Unfortunately, a patient death can happen during the course of podiatric care and treatment. A patient may unexpectedly die from a DVT/PE following surgery. A patient you are treating for an infection may develop sepsis and die. A patient you are treating for a lesion may eventually be diagnosed with cancer and die. These scenarios are traumatic for the treating physician, as well as for the deceased patient’s family. Not all deaths can be prevented; however, there may be warning signs that a patient is at risk for this tragic outcome. Here are some warning signs you should never ignore.

Patient/Family History
Obtain and document a thorough patient and family history at the patient’s initial visit, then review the history for any risk factors that might be relevant when creating your treatment plan. Document any potential risk factors, any further investigation performed, and your rationale for your treatment decisions. 

Lack of Treatment Progress
If a patient is not progressing as expected, reevaluate your treatment plan. Consider possible reasons for the lack of progress. Is your diagnosis correct? Does the patient have unmanaged comorbidities? Does the patient have the ability and resources to comply with the current treatment plan? Does the patient fully understand the severity of their condition and the necessity of compliance with your treatment plan? Does the patient have the proper nutrition to promote healing? There can be many reasons a patient is not progressing with treatment, and promptly addressing these reasons can potentially prevent a poor patient outcome, including death.

Complications

Recognize and address any complications a patient may have in a timely manner. Failure to recognize and address a complication – such as infection or circulatory issues – as quickly as possible increases the risk the patient will have a bad outcome due to the complication. Document the complication, your conversations with the patient regarding the complication, your treatment plan to address the complication, any referrals for further evaluation, and the reason for the referral, follow-up evaluations, and the patient’s response to treatment. 

A Patient Tells You Something Isn't Right
Patients know their bodies and know when something is just not right. Listen to them. Document their concerns and your immediate steps to address their concerns. In some cases, a post-op patient calls their doctor stating they feel anxious or just do not feel right, the doctor chooses not to evaluate the patient, and the patient dies from a pulmonary embolus. The patient’s concerns may not be indicative of a problem, but it is much better to rule out a problem than find out later the patient suffered a bad outcome from an unrecognized problem.

The Patient Doesn't Return for Treatment
If you are treating a patient that needs follow-up and the patient does not return for treatment, the patient needs to be informed of the necessity for continued treatment and the risks of not seeking further treatment. This is especially important if you have diagnostic study findings that indicate a potentially life-threatening problem, such as a biopsy report stating the patient’s lesion is cancerous. These patients sometimes fall through the cracks leading to prolonged treatment, deformity, pain and suffering, and even death. If the patient does not respond to phone calls, it is advisable to send the patient a certified letter, return receipt requested, detailing the patient’s condition, recommended treatment, risks of not receiving treatment, and the need to seek care from a healthcare provider. Document all conversations with the patient and phone call attempts in the patient’s medical record. Copies of any written correspondence with the patient and return receipts, if applicable, should be kept in the patient's medical record.

By being cognizant of these warning signs, you could save a patient’s life - or in the unfortunate and tragic event of a patient’s death, you will reduce your risk of a lawsuit alleging your actions or inactions resulted in the patient’s death.

Introduction
November is Diabetes Awareness Month. Diabetes, particularly type 2 diabetes, comes accompanied by a host of comorbidities that directly impact the type and effectiveness of care required in treating the lower extremity, specifically the foot and ankle. Podiatrists are trained in the recognition of these comorbidities as well as their influence in outcomes of treatment. In this article, we will examine prevalent comorbidities and relate them to the anatomical considerations of foot and ankle pathology and where issues in successful treatment can possibly arise.

Diabetes is essentially a systemic abnormality of insulin regulation or the body’s ability to process sugar correctly. This irregularity leads to many other organ issues that can then manifest in the lower extremity. In effect, the lower extremity mirrors systemic disease. The patient complaints and condition that can appear in a podiatrist’s office can be related to conditions that affect their whole body. The most common comorbidities related to diabetes that intersect with podiatric medicine and patient care are obesity, heart disease, cerebrovascular disease, peripheral arterial disease, kidney disease, neuropathy, retinopathy, immune system compromise, and mental health issues.

How do each of these comorbidities affect foot and ankle pathology in a holistic sense?

Artificial intelligence (AI) is generally defined as computer systems that can perform complex tasks that previously only a human could do, such as reasoning, decision-making, or problem-solving. AI is rapidly being integrated into our world, including healthcare. Proponents of the use of AI in healthcare believe it has the potential to make healthcare more efficient, less expensive, more accessible, and safer for patients. 

AI Software for Medical Documentation
One of the more common uses of AI in physician offices is software for medical record documentation. This AI software is being marketed as a tool to make documentation more accurate and less burdensome. AI medical documentation tools work by using advanced algorithms and machine learning techniques to analyze and interpret large amounts of data related to healthcare, including patient records, lab results, and clinical notes. A key component of these tools is natural language processing (NLP), which allows the AI to understand and generate human-like language. 
AI automates documentation by creating notes in real-time by listening to physician-patient communication. AI can collect, sort, and assemble clinical information from previous notes, laboratory results, reports, and other contents of the medical record and provide real-time recommendations using dynamic clinical data mining. Additionally, AI can automate billing and coding based on risk-adjustment factors and can also draft level-of-service recommendations.

Potential Risks of Using AI Software at Your Practice
While the advancements in AI and the opportunities to streamline processes at a doctor’s office are exciting, the use of AI in healthcare is not without risk.

We know you’ve dealt with patients who have their own agenda, who do not follow instructions, who are apathetic with their care and treatment, or who are otherwise “difficult.” These patients can be a source of frustration for you and your office staff. They take up more of your time (and your staff’s time) and tend to have poor outcomes – and consequently, also tend to be dissatisfied with your care.

Peripheral neuropathy is a general term that refers to nerve diseases that impact the nerves outside your brain or spinal cord and cause numbness, weakness, or pain, usually in the hands and feet. These conditions can result from traumatic injuries, vascular and blood problems, autoimmune diseases, hormonal imbalances, kidney and liver disorders, nutritional or vitamin imbalances, alcoholism, exposure to toxins, certain cancers and tumors, chemotherapy, or infections. One of the most common causes of peripheral neuropathy is diabetes.

Complex regional pain syndrome (CRPS) is a diagnosis that is frequently involved in medical malpractice lawsuits against podiatrists. It is not uncommon to see plaintiff attorney ads targeting individuals who have been diagnosed with CRPS. Why? Because the plaintiff’s medical expenses and other damages such as pain and suffering, lost wages, family disruption, and loss of quality of life can be quite high. Therefore, settlements or jury verdicts in these claims can exceed a million dollars.

The most common precursors to CRPS are fractures, surgery, sprains/strains, burns, cuts, being in a cast, and nerve injury. CRPS can occur in anyone at any age, but it is more common in women and in middle-aged individuals.

A patient suffers cardiac arrest while waiting in the exam room. An elderly visitor falls in the waiting room, is complaining of leg pain and is unable to get up. A diabetic staff member passes out from hypoglycemia. These are just a few examples of unexpected medical emergencies that could happen in a medical office.

As a podiatrist, you have no doubt seen patients with wounds, masses, or lesions on their lower extremities. If these wounds, masses, or lesions are later found to be skin cancer, the treating podiatrist is at risk of a lawsuit. A common allegation in these cases is a delay in diagnoses and treatment of cancer resulting in harm to the patient. Skin cancer developing on the lower extremities is not uncommon and podiatric medical physicians are in a unique position to detect these types of cancers on their patients.

If you prescribe opioids in your practice, it is important to be familiar with current clinical practice guidelines for prescribing opioids, DEA requirements, and federal and state laws and regulations to reduce your professional and administrative liability risk. In this article we will discuss some of the guidelines, requirements, and regulations relating to prescribing opioids.

Over the years, there have been many lawsuits filed against physicians because the patient was not satisfied with a surgical outcome. It could have been a post-operative complication, delayed healing, prolonged pain, cosmetically undesirable result, or a host of other reasons. In the majority of these cases, the physician was found to have acted within the standard of care and the case was eventually dropped or in the event the case went to trial, the jury found in favor of the physician. In the meantime, a lot of time, effort, money, frustration, and stress was spent on claims in which the medicine was good.

So, Why Do These Patients Sue?
This quote by S. Jay Jayasankar, MD is insightful, “The patient’s expectation, not ours, is the yardstick by which our patients measure the course of recovery, occurrence of complications, and the outcome.” If the patient’s expectations are not met, the patient is more apt to sue, regardless of whether malpractice occurred.