Shows
Within Normal Limits: Navigating Medical RisksAn Inside Look at Today’s Medical School Environment with Brian DwinnellThis episode features Brian Dwinnell, Associate Dean of Student Life at the University of Colorado School of Medicine, who shares his insights on medical school admissions, student support, and curriculum changes. The discussion touches on the competitive application process, the school’s holistic review philosophy, and how the new systems-based curriculum known as “Trek” is designed to better prepare and support students. The episode also covers trends in residency matching and dispels common myths about medical school, ending with an optimistic outlook on the next generation of physicians.
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2026-03-0530 minWithin Normal Limits: Navigating Medical RisksA Physician’s Journey Through Injury and Return to Practice with Dr. Catrina BubierIn this episode, we welcome Catrina Bubier, MD, an OB/GYN physician and member of Copic’s Board of Directors. Dr. Bubier details her experience with a serious hand injury that temporarily sidelined her from surgical practice. She shares how the injury and subsequent surgeries impacted her ability to work, her relationships with practice partners, and her finances. Dr. Bubier discusses the importance of disability insurance, the emotional challenges of facing a potential end to her career, and the value of planning ahead for unexpected life events. The episode also touches on her advocacy work with ACOG and offers pr...
2026-02-1935 minWithin Normal Limits: Navigating Medical RisksUnderstanding the Concepts of Psychological Size and Psychological SafetyThis episode’s guest is Dr. Mark Earnest, Division Head of Internal Medicine at the University of Colorado Anschutz Medical School. The conversation centers on the concepts of psychological size and psychological safety in medicine. Psychological size is described as a relational dynamic involving power and status within professional interactions. Psychological safety refers to creating an environment where people feel comfortable having open, honest conversations. Dr. Earnest shares stories that illustrate these concepts in the healthcare setting and emphasizes how leaders must be proactive in recognizing and managing power dynamics. In addition, he highlights the benefits of early education, ho...
2026-01-0324 minWithin Normal Limits: Navigating Medical RisksResponding to Subpoenas—Best Practices and What to AvoidWe welcome Dean McConnell, deputy general counsel at Copic, as this episode’s guest who shares his thoughts on handling subpoenas, especially those involving medical records. McConnell starts by describing key details about subpoenas, the requirements of serving subpoenas, and how medical providers can confirm the validity of a subpoena. He explains the importance of carefully reviewing the scope of medical records requests and only producing the requested information while respecting confidentiality and privileges due to HIPAA, physician-patient privilege, and attorney-client privilege. In addition, Dean walks through a list of pitfalls to avoid with subpoenas, along with practical suggestions an...
2025-10-0929 minWithin Normal Limits: Navigating Medical RisksA Conversation with Heidi Baskfield About Addressing Youth Mental HealthIn this episode, we talk with Heidi Baskfield, the founder of Speak Our Minds, an organization dedicated to addressing the youth mental health crisis in the United States. Baskfield talks about her journey from political advocacy to health leadership and the committed effort required to transform youth mental health care. Their conversation explores the overwhelming mental health needs of children and the insufficiency of existing resources, which led to the declaration of a state of emergency in Colorado regarding youth mental health. Baskfield outlies four principle aims that Speak Our Minds is focused on: building robust systems of care...
2025-09-2526 minWithin Normal Limits: Navigating Medical RisksThe Risks and Benefits of Remote Patient Monitoring WearablesThis episode features a conversation with Kate Castells, a risk management nurse at Copic, who talks about remote patient monitoring (RPM) wearables. They discuss the evolution and range of RPMs, from FDA-approved medical devices to consumer smart watches, with a focus on the clinical value of data collected and what can be used in medical decision-making. In addition, they look at the risks of using consumer device data, the importance of staff and patient education, and the potential benefits that may support care for certain patients.
Feedback or episode ideas email the show at wnlpodcast@copic...
2025-09-0419 minWithin Normal Limits: Navigating Medical RisksA Discussion with Dr. Josina Romero O'Connell, Director of the Colorado Area Health Education CenterColorado AHEC website: https://www.cuanschutz.edu/centers/coahec
Feedback or episode ideas email the show at wnlpodcast@copic.comDisclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to...
2025-08-0123 minWithin Normal Limits: Navigating Medical RisksCopic Medical Foundation Grant Recipient: Healing Hands Community Doula ProjectThis episode features Darlene Turner from Healing Hands Community Doula Project, which aims to support expectant mothers, particularly in the Black community, through their pregnancy journey. The grant from the Copic Medical Foundation is being used for a program that trains perinatal community health workers to provide extensive support, including birth and postpartum planning, lactation guidance, family dynamics, and more. This initiative primarily serves Medicaid populations, addressing additional complexities such as Medicaid reimbursement, and aims to improve overall birth outcomes. Website -- Healinghandscp.org
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2025-04-1917 minWithin Normal Limits: Navigating Medical RisksAddressing the Issue of Pediatric Medication ErrorsMedication errors are traditionally defined as an avoidable event, but they don’t just happen during the prescribing phase. In fact, it’s important to remember that there are many steps—transcribing, dispensing, and administering—where an error can occur. To learn more about pediatric medication errors specifically, we invited COPIC Patient Safety and Risk Manager, Kayla Boyd, to the podcast. In this episode, Kayla looks at the overall process of pediatric medication prescription, from diagnosis to accurate compilation of records to ongoing monitoring. Plus, you’ll hear about ways to avoid adverse outcomes and mitigate risks with young children...
2025-03-2926 minWithin Normal Limits: Navigating Medical RisksCopic Medical Foundation Grant Recipient: Kansas Health Care CollaborativeThis episode features Liz Warman and Mandy Johnson from the Kansas Health Care Collaborative and focuses on the organization’s transition-in-care program that aims to leverage Health Information Exchange (HIE) to reduce care fragmentation and improve health outcomes by developing processes, workflows, and policies in clinics. This initiative is supported by grant funding from the Copic Medical Foundation and the model used has shown significant efficacy in reducing readmissions. The program received a high level of engagement from clinics and hospitals across Kansas and next steps include creating a rural network of facilities using HIE data, with the goal of...
2025-03-2925 minWithin Normal Limits: Navigating Medical RisksExecutive Orders and Federal Legislation: Considerations for Healthcare ProvidersIn this episode, Matt Groves, Copic’s General Counsel, talks about the impact of recent federal executive orders and legislation on healthcare providers. He provides general information about new federal initiatives and their potential risks, emphasizing the rapid changes and uncertainty in the legal landscape. Matt explains the differences between executive orders and legislation, and the concept of federal preemption over state laws. The discussion also covers the executive order on gender-affirming care, its implications for funding, and the potential risks for healthcare providers, including criminal and civil liabilities. In addition, the episode addresses issues related to immigration enforcement an...
2025-02-2238 minWithin Normal Limits: Navigating Medical RisksCopic Medical Foundation Grant Recipient: AIRnycThe episode features staff from AIRnyc—Lola Simpson, Chief Executive Officer; Kathleen Agaton, Chief Impact Officer; and Lydia Baez, Senior Outreach Coordinator and Community Health Worker. AIRnyc received a grant from the Copic Medical Foundation to support their efforts to reduce fragmentation in prenatal and postpartum clinical and social care for high-risk Black and Latinx pregnant persons. The discussion highlights AIRnyc’s focus on addressing developmental delays in children and implementing a two-generation model for maternal and child health, which involves working with both mothers and children. Website: https://www.air-nyc.org/Donations https...
2025-02-0132 minWithin Normal Limits: Navigating Medical RisksA Legal Expert’s View on Non-Compete AgreementsFor this episode, we sit down with Copic’s General Counsel, Matt Groves, to talk about non-compete agreements in the medical field. The discussion starts with looking at the purpose of non-compete agreements such as protecting patient revenue, preventing competition, and safeguarding the investment in recruiting and developing physicians. Matt highlights key legal terminology (e.g., non-solicit, non-disclosure, and liquidated damages clauses), the various ways these agreements are enforced, and how they may vary by state. In addition, he reinforces the importance of seeking legal advice before signing non-competes, especially in situations where you are negotiating terms.
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2025-01-1639 minWithin Normal Limits: Navigating Medical RisksCopic Medical Foundation Grant Recipient: Metropolitan State University of DenverThis episode features Mary Tucker and Garrett Chism discussing an interprofessional education pilot program between Metropolitan State University of Denver and Denver Health. The program is supported by a grant from the Copic Medical Foundation and focuses on simulation training for nursing and EMT students to improve patient outcomes. The objectives include evaluating critical changes in patient assessment, completing trauma assessments, and demonstrating closed-loop communication. A key aim is to teach students from different disciplines to communicate effectively and understand each other's roles to reduce errors in patient care. Metropolitan State University Nursing Program: https://w...
2025-01-0327 minWithin Normal Limits: Navigating Medical RisksThe Value of Early Reporting of IncidentsWe welcome Beth Chow, an occurrence nurse with Copic, who provides some great perspective about the benefits and value of early reporting of incidents. Beth explains the interchangeable terms "occurrence" and "incident" and clarifies what constitutes an adverse event and the types of events you should report to your medical liability insurance carrier. She goes on to explain how Copic’s reporting process works, why early reporting does not negatively impact your policy or premiums, and how early intervention programs like Copic’s 3Rs Program and Candor help resolve issues and maintain open communication with patients.
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2024-12-0627 minWithin Normal Limits: Navigating Medical RisksAn Expert’s Insight on Risk Management and Colorectal Cancer ScreeningsLinks/ResourcesU.S. Preventive Services Task Force- https://www.uspreventiveservicestaskforce.org/uspstf/American Cancer Society- https://www.cancer.org/American College of Gastroenterology -https://gi.org/
Feedback or episode ideas email the show at wnlpodcast@copic.comDisclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The...
2024-11-2128 minWithin Normal Limits: Navigating Medical RisksUnderstanding How and When EMTALA AppliesAmy Herum, a nurse and patient safety and risk manager with Copic, joins us to talk about the purpose and scope of EMTALA. Amy explains the situations that trigger EMTALA obligations and the definition and assessment of an “emergency medical condition.”The discussion then looks at the requirements and process of transferring a patient under EMTALA, the penalties and consequences of violating EMTALA, and the conditions that end EMTALA obligations such as when a medical screening exam shows no emergency medical condition, the patient is transferred to another hospital in compliance, or when the patient refuses examination, treatment, or trans...
2024-09-1317 minWithin Normal Limits: Navigating Medical RisksKey Considerations Before Terminating a PatientOur guest is Anna Barr, a patient safety and risk manager with Copic, who joins us to talk about terminating the provider-patient relationship. The discussion starts by looking at the main considerations before terminating a patient: trying to mend the relationship by using effective communication and conflict resolution skills, assessing the clinical situation, the risk of abandonment, the possibility of discrimination, and the contractual obligations that may apply. Anna then highlights key termination steps such as notifying and assisting the patient, and documentation. She also talks about the benefits of having a practice-wide policy for non-compliance or disruptive behavior t...
2024-08-2322 minWithin Normal Limits: Navigating Medical RisksManaging Risks in the Perioperative SettingThis episode features Renee Blattman, a nurse and risk manager with Copic, who has 20 years of experience in the perioperative environment. The discussion focuses on the challenges and risks in this environment—a high-paced, high-volume, and fast-turnover setting, where there is a lot of pressure to keep the patients moving and the OR schedule tight. Renee talks about the growth and trends in ambulatory surgery centers along with the increased risks of discharge and follow-up care, as patients may need more education and support at home. In addition, she highlights how a culture of safety is essential and how th...
2024-08-0329 minWithin Normal Limits: Navigating Medical RisksDocumentation—The Little Things That Make a Big DifferenceIn this episode, our guest is Heather Westermeyer, a Patient Safety and Risk Manager with COPIC, and the topic is documentation. Heather highlights the role documentation plays in continuity of care—from ensuring an accurate medical history to supporting communication among providers. She also talks about how documentation serves a key purpose in legal protection/defense in medical liability issues and the importance of articulating your thought process. In addition, the discussion touches on best practices, standardized templates and protocols, and the dangers of copying and pasting.
Feedback or episode ideas email the show at wnlpodcast@co...
2024-07-1230 minWithin Normal Limits: Navigating Medical RisksCaring for Geriatric PatientsLaDonna Kelley, a nurse risk manager with COPIC, is the guest for this episode, which looks at patient safety and risk management for geriatric patients. LaDonna tells a personal story about the challenges with caring for this patient population and how certain situational factors impact their care experience. She mentions issues such as hearing limitations, technology, and mobility and being aware of these during interactions. The conversation also examines communication challenges and the importance of clear communication with geriatric patients.
Feedback or episode ideas email the show at wnlpodcast@copic.comDisclaimer: Information provided...
2024-06-2020 minWithin Normal Limits: Navigating Medical RisksJust Culture—A Framework that Promotes Patient SafetyIn this episode, we talk with Carrie Beth Roddy, a COPIC Patient Safety and Risk Manager, who joins Dr. Zacharias for a conversation on Just Culture. Carrie starts with defining the concept of Just Culture, explaining how it is being integrated into traditional medical culture, and the importance of using it to create opportunities to prevent future medical errors. We dig into the difference between human and system errors, factors that contribute to Just Culture’s success, how it facilitates more open discussions among providers while ensuring the highest level of safe treatment for patients, and ways that it su...
2024-06-0631 minWithin Normal Limits: Navigating Medical RisksEnsuring Patients Make Informed Decisions Through Informed ConsentAnna Barr, a nurse risk manager with COPIC, joins us for this episode to talk about the benefits of using informed consent in your medical practice. Anna highlights how informed consent is a process (not just a form), the goals of shared decision making that guide this, and how it can be a tool to foster trust and understanding with patients. In addition, we look at what situations require informed consent and key considerations in how you approach the process. Anna also explains what informed refusal is, how this differs from “against medical advice,” and provides examples of when you...
2024-05-2318 minWithin Normal Limits: Navigating Medical RisksDocumentation—Telling the Story of Patient CareThis episode features COPIC Patient Safety and Risk Manager, Amanda Heinrichs, who discusses the importance of documentation—from sharing patient information with other medical team members to supporting care decisions. Amanda covers a wide breadth of documentation issues, such as limiting documentation to only facts about the case, moving past finger-pointing in the event of an undesirable outcome, and timely documentation to ensure quality of care. Furthermore, she talks about insights from attorneys, the pros and cons of using scribes, and conducting assessments to evaluate what is going on with patients to support your documentation.
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2024-05-0930 minWithin Normal Limits: Navigating Medical RisksRetaining and Maintaining Medical RecordsCOPIC Patient Safety and Risk Manager Cindy Walsh is our guest to set the record straight on medical records retention—giving us insight into ethical obligations, key considerations when referring patients or closing a practice, and the importance of having a clear records maintenance/retention policy. Furthermore, Cindy outlines how regular record audits and attention to state mandates now can prevent retention headaches in the future.Resources mentioned in the episode:Medical record laws overview- www.HealthIT.govHIPAA- www.HHS.govRecord retention ethics- https://www.ama-assn.org/
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2024-04-2522 minWithin Normal Limits: Navigating Medical RisksSemaglutide Medications: Liability Issues to ConsiderDr. Susan Sgambati, a colorectal surgeon and medical director with COPIC, is our guest on this episode that looks at the increased use of semaglutide medications driven by the popularity of Ozempic being used for weight loss. The discussion focuses on liability and risk issues, including recently issued FDA warning letters surrounding the use of compounded forms of the medication. Dr. Sgambati talks about how the medication works, side effects, how to assess patients who are interested in these medications, and other considerations as part of your evaluation.
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2024-03-0931 minWithin Normal Limits: Navigating Medical RisksPreventing Falls in the Healthcare SettingPamela Johnson—a nurse and Senior Manager of Practice Quality and Facilities Risk Management at COPIC—joins us for a discussion about data around patient falls in health care facilities. Pamela highlights the top three areas where falls occur in these settings and talks about top risk factors that contribute to these incidents. She also points to adjustments that can make an immediate preventative impact, such as proper lighting and pathways, the importance of environmental rounds, and dispels major myths about falls and healthcare. CDC STEADI- Older Adult Fall Prevention https://www.cdc.gov/steadi/index...
2024-03-0122 minWithin Normal Limits: Navigating Medical RisksEnsuring Patients Make Informed Decisions Through Informed ConsentAnna Barr, a nurse risk manager with COPIC, joins us for this episode to talk about the benefits of using informed consent in your medical practice. Anna highlights how informed consent is a process (not just a form), the goals of shared decision making that guide this, and how it can be a tool to foster trust and understanding with patients. In addition, we look at what situations require informed consent and key considerations in how you approach the process. Anna also explains what informed refusal is, how this differs from “against medical advice,” and provides examples of when you...
2024-02-1018 minWithin Normal Limits: Navigating Medical RisksCOPIC Medical Foundation Grant Recipient: Children's Hospital ColoradoThis episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes back Jennifer Disabato, DNP, and William Anderson, MD, who are co-directors for the ImPACT Program and Navigation Hub, which focuses on care coordination for complex pediatric patients as they transition to adult care. Jennifer and Dr. Anderson talk about the progress made in building skilled teams to support patients going through these transitions. In addition, they discuss the other key focus of the...
2024-01-2516 minWithin Normal Limits: Navigating Medical RisksCOPIC Medical Foundation Grant Recipient: West Mountain Regional Health AllianceThis episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes two staff members from West Mountain Regional Health Alliance—Christina Gair, Executive Director, and Namrata Shrestha, Assistant Director. Grant funding went toward a care coordination effort to support individuals experiencing homelessness with coordination by hospitals, health and behavioral health providers, community organizations and government agencies. The discussion looks at the challenges of coordination across multiple organizations and different workflows, consideration of factors such as...
2024-01-1224 minWithin Normal Limits: Navigating Medical RisksCOPIC Medical Foundation Grant Recipient: Providence Portland Medical FoundationThis episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes Dr. Matthew Gonzales and Dr. Deborah Unger who are affiliated with a grant provided to the Providence Portland Medical Foundation. Grant funding supported Providence and the Oregon Physician Orders for Life Sustaining Treatment (POLST) Registry for a partnership to build a bi-directional interface which integrates Providence's Epic electronic health record with the Registry. Dr. Gonzales and Dr. Unger discuss about how POLST is...
2023-12-2129 minWithin Normal Limits: Navigating Medical RisksCOPIC Medical Foundation Grant Recipient: Minnesota Medical Association FoundationThis episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes Tori Bahr, MD and Katie Stangl who are affiliated with a grant provided to the Minnesota Medical Association Foundation. Grant funding supported Project ECHO, which focuses on the challenge of transitioning youth with medical complexity to adult care in Minnesota. The discussion explains the different conditions that fall under “childhood onset medical complexity” and how the ECHO hub-and-spoke model leverages virtual collaboration to expa...
2023-12-0226 minWithin Normal Limits: Navigating Medical RisksDocumentation: How Much is Enough?Documentation in medicine is no one’s favorite topic. In this episode, host Dr. Eric Zacharias aims to simplify guidance surrounding “what” and “how much” is needed for patient safety and risk management purposes. What follows is not “hard” science, but rather a discussion of basic criteria—and what's realistic and reasonable outside of policy rules and guidelines.
Feedback or episode ideas email the show at wnlpodcast@copic.comDisclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate profe...
2023-11-0936 minWithin Normal Limits: Navigating Medical RisksBurnout, Exhaustion, and Leaving the Practice of MedicineIn this episode, we are joined by David Weill, MD, a transplant doctor and author of Exhale: Hope, Healing, and a Life in Transplant. Dr. Weill shares openly about losing and saving patients, dysfunctional teams and systems, and burnout in transplant medicine. Through the lens of his own emotional and physical exhaustion, he explores the underbelly of hospital systems and the clinical, administrative, and financial issues plaguing the specialty. He is an advocate of shifting the blame of burnout away from the individual and placing it on the macro problems that contribute to physician dissatisfaction.
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2023-10-2727 minWithin Normal Limits: Navigating Medical RisksAI’s Impact on Medicine (Part Two)We continue the conversation about artificial intelligence (AI) in this second episode of a two-part series. Our guest is Dr. Michael Victoroff, a family medicine physician, patient safety and risk management specialist, and clinical informatics expert. Dr. Victoroff uses image interpretation in radiology as an example of AI because it sees things humans miss and humans see things AI misses. We look at other AI applications—support for diagnosing and creating a treatment plan, concerns with visit notes (e.g., inaccuracies, information designed for billing purposes versus information for patient care, bias that can emerge, etc.), and the knowledge me...
2023-09-2928 minWithin Normal Limits: Navigating Medical RisksAI’s Impact on MedicineIn this two-part series, we look at the rise of artificial intelligence (AI) and examine the potential ways it may impact medicine. Our guest is Dr. Michael Victoroff, a family medicine physician, patient safety and risk management specialist, and clinical informatics expert who has gone down the rabbit hole of trying to understand the good, the bad, and the ugly of AI. Dr. Victoroff explains the fundamental technology behind AI applications, such as ChatGPT, and its interactive structure designed to generate human-like language and conversation. He talks about the concept of machine learning, how the “garbage in, garbage out” theo...
2023-09-1426 minWithin Normal Limits: Navigating Medical RisksAddressing the Issue of Maternity Care DesertsIn this episode, we look at a major challenge in obstetrics (OB) care with our guest, Lori Adams, who is a nurse, COPIC risk manager, and OB expert. Lori talks about her experience in a rural hospital and educating providers. The discussion focuses on “maternity care deserts” where access to OB services is limited or not available. Lori highlights how these deserts contribute to maternal death rates, the disparities we are seeing in certain geographic and demographic areas, and how emergency care units are dealing with OB situations. She also points to the training and education that is being impl...
2023-08-3120 minWithin Normal Limits: Navigating Medical RisksIncreasing Racial and Ethnic Diversity in Medical EducationIn this episode, we are joined by Dr. Shanta Zimmer, associate dean for diversity and inclusion at the University of Colorado School of Medicine. Dr. Zimmer talks about how the COVID-19 pandemic highlighted racial disparities and health care inequities in severity of illness and the role the health care system ultimately plays in systemically-addressing social determinants of health. She also speaks on how the university is working toward inclusive excellence and removing barriers that prevent the best and brightest from entering medical education. COPIC has supported diversity, equity and inclusion (DEI) scholarships for medical students and purchased simulation equipment...
2023-08-0216 minWithin Normal Limits: Navigating Medical RisksHow You Drive May Affect Patient CareIn this episode, we’re joined by surgeon and COPIC risk manager, Dr. Jeff Varnell. Starting with the premise that, like driving, the practice of medicine is governed by systemic rules and dependent on individual responsibility, Dr. Varnell uses metaphors and general understandings we hold about driving to illustrate how adverse events in medicine are often avoidable and preventable, like many of our road-based accidents. He invites listeners to examine through a lens of personal accountability the human factors that lead to errors in communication and cognitive bias, including "reckless" versus "risky" behavior. a Email: wnlp...
2023-07-1920 minWithin Normal Limits: Navigating Medical RisksHope, Help, and Possibilities for People at Risk for Limb Loss.With 28 million Americans at risk for limb loss due to trauma, tumors, or infections, the nonprofit Limb Preservation Foundation is enhancing the quality of life of people in the Rocky Mountain region. Executive Director Marcy Rubik joins us to talk about how health care professionals from all backgrounds have joined this effort to offset financial stressors, provide education, and advance research.***Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should...
2023-07-0523 minWithin Normal Limits: Navigating Medical RisksThe Nuanced Role Physicians Play with Advanced Practice ProvidersUnderstanding the regulatory environment is key to managing risks associated with working with advanced practice providers (APPs), Dr. Alan Lembitz, COPIC's Chief Medical Officer says. But he cautions providers to understand this isn’t always simple. He reminds providers that it’s on them to ensure they are following the regulatory rules, which vary based on state and provider type. COPIC has seen cases of plaintiff attorneys alleging APPs practicing outside of the scope of licensure and inadequate supervision. In this episode, Dr. Lembitz breaks down high-risk areas, as well as what physicians and APPs need to know about mana...
2023-06-1630 minWithin Normal Limits: Navigating Medical RisksA Conversation on Risk in Urology, Including the Pandemic’s Impact on Patient CareThe guest for this episode is Stephen Siegel, MD, a urologist in a multi-specialty group and a medical school classmate of our host. The former classmates discuss the impact of COVID-19 on surgical intervention, delay of diagnosis, and routine screening. They also discuss general risk areas in urology, including transitions of care, telehealth, and risks associated with PSA-level management across a patient’s lifetime. Legal Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that...
2023-05-2635 minWithin Normal Limits: Navigating Medical RisksFulfilling Opioid Education Training RequirementsThis episode features Dr. Alan Lembitz, Chief Medical Officer for COPIC, and focuses on uncertainty around federal and state opioid education requirements for medical providers. The conversation examines common questions from “what do I need to do to fulfill my licensure requirements?” to “how do I prove that I am in compliance with these requirements?” Dr. Lembitz also looks at details with the new DEA requirement of eight hours of training around substance use disorders, concerns if providers don’t fulfill these requirements, and highlights of COPIC resources that are available to help meet these requirements. Informati...
2023-05-1318 minWithin Normal Limits: Navigating Medical RisksPhysician Health Programs—Caring for CaregiversThis episode’s guest is Scott Humphreys, MD, forensic psychologist and medical director of the Colorado Physician Health Program (CPHP). This nonprofit independent peer assistance program provides licensed professionals with confidential, individualized evaluation and treatment referrals for health problems such as psychiatric illness and substance abuse. Dr. Humphreys discusses the stigma associated with physicians transitioning into the role of patient and the approach CPHP takes to ensure they can ultimately have a healthy practice and healthy life. Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and...
2023-04-2728 minWithin Normal Limits: Navigating Medical RisksDealing with Potentially Violent PatientsDr. Michael Victoroff, a family medicine physician and COPIC consultant with expertise in clinical informatics, is our guest for this episode that focuses on situations where patients may become violent. The discussion examines emotional states in patients, such as frustration or unhappiness, that can escalate into physical conflict and why we have seen a substantial increase in these types of encounters. Dr. Victoroff talks about de-escalation and conflict management skills, our innate flight-or-fight reactions, and the importance of appropriate training for the health care setting. In addition, the conversation explores ethical and legal considerations along with the moral dilemma...
2023-04-1337 minWithin Normal Limits: Navigating Medical RisksWhat I Wished I Knew When I Started Out in MedicineIn this episode, Dr. Jeffrey Varnell, a former surgeon and risk management consultant, reflects back on things physicians wished they would have learned during their medical residencies and when they first started their practice. In particular, he talks about effectively utilizing professional review, onboarding and managing expectations around a practice’s policies and procedures (from billing to EHRs), the importance of peer support and mentorship, and the benefits of creating a “toolkit” to help new physicians integrate into the practice setting. Show email: wnlpodcast@copic.com
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2022-11-2316 minWithin Normal Limits: Navigating Medical RisksEducating Providers About Health Care Disparities and Patients with DisabilitiesThe episode’s guest is Chanda Hinton, the founder and executive director of the Chanda Plan Foundation, who also helps run the Chanda Center for Health, an organization that helps people living with long-term disabilities through integrative health care. The discussion focuses on looking at health care through a lens of disability and disparity, and how medical providers can help address this. Chanda talks about her organization’s belief that “people living with long-term physical disabilities have the right to create their own healthcare path, live independently, and be active members in community” and the various ways they support this ide...
2022-11-1019 minWithin Normal Limits: Navigating Medical RisksCOPIC Medical Foundation Grant Recipient: Children’s Health FundThis episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes Arturo Brito, MD, MPH, the President and CEO of Children’s Health Fund. Dr. Brito highlights how the grant was used to support the review, update, and dissemination of the successful Referral Management Initiative to incorporate new technologies that enhance care coordination procedures for pediatric populations living in under-resourced communities. They talk about health equity, innovation with mobile clinic programs, concern over COVID-19’s lo...
2022-10-2624 minWithin Normal Limits: Navigating Medical RisksCOPIC Medical Foundation Grant Recipient: Children’s Hospital Colorado FoundationThis episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes two guests from the Children’s Hospital Colorado: Jennifer Disabato, a pediatric nurse practitioner, and William Anderson, MD, an Associate Program Director. Ms. Disabati and Dr. Anderson highlight how the grant was used to support the ImPACT Navigation Hub—a centralized resource hub to coordinate the transition of young adult patients with pediatric onset conditions to adult care. They talk about some of the...
2022-09-2830 minWithin Normal Limits: Navigating Medical RisksCOPIC Medical Foundation Grant Recipient: Mile High Health AllianceThis episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes two guests from the Mile High Health Alliance: Dede de Percin, Executive Director, and Vicente Cardona, Program Manager. Dede and Vicente highlight how the grant was used to support the “Orange Flag” Project—an initiative that uses historic, predictive, and real-time data to inform emergency department personnel of a patient’s high utilization of emergency services to aid in care coordination. They talk about ap...
2022-09-2223 minWithin Normal Limits: Navigating Medical RisksCOPIC Medical Foundation Grant Recipient: Children’s NationalThis episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes Olivia Soutullo, a psychologist and Director of Parent-Child Interaction Therapy Services at Children’s National (Washington, D.C.). Olivia highlights how grant funding from the Foundation was used to support a program aimed at improving coordination of pediatric mental care after psychiatric hospitalization. She talks about some of the key challenges faced in these situations, the importance of connecting with the families involved an...
2022-09-0819 minWithin Normal Limits: Navigating Medical RisksTreating Family, Friends, and StaffDr. Dennis Boyle, a COPIC physician consultant and rheumatologist, is the guest on this episode which looks at the issue of treating friends, family, and staff as patients. The discussion looks at the ethical, legal, and other considerations in these types of situations using some case studies and highlighting the American Medical Association’s guidance. In particular, there is the issue of how your professional judgement may be impacted when you have a close, personal relationship with a patient. Dr. Boyle also highlights other concerns that include confidentiality, sensitive examinations, and dealing with the urge to provide medical advice to...
2022-08-1725 minWithin Normal Limits: Navigating Medical RisksThe Ongoing Challenge of Chest Pain in PatientsThis episode examines patients who present with chest pain and how this can run the full spectrum of being a minor irritation to a more serious condition that requires immediate attention. Dr. Zacharias draws upon his experience in internal medicine to talk about using clinical judgment to work through an assessment. He delves into using a differential diagnosis approach, addressing emergency situations, and evaluating considerations based on a patient’s medical history. In addition, Dr. Zacharias looks at how mental health conditions can influence chest pain and tests to rule in (and rule out) certain conditions. S...
2022-08-0321 minWithin Normal Limits: Navigating Medical RisksNavigating Conversations with Patients About GunsDue to recent active shooter situations and a renewed focus on the safety of health care providers, COPIC is re-releasing this past episode. Some providers may draw a strict boundary about discussing guns with their patients (or not think about it). But research has shown there are situations when access to firearms is a potential risk factor and raising this issue can be not only appropriate but necessary. Dr. Michael Victoroff, who is a firearms safety expert, addresses some scenarios associated with guns that can arise in the clinical setting. These range from imminent danger (e.g., suicide risk...
2022-07-2532 minWithin Normal Limits: Navigating Medical RisksHelping Kids Cope with Anxieties Around Medical Care and Pain ManagementThis episode’s guest is Jody Thomas, PhD, Founder/Chief Executive Officer of The Meg Foundation, a nonprofit whose mission is to empower families with the pain management strategies, skills, and support they need to prevent and reduce pain. The discussion examines how “fear of needles” and health care avoidance can develop in early childhood, and what strategies can be implemented—by parents and medical providers—to prevent negative associations with medical care. Thomas highlights some best practices for pain management with children, such as over-the-counter numbing creams and comforting techniques, and talks about resources they have developed in partnershi...
2022-06-3030 minWithin Normal Limits: Navigating Medical RisksDiagnosing Stevens-Johnson SyndromeOur guest for this episode is Dr. Dan Rosenquist, a family medicine physician in Nebraska and risk manager for COPIC. The focus is on Stevens-Johnson syndrome and toxic epidermal necrolysis, which are commonly caused by medications or infections and typically present as skin reactions. Dr. Rosenquist walks through the causes and symptoms to be aware of, the role of certain medications in this condition, and discussing the issue with patients. The conversation also touches on having a high index of suspicion, particularly early in its presentation, as the findings may be subtle or confused with more common conditions.
2022-06-1323 minWithin Normal Limits: Navigating Medical RisksA Return to Discussing Spinal Epidural AbscessDr. Zacharias reexamines the issues that lead to spinal epidural abscess, a rare condition that can result in severe adverse outcomes and allegations of negligent care. We start with a clear definition of spinal epidural abscess, why it occurs, and some notable contributing factors. From there, Dr. Zacharias examines risk factors with patients and some suggestions on being highly vigilant about certain signs that should increase your index of suspicion. He also walks through some examples of symptoms that patients commonly present with as well as key considerations when evaluating and treating patients with these symptoms.
2022-05-2014 minWithin Normal Limits: Navigating Medical RisksA Discussion with Dr. MeiLan Han—A Leading Pulmonologist and AuthorThis special episode features Dr. MeiLan Han, a Professor of Medicine and Chief of Pulmonary and Critical Care at the University of Michigan and author of the book Breathing Lessons: A Doctor’s Guide to Lung Health. Dr. Han shares her perspective on the impact of COVID-related respiratory issues and how this emphasized the importance of healthy lungs and the vital role they play. She talks about her background in pulmonary care and why her desire to better educate patients (and other physicians) on lung health led to writing Breathing Lessons. The discussion also touches on research data insights, me...
2022-04-2652 minWithin Normal Limits: Navigating Medical RisksCan You Really “Clear a Patient for Surgery”?This episode features Dr. Jeff Varnell, a surgeon and COPIC physician risk manager, who offers some insight about the phrase of “clearing a patient for surgery,” and how this has evolved over time. The discussion starts on the idea of evaluating patients prior to surgery with a focus on maximizing their condition and ability to get through surgery safely, and how this informs the post-surgery recovery plan. Dr. Varnell then talks about preoperative screening processes, from nutritional screening to pain management, and the importance of using a team/systematic approach to improve outcomes and reduce risk. Show...
2022-04-0812 minWithin Normal Limits: Navigating Medical RisksManaging Patients Who Bring in Wearable Device DataDr. Zacharias tackles the subject of managing patients who come armed with data from wearable devices (e.g., Fitbits, Apple Watches) believing that this information is valuable for their medical care. He uses the case study of a patient who is a trail runner and has concerns about elevated heart rates (as indicated by device data) and how this may connect with a family history of early heart disease. In responding to this type of situation, Dr. Zacharias highlights the importance of differentiating consumer-grade devices from approved medical diagnostic devices, explains how the data may inform a careful evaluation...
2022-03-2312 minWithin Normal Limits: Navigating Medical RisksUsing Ketamine to Treat DepressionThis episode’s guest is Dr. Will Van Derveer, a recognized leader in integrative psychiatry, who shares his insight about using ketamine to treat depression and the different schools of thought about how it should be used. He provides some background about the origins of ketamine use in medicine and research studies that demonstrated positive results for patients with depression. The discussion touches on the concerns with ketamine (diversion and addiction), the duration of benefit, “rule outs” to consider, and the influence of Michael Pollan’s book, How to Change Your Mind, on the renewed interest in psychedelics as therapeu...
2022-03-0236 minWithin Normal Limits: Navigating Medical RisksPreventing Surgical Fires and Injuries Related to Electrical Surgical UnitsDr. Rebecca Vogel, a general surgeon and COPIC board member, is the guest for this episode that explores key areas of risk management associated with certain surgical injuries. Dr. Vogel talks about her involvement with surgical residency programs and integrating a focus on “maintaining your passion and humanism” throughout your career in medicine. Using a case study about a surgical fire, we look at key factors that contribute to these types of incidents—from the risk of a laser igniting oxygen to miscommunication between a surgeon and an anesthesiologist. Dr. Vogel then highlights the importance of “putting the patient first,”...
2022-01-2828 minWithin Normal Limits: Navigating Medical RisksReducing the Risk of Bile Duct Injuries During Laparoscopic Cholecystectomy ProceduresDr. Sue Sgambati, COPIC’s Medical Director and a colorectal surgeon, returns to the podcast to discuss risks and guidelines associated with laparoscopic cholecystectomy. Dr. Sgambati talks about the background behind utilizing this approach and how a reduced recovery time led to improved patient and provider satisfaction. However, one of the concerns that has emerged is the risk of bile duct injuries (BDIs). Dr. Sgambati focuses on guidelines developed from a multi-society consensus that identify optimal strategies for the prevention of BDIs. In particular, she highlights five key guidelines to consider, provides some real-life context from her experience as a...
2022-01-1420 minWithin Normal Limits: Navigating Medical RisksThe Delicate Process of Terminating a PatientDr. Zacharias is joined by Dr. Sue Sgambati, COPIC’s Medical Director, to discuss situations where a physician is thinking about terminating a patient from their practice. Common issues that we see include multiple missed appointments, rude behavior, or non-compliance with medication. The conversation focuses on considerations from a physician’s perspective (disclaimer: consult an attorney for legal advice in these situations) starting with a thoughtful analysis of “why do you want to terminate a patient? what is the core issue?” We look at assessing the timing of a termination, how to draft a formal letter that is brief and obje...
2021-12-1037 minWithin Normal Limits: Navigating Medical RisksGetting to the Heart of Health Care: Perspectives from an Esteemed CardiologistThis episode’s guest is Dr. Nelson Trujillo, a cardiologist out of Boulder, Colorado, who also has a background in biomedical engineering and nuclear medicine. Dr. Trujillo shares his personal journey, the influence of prominent mentors, why he gravitated toward the prevention of cardiovascular disease, and the notable paradigm shifts he has observed during his career. He shares some insights about “triple rule out,” diagnosing acute coronary syndrome, and considerations when evaluating major risk factors. Dr. Trujillo also talks about prevention and intervention strategies—from adopting a Mediterranean diet to the threshold between benefits and risks with exercise, and the ongo...
2021-12-0246 minWithin Normal Limits: Navigating Medical RisksHandling Unsolicited Diagnostic TestsThis episode focuses on the issue of what medical practices should do when they receive clinical information (often test results) about an individual who is not a recognized patient, or which did not originate from an order or request from the practice. This situation increases as patients have more options to self-refer for tests, and more ways to deliver results to providers. Examples include health fair reports, results of self-authorized tests, or records from external providers. Such information, once received, can present an information management dilemma and potential liability exposure. We walk through considerations such as evaluating if there...
2021-11-1116 minWithin Normal Limits: Navigating Medical RisksForum Panel Discussion: A Candid Conversation on the Risks We See and What You Need to KnowTaped live at the annual Patient Safety & Risk Management Forum, this episode features a panel discussion with Dr. Zacharias, Dr. Alan Lembitz, COPIC’s Chief Medical Officer, and Dr. Sue Sgambati, COPIC’s Medical Director. Using a series of real case studies, the panel highlights key patient safety and risk management principles based on where we consistently see medical liability issues. The cases cover topics such as “normalized deviance” that occurs with system workarounds; empowering medical staff to voice concerns; common diagnostic errors associated with heads, hearts, bellies, bugs, and cancer; the importance of checking vital signs; subtle symptoms that can...
2021-10-2850 minWithin Normal Limits: Navigating Medical RisksWhen a Patient Disagrees with Your Care Recommendations: Using Informed Refusal as a ToolDr. Alan Lembitz, COPIC’s Chief Medical Officer, joins us to talk about managing situations where patients make decisions about their care that you don’t believe is in their best interest. Using a case study review, we analyze a scenario that illustrates the importance of using an informed refusal form to document a patient’s choice that goes against your recommended care. This presents a challenge in balancing the concerns of protecting your patient while protecting yourself from a medical liability lawsuit. In addition, we look at factors such as patient competency, reasons why patients may refuse care (includ...
2021-10-1622 minWithin Normal Limits: Navigating Medical RisksSpecial Episode: Requirements for Nebraska Physicians Who Prescribe Opioids/Controlled SubstancesThis episode focuses on Nebraska legislation that outlines rules for prescribing and continuing education around opioids and controlled substances. The legislation was passed in 2018, but its implementation was delayed because of COVID. However, these requirements are now in effect starting in October 2021. Among the requirements are that prescribers must obtain 3.0 hours of CME regarding prescribing opioids on a biennial basis (0.5 hours of which MUST cover Nebraska’s Prescription Drug Monitoring Program or PDMP). Dr. Zacharias outlines the details of meeting these requirements, including accessing a half-hour PDMP training video on the Nebraska Department of Health and Human Services’ website and...
2021-09-1314 minWithin Normal Limits: Navigating Medical RisksTalking with Patients Who Are Hesitant About the VaccineIt’s an issue that many physicians are facing and something that continues to be a focus in public discourse—people who don’t want to take the COVID vaccine. The conversations providers are having on this topic can be emotionally charged, full of confusion and disinformation, and difficult to navigate. This episode’s guest, Dr. Dennis Boyle, is an expert on communication and shares some insight on how to approach these situations such as the idea of “developing a therapeutic alliance” as a framing point, inquisitive inquiries, and seeking first to understand why a patient is hesitant. In addition, th...
2021-09-0923 minWithin Normal Limits: Navigating Medical RisksMedication Errors: The Potential Side Effects and Risks of PrescribingDr. 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 ti...
2021-04-2830 minWithin Normal Limits: Navigating Medical RisksNonverbal Communication: How Your Body Talks and What Patients HearDr. 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 connecti...
2021-04-2119 minWithin Normal Limits: Navigating Medical RisksA Conversation with the Colorado Medical Society’s President—Dr. Sami DiabIn 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...
2021-04-1430 minWithin Normal Limits: Navigating Medical RisksWith Power Comes Responsibility—Ethical and Legal Issues That Physicians FaceDr. 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 ot...
2021-04-0729 minWithin Normal Limits: Navigating Medical RisksConsiderations with Opioids and Pain Management—A Surgeon’s PerspectiveDr. 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 bein...
2021-03-3125 minWithin Normal Limits: Navigating Medical RisksTelehealth: The Evolving World of Remote CareDr. 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 cons...
2021-03-2436 minWithin Normal Limits: Navigating Medical RisksCultivating a Culture of SafetyDr. 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...
2021-03-1725 minWithin Normal Limits: Navigating Medical RisksAn Inside Look at How the Colorado Medical Board Responds to ComplaintsDr. 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 a...
2021-03-0938 minWithin Normal Limits: Navigating Medical RisksCOVID-19 and Its Potential Impact on Medical Liability IssuesDr. 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...
2021-03-0322 minWithin Normal Limits: Navigating Medical RisksUsing Simulation Technology to Teach the Next Generation of Medical ProfessionalsIn 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...
2021-02-2425 minWithin Normal Limits: Navigating Medical RisksColorectal Cancer Screenings: A Shift in GuidelinesDr. Sue Sgambati, a colorectal surgeon and COPIC’s medical director, discusses the recent recommendation from the U.S Preventive Services Task Force that colorectal cancer screening routinely begin at age 45, instead of age 50. This recommendation is in response to the sharp rise in the number of colorectal cancers in young adults. Dr. Sgambati draws upon her own experience to talk about considerations when evaluating symptoms and whether or not to include a colonoscopy as part of a workup. She also highlights her perspective on colonoscopies versus additional tests for patients that can identify signs of cancer based on st...
2021-02-1711 minWithin Normal Limits: Navigating Medical RisksA View from the Inside: Dr. Alan Lembitz, Chief Medical Officer at COPICDr. Alan Lembitz joins us on this episode to talk about some of his key lessons learned over the years as COPIC’s chief medical officer. In particular, the conversation focuses on how and why COPIC developed its Practice Quality Reviews that help identify potential areas of risk. Dr. Lembitz discusses how claims data is distilled down to develop Level One Guidelines (best practices) about common areas where we see issues occur such as documentation, patient communication, and medication safety. He also highlights the importance of vital signs when care is reviewed and how physicians should view the terms “negl...
2021-02-1013 minWithin Normal Limits: Navigating Medical RisksAddressing Adverse Outcomes Part II: A Deeper Dive Into CandorWhat is Candor? How does it benefit patients and providers? Dr. Zacharias is joined by Dr. Sue Sgambati, the medical director at COPIC, to answer these questions and provide some insight. In this context, Candor refers to a framework that emerged out of efforts by the Agency for Healthcare Research and Quality (AHRQ) to encourage an environment that supports open, honest conversations with patients after adverse outcomes occur. It is also designed to investigate and learn from what happened, to address the patients’ needs alongside providers’ needs, and to disseminate any lessons learned in order to improve future outcomes. Dr...
2021-02-0321 minWithin Normal Limits: Navigating Medical RisksAddressing Adverse Outcomes Part I: COPIC’s 3Rs and CANDOR ProgramsDr. Jeff Varnell, a surgeon and COPIC physician risk manager, is the guest for this episode that focuses on addressing adverse outcomes through COPIC’s 3Rs and CANDOR Programs. Dr. Varnell has managed the 3Rs (Recognize, Respond, and Resolve) process and highlights its origins and goals of maintaining the physician-patient relationship and improving the quality of medical care. He also talks about how 3Rs and CANDOR try to move away from an adversarial approach to one that guides physicians through managing difficult patient conversations and using best practices for disclosure that includes open and honest conversations. In addition, Dr. Varn...
2021-01-2715 minWithin Normal Limits: Navigating Medical RisksPhysician Leaders: A Pediatrician’s Perspective on Care Integration and Improving Patient SafetyDr. Zacharias welcomes Dr. Sophia Meharena, a pediatrician and member of COPIC’s Board of Directors, to talk about her personal journey into medicine and the transformative experience of doing her residency at Children’s Hospital Colorado. She also discusses her current role at a safety net clinic and highlights the value of integration that occurs with other specialists, health care navigators, and social services; along with her concerns about the pandemic’s impact on pediatric patients (i.e., social isolation, dietary health, financial constraints, etc.). In addition, Dr. Meharena talks about her involvement with the COPIC Medical Foundation and ho...
2021-01-2030 minWithin Normal Limits: Navigating Medical RisksA Brotherly Discussion on Cognitive Issues and AlzheimersDr. Zacharias’s brother, Alan, is our guest, not just because he is related to our host, but because he is a neurologist and expert in cognitive impairment. The two discuss having patient conversations about memory issues associated with “normal aging” and differentiating these from possible early indicators of Alzheimer's disease. Alan then does a deep dive into diagnosing Alzheimer’s; the role of diet, physical activity, social engagement to improve functionality; and available treatments as well as potential new therapeutics on the horizon. Lastly, Eric finally learns the truth regarding his often used conjecture that there are no Grandmas...
2021-01-1335 minWithin Normal Limits: Navigating Medical RisksUsing the Mediterranean Diet as a Patient Wellness ToolComing off the holidays, this episode taps into Dr. Zacharias’s knowledge as a published author on the benefits of the Mediterranean diet. In a conversation with Dr. Sue Sgambati, COPIC’s Medical Director, Dr. Zacharias talks about how a six-month sabbatical traveling across countries such as France, Italy, and Spain, enabled him to research how dietary habits can reduce coronary heart disease and optimize your health. The discussion focuses on the eight principle areas of the Mediterranean diet and how physicians can incorporate these into recommendations for patients that encourage healthy habits and still allow them to enjoy the...
2021-01-0633 minWithin Normal Limits: Navigating Medical RisksThe Senior Surgeon: Assessing Skills as We AgeAs we get older, there is value in the wisdom and experience we gain. However, there is also a well-documented risk for cognitive and physical decline that accompanies aging. In this episode, Dr. Zacharias looks at the issue of assessing the skills of aging physicians with his guest, Dr, Jeffrey Varnell, a surgeon and COPIC physician risk manager. It’s a topic filled with gray areas (pun intended) that include evaluation through voluntary testing, mandatory retirement ages, and patient safety considerations. There is also a discussion of the fulfillment and identity that comes with being a physician and how th...
2020-12-3015 minWithin Normal Limits: Navigating Medical RisksSpecial Episode: A Good Outcome from a Patient's PerspectiveIn this episode, we hear from one of Dr. Zacharias’ patients who is doing well due to early recognition of an often-missed condition—epidural spinal lesion. The patient initially presented with symptoms that included back pain and mild saddle anesthesia. The episode provides an insightful perspective from the patient’s point-of-view and reinforces the importance of remaining hypervigilant to subtle signs that can escalate quickly. Podcast Email: wnlpodcast@copic.com
Feedback or episode ideas email the show at wnlpodcast@copic.comDisclaimer: Information provided in this podcast should not be relied up...
2020-12-2623 minWithin Normal Limits: Navigating Medical RisksNavigating Conversations with Patients About GunsSome providers may draw a strict boundary about discussing guns with their patients (or not think about it). But research has shown there are situations when access to firearms is a potential risk factor and raising this issue can be not only appropriate but necessary. Dr. Michael Victoroff, who is a firearms safety expert, addresses some scenarios associated with guns that can arise in the clinical setting. These range from imminent danger (e.g., suicide risk) to general considerations that vary from household to household (e.g., storage methods). Dr. Victoroff offers guidance on how to approach this topic with non-conf...
2020-12-2330 minWithin Normal Limits: Navigating Medical RisksBurnout from COVID-19: Moving Forward with ResilienceWhile burnout is a long-standing issue in health care, the compounded impact of COVID-19 has heightened its prevalence and the importance of efforts to address the well-being of medical providers. In this episode, Dr. Zacharias talks to one of COPIC’s experts on physician burnout, Dr. Dennis Boyle. They dissect the root causes of burnout and three key diameters to consider—depersonalization, emotional exhaustion, and feelings of low accomplishment. They also look at other influential factors such as EHRs, workplace culture, and personality traits as well as the omnipresence of grief in health care. In addition, they talk about how...
2020-12-1633 minWithin Normal Limits: Navigating Medical RisksA Frontline Doctor’s Perspective on COVID-19Dr. Zacharias talks with Dr. Connor Graham, a frontline hospitalist at a critical care access hospital, about his direct experience in dealing with COVID-19. Dr. Graham discusses how patient cases have changed since March, the risk of exposure and the emotional strain medical providers face, and the ways treatment options have evolved. In addition, he addresses the challenging logistics of prolonged hospitalizations, from the delicate balance of staffing needs to the coordination that occurs between different facilities to managing patients with urgent, non-COVID-19 conditions. The two doctors also share insight on how they handle the personal stress and their...
2020-12-0824 minWithin Normal Limits: Navigating Medical RisksInformed Consent: The Joy (and Pain) of Shared DecisionsInformed consent shouldn’t be viewed as just an obligation to get a signed form, but rather, an opportunity to engage patients in shared decision-making. Dr. Jeffrey Varnell, a surgeon and COPIC physician risk manager, joins Dr. Zacharias to talk about the process of disclosing essential information during the informed consent process so that patients understand the recommended treatment and indications, risks, benefits, alternatives, and risks of not proceeding. In addition, they review the importance of not delegating this process to those who aren’t performing the procedure and assessing a patient’s understanding. Email: wnlpodc...
2020-12-0212 minWithin Normal Limits: Navigating Medical RisksSepsis—A Bad Infection That Can Get WorseSepsis is a common syndrome, and although our knowledge of how to treat it has improved significantly, this bacterial infection can be very lethal if not caught early. Dr. Susan Sgambati, a colorectal surgeon and COPIC’s medical director, joins Dr. Zacharias to review some sepsis case studies and discuss why early recognition is critical, the value of clinical judgement and vital signs, and how pain out of proportion to what you are seeing can be a key indicator. BONUS CONTENT: COVID-19 Considerations During the HolidaysThe latest developments in the COVID-19 saga include some goo...
2020-11-2535 minWithin Normal Limits: Navigating Medical RisksSpinal Epidural Abscess: A Difficult DiagnosisDr. Zacharias switches places with his peer, Dr. Boyle, who asks questions about a classic case study that involves…you guessed it—spinal epidural abscess. The conversation gets deep into the clinical aspects surrounding a patient who visits the emergency room several times in an eight-day period with complaints of a subjective fever and severe back pain. As Dr. Zacharias notes, this is a difficult case and “the standard of care is to miss it.” Using a step-by-step analysis, the two doctors offer guidance on where things can go wrong and the factors that should be examined to avoid a bad ou...
2020-11-1714 minWithin Normal Limits: Navigating Medical RisksMed Mal 101: Heads, Hearts, Bellies and BugsOur first episode draws upon decades of medical liability experience to distill down the key areas where we consistently see malpractice lawsuits—heads (neurologic), hearts (chest pain), bellies (abdominal pain), and bugs (infections). We examine why physicians sometimes misdiagnose symptoms that seem obvious in hindsight, but in actual practice, are not so simple. Our guest is Dr. Dennis Boyle, a rheumatologist who also teaches at University of Colorado School of Medicine and is a physician risk manager with COPIC. Dr. Boyle and Dr. Zacharias walk through some sample scenarios and offer guidance on how to avoid common risks while en...
2020-11-1333 min