COPIC Podcast: Within Normal Limits

COPIC Podcast: Within Normal Limits

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COPIC's Podcast—Within Normal Limits: Navigating Medical Risks

Within Normal Limits is a podcast produced by COPIC that focuses on a wide variety of risk management, patient safety, and professional liability issues. Hosted by Eric Zacharias, MD, an internal medicine doctor and physician risk manager with COPIC.

Within Normal Limits provides physicians and medical professionals with unfiltered insights that focus on pitfalls to avoid in medicine and best practices to improve patient care. The podcast centers around open conversations between physicians and medical experts. Each episode is around 20 minutes and dives into topics including practical guidance, detailed analysis, current issues, and case study reviews. Within Normal Limits is an opportunity to learn from others’ experience and gain knowledge that may help you be a better medical provider and deliver the best patient care possible.

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Episode 1: Med Mal 101—Heads, Hearts, Bellies, and Bugs
Our 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 enhancing patient safety. 
BONUS CONTENT: Dr. Zacharias talks about how medical residents are named in up to 30% of medical liability lawsuits, what types of lawsuits these are, and the long-term impact these can have on residents. He also highlights COPIC’s Resident Rotation Program that helps the next generation of physicians prepare for issues they will likely face during their careers.   

Episode 2: Spinal Epidural Abscess—A Difficult Diagnosis
Dr. 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 outcome.

Episode 3: Sepsis—A Bad Infection That Can Get Worse
Sepsis 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 Holidays
The latest developments in the COVID-19 saga include some good news (promising results from COVID-19 vaccines) and some not-so-good news (a spike in cases across the country). Dr. Zacharias offers an honest assessment about the risks in a clinical setting, the risks at home, realistic precautions to take, and why Clorox wipes may be the best Christmas present (if you can find them).

Episode 4: Informed Consent—The Joy (and Pain) of Shared Decisions
Informed 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.

Episode 5: A Frontline Doctor’s Perspective on COVID-19
Dr. 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 cautious, yet optimistic view on how vaccines will be a game changer.

Episode 6: Burnout from COVID-19: Moving Forward with Resilience
While 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 the trend of prescribing “simple mindfulness” can be a challenging practice to put into action, and what steps can be taken to effectively approach this.

Episode 7: Navigating Conversations with Patients About Guns
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) 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-confrontational questions and suggestions for credible resources for healthcare providers.

Special Episode: A Good Outcome from a Patient's Perspective
In 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.  

Episode 8: The Senior Surgeon: Assessing Skills as We Age
As 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 this can influence when people finally decide to hang their white coats up.

Episode 9: Using the Mediterranean Diet as a Patient Wellness Tool
Coming 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 “pleasure of eating.”

Episode 10: A Brotherly Discussion on Cognitive Issues and Alzheimer's
Dr. 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 Grandmaster chess players over the age of 60.