Internal Medicine
May 22, 2023
Laboratory and Diagnostic Test Tracking in Ambulatory Practice
Managing patient test results in ambulatory practices can pose a significant challenge. Establishing a standardized workflow to track results is a successful strategy for avoiding missed or delayed diagnosis that can lead to patient injury.
Apr 26, 2023
Curbside Consultations: Patient Safety and Legal Risks
Informal consultations are tempting to busy healthcare practitioners because they are convenient and speedy, but these situations also include inherent liability risks for the consulting practitioner.
Apr 25, 2023
Nonadherent and Noncompliant Patients: Overcoming Barriers
Nonadherent or noncompliant patient conduct (whether intentional or inadvertent) can adversely affect clinical outcomes, undermine the practitioner-patient relationship, and disrupt the operation of practice.
Apr 14, 2023
Postpartum Malpractice Claims: Understanding Preventable Harms and Socioeconomic Factors
Investigators reviewed 43 closed postpartum medical malpractice claims to develop clinical recommendations to decrease the risks of postpartum morbidity and mortality.
Mar 22, 2023
Remote Patient Monitoring: Considerations for Telehealth Care
Remote patient monitoring is advancing the safety and accuracy of telehealth by filling in some gaps and increasing the types of care that can safely be provided in the home.
Mar 13, 2023
Patient Safety Strategies for Gastroenterologists
Gastroenterologists can reduce potential liability with strategies that include conducting a thorough preprocedure patient evaluation and matching the facility and setting to the patient.
Professional Education
Prevention of Medical Errors (2023–2025 Edition)
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. We analyzed loss prevention measures in tandem with the elements necessary to conduct a credible and thorough root cause analysis to reduce system failures, respond to sentinel events, prevent medical errors, and improve patient safety. The purpose of this program is to provide clinicians with the most current information regarding the prevention of common performance and diagnostic errors.
Professional Education
Prevention of Medical Errors – Florida (2023–2025 Edition)
This activity is specific to Florida statutes and reflects regulations effective February 2022. 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, gastroenterology conditions, cardiology issues, neurological issues, and adverse drug events, which will serve as the focal point of this patient safety and risk management course.
Oct 24, 2022
Why Medical Clearance Is Really a Preoperative Evaluation
The goals of the preoperative evaluation are to determine the patient's level of risk and to identify opportunities to mitigate it.
Oct 20, 2022
Job Shadowing: Observers, Volunteers, and Students in Clinical Settings
Create guidelines to prevent practice risks, eliminate patient harm, and protect patient privacy.
Oct 12, 2022
Suicide and Crisis Lifeline: Call or Text 988
The National Suicide Prevention Lifeline is now 988, an easy-to-remember number for 24/7 crisis care.
Professional Education
Reducing the Risk of a Malpractice Claim
This enduring program is designed to assist physicians, dentists, and advanced practice clinicians, improve patient safety by providing information on how to implement a root cause analysis (RCA2) when a near-miss, or injury has been identified. Real cases serve as examples of how sustainable change can minimize human and environmental factors while decreasing system failures and reducing the risk of a malpractice claim.
Sep 16, 2022
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.
Professional Education
Alzheimer's 7: Questions and Answers - What Physicians Ask About Diagnosing and Treating Dementia
This activity consists of eight videos and is the seventh in a series of courses that seek to educate clinicians on standardized screening, evaluation, and disease management of Alzheimer's and related dementia. 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.
Aug 26, 2022
Dispensing Sample Medications: Risk Management Strategies
If not carefully managed, sample medications can create issues that place patients and the practice at risk.
Professional Education
Alzheimer's 6: Pharmacological Management of Behavioral and Psychological Symptoms of Dementia
This is the sixth in the series of on-demand webinars training on screening, evaluation, and management of dementia. This webinar details how to discern the signs and symptoms of dementia from other psychiatric issues, and how to effectively treat these symptoms with pharmacological interventions.
Professional Education
Alzheimer's 5 : Use of Pharmacotherapy for Patients with Major Neurocognitive Disorder
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 fifth course focuses on the most frequently used and FDA-approved prescription medications for Alzheimer's disease and dementias, the current research regarding its use, and guidelines for prescribing and discontinuing medication. The program will incorporate cultural values and beliefs when creating and sharing the pharmacological care plan.
Jul 28, 2022
Defensible Medical and Dental Records
Patient records, which serve a critical function in healthcare delivery and routine clinical operations, can provide key evidence in the event of a professional liability action.
Professional Education
Preventing Diagnostic Error in Primary Care: Strategies for Advanced Practice Clinicians
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 among advanced practice clinicians (APCs). 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. Examples of some best practices for the diagnostic process involves a timely and accurate diagnosis, patient engagement, effective system processes, active follow up, and communication. The information in this course will focus heavily on prevention strategies related to the primary care setting.
Professional Education
Understanding and Preventing Adverse Events (HRA)
This enduring activity will explore patient safety and quality through multiple lenses. The initial session addresses the value of understanding adverse events, the second session focuses on engaging the C-suite, and the third covers teaching these topics to students, residents, attending, and other healthcare professionals.
May 31, 2022
The Role of the Medical Assistant in Your Office Practice
A medical assistant (MA) can be a valuable addition to an office practice, but MAs should not perform tasks outside their scope of practice.
Professional Education
HIPAA Fundamentals 2022–2023 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. This program provides details on the HIPAA Privacy, Security, and Breach Notification Rules, such as the type of information that is protected, who must comply with the rules, and how patient information can be used and disclosed. This on-demand program includes many resources useful to staff training.
Apr 01, 2022
Analysis of Cerebrovascular Accidents and Malpractice Claims
Because cerebrovascular accidents can happen at any time and in any location, it is imperative that all members of the healthcare team are able to recognize and respond to symptoms in a timely manner.
Mar 03, 2022
Challenges of Cultural Diversity in Healthcare: Protect Your Patients and Yourself
A clinician’s cultural competence is critically important in helping to eliminate health disparities and social disadvantages for all patients, regardless of their ethnicity or race.
Professional Education
Burnout: Spotlight on System Changes
There is a national movement to address the systemic causes of clinician burnout. Read the article "Clinician Burnout: From a Crisis to a Movement" to learn ways that clinicians can create system change in their own work environments.
Professional Education
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.
Dec 06, 2021
Alzheimer’s Disease and Dementia: What Healthcare Providers Need to Know
Alzheimer’s disease, the most common cause of dementia, is the sixth-leading cause of death in the United States. Early diagnosis provides important benefits to diagnosed individuals, their loved ones and caregivers, and society.
Nov 29, 2021
The Evolving Landscape of Diagnostic Errors—Challenges and Opportunities
Internationally recognized healthcare leader David E. Newman-Toker, MD, PhD, presents a compelling case example and shares key insights into transforming diagnostic accuracy.
From
The Doctor’s Advocate
Nov 15, 2021
To Measure and Reduce Diagnostic Error, Start With the Data You Have
Chief Medical Officer David L. Feldman, MD, MBA, FACS, recaps important recommendations by diagnostic safety expert Hardeep Singh, MD, MPH, for measuring and reducing diagnostic error.
From
The Doctor’s Advocate
Professional Education
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.
Professional Education
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.
Professional Education
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.
Professional Education
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.
Professional Education
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.
Professional Education
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.
Sep 29, 2021
Getting Sued for Breast Cancer Malpractice
Our closed claims data reveal that suits involving breast cancer are the most common type of cancer-related claim. This article lists the issues that most often lead to claims.
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.
Aug 04, 2021
Cognitive Assessments in Primary Care: Preparation and Tools May Mitigate Diagnosis Risks
Recent reimbursement changes by the Centers for Medicare and Medicaid Services (CMS) allow primary care providers to meet their patients’ mental health needs and help build their practices by performing cognitive assessments.
Professional Education
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.
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.
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.
Apr 14, 2021
Off-Label Use: Patient Safety Implications
The standard for appropriate off-label use of medications and other products is what other similarly trained physicians would do, not what the manufacturer of the medication or product recommends.
Mar 29, 2021
Is Your Patient a Victim of Human Trafficking?
Although trafficking victims rarely find opportunities to interact with others, a visit to a physician or dental practice may provide an opportunity for a victim to receive help. Learn to recognize the signs of human trafficking and know what steps to take.
Mar 23, 2021
Prescribing Opioids Safely: How to Have Difficult Patient Conversations
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
Take steps to reduce risks in dermatology by reviewing your practices and systems and implementing these strategies.
Feb 23, 2021
Telehealth from the Field: Case Study Involving Remote Monitoring Problems
Although remote monitoring technologies offer many benefits, they also present potential malpractice risks. Lessons from this case study highlight the importance of careful planning and preparation when incorporating technologies into patient care services.
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.
Jan 20, 2021
Implicit Bias Against Obesity: An Opportunity to Improve Patient Safety
Many patients with obesity delay seeking medical care because of previous negative experiences with healthcare providers.
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.
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.
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.
Dec 08, 2020
Suicide Prevention: Primary Care Is a Crucial Setting for Identifying Risk
At any given time, some of your patients are having thoughts of suicide. Effective suicide prevention requires a comprehensive approach.
Dec 02, 2020
The Role of Pretest Probability in the Evaluation of Suspected Venous Thromboembolism
The presenting signs and symptoms of venous thromboembolism are often vague and nonspecific, and early diagnosis—often crucial to the patient’s outcome—may be challenging.
From
The Doctor’s Advocate
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.
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.
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.
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.
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.
Jun 15, 2020
Overview of Obesity-Related Malpractice Claims
The Doctors Company continues to see an increase in lawsuits involving patients with obesity.
Mar 11, 2020
Analysis of Medical Oncology Claims
We analyzed 101 medical oncology claims to examine common injuries, identify strategies for mitigating risk, and learn what drives claims.
From
The Doctor’s Advocate
Jan 30, 2020
Doctors: How to Talk to Patients About Nutrition and Diet
No more powerful an approach exists to preventing or even reversing heart disease than improving lifestyle, especially nutrition and diet. The challenge for physicians is finding an effective way to talk about nutrition with their patients, because the usual admonitions to eat better and exercise often do not work.
Dec 12, 2019
Office of National Drug Control Strategy Promotes Building an Addiction Medicine Workforce
Dr. Lev recaps a White House event that focused on the field of addiction medicine.
From
The Doctor’s Advocate
Dec 05, 2019
Caring for Patients with Diabetes: Risk Management Strategies
Diabetic patients pose unique risk management concerns for physicians.
Dec 01, 2019
Dilaudid-Related Morbidity and Mortality from Respiratory Depression
Patient safety organizations and the FDA are focusing on ways to reduce patient harm from opioids.
Sep 05, 2019
Advanced Practice Provider Closed Claims: What Can We Learn?
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
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.
Jun 13, 2019
The Waning of the Physical Examination and Its Impact on Outcomes
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
A gender-specific analysis of 5,897 claims from six medical specialties.
From
The Doctor’s Advocate
Mar 20, 2019
Study of Malpractice Claims Involving Children
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.
Dec 26, 2018
Mitigating the Risk of Osmotic Demyelination Syndrome
Insights into managing patients with severe hyponatremia.
From
The Doctor’s Advocate
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.
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.
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.
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.