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.
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.
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.
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.
Dec 20, 2019
Burnout Can Affect How Patients Communicate
If a physician appears burned out, patients may avoid asking questions for fear of adding to the stress.
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.
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.
Dec 11, 2019
Cultural Diversity Creates Language Barriers: Reducing Claims with Multilingual Patients
Clear and unambiguous communication constitutes the key component of the physician-patient relationship. Proactively implementing office procedures to promote optimum communication reduces the risk of disputes.
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.
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.
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.
Interventional Radiology: Communications and Assessments
Ensuring patient safety for any procedure requires communication between the diagnosing physician and the proceduralist. This includes ensuring all physicians are aware of pre-procedural testing that the proceduralist would need to adequately care for the patient and manage complications.
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.
Dementia Q&A: What Physicians Ask About Diagnosis and Treatment
This course focuses on the common concerns and questions expressed by physicians about dementia and cognitive impairment. This course covers making the initial observation of cognitive decline and beginning a conversation with older adult patients; overcoming common barriers to making a definitive diagnosis of dementia; and managing the ongoing clinical needs of patients experiencing dementia.
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.
Medical Office Assessments Reveal Hidden Liabilities
The Doctors Company’s patient safety risk managers conducted office practice assessments across a range of practice environments around the country. This activity analyzes the results, highlights problem-prone areas, and offers strategies to minimize areas where patients can “fall through the cracks” and leave the practice vulnerable to a malpractice claim.