Within Normal Limits: Navigating Medical Risks
75 episodes - English - Latest episode: 3 days ago - ★★★★★ - 31 ratingsWithin 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. Hosted by Eric Zacharias, MD, an internal medicine doctor and physician risk manager with COPIC, a leading medical liability insurance company, this podcast centers around open conversations between physicians and medical experts. Each episode 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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Episodes
Medication Errors: The Potential Side Effects and Risks of Prescribing
April 27, 2021 23:59 - 30 minutes - 24.4 MBDr. 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 situa...
Nonverbal Communication: How Your Body Talks and What Patients Hear
April 21, 2021 17:49 - 19 minutes - 18.1 MBDr. 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 al...
A Conversation with the Colorado Medical Society’s President—Dr. Sami Diab
April 14, 2021 00:00 - 30 minutes - 25.6 MBIn 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,...
With Power Comes Responsibility—Ethical and Legal Issues That Physicians Face
April 07, 2021 14:50 - 29 minutes - 25.7 MBDr. 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 inves...
Considerations with Opioids and Pain Management—A Surgeon’s Perspective
March 31, 2021 21:23 - 25 minutes - 22.9 MBDr. 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 r...
Telehealth: The Evolving World of Remote Care
March 24, 2021 17:27 - 36 minutes - 18.5 MBDr. 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, ...
Cultivating a Culture of Safety
March 17, 2021 21:29 - 25 minutes - 20 MBDr. 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 ...
An Inside Look at How the Colorado Medical Board Responds to Complaints
March 09, 2021 21:21 - 38 minutes - 28.2 MBDr. 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 dr...
COVID-19 and Its Potential Impact on Medical Liability Issues
March 03, 2021 21:31 - 22 minutes - 19.5 MBDr. 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...
Using Simulation Technology to Teach the Next Generation of Medical Professionals
February 23, 2021 23:23 - 25 minutes - 17 MBIn 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 ...
Colorectal Cancer Screenings: A Shift in Guidelines
February 17, 2021 19:50 - 11 minutes - 8.78 MBDr. 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. ...
A View from the Inside: Dr. Alan Lembitz, Chief Medical Officer at COPIC
February 10, 2021 01:49 - 13 minutes - 12.2 MBDr. 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 safe...
Addressing Adverse Outcomes Part II: A Deeper Dive Into Candor
February 03, 2021 00:09 - 21 minutes - 19.8 MBWhat 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,...
Addressing Adverse Outcomes Part I: COPIC’s 3Rs and CANDOR Programs
January 27, 2021 01:47 - 15 minutes - 12.3 MBDr. 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 ...
Physician Leaders: A Pediatrician’s Perspective on Care Integration and Improving Patient Safety
January 20, 2021 00:55 - 30 minutes - 22.8 MBDr. 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...
A Brotherly Discussion on Cognitive Issues and Alzheimers
January 13, 2021 00:09 - 35 minutes - 26 MBDr. 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 ...
Using the Mediterranean Diet as a Patient Wellness Tool
January 05, 2021 23:20 - 33 minutes - 26.1 MBComing 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 ...
The Senior Surgeon: Assessing Skills as We Age
December 30, 2020 00:53 - 15 minutes - 13.8 MBAs 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 safet...
Special Episode: A Good Outcome from a Patient's Perspective
December 25, 2020 23:18 - 23 minutes - 18.3 MBIn 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: [email protected] Feedback or episod...
Burnout from COVID-19: Moving Forward with Resilience
December 16, 2020 02:09 - 33 minutes - 26.5 MBWhile 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...
A Frontline Doctor’s Perspective on COVID-19
December 08, 2020 22:52 - 24 minutes - 18.9 MBDr. 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...
Informed Consent: The Joy (and Pain) of Shared Decisions
December 02, 2020 00:50 - 12 minutes - 11.2 MBInformed 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...
Sepsis—A Bad Infection That Can Get Worse
November 25, 2020 00:38 - 35 minutes - 28 MBSepsis 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 C...
Spinal Epidural Abscess: A Difficult Diagnosis
November 17, 2020 21:29 - 14 minutes - 13 MBDr. 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 ...
Med Mal 101: Heads, Hearts, Bellies and Bugs
November 13, 2020 20:13 - 33 minutes - 30.9 MBOur 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...