Dr. Dennis Boyle, COPIC physician risk manager, joins the podcast again to talk with Dr. Zacharias about ongoing issues we see with medication errors. These include drug-to-drug interactions, medications that are most prevalent in medical liability lawsuits (antibiotics, pain medicine, and anticoagulants), and awareness about black box warnings. Dr. Boyle walks through some case studies to illustrate why errors occur and highlights steps physicians can take to proactively address these situations. The conversation also covers the importance of documenting your thought process when prescribing, the use of “read backs,” the “five rights” of medication use (right patient, right drug, right time, right dose, and right route), the challenges of drug monitoring.

Dr. Zacharias is joined by Dr. Dennis Boyle, a COPIC physician risk manager, to talk about key elements of nonverbal communication that occur during physician-patient interactions such as touch, facial expressions, posture as well as the speed and tone of your voice. Dr. Boyle talks about nonverbal cues in both how we sent messages to patients and how “micro expressions” from patients can provide valuable insight into how our messages are being received and the patient’s state of mind. He also mentions the “golden minute” of when you first encounter a patient and have an opportunity to form a connection, how nonverbal communication may influence the likelihood of being sued, and the importance of nonverbal communication from other medical staff in a patient’s overall experience. Show email: [email protected]

In this episode, we are proud to have Dr. Sami Diab, the president of the Colorado Medical Society (CMS). Dr. Diab describes his journey into medicine, from growing up in Syria to finding his calling as an oncologist to joining the leadership team at CMS. He talks about how his medical background is applied in his current role when dealing with public policy and state legislative issues, and how he approaches his work by thinking about the ways broader decisions may impact medical providers, patients, and the overall health care system. Other topics on his mind include managing the challenges of physician burnout, the value of talking to peer physicians, and access to care and affordability. In addition, Dr. Diab emphasizes the importance of energizing other physicians about their role within health care and how to sustain joy in your medical practice while cultivating resilience. Email the show with feedback or ideas at [email protected]

Dr. Michael Victoroff joins the podcast again to talk about administrative or conduct issues that can create legal concerns for physicians. Many of these relate to the authority a medical license grants and the power of a physician’s signature (i.e., prescribing medications, signing off on medical charts, etc.). Dr. Victoroff makes the distinction between willful misconduct and inadvertent actions that can lead to accusations of billing fraud, disciplinary proceedings, and governmental investigations. He also highlights common situations where these issues occur such as supervising other medical staff, serving as a medical director, or providing patient coverage for other physicians. Dr. Victoroff notes that well-intentioned favors and a desire to help can sometimes place good physicians in bad situations, and he provides some guidance that includes staying within your scope of practice—things you do on a regular basis. In addition, the discussion turns to EHRs, the challenges of automated templates, and being aware that your notes accurately reflect the care you provided. Show email: [email protected]

Dr. Sue Sgambati, COPIC’s medical director and a colorectal surgeon, joins Dr. Zacharias to talk about her personal experience in balancing the professional responsibility to treat pain with concerns over opioid addiction. Dr. Sgambati reviews the historical background of key factors that contributed to the overprescribing of opioids and what she saw and learned in her own practice. She then talks about the value of using tools such as a state’s prescription drug monitoring program, opioid risk assessment tools, and guidelines published by organizations such as the CDC. Dr. Sgambati also addresses alternatives to opioids that are being used, the challenges of having conversations with patients about opioids and how to document these, and the availability of naloxone to counter overdoses. Show Email [email protected]

Dr. Zacharias welcomes Dr. Michael Victoroff, a COPIC consultant and health information technology expert, to talk about the increased use of telehealth driven by COVID-19 and how this has become a more permanent shift in health care. They discuss the applicable regulations and practical guidelines that are defining the telehealth environment and what physicians should know to effectively navigate these interactions. Dr. Victoroff shares his thoughts about how the perspectives of providers, patients, and regulatory agencies have changed, the importance of reimbursement, and why “telehealth is one of the best things to happen to medicine.” In addition, he highlights considerations with technical platforms, privacy and security standards, documentation elements unique to telehealth, and concerns with providing telehealth care to patients in other states.

Dr. Benjamin Keidan, Boulder Community Health's Chief Medical Officer, joins us to share his thoughts on how to implement and reinforce a culture of safety. Dr. Keidan talks about his personal journey and how an MBA gave him a better understanding of the financial, human resources, and legal perspectives that impact health care. He highlights the importance of creating a system that values collaboration among all medical team members and a shared commitment to clearly defined patient safety goals. The conversation then focuses on the benefits of shifting away from a culture of blame to one that encourages reporting, continuous learning, and prevention. Dr. Keidan also talks about his experience with using a “systems perspective” to identify areas for improvement, making “the right thing the easiest to do” for staff, and ensuring that medical providers understand how to report incidents and that there is consistent follow up to explain how concerns are being addressed.

Dr. Zacharias is joined by Dr. Dennis Boyle, a COPIC physician risk manager, and Dr. Donald J. Lefkowits, the current president of the Colorado Medical Board. Dr. Lefkowits talks about his journey from working in emergency medicine to becoming part of the Board’s leadership. He then walks through the types of complaints the Board receives and how they manage the process of addressing these. This includes recommendations for physicians who receive complaints, from using an attorney to help draft a response (a no-cost service available with COPIC’s coverage) to using a factual, non-emotional tone in your response to adhering to the 30-day timeframe. Dr. Lefkowits also talks about the issue of physician wellness and the assistance programs available to support providers dealing with challenges.

Dr. Zacharias welcomes Dr. Alan Lembitz, COPIC’s chief medical officer, to talk about what we are seeing in terms of the medical liability issues that may come in the wake of COVID-19. Dr. Lembitz highlights what initial claims data and trends is telling us, and how, due to the “long-tail” of incident reporting, the full impact of COVID-19 will take some time to emerge and understand. The discussion also looks at public perception of the challenges medical providers faced during the pandemic, concerns over patients with non-COVID-19 conditions that held off on treatment because of fears of the virus, and the benefits and limitations of telehealth. In addition, Dr. Lembitz mentions the importance of documenting shared decision making with patients during this time to detail the factors that may have impacted patient care.

In this episode, we look at medical education with two representatives from Pikes Peak Community College (PPCC)—Lisa James, Executive Director of PPCC’s Foundation, and Amber Lippincott, Associate Dean of Nursing. Their discussion explores health care trends that are influencing student programs in nursing and other allied health professional fields. In particular, they highlight simulation technology to teach students evidence-based practices, and the benefits of using an advanced birthing simulation mannequins funded by a grant from the COPIC Medical Foundation. This allows students to develop essential clinical skills and practice labor/delivery scenarios in an environment that allows them to learn from their mistakes and develop teamwork, communication, and decision-making skills.