Internal Medicine

Aug 19, 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.

Aug 13, 2019
Reduce Patient Safety Risks with Vaccinations
Debbie A. Hill, RN, MBA, CPHRM, and Lisa McCorkle, MSN, CPHRM, Senior Patient Safety Risk Managers, The Doctors Company
Whether seeing patients for back-to-school immunizations or preparing adult patients for travel abroad, this article can help doctors assess the vaccine administration protocol in their practice to reduce risks and enhance patient safety.

Professional Education
Dementia Q&A: What Physicians Ask About Diagnosis and Treatment
The Alzheimer's Project Series
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.
1.5 Credits

Jun 13, 2019
The Waning of the Physical Examination and Its Impact on Outcomes
Howard Marcus, MD, FACP
The physical exam should remain a central tool for evaluating and managing patients.
From The Doctor’s Advocate

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
Alzheimer’s Disease and Related Dementias Evaluation and Diagnosis
The Alzheimer's Project Series
The second course introduces The Alzheimer's Project Evaluation Algorithm and Evaluation Instruments, and focuses on differential diagnoses. The course includes ideas for how to prepare and engage in a sensitive dementia diagnosis disclosure with patients and caregivers.
1.5 Credits

Professional Education
Dementia End of Life Planning: Effective Communications with Patients and Families
The Alzheimer's Project Series
The fourth course covers important end of life planning topics and concepts, and tips for having these sensitive conversations with patients and family members. The course finishes with a focus on dementia community resources, effective communication strategies, and understanding when it is appropriate to make a referral to a specialist.
1.0 Credit

Professional Education
Pharmacotherapy for Patients with Major Neurocognitive Disorder
The Alzheimer's Project Series
This activity includes video lectures and is the fifth in a series of courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer's disease and related dementias. This course focuses on the most frequently used prescription medications for Alzheimer's disease and dementias, the current research regarding its use, and guidelines for prescribing and discontinuing medication.
1.25 Credits

Professional Education
Dementia: Pharmacological Management of Behavioral and Psychological Symptoms
The Alzheimer's Project Series
This activity includes three video lectures and is the sixth in a series of courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer's and related dementias. This course focuses on the selection and appropriate usage of psychotropic prescription medications to manage the behavioral and psychological symptoms most frequently exhibited by patients with Alzheimer's and dementia diagnosis.
1.25 Credits

Professional Education
Dementia Screening Among Adults with Cognitive Decline
The Alzheimer's Project Series
The first course introduces The Alzheimer’s Project and highlights the increasingly important role of primary care practitioners in dementia care. It presents The Alzheimer’s Project Cognitive Impairment Screening Algorithm and Screening Instruments, and it addresses reversible conditions that may present similar symptoms to cognitive impairment. The course incorporates four videos, each followed by a series of related questions.
1.25 Credits

Professional Education
Physical Examination and Its Impact on Outcomes
The Doctor's Advocate
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.
0.75 Credits

Professional Education
Neurological Case Study: Management of the Surgical Patient
Claims Corner CME
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 Credits

May 13, 2019
Challenges of Cultural Diversity in Healthcare: Protect Your Patients and Yourself
Susan Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education
Physicians often care for a multicultural society complicated by literacy issues. To address cultural diversity in healthcare, physicians must understand how each patient’s sociocultural background affects his or her health beliefs and behavior.

Apr 19, 2019
Rising Number of Measles Cases Creates Numerous Patient Safety Issues
Debbie Hill, RN, MBA, LHRM, CPHRM, Patient Safety Risk Manager
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.

Apr 17, 2019
Patient Safety Strategies for Dermatology
Victoria H. Rollins, MHA, CPHRM, Senior Director, Patient Safety Programs
Doctors can reduce potential liability in dermatology by taking risk management steps, such as avoiding verbal prescription orders.

Professional Education
Ob/Gyn: Telephone Communications
Claims Corner CME
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 Credits

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.

Professional Education
Psychiatry: Preventing Adverse Outcomes
The Doctors Company study of closed claims reveals areas of higher risk in outpatient psychiatry practices. Using this as a foundation, the course provides information to evaluate your practice and make changes to improve decisions about treatment, operational processes, reporting, and documentation.
1.5 Credits

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
Preventing Adverse Outcomes When Treating Children
The Doctor's Advocate
The Doctors Company studied claims filed on behalf of pediatric patients that closed over a 10-year period from 2008 through 2017. You are provided the most common types of claims and includes expert insights into the specific elements that led to patient injury, and risk mitigation strategies.
1.0 Credit

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

Feb 15, 2019
Is Your Patient a Victim of Human Trafficking?
Amy Wasdin, RN, MBA, Patient Safety Risk Manager II
A visit to a physician or dental practice may provide an opportunity to help a human trafficking victim.

Dec 28, 2018
Curbside Consultations: Patient Safety and Legal Risks
Susan Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education, and Carol Murray, RHIA, CPHRM, Patient Safety Risk Manager II
Physicians should be aware of the potential liability of informal "curbside" consultations, especially if expectations between the physicians are not clearly communicated.

Dec 26, 2018
Mitigating the Risk of Osmotic Demyelination Syndrome
Howard Marcus, MD, FACP
Insights into managing patients with severe hyponatremia.
From The Doctor’s Advocate

Dec 01, 2018
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.

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
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
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 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.

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
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.

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.

Sep 06, 2018
On Alert: What All Doctors Need to Know About Alzheimer’s Disease
Cynthia Morrison, RN, ARM, CPHRM, CPPS, 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 27, 2018
Distracting Devices in Healthcare: Malpractice Implications
Shelley Rizzo, MSN, CPHRM, Patient Safety Risk Manager II
Digital distraction in healthcare is emerging as a great 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.

Jun 26, 2018
Remote Patient Monitoring: Handling Real-Time Data
Susan Shepard, MSN, RN, Director, Patient Safety Education
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.

Jun 26, 2018
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.

Mar 26, 2018
Nurse Practitioner Closed Claims: Risk Mitigation Strategies
Strategies to help nurse practitioners and physicians prevent patient injuries.
From The Doctor’s Advocate

Mar 09, 2018
Nurse Practitioner Closed Claims Study: Top Risks in the Changing Delivery of Primary Care
Our study of nurse practitioner medical malpractice claims, compared against family medicine and internal medicine claims, identifies the top patient safety risks that may lead to adverse events.

Video Feb 23, 2018
What to Expect from Litigation: Dr. Johnson's Perspective
Dr. Jeffrey D. Johnson, a family physician in Corpus Christi, describes his experience defending himself against a medical malpractice suit involving a young man who committed suicide using prescription medication.

Professional Education
The Alzheimer's Project
The goal of this series is to educate clinicians on standardized screening, evaluation, and management of Alzheimer’s disease and related dementias. The Doctors Company is pleased to support Champions for Health in training primary care physicians and other healthcare practitioners to diagnose and care for patients with Alzheimer’s or dementia.
Up to 9.0 Credits

Video Jan 22, 2018
Internal Medicine: Innovations in Patient Safety
Howard Marcus, MD, an internal medicine physician in Austin, Texas, describes changes his practice made to improve patient safety based on the data and recommendations in The Doctors Company’s Internal Medicine Closed Claims Study. Thirty-nine percent of claims against internal medicine physicians are the result of a failure to diagnose. There are 8,000 possible diagnostic conditions, but the average primary care physician sees only about 400 per year—leaving a large number of diagnoses the physician sees only rarely.

Professional Education
Gastroenterology: Preventing Adverse Outcomes
This activity identifies the factors that contribute to patient allegations and injuries as revealed by closed claims involving gastroenterologists. It provides physicians with appropriate strategies for their practice that, if implemented, can improve quality and safety and positively affect patient outcomes.
1.0 Credit

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.

Professional Education
Internal Medicine Closed Claims Study: Lessons Learned
The Doctors Company analyzed 1,180 closed claims against internal medicine physicians to identify what motivates patients to pursue claims, where system failures and processes result in patient harm, and what strategies can be used to mitigate risk. 
1.0 Credit

Professional Education
Breast and Cervical Cancer Diagnosis
This activity, designed for providers who are actively involved in delivering women’s healthcare, presents lessons gleaned from The Doctors Company malpractice claims related to diagnosing breast and cervical cancers. It includes data analysis by experts and discussion of established best practices.
1.5 Credits

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

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

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 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.

Video Sep 20, 2016
Why Internists Get Sued
Why do internists get sued, and how do patients get injured? The Doctors Company’s study of 1,180 closed claims against internal medicine physicians revealed the most common patient allegations and the most common factors that lead to patient injury.

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).

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.

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.

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.

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.

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