The Doctors Advocate

IN THIS ISSUE:
page 2
Directors Forum
A Tragic Lesson in Drug Safety
page 3
An Ounce of Prevention
Patient-Centered Communications:
Building Patient Rapport
page 4
Litigation Education Retreat:
One Members Story
page 5
Insights from the Florida Physician
Advisory Board
page 6
Advance Drug Safety and
Earn CME Credits
page 10
Foundation News
Foundation Supports Patient Safety
Educational Roundtable
Validate Your Malpractice Risks
on November 11
page 1 1
PDR Network Launches RxEvent
Obstetrics Fall Webinar Series
page 1 2
The Back Page
Industry and Company News
THI RD QUARTER 2011
2 the doctors company
DIRECTORS FORUM
ABOUT US
The Doctors Advocate is published
by The Doctors Company to advise
and inform its members about loss
prevention and insurance issues.
The guidelines suggested in
this newsletter are not rules, do
not constitute legal advice, and do
not ensure a successful outcome.
They attempt to dene principles of
practice for providing appropriate care.
The principles are not inclusive of all
proper methods of care nor exclusive
of other methods reasonably directed
at obtaining the same results.
The ultimate decision regarding
the appropriateness of any treatment
must be made by each health care
provider in light of all circumstances
prevailing in the individual situation
and in accordance with the laws
of the jurisdiction in which the care
is rendered.
The Doctors Advocate is published
quarterly by Corporate Communications,
The Doctors Company. Letters and
articles, to be edited and published
at the editors discretion, are welcome.
The views expressed are those of the
letter writer and do not necessarily
reect the opinion or ofcial policy of
The Doctors Company. Please sign your
letters, and address them to the editor.
The Doctors Company
185 Greenwood Road
PO Box 2900
Napa, CA 94558-0900
(800) 421-2368
info@thedoctors.com
The Doctors Advocate
2011 The Doctors Company
All rights reserved.
www.thedoctors.com/advocate
A
four-year-old female with a history of asthma
presented with her mother to our insured pediatrician
for treatment of a barky cough (croup). Te pediatrician
prescribed Tussionex, one-half teaspoon once a day. Te
following day at 6:30 pm, the ofce nurse telephoned the
residence and spoke with the mother, who reported the
child was much better and was running around. Te
next day, the mother found the child unresponsive and
summoned the emergency squad. Tey administered
CPR and transported the child to the hospital, where she was pronounced
dead. An autopsy revealed the child had toxic blood levels of hydrocodone and
chlorpheniramine (components of Tussionex) and diphenhydramine (an active
ingredient of Benadryl).
A Tragic Lesson in Drug Safety
by David B. Troxel, MD, Medical Director, Board of Governors
It was alleged the insured pediatrician
failed to heed the warnings and recom-
mendations of the manufacturer of
Tussionex, including explicit warnings
against its administration to children
under the age of six; that he failed to
heed the warnings of the Food and Drug
Administration (FDA) and the Ameri-
can Academy of Pediatrics against
prescribing Tussionex to children under
the age of six; and that he prescribed an
excessive dose of Tussionex based on the
childs age and weight.
Defense Experts
A pediatrician expert stated he had
no issue with the insured prescribing
Tussionex to a child this age. He said
the FDA Alert regarding Tussionex was
released just a week before this event
occurred, and he felt it was understand-
able that the insured was not aware of it.
He also did not believe the standard of
care required the insured to be aware of
the FDA press release on Tussionex
(released three months before this event)
or the notice posted on the FDA Web site.
However, he believed the insured was
responsible for knowing the contents of
the FDA Dear Provider letter that had
been sent within a week of this prescrib-
ing event. He also questioned whether
a physician is responsible for reviewing
each medication he prescribes when a
new edition of the Physicians Desk
Reference (PDR) is released.
A toxicology expert stated that both
the Benadryl and the antihistamine
in the hydrocodone are inhibitors
of metabolism of hydrocodone. Te
toxicologist concluded the amount
of hydrocodone found in the blood
meant that the child had 3.4 doses in
her body at the time of death, which
is more than would be expected based
on the dosage prescribed. He made
continued on page 6
An autopsy revealed the child had toxic blood
levels of hydrocodone, chlorpheniramine,
and diphenhydramine.
David B. Troxel, MD
: the doctors advocate
continued on page 8
AN OUNCE OF PREVENTION
Patient-Centered Communications:
Building Patient Rapport
by Wendy G. Anderson, MD, MS, Assistant Professor, Division of Hospital Medicine, University of California, San Francisco
A
s more hospitalized medical
patients are cared for by hospital-
ists, both the patient and the physician
are challenged to develop an efective
patient-physician relationship. Hospi-
talists usually meet their patients for
the frst time at admission and care for
them for a limited time before hand-
ing of care to a colleague. Te chal-
lenges created by this situation can
lead to poor outcomes and decrease
the patients trust in the hospitalist
and, potentially, the hospital. Com-
munication skills can help hospitalists
overcome these barriers by ensuring
a clear exchange of information that
engenders patient trust.
How Does Communication
Infuence Whether a Malpractice
Claim Is Filed?
Research in the 1990s documented
that communication and the patient-
physician relationship are potent
predictors of whether patients decide
to fle medical malpractice claims.
1
In
a review of Te Doctors Companys
closed claims from 2005 to 2010,
communication was noted as a risk
management issue in 40 percent of
the cases.
Incomplete communication during
the initial assessment and during
the hospital course can cause or
contribute to poor patient outcomes.
Te patients presenting symptoms or
medical history may not be completely
elicited, or the doctor may not present
information in a clear manner. Tese
issues can compromise the patients
ability to understand and adhere to the
treatment plan. In addition, patients
who do not trust their physicians or
feel that the physician does not care
about them are more likely to fle
claims, even if there is no negligence.
2

A Model of Patient-
Centered Communication
A model of patient-centered communi-
cation can be used to address the issue
of developing efective communica-
tion and a healthy patient-physician
relationship (Figure 1). Key tasks in the
model are eliciting patient concerns
and addressing both informational and
emotional aspects of the concerns.
3

Eliciting and responding to patient
concerns is associated with higher
patient satisfaction.
4

To rate or share the articles in this issue, visit www.thedoctors.com/advocate.
Te relationship between physician and patient is crucial
to patient safety and good patient outcomes. Tis quarters
article describes the importance of developing a good
patient-physician relationship and the skills needed to
overcome challenges during the patients stressful hospital
admission with unfamiliar physicians.
Robin Diamond, JD, RN; AHA FellowPatient
Safety Leadership; Senior Vice President, Department
of Patient Safety
Robin Diamond
Hospitalists usually meet their patients for the rst time
at admission and care for them for a limited time before
handing off care to a colleague.
Wendy G. Anderson, MD, MS
thi rd quarter 201 1 ,
Incomplete
communication
during the initial
assessment and
during the hospital
course can cause or
contribute to poor
patient outcomes.
the doctors advocate
seminar designed for physicians who
are in the process of medical litigation.
While attending the Litigation
Education Retreat, Dr. Lutz found
that other physicians who were facing
claims expressed similar concerns
and anxietiesthe loss of confdence
in their decision-making, the loss of
sleep, the desire to vindicate their
reputations, and a decrease in the
reward from practicing medicine. He
met with a local defense attorney, a
jury consultant, and a psychiatrist,
gaining tools to help him become his
own best witness. He was also able to
participate in a mock deposition that
simulated a court environment.
Te retreat prepared Dr. Lutz to be an
active member of his defense team,
while helping him learn constructive
ways to cope with the stress of being
sued. When the case went to trial in
August 2010, Dr. Lutz felt confdent
and ready to fght for his reputation.
A jury heard the case and agreed that
it had no merit, returning a verdict in
Litigation Education Retreat: One Members Story
I
n 2008, Dr. Stephen Lutz, a radia-
tion oncologist practicing in Findlay,
Ohio, was stunned to learn that he was
being sued for negligence by a patient
he had treated a year earlier.
Te patient, who had a history of
breast cancer, was showing signs
of cancer in her spine. She refused
to undergo a biopsy to verify the
diagnosis and, instead, agreed to a
course of radiation therapy. Shortly
afer the treatment, she underwent
an unrelated spine surgery in which
no cancer was observed. She sued
Dr. Lutz, claiming that the radiation
had been unnecessary.
Dr. Lutz, who had never faced an
accusation of malpractice, agreed with
our recommendation to take the case
to trial. Although he had spent 14
years successfully practicing radiation
oncology, he realized he would be a
novice in the courtroom.
As a member of Te Doctors Company,
Dr. Lutz was able to attend a Litigation
Education Retreat, our one-day
favor of Dr. Lutz. Dr. Lutz says, If you
know in your heart that you did your
best and refuse to repudiate who you
are, then you win. Its that simple.
We are the only national carrier to
provide Litigation Education Retreats.
It is a beneft that refects our passion
for protecting and defending our
membersand it draws on our more
than 35 years of experience with
medical malpractice cases. n
Although Dr. Lutz
had spent 14
years successfully
practicing radiation
oncology, he realized
he would be a novice
in the courtroom.
The retreat prepared Dr. Lutz to be an active member of his defense
team, while helping him learn constructive ways to cope with the
stress of being sued.
To rate or share the articles in this issue, visit www.thedoctors.com/advocate. thi rd quarter 201 1 ,
and disquieting in that any physician
could fall into the same traps as the
defendants. Discussion was lively in
trying to understand how each case
evolved and where errors may have
been made in judgment and treatment.
Having a discussion between the
physicians and Te Doctors Companys
representatives gave us added insight
into how the cases should have
progressed and how to avoid such
pitfalls in the future.
One report highlighted how physician
bias might play a role in inadequate
patient assessment, such as in the case
of an obese patient not being fully
assessed neurologically. Te inadequate
assessment led to a missed opportunity
to intervene in a devastating,
irreversible neurologic defcit.
Insights from the Florida Physician Advisory Board
by Howard F. Berlin, MD, FACC, President of Cardiovascular Consultants of South Florida, Chairman of The Doctors
Company Florida Physician Advisory Board
I
have the honor of leading the Florida
Physician Advisory Board. I have
been involved in these meetings for the
past four years and always fnd them
incredibly educational.
Our most recent meeting started with
a presentation by Associate General
Counsel Richard Cahill, Esq, on
Recovery Audit Contractors, Zone
Program Integrity Contractors, and
Medicare Prescription Drug Integrity
Contractors. All physicians need
to take the time to understand the
diferent mandates of these entities and
the potential consequences of an audit.
Te Doctors Company is ready to assist
and should be contacted immediately
upon notifcation of an audit.
Te meeting continued with four case
reports. Te cases were interesting
Audit Assistance
If you receive notication of an audit and need assistance, call our Patient Safety Department at
(800) 421-2368, extension 1243. Members also receive MediGuard

protection as part of their

coverage. MediGuard provides legal representation for administrative actions. For more information,
go to www.thedoctors.com/mediguard.
Having a discussion between the physicians and The Doctors
Companys representatives gave us added insight into how the cases
should have progressed and how to avoid such pitfalls in the future.
Howard F. Berlin, MD, FACC
Over the past two years, we have
reviewed two separate cases of
back pain that turned out to be a
presentation of an epidural abscess.
Te initial patient presentation can be
very subtle, but delay in diagnosis can
lead to permanent neurologic defcits.
Each Physician Advisory Board
meeting serves as a very useful
interaction between practicing Florida
physicians and Te Doctors Company.
Each meeting provides an opportunity
to evaluate cases from an entirely
diferent point of view that includes
standard of care and causation. Te
meetings make the participants
better doctors and give Te Doctors
Company unique insight into the
physician thought process. n
Howard F. Berlin, MD, FACC, is
board certifed in internal medicine
and cardiovascular disease.
A TRAGIC LESSON IN DRUG SAFETY
continued from page 2
similar calculations with regard to
chlorpheniramine and concluded there
were approximately 4.8 doses at death.
Chlorpheniramine has a longer half-
life than hydrocodone, which could
account for the diference.
A pediatric neonatologist felt it was
a breach of the standard of care to
prescribe Tussionex to this child.
He said slow-release narcotics can
accumulate in the system and lead
to respiratory depression, which is
aggravated by the childs age, by other
drugs in the mixture, and by Benadryl.
Tere is no safe amount to prescribe.
Te specifc drug for croup (when it is
very bad) is a corticosteroid; otherwise
a vaporizer and observation are the
standard of care.
Te pharmacy that flled the
prescription was a co-defendant. Its
pharmacist received an electronic
Drug Utilization Review (DUR)
Alert requiring him to contact the
physician regarding the safety of the
prescription. He entered prescriber
contacted, prescribe as is to override
the Alert and flled the prescription
without calling the insured.
half teaspoon, but he opined that the
insured prescribed twice as much as he
should have based on the childs weight.
He added that it was not appropriate
to recommend using Benadryl as a
sleeping aid in a child. (Our insured
did not remember ever making this
recommendation, while the parents
alleged that he did.)
Should Tis Case Be Tried?
Te death of a four-year-old child is
tragic and would be viewed as such by
a jury. While there was one expert to
support the insureds lack of knowledge
of the multiple warnings against using
Tussionex in children, the plaintifs
counsel had multiple experts to state the
contrary. Furthermore, the PDR in the
insureds ofce contained the warning,
and a jury would likely expect a physi-
cian to be fully knowledgeable about
medications being prescribed and the
dangers contained therein. Te insured
would be susceptible to the question,
Doctor, who is responsible for knowing
about a medication that is prescribed to
a patient? Clearly, the correct answer
is the physician who is prescribing it.
With the insureds consent, the case
was settled.
Plaintifs Experts
A forensic pathologist and a toxicologist
from the coroners ofce believed there
were toxic-to-lethal blood levels of the
components of Tussionex, which caused
the childs death.
A pediatrician opined that the
insured should never have prescribed
Tussionex to this child, adding that
this drug should never be considered
for any child under six years of age. He
could not say if the proper dose was
one-quarter teaspoon rather than one-
o the doctors advocate
T
he Doctors Company has part-
nered with PDR Network to help
our members meet their CME require-
ments. You can earn CME credits
while improving your knowledge of the
safe and appropriate use of the FDA-
regulated medical products you most
commonly prescribe.
Te Doctors Company designates this
educational activity for a maximum
of .5 AMA PRA Category 1 Credit(s)
per product label. Upon completion of
two courses, you will be issued one full
AMA PRA Category 1 Credit. Learn
more or register at www.PDR.net. n
Advance Drug Safety and Earn
CME Credits
courses as part of our online collaboration
with PDR Network.
During the rst half of 2011,
physicians completed
3,868
A jury would
likely expect a
physician to be fully
knowledgeable about
medications being
prescribed and the
dangers contained
therein.
David B. Troxel, MD
To rate or share the articles in this issue, visit www.thedoctors.com/advocate.
Discussion
Each year, almost 25 percent of drugs
have clinically relevant changes made
to their FDA-approved labels. FDA-
approved labeling is ofen the standard
to which physicians are held in claims
involving medication errors. An analy-
sis of all claims closed at Te Doctors
Company in 2010 revealed that 6.1 per-
cent contained medication errors. Te
most prevalent claims in this category
included giving the wrong medication
(18 percent), failing to follow guidelines
or protocols (16 percent), giving the
wrong dosage (13 percent), errors in
drug administration (12 percent), and
ordering errors (5 percent). It is likely
that some of these errors could have
been prevented by keeping current on
FDA-approved drug labeling.
We encourage our members to join
the Health Care Notifcation Network
(PDR Drug Alert Network) to receive
their FDA Drug Alerts via e-mail.
Physicians who participate are less
likely to overlook an important FDA
Alert, and they can earn continuing
medical education (CME) credits for
reading the Alert and taking a short
online test on its content.
PDR Network hosts the CME
programs, and Te Doctors Company
provides the CME credits to all U.S.
physicians at no charge. Tese CME
courses are available for physicians
who are registered PDR.net users. For
more information on this free service,
visit www.PDR.net. n
Implications for E-Prescribing Liability
The pharmacist overrode the DUR Alert and lled the prescrip-
tion without calling the insured. This may be a harbinger of
electronic health record e-prescribing liability risk, because there
is a danger that doctors may suffer alert fatigueand ignore,
override, or disable alerts, warnings, reminders, and clinical
decision support guidelines. If following an alert or guideline
would have prevented an adverse patient event, the physician
may be found liable for ignoring it.
thi rd quarter 201 1 ,
An analysis of all claims closed
at The Doctors Company in 2010
revealed that 6.1 percent contained
medication errors.
Each year, almost 25 percent of drugs have clinically relevant changes
made to their FDA-approved labels.
David B. Troxel, MD
3,868
8 the doctors advocate
When patients arrive at the hospital,
they have preexisting concerns they
want to discuss with their doctors.
5

Tese concerns are relevant to each
patients hospital and follow-up care,
being most frequently about medical
diagnoses and treatments, logistics
of care, prognosis, and symptoms.
6

Patient-centered communication
draws out these concerns and presents
medical information in a relevant
context. Te patients concerns can be
informational, revealing a question
or lack of knowledge; for example, I
dont know much about the treatment
of pneumonia or How long will
I be in the hospital? Te concerns
may also disclose emotional distress;
for example, Im worried about my
daughter or Im feeling vulnerable.
Eliciting and responding to both types
of patient concerns is important.
Skills for Success: Elicit and Respond
Tough most patients present with
more than one pre-visit concern, many
patients concerns are not addressed.
7

Concerns may not be elicited because
the physician doesnt inquire about
them, or the physician may interrupt
the patient before he or she can fnish
describing the issue.
8
Physicians may
also assume that patients have only one
concern. If information is not presented
clearly, patients may report that their
concerns are not addressed. Physicians
frequently miss and, thus, do not ad-
dress emotional aspects of concerns.
9

Table 1 summarizes key skills for
eliciting concerns and responding to
information and emotional aspects.
Eliciting concerns should be done
at the beginning of the visit using
an open-ended question. When
the patient discloses a concern, the
physician should acknowledge it. Te
physician can then inquire about the
patients other concerns, a technique
called emptying. Usually patients
have no more than three concerns.
10
If
there are a high number of concerns,
the physician and the patient can set an
agenda prioritizing the concerns that
are most pressing for the patient and
leave the others for another time.
11

Next, the physician addresses and
responds to the informational and
emotional aspects of the patients
concerns. Te Ask-Tell-Ask technique
ensures that relevant information is
given and received by bracketing each
piece of information with a question
to the patient. Tis technique focuses
frst on the information to be given and
then on ensuring it was understood.
12

To respond to emotion, physicians
should show empathy: Acknowledge
the emotion, provide respect and
support, and explore the source of
the patients distress. Te acronym
NURSE (Name-Understand-
Respect-Support-Explore) describes
empathic responses that physicians
can provide.
13
Tough physicians may
worry that responding to emotion will
take too much time, it is not associated
with longer visit lengths, and as little
as 40 seconds of empathy can increase
patient satisfaction.
14, 15

Conclusion
Eliciting and addressing patient con-
cerns builds rapport and increases
patient understanding and adherence.
Learning key skills to develop an ef-
fective and satisfying patient-physician
relationship is an important step for
physicians in decreasing the likelihood
of medical malpractice claims and in-
creasing positive patient outcomes. n
References
1. Hickson GB, Clayton EW, Entman SS, et al.
Obstetricians prior malpractice experience
and patients satisfaction with care. JAMA.
1994;272(20):1583-7.
2. Beckman HB, Markakis KM, Suchman
AL, Frankel RM. The doctor-patient
relationship and malpractice. Lessons from
plaintiff depositions. Arch Intern Med.
1994;154(12):1365-70.
3. Stein T, Frankel RM, Krupat E. Enhancing
clinician communication skills in a large
healthcare organization: a longitudinal case
study. Patient Educ Couns. 2005;58(1):4-12.
4. Ibid.
5. Anderson W, Winters K, Auerbach A. Patient
concerns at hospital admission. Arch Intern
Med. In press.
6. Ibid.
7. Ibid.
8. Beckman HB, Frankel RM. The effect of
physician behavior on the collection of data.
Ann Intern Med. 1984;101(5):692-6.
PATIENT-CENTERED COMMUNICATIONS
continued from page 3
FIGURE 1: Model of patient-centered communication.
Concerns
Satisfaction
Rapport
Trust
Understanding
Adherence
Informational
Emotional
STEP 1
Elicit Concerns
STEP 2
Address Concerns
TABLE 1: Communication skills for eliciting and responding to informational and emotional
aspects of patient concerns.
Function Skills Example
Elicit concerns Open-ended questions Im hoping to ask you some questions and discuss
the treatment plan. But frst, could you tell me what
you d like to talk with me aboutso we can be sure to
address that?
Acknowledging and emptying Okay, we ll make sure to discuss that. What else
would you like to talk about?
Communicate Ask-Tell-Ask Patient: I dont understand the treatment
information for pneumonia.
clearly Doctor (Ask): Would it help if I give you
an overview?
Patient: Tat would be great.
Doctor (Tell): We ll give you antibiotics in the IV
for a few days here in the hospital,
then send you home with some pills
for a week.
Doctor (Ask): Does that answer your question?
Show empathy NURSE (Name-Understand- Patient: It will just be so hard if I cant take
Respect-Support-Explore) care of my family.
Doctor:
Name: You sound worried.
Understand: I can understand how you would feel
that way.
Respect: It sounds like you have been so
strong for them.
Support: We ll work on this together.
Explore: What worries you most?
To rate or share the articles in this issue, visit www.thedoctors.com/advocate. thi rd quarter 201 1 ,
9. Levinson W, Gorawara-Bhat R, Lamb J. A
study of patient clues and physician responses
in primary care and surgical settings. JAMA.
2000;284(8):1021-7.
10. Anderson W, Winters K, Auerbach A. Patient
concerns at hospital admission. Arch Intern
Med. In press.
11. Stein T, Frankel RM, Krupat E. Enhancing
clinician communication skills in a large
healthcare organization: a longitudinal case
study. Patient Educ Couns. 2005;58(1):4-12.
12. Back AL, Arnold RM, Baile WF, Tulsky JA,
Fryer-Edwards K. Approaching difcult
communication tasks in oncology. CA Cancer
J Clin. 2005;55(3):164-77.
13. Ibid.
14. Stein T, Frankel RM, Krupat E. Enhancing
clinician communication skills in a large
healthcare organization: a longitudinal case
study. Patient Educ Couns. 2005;58(1):4-12.
15. Fogarty LA, Curbow BA, Wingard JR,
McDonnell K, Somereld MR. Can 40
seconds of compassion reduce patient
anxiety? J Clin Oncol. 1999;17(1):371-9.
For more on this topic, we
invite you to attend Patient-
Centered Communication Skills
for Hospitalists, a Webinar to be
presented by Dr. Wendy Anderson
on Tuesday, December 6, 2011,
from noon to 1:00 PM (PST)/
3:00 PM to 4:00 PM (EST).
Learn more or register at
www.thedoctors.com/webinars.
FOUNDATION NEWS
T
he Doctors Company Foundation
provided a grant to the University
of Illinois Institute for Patient Safety
Excellence in support of the Seventh
Annual Telluride Patient Safety
Educational Roundtable, Dilemmas
Surrounding Medical Errors and
Adverse Events.
T
he Healthcare Safety Research
Institute, with support from
Te Doctors Company Foundation, is
presenting Validate Your Malpractice
Risks at the Westin San Diego on
Friday, November 11, 2011.
Te agenda highlights strategies
for capturing risk data, putting the
fndings into context, prioritizing
problems, and identifying solutions.
Breakout sessions will give attendees
opportunities to meet with others
from similar clinical areas to
Foundation Supports Patient Safety
Educational Roundtable
Validate Your Malpractice Risks on November 11
Te grant allowed 20 qualifed medical
students from around the country
to attend the roundtable retreat in
Telluride, Colorado, in June. Te
student scholars learned efective
communication skills for overcoming
share ideas for capturing data and
reducing vulnerability.
Te faculty for this event includes
Richard E. Anderson, MD, FACP,
chairman and CEO of Te Doctors
Company. Dr. Anderson is a nationally
recognized advocate in advancing the
practice of good medicine.
Participants are invited to attend
a cocktail reception on Tursday,
November 10. Te event will take
place from 8:30 am to 4:15 pm on
Friday, November 11. n
Learn more or register for the event at
www.rmf.harvard.edu/11/11/11.
It is hoped that, as a result of their participation, the students
will become champions for including patient safety education
at their medical schools.
the multiple barriers to transparency.
It is hoped that, as a result of their
participation, the students will become
champions for including patient safety
education at their medical schools. n
I o the doctors advocate
The agenda
highlights strategies
for capturing risk
data, putting
the ndings into
context, prioritizing
problems, and
identifying solutions.
To rate or share the articles in this issue, visit www.thedoctors.com/advocate. thi rd quarter 201 1 I I
P
DR Network and its partners
have launched an online service
to collect and distribute adverse drug
events. Tis new service, called
RxEvent, is available to all prescribers
directly at www.RxEvent.org and via a
direct link on Te Doctors Companys
Web site at www.thedoctors.com/ehr. It
is also being integrated into electronic
health record (EHR) platforms.
Physicians reporting adverse drug
events is a critical component of drug
safety. Roughly half a million adverse
drug events are reported annually to
the Food and Drug Administration
(FDA). More than 90 percent of these
reports come from pharmaceutical
manufacturers who receive them
initially from physicians and other
providers, typically via telephone.
Manufacturers then triage and attempt
to investigate these reports, notifying
the FDA when appropriate. Published
studies indicate that as few as one in
10 adverse drug events are actually
reported by health care professionals,
largely due to the time-consuming
and inefcient processes involved in
reporting them.
RxEvent was designed to improve
the convenience of adverse event
reporting for physicians and the
quality of information ultimately
reported to the FDA. Integration
of adverse event reporting into EHR
systems places this service at the
prescribers fngertips, adding to
convenience and ultimately improved
drug safety, noted Janet Woodcock,
MD, Director, Center for Drug
Evaluation and Research at
the FDA. n
PDR Network Launches RxEvent
W
e proudly present our fall
Webinar series for obstetricians,
family practitioners providing obstetri-
cal care, and certifed nurse midwives
who are actively involved in deliver-
ies. Presented by renowned experts
in obstetrics, our Webinars provide a
convenient way to help you reduce risk
and improve patient safety while you
earn CME credits. n
Obstetrics Fall Webinar Series
Register online by selecting a Webinar under the For Doctors
tab at www.thedoctors.com/webinars.
Te Neurologically Compromised
Newborn: A Checklist for the First
Days of Life
Tuesday, October 11, 2011 Noon
1:00 pm (PDT)/3:00 pm4:00 pm (EDT)
Presented by Larry Veltman, MD
Optimizing Chances for a
Successful VBAC
Tuesday, December 6, 2011 Noon
1:00 pm (PST)/3:00 pm4:00 pm (EST)
Presented by Duncan Neilson, MD
RxEvent was
designed to improve
the convenience
of adverse event
reporting for
physicians and the
quality of information
ultimately reported
to the FDA.

The Doctors Company
Named to 2011 Wards 50

Top-Performing Companies
The Doctors Company has been named to
the 2011 Wards 50 top-performing insur-
ance companies.
Ward Group, an insurance industry
management consulting rm and pro-
vider of benchmarking and best practices
services, analyzed the performance of
over 3,000 property-casualty insurance
companies based in the U.S. and chose
the 50 top-performing companies.
We are pleased that Ward Group has
recognized The Doctors Companys nan-
cial strength and consistently excellent
performance, said Richard E. Anderson,
MD, FACP. This award is an afrmation
of our commitment to our mission, to our
members, and to our operational excel-
lence. We are rmly positioned to provide
the industrys most aggressive claims de-
fense and nancially reward our physician
members for their delivery of outstanding
patient care.
This years honor marks the 10th Wards
50 award for The Doctors Company.
The Doctors Company Awarded
UHC Contract
We are proud to announce that UHC,
an alliance of 113 academic medical
centers and 254 of their afliated hospi-
tals, has selected The Doctors Company
to provide professional liability insurance
services for its physicians and surgeons.
The three-year contract is effective as of
July 1, 2011.
We offer UHC members a unique combi-
nation of coverage features. Our under-
writing and pricing models are geared
toward academic medical centers and
complex teaching environments. In
addition, we are noted for our aggressive
approach to claims management, proactive
approach to education, and commitment
to medical-legal reform.
The Doctors Company understands the
complex needs of our UHC members and
offers robust products and services for
them at competitive prices, said Jake
Groenewold, UHCs senior vice president,
Supply Chain.
The Tribute Plan:
Unprecedented Rewards
A career spent practicing good medicine
is an extraordinary accomplishment. We
created the Tribute Plan to reward our
members for their commitment to provid-
ing outstanding patient care and their
loyalty to The Doctors Company.
With more than $175 million in their
Tribute accounts, over 18,000 members
have already qualied for a Tribute distri-
bution when they retireincluding 2,500
members with balances over $20,000.
Estimate your payout or learn more at
www.thedoctors.com/tribute.
THE BACK PAGEINDUSTRY AND COMPANY NEWS
J8355 9/11
A.M. Best Recognizes Our
Financial Strength
We have received an A (Excellent)
rating from leading rating agency
A.M. Best Company.
A.M. Best recognized our consistently
strong nancial results, noting
excellent capitalization, long-term
underwriting protability, favorable
reserve development, and leadership
position in the national medical
professional liability market.
A.M. Best also noted our outstand-
ing benets and member focus, citing
continued support for our physician
members through strong patient safety
programs and dedication to sharing our
nancial success with members through
dividends and the Tribute

Plan.
We are pleased that A.M. Best
recognizes The Doctors Companys
exceptional nancial strength and
mission-driven operational excellence,
said Richard E. Anderson, MD, FACP,
chairman and CEO of The Doctors
Company. Our continued success
ensures that members receive the
most aggressive claims defense,
outstanding service, and industry-
leading member benets.
A.M. Best assigned the A (Excellent)
rating with a stable outlook, based
on excellent underwriting results,
geographic diversication, and success-
ful integration of multiple acquisitions
made within the last six years.
$48,952 is the
highest Tribute
award to date.
I : the doctors advocate