Internal Medicine

Oct 24, 2017
General Practitioners and Misdiagnosed Cardiovascular Disease
Sandeep S. Mangalmurti, MD, JD
A study by The Doctors Company and CRICO Strategies found that a significant proportion of liability cases involving cardiovascular disease were due to errors of diagnosis and the real liability danger doesn’t come from unusual or ambiguous cases, but from the relatively straightforward ones.

Oct 24, 2017
Give Your Patient Safety Culture a Check Up Using Assessment Survey
Robin Diamond, MSN, JD, RN, Senior Vice President of Patient Safety and Risk Management, The Doctors Company
Healthcare managers are making concerted efforts to cultivate a pervasive culture of patient safety. Creating a patient safety culture shifts the focus away from the blame game that punishes individuals for failures—which can increase liability over the long term—toward creating policies and procedures that cultivate an environment of openness and foster patient safety.

Oct 24, 2017
Physicians Can Be at Risk When Homebound Patients Refuse Help
Robin Diamond, MSN, JD, RN, Senior Vice President of Patient Safety and Risk Management, The Doctors Company
Physicians are focusing on treatment plans that include the kind of care patients need at home. However, physicians face potential liability when patients refuse help that is offered or neglect to follow up as instructed.

Oct 24, 2017
Doctors Examine Injury Risks with Malpractice Closed Claims
Robin Diamond, MSN, JD, RN, Senior Vice President of Patient Safety and Risk Management, The Doctors Company
Taking a close look at research into real-life malpractice claims and incorporating some of the findings into their practices is one way physicians are reducing risks of adverse events.

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

Jun 06, 2017
The Doctors Company Introduces a New CME Series
Robin Diamond, JD, RN, Senior Vice President, Department of Patient Safety and Risk Management, and Julie Hopkins, MA, MBA, Director, Continuing Medical Education, Department of Patient Safety and Risk Management
Earn complimentary CME credit for reading designated articles online.
From The Doctor’s Advocate

Apr 20, 2017
The Opioid Epidemic: Resources and Insights
The dramatic increase in opioid use over the past few decades has resulted in an opioid-related epidemic of addiction and death. These expert resources, including data analysis that shines a light on trends in opioid claims, can help address this important issue.

Apr 17, 2017
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 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

Mar 01, 2017
Boost Patient Safety: How to Reduce Risks with Vaccinations
Debbie Hill, RN, MBA, CPHRM, and Lisa McCorkle, MSN, CPHRM, Patient Safety Risk Managers, The Doctors Company
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 18, 2017
Up for Review: Five Keys to Managing Online Criticism
Kevin Pho, MD, Founder and Editor, KevinMD.com
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 25, 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 30, 2016
Watch for the Signs: Screen All Patients for Suicidal Thoughts
Robin Diamond, MSN, JD, RN, Senior Vice President of Patient Safety and Risk Management, The Doctors Company
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 26, 2016
Optimize the EHR: Better Workflow Means Better Work-Life Balance
Chad Anguilm, Director of Professional Services, Medical Advantage Group. Medical Advantage Group is a wholly owned subsidiary of The Doctors Company.
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, Senior Vice President, Department of Patient Safety and Risk Management, and Julie Brightwell, JD, RN, Director, Healthcare System Patient Safety and Risk Management
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

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
Ralph A. Gambarella, MD, Chairman and President of Kerlan-Jobe Orthopaedic Clinic, and a member of The Doctors Company's Orthopedic Advisory Board.
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 Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education.
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, Medical Director, Board of Governors
From The Doctor’s Advocate

Dec 15, 2015
Analysis of Cerebral Vascular Accidents and Case Studies
Susan Shepard, MSN, RN, Director, Patient Safety and Risk Management Education.
Physicians can improve patient prognosis by educating staff to recognize signs and symptoms of cerebral vascular accidents (CVAs).

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

Oct 19, 2015
Navigating Risks in Breast Cancer Diagnosis and Treatment: How Physicians Can Enhance Patient Safety
Penny Greenberg, RN, MS, Senior Program Director, Patient Safety Services, CRICO Strategies; Darrell Ranum, JD, CPHRM, Vice President, Patient Safety and Risk Management, The Doctors Company; Dana Siegal, RN, CPHRM, Director, Patient Safety, CRICO Strategies
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
Cynthia Morrison, RN, ARM, CPHRM, Patient Safety Risk Manager, The Doctors Company
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
Debbie Hill, RN, MBA, LHRM, CPHRM, Patient Safety Risk Manager, The Doctors Company
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 22, 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
Susan Shepard, MSN, RN, Director, Patient Safety Education, The Doctors Company
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, Medical Director, Board of Governors
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, Medical Director, Board of Governors
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
Susan Shepard, Director, Patient Safety Education, The Doctors Company.
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 05, 2014
Conflicting Guidelines on Mammograms Can Pose Risks
David B. Troxel, MD, Medical Director, 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.

Jun 25, 2014
Rising Number of Infectious Disease Cases Creates Patient Safety Issues
Debbie Hill, RN, MBA, LHRM, Patient Safety Risk Manager, The Doctors Company
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 (Video)
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, Chair, Texas Alliance for Patient Access, and Chairman, The Doctors Company Texas Physician Advisory Board
From The Doctor’s Advocate

Aug 28, 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, Director, Patient Safety Education.
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, Medical Director, Board of Governors
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, Medical Director, Board of Governors
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

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

Jul 26, 2011
Medicine Is an Open Book Exam
Howard Marcus, MD, FACP, Chair, Texas Alliance for Patient Access, and Chairman, The Doctors Company Texas Physician Advisory Board.
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, Patient Safety/Risk Management Account Executive.
Doctors can reduce potential liability in dermatology by taking risk management steps, such as avoiding verbal prescription orders.

Jun 22, 2010
Dilaudid-Related Morbidity and Mortality from Respiratory Depression
Howard Marcus, MD, FACP, a general internist in Austin, Texas, and chairman of The Doctors Company Physician Advisory Board in Texas.
Patient safety organizations and the FDA are focusing on ways to reduce patient harm from opioids.

Jun 22, 2010
Focusing on Missed or Delayed Diagnosis
Robin Diamond, JD, RN; AHA Fellow–Patient Safety Leadership; Senior Vice President, Department of Patient Safety, and Susan Shepard, MSN, RN, Director, Patient Safety Education.
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
An Analysis of Internal Medicine Malpractice Claims
David B. Troxel, MD, Medical Director, Board of Governors.
369 consecutive closed internal medicine claims were reviewed to identify events that place internists at risk for a malpractice claim.

Jun 01, 2010
Focusing on Selection and Management of Therapy
Robin Diamond, JD, RN; AHA Fellow—Patient Safety Leadership; Senior Vice President, and Susan Shepard, MSN, RN, Director, Patient Safety Education.
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.

May 01, 2003
When to Evaluate for a Hypercoagulable State
Richard Lanzerotti, M.D., practices internal medicine and oncology in San Francisco. He is former chair of the Department of Medicine and the Department of Oncology at St. Francis Memorial Hospital. Dr. Lanzerotti is an assistant clinical professor in the Department of Medicine at UCSF and a consultant for The Doctors Company. David B. Troxel, M.D., is medical director of The Doctors Company. Dr. Troxel is clinical professor emeritus in the School of Public Health at the University of California at Berkeley. He is past president of the American Board of Pathology and the California Society of Pathologists.
This article discusses the increased risk for thromboembolic events as a result of genetic or acquired abnormalities.

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