Being A Pre-Litigation Expert with Jeff Willis, MD

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jeff-willis_1_01-28-2026_090207: I look at
all four of those components of the case.
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Analyze them and then using the experience
that I've gathered doing this for the
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last few years, bring that back to the
attorney and say, Hey here's why I think
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it's probably a case, probably not a case,
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Sam: Hi everyone, and welcome
to another episode of EMPlify.
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I'm your host, Sam Ashoo.
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Before we dive into this episode, I
want to say thank you for joining us.
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I sincerely hope that you find it to
be helpful and informative for your
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clinical practice, and I want to remind
you that you can go to ebmedicine.net
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where you will find our three journals,
Emergency Medicine Practice, Pediatric
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Emergency Medicine Practice, and Evidence
Based Urgent Care, and a multitude of
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other resources, like the EKG course,
the laceration course, interactive
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clinical pathways, just tons of
information to support your practice
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and help you in your patient care.
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And now I want to introduce our special
guest for this episode, Dr. Jeff Willis,
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who happens to be one of the expert voices
behind safeguarding charting documentation
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support that will stand up in court, an
EB medicine video course with practical
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courtroom tested strategies to help
you chart with confidence and reduce
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risk, and also an emergency physician.
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And so let's jump into that episode.
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sam_1_01-28-2026_100207: Welcome
back to the podcast everyone.
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Today we have a special guest
with us, Dr. Jeff Willis, who is
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here to share his experience and
his knowledge about his craft.
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And I'm excited to have him on the
podcast, and I'm gonna actually let
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him introduce exactly what he does.
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Jeff, thanks for being on the podcast.
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Tell me about what you do what you did.
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Now you, you worked in the
emergency department for how long?
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jeff-willis_1_01-28-2026_090207: About 20
years, I guess, if you include residency.
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Yeah.
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So I, I finished residency
in oh six and I did my last
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clinical shift in October of 23.
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So 17 years after residency.
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sam_1_01-28-2026_100207: Great.
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And then tell me now what you do.
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jeff-willis_1_01-28-2026_090207: So now I
do, I don't really know what you call it.
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I call it medical legal consulting.
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Primarily I work in the medical
malpractice arena, doing pre-litigation
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analysis for plaintiff medical malpractice
attorneys, helping them determine
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whether or not cases should move forward.
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And then also, I do a lot of expert
witness search and referral for both
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plaintiff and defense attorneys, helping
them find expert witnesses for cases.
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And I do that in all specialties,
not just emergency medicine.
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So, across all of medicine, there's a few
things I don't do just because it's so
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specialized I, I really can't add value.
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But yeah, that's what I do
all day long, every day.
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sam_1_01-28-2026_100207: And you have
your own online expert retainer website
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where people can register if this is
something they're interested in doing.
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Is that right?
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jeff-willis_1_01-28-2026_090207:
Yeah, absolutely.
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Yeah.
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I launched expert retainer last year,
probably six to nine months ago, and so
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it's, that part is very fresh and new,
but that is an online platform that
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directly connects testifying experts with
attorneys both plaintiff and defense.
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It's free for experts to sign up
and it's completely anonymous.
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So there are no public facing profiles.
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So if it's something that physicians
are wanting to get into or if they've
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been in it for a long time and are
maybe in academia and don't necessarily
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like their name out there, as someone
who does expert work this gives them
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access to cases that they otherwise
might not have without advertising
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or marketing themselves in any way.
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always free and completely
anonymous for experts.
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sam_1_01-28-2026_100207: All
right, and this is such an
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interesting area of medicine for me.
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Tell me how did you get into
doing this kind of work?
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jeff-willis_1_01-28-2026_090207:
So I stumbled into it, right?
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So I, did emergency medicine, like
I said, for about 20 years total.
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I was the medical director of a
level one trauma center seeing
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about 90,000 patients a year.
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So, did that for many years.
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And then I finished off my
career in a rural critical access
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hospital, little six bed ER, 24
hour shifts through and after COVID.
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And as I was finishing that up, I
realized that my time in emergency
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medicine was probably done.
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I, I'd enjoyed it, but I, I wasn't
really that excited by it anymore.
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And so I just started looking
for other things to do.
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Really, I just stumbled on this idea.
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Like a lot of ER docs, I was sued a
couple times in my career and going
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through that process, I realized that
both the plaintiff's counsel and the
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defense counsel, I didn't feel really
understood the medicine very well that
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they were litigating this case, but
really didn't have a grasp of what
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was going on and what was important.
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so I had originally intended to
create a consulting business where I
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was helping defense firms understand
the medicine better and defend
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physicians and quickly learned that
there's not much of a market there.
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I think what a lot of us don't understand
is that these defense firms, they
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work for insurance companies, right?
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They work for the malpractice insurance
companies, or they work for the hospitals
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directly or somewhere in between,
depending on, you know, if they're
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self-insured and so the attorneys don't
have much control over their budget
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and what they spend their money on.
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So
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If they want to hire a consultant
for help, they don't just have
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an open budget to do that.
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They have to go back to the insurance
carrier and ask permission every time to
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hire a consultant or to hire an expert.
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And so that layer of friction made it
very difficult for attorneys who were
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even interested in hiring me on as
a consultant to get that work done.
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And so I quickly learned that the better
way to both make a business of the medical
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legal consulting as well as still be
helping physicians was actually to work
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with plaintiff attorneys and look at
cases in pre-litigation before anything
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was filed and make sure that the cases
that were moving forward actually had
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viability and actually had merit to
move forward, rather than the frivolous
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cases that we hear so much about in the
throwaway journals and, that we talk
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about online and that sort of thing.
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And so I really just locally here went
to a local attorney and said, Hey.
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Mind if I take a look at a couple cases?
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And he was like, yeah, sure, why not?
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And I did.
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and he said, wow, that was really helpful.
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And neither of the cases that I looked at
moved forward, and he was very thankful
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and saved him a lot of time and money
and expert retainer fees and litigation.
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And he started using me quite a bit then
started referring me to other folks.
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And then I said, okay, I can make
a business of this and hung up the
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stethoscope after about six months
of dabbling without a client base
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and just said let's give this a shot.
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If I'm gonna do it, let's, let's give it
a shot for a year and see what happens.
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And over the course of a
year, it grew and grew.
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And now I've been doing it for
a couple years and have clients
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in 29 different states, and I'm
about as busy as I can handle.
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sam_1_01-28-2026_100207: Because you
do reviews in pre-litigation, you don't
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have to be licensed as a specialist
in whatever state is that the case
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occurred in or even be in the specialty
for the case that's in question.
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jeff-willis_1_01-28-2026_090207: Exactly.
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Yeah.
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So I am a consultant, so everything
that I do is behind the scenes.
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It's confidential work
product with the attorney.
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So I'm not a testifying expert.
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You know, To be a testifying expert
in virtually every state, you have to
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be an active clinical practice, or at
least 51% clinical practice or clinical
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practice within the last three years.
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Every state has its own set of rules
for who can be a testifying expert.
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but yes, I am disqualified from
being a standard of care expert.
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Now, technically, I could still
be a causation expert where
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you're testifying on causation.
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I'm actually in one case like that right
now where I am actually a testifying
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expert, but nothing to do with standard
of care, just describing causation and how
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A leads to b more of a science expert, if
you will than the practice of medicine.
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sam_1_01-28-2026_100207: Interesting.
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And so for our listeners purposes, if
you're a causation expert as you just
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mentioned, you're testifying that you
know this event A could have led to event
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B, but you're not really touching on the
practice of medicine as far as who did
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what or what labs they ordered or whether
or not there was malpractice involved.
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jeff-willis_1_01-28-2026_090207: Exactly.
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So let's take one step back, Sam.
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So for a medical malpractice
case to have merit and viability,
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it has to have four components.
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It has to have what we call duty
breach causation and damages.
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And so duty is usually just a
check box, you know, was there
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an established physician patient
relationship of some kind.
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So that's usually a check box.
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'cause there almost always is if it's, you
know, if the case is brought and there's
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a, physician or nurse or someone involved
usually there was a duty to provide care.
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The standard of care is what a similarly
trained healthcare provider would do
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in similar clinical circumstances.
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so that's your standard of care, right?
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So did this physician in this case, it
can be anything but let's say physician,
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did the physician practice in a way
that a similarly trained physician
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would practice in that setting?
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And that setting can be, in a rural
critical access hospital or in a
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academic center or on an airplane,
you know, whatever that may be.
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Right?
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Like given the situation presented to
them, did they practice reasonably?
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That's standard of care.
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Then there are, there's damages, right?
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What harm did the patient suffer?
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And that can be emotional, physical,
financial, death, a whole host of things.
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And then the thing linking
those two is causation.
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So did the breach and standard of care
did the thing that that physician do
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incorrectly actually lead to the outcome.
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And you have to have all
four of those components to
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have a viable case to pursue.
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And that's why so many cases
don't actually move forward.
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Sometimes there's a clear duty,
a clear breach, and even clear
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causation sometimes, but the damages
are just so small that it's not
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worth for the attorney to, pursue.
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So that's what I do every
day, is I look at all four of
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those components of the case.
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Analyze them and then using the experience
that I've gathered doing this for the
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last few years, bring that back to the
attorney and say, Hey here's why I think
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it's probably a case, probably not a
case, not my decision to make, but based
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on everything that I know and have looked
through on the records and my experience,
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this would be my recommendation.
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sam_1_01-28-2026_100207: Interesting.
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And then if that case ends up moving
forward to court, would you ever
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need to show up there and testify
to your opinion regarding causation
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or would somebody else do that?
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jeff-willis_1_01-28-2026_090207:
Nope, not at all.
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No I'm completely behind the scenes
and that allows me to be completely
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candid with my clients about everything,
Hey, this is a terrible case.
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Don't touch it.
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And if they elect to go
otherwise, that's fine.
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But you know, that way everything
that I say is, confidential
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uh, confidential work product.
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But no, none of the cases that I do
any type of pre-litigation work on
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would I ever be a testifying expert.
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Now, there are some clients for
whom I will stay on the matter for
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the duration of the case and be a
consultant throughout the case and
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help them look at depositions and help
prepare for depositions and, assess,
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expert reports, that sort of thing.
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But I don't do a ton of that.
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Almost everything I do
is in pre-litigation.
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sam_1_01-28-2026_100207: So interesting.
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And then you're not limited
to just emergency medicine.
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Then in that arena, you're comfortable
reviewing all forms of medical cases that
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one of your clients might bring to you.
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jeff-willis_1_01-28-2026_090207: Right?
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Absolutely.
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So, as an emergency physician, we're
familiar with and interact with just
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about every specialty in medicine.
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And, the more that we've broadened
our expertise over the decades, right?
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We've sort of become the
experts in lots of things.
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And through those interactions with
consultants and other specialties
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and just through the practice of
emergency medicine, we're comfortable
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enough being able to figure it out.
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Right.
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We figure it out on the fly.
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And so over the course of the last
three years I've become better and
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better at assessing other specialties.
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So, are there things
that I'm not great at?
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Like, can I determine whether or not an
orthopedic surgeon used the exact right
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angle on the implant that caused X, Y, Z?
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00:11:54,408 --> 00:11:55,038
But.
224
00:11:55,838 --> 00:11:59,288
I have a network of about 900 experts
across the country, and if there's
225
00:11:59,288 --> 00:12:01,658
something I don't quite understand,
they're more than willing to give me a
226
00:12:01,658 --> 00:12:05,168
curbside consult and I can, give them
the, just like the pitch you would
227
00:12:05,168 --> 00:12:06,418
when you call the consultant, right?
228
00:12:06,418 --> 00:12:09,698
You know, tibial plateau,
fracture, stable, no compartment
229
00:12:09,698 --> 00:12:10,238
syndrome, blah, blah.
230
00:12:10,708 --> 00:12:11,878
Same kind of thing, right?
231
00:12:11,878 --> 00:12:15,088
I can call up one of my testifying experts
and be like, Hey man, here's what I got.
232
00:12:15,088 --> 00:12:15,588
What do you think?
233
00:12:16,138 --> 00:12:18,418
He'll give me the five minute
blurb and I can add that in.
234
00:12:18,838 --> 00:12:23,938
And then also the research capabilities
that we have now, even just compared to
235
00:12:23,938 --> 00:12:25,598
when I started doing this three years ago.
236
00:12:26,398 --> 00:12:29,698
Through AI and, open evidence
and UpToDate and all of those
237
00:12:29,698 --> 00:12:34,918
resources, I'm really able to
dissect down and, get a really solid
238
00:12:34,918 --> 00:12:37,078
evidence-based answer for my clients.
239
00:12:37,078 --> 00:12:43,358
And I do it in a way that is much more
cost efficient than having a retainer
240
00:12:43,358 --> 00:12:45,188
paid to a testifying expert, right?
241
00:12:45,188 --> 00:12:47,138
Because a, retainer to
a testifying expert.
242
00:12:47,138 --> 00:12:50,568
Let's stick with the same example,
A orthopedic surgeon, right?
243
00:12:51,188 --> 00:12:53,858
You're probably not getting an
orthopedic surgeon to look at a case
244
00:12:53,858 --> 00:12:56,898
for less than five grand, you know,
and it, might only be a couple hundred
245
00:12:56,898 --> 00:13:01,788
pages of records and op note, or two,
but those guys charge a lot, right?
246
00:13:01,788 --> 00:13:04,148
'cause their time away from
the OR is, expensive to them.
247
00:13:04,808 --> 00:13:08,158
And most of those cases don't
just involve one specialty.
248
00:13:08,503 --> 00:13:10,393
There was probably an ER doc involved.
249
00:13:10,423 --> 00:13:14,023
There was a hospitalist, and then there
was an orthopedic surgeon who missed the
250
00:13:14,023 --> 00:13:15,893
compartment syndrome, all of those things.
251
00:13:15,893 --> 00:13:20,093
So it's much more cost effective and
time effective for these attorneys
252
00:13:20,093 --> 00:13:22,553
to bring it to me and say, Hey, Jeff,
look at everything on a whole, look
253
00:13:22,553 --> 00:13:27,503
at the ER care, the nursing care, the
hospitalist care, the post-acute care,
254
00:13:27,503 --> 00:13:31,583
look at everything, come back and gimme
a general idea of what happened and
255
00:13:31,583 --> 00:13:33,083
whether there's anything to move forward.
256
00:13:33,713 --> 00:13:34,133
sam_1_01-28-2026_100207: Wow.
257
00:13:34,373 --> 00:13:37,883
And now tell me in the years
you've been doing this.
258
00:13:38,283 --> 00:13:40,203
Is there a, pattern that develops?
259
00:13:40,203 --> 00:13:44,253
Like how often are you looking at
a case and going, oh yes, this is
260
00:13:44,253 --> 00:13:46,263
a clear, yes, this is a clear no.
261
00:13:46,323 --> 00:13:50,763
Or did the majority fall in a gray
zone and then you're kind of giving
262
00:13:50,763 --> 00:13:52,773
an opinion and you're not really sure.
263
00:13:52,923 --> 00:13:54,303
How often is it very clear.
264
00:13:55,103 --> 00:13:57,623
jeff-willis_1_01-28-2026_090207: I
would say it's very clear on either
265
00:13:57,623 --> 00:14:00,183
side, I would say about 80% of the time
266
00:14:00,248 --> 00:14:00,468
sam_1_01-28-2026_100207: Wow.
267
00:14:00,738 --> 00:14:01,028
Okay.
268
00:14:01,433 --> 00:14:04,133
jeff-willis_1_01-28-2026_090207: and
of that 80%, let's take a step back.
269
00:14:04,163 --> 00:14:08,963
Of the cases that I review, I would
say about 90% don't move forward.
270
00:14:09,273 --> 00:14:12,163
There are cases that never get filed and.
271
00:14:12,583 --> 00:14:17,103
I would say probably about 80% of
those are very clear because so many
272
00:14:17,103 --> 00:14:22,443
times patients or more often family
members bring cases to an attorney.
273
00:14:23,163 --> 00:14:23,973
And they're upset.
274
00:14:23,973 --> 00:14:25,803
They want answers or they want justice.
275
00:14:25,803 --> 00:14:27,603
They just, they don't
understand what happened.
276
00:14:27,603 --> 00:14:28,803
The communication wasn't good.
277
00:14:28,803 --> 00:14:31,723
It was an unexpected outcome,
and the attorney just doesn't
278
00:14:31,743 --> 00:14:33,003
know where to go with it.
279
00:14:33,003 --> 00:14:36,723
The story, the family or the patient
is telling sounds horrible, right?
280
00:14:36,773 --> 00:14:37,583
They did this to me.
281
00:14:37,583 --> 00:14:38,333
Can you believe it?
282
00:14:38,453 --> 00:14:39,413
No, I can't believe it.
283
00:14:39,413 --> 00:14:40,373
That sounds terrible.
284
00:14:40,403 --> 00:14:42,563
And then you get into the records,
you're like, whoa, whoa, whoa.
285
00:14:42,773 --> 00:14:44,093
The family wasn't even there.
286
00:14:44,173 --> 00:14:44,593
Right.
287
00:14:44,713 --> 00:14:46,993
you know, the family wasn't even
there when things were going on.
288
00:14:46,993 --> 00:14:50,383
This was what the patient said, this
was what their decision was like.
289
00:14:50,413 --> 00:14:51,463
There's nothing here.
290
00:14:51,463 --> 00:14:51,763
Right.
291
00:14:51,763 --> 00:14:53,703
So those things are extremely clear.
292
00:14:53,923 --> 00:14:56,293
And then sometimes it's
the other way around.
293
00:14:56,293 --> 00:14:59,403
Sometimes it's just completely obvious.
294
00:14:59,403 --> 00:15:02,673
Somebody came in with severe
abdominal pain, out of proportion
295
00:15:02,673 --> 00:15:04,713
to exam, the lactate was 12.
296
00:15:05,023 --> 00:15:08,129
And they called it a, renal
colic because there was a stone
297
00:15:08,129 --> 00:15:09,449
floating around, in the kidney.
298
00:15:09,449 --> 00:15:12,809
But everything else looked okay and they
sent him home and missed, bowel ischemia.
299
00:15:12,809 --> 00:15:15,449
Like sometimes you look at it
and be like, there's nothing
300
00:15:15,449 --> 00:15:16,829
I can do to defend this, bro.
301
00:15:16,829 --> 00:15:18,089
It's like, it, it is what it is.
302
00:15:18,089 --> 00:15:18,239
Right?
303
00:15:18,239 --> 00:15:20,739
And so, and then those
cases that are fuzzy.
304
00:15:21,149 --> 00:15:23,219
Honestly, most of those
don't go forward either.
305
00:15:23,289 --> 00:15:27,329
'Cause attorneys just really don't
want fuzzy cases 'cause they just
306
00:15:27,329 --> 00:15:30,659
don't play well in court and they're
really expensive to litigate.
307
00:15:30,909 --> 00:15:33,519
And they're gonna drag on forever
and it's gonna cost 'em a fortune.
308
00:15:33,519 --> 00:15:34,739
And their likelihood of winning is low.
309
00:15:35,539 --> 00:15:35,839
sam_1_01-28-2026_100207: Wow.
310
00:15:35,869 --> 00:15:39,119
So that's a much higher percentage
of cases not moving forward or a
311
00:15:39,119 --> 00:15:41,699
much higher percentage that even
that you're recommending not move
312
00:15:41,699 --> 00:15:42,744
forward than I would've anticipated.
313
00:15:43,544 --> 00:15:43,844
jeff-willis_1_01-28-2026_090207: Yeah.
314
00:15:43,844 --> 00:15:44,054
Yeah.
315
00:15:44,054 --> 00:15:51,784
So, the actual statistics across all
plaintiff firms for every 100 cases
316
00:15:51,784 --> 00:15:54,604
that come into a plaintiff firm,
and they get them all sorts of ways.
317
00:15:54,604 --> 00:16:00,104
They get them through referrals, web
forms, walk-ins, phone calls, all sorts
318
00:16:00,104 --> 00:16:04,634
of ways that the plaintiff firms get
referred potential cases for every 100
319
00:16:04,634 --> 00:16:06,199
cases that come through their door.
320
00:16:06,949 --> 00:16:11,899
they filter out about 90 of those
and just say, there's nothing here.
321
00:16:11,929 --> 00:16:13,669
'cause it's the people that walk
in and say, they didn't give
322
00:16:13,669 --> 00:16:17,056
me enough pain medications, or
This scar was ugly or like that.
323
00:16:17,056 --> 00:16:18,256
There's just, there's no case there.
324
00:16:18,286 --> 00:16:19,276
They filter those out.
325
00:16:19,306 --> 00:16:19,696
Right.
326
00:16:20,056 --> 00:16:24,076
And then of those 10 that they decide
to investigate where they get records,
327
00:16:24,076 --> 00:16:29,116
they look through them themselves, they
send them off to experts or guys like me.
328
00:16:29,536 --> 00:16:34,726
Of those 10 only about one or
slightly less than one get filed.
329
00:16:34,831 --> 00:16:34,991
sam_1_01-28-2026_100207: Hm.
330
00:16:35,026 --> 00:16:38,146
jeff-willis_1_01-28-2026_090207: So
the true data is that about 1% of
331
00:16:38,146 --> 00:16:42,046
cases that people bring to a plaintiff
attorney ever actually get filed.
332
00:16:42,496 --> 00:16:46,486
Which I did not understand or believe
until I started doing this work.
333
00:16:46,676 --> 00:16:48,116
Because that's not what we're taught.
334
00:16:48,176 --> 00:16:50,886
That's not how we, not how we
interact with each other right?
335
00:16:50,956 --> 00:16:51,196
sam_1_01-28-2026_100207: Yeah.
336
00:16:51,206 --> 00:16:52,256
jeff-willis_1_01-28-2026_090207:
They'll sue you for anything.
337
00:16:52,256 --> 00:16:54,656
Look at this case, and you always
hear the story of, can you believe
338
00:16:54,656 --> 00:16:56,306
this guy lost this case, et cetera.
339
00:16:56,396 --> 00:16:56,576
Yeah.
340
00:16:56,576 --> 00:16:57,876
And there's those fringe cases.
341
00:16:58,436 --> 00:17:00,701
But those are truly fringe cases.
342
00:17:00,941 --> 00:17:04,511
It really is only about 1% of cases
that are brought in that ever get filed.
343
00:17:04,791 --> 00:17:08,861
And so it's much smaller than we're led
to believe and certainly that I ever
344
00:17:08,861 --> 00:17:10,331
believed for the years I was practicing.
345
00:17:11,006 --> 00:17:11,846
sam_1_01-28-2026_100207: So interesting.
346
00:17:11,996 --> 00:17:16,256
And so by the time a case is filed, say
I'm the practicing physician and I'm
347
00:17:16,256 --> 00:17:20,043
now being sued, and I've been notified
already that this lawsuit has been
348
00:17:20,043 --> 00:17:24,513
filed by the time that's occurred, it's
already been examined by maybe someone
349
00:17:24,513 --> 00:17:29,763
like you in pre-litigation, and then
they've already got maybe some expert
350
00:17:29,763 --> 00:17:32,793
witnesses who are willing to testify
and have already reviewed the case.
351
00:17:32,793 --> 00:17:36,213
So multiple parties have already
looked at this and found merit
352
00:17:36,433 --> 00:17:37,753
before this was even filed.
353
00:17:37,963 --> 00:17:38,383
Is that right?
354
00:17:39,183 --> 00:17:40,893
jeff-willis_1_01-28-2026_090207:
Typically it's state dependent.
355
00:17:40,923 --> 00:17:45,903
Some states have like certificates of
merit that, before you can file the
356
00:17:45,903 --> 00:17:50,913
matter, you have to have a physician
that has reviewed the case in some
357
00:17:50,913 --> 00:17:54,933
way or the other, and signed off
on a certificate of merit saying
358
00:17:54,933 --> 00:17:56,633
that , this has merit to pursue.
359
00:17:56,903 --> 00:18:04,623
Now in reality, there are physicians
that will sign certificates of merit
360
00:18:04,683 --> 00:18:06,333
for any case that you want them to sign.
361
00:18:06,333 --> 00:18:09,556
Like there are bad players out
there that are just getting paid to
362
00:18:09,556 --> 00:18:10,906
sign off on certificates of merit.
363
00:18:10,936 --> 00:18:11,896
It's not common.
364
00:18:11,926 --> 00:18:12,376
Right?
365
00:18:12,466 --> 00:18:13,156
But it happens.
366
00:18:13,156 --> 00:18:15,309
These are the fringe
cases but it does happen.
367
00:18:15,709 --> 00:18:18,989
There are some states that do not
require that, that you can just file.
368
00:18:19,259 --> 00:18:23,839
But any plaintiff attorney who knows
what they're doing is not going to
369
00:18:23,839 --> 00:18:27,599
waste time filing a case without
having a standard of care expert
370
00:18:28,229 --> 00:18:30,899
review the matter because they're
gonna be wasting their time and money.
371
00:18:30,899 --> 00:18:35,399
So yes, in general, if a case gets
filed, someone within your specialty
372
00:18:35,399 --> 00:18:38,639
has looked at it and said, yeah,
there's probably something here.
373
00:18:39,439 --> 00:18:39,739
sam_1_01-28-2026_100207: All right.
374
00:18:39,739 --> 00:18:40,579
And now I'm curious.
375
00:18:40,579 --> 00:18:45,189
So in the time you've been doing
this, have you noticed common patterns
376
00:18:45,219 --> 00:18:47,289
to cases that do move forward?
377
00:18:47,389 --> 00:18:51,789
One of the things that I enjoy doing
is actually learning from these things.
378
00:18:51,789 --> 00:18:55,929
So, I have been involved in medical
malpractice cases myself and it
379
00:18:55,929 --> 00:18:57,939
was a highly unpleasant experience.
380
00:18:57,939 --> 00:19:02,519
So, for someone in your position who is
looking at many of these on a regular
381
00:19:02,519 --> 00:19:07,409
basis, have you noticed a pattern,
maybe things that you could say, oh,
382
00:19:07,409 --> 00:19:10,959
this is a very common mistake that's
made and maybe we could teach some
383
00:19:10,959 --> 00:19:13,989
people about it and see if we could
prevent this from occurring again.
384
00:19:14,744 --> 00:19:16,094
jeff-willis_1_01-28-2026_090207:
Yeah, absolutely.
385
00:19:16,094 --> 00:19:18,344
And it's hard to quantify.
386
00:19:18,444 --> 00:19:24,744
But ultimately communication and
documentation of the communication
387
00:19:25,104 --> 00:19:27,504
is absolutely everything.
388
00:19:27,744 --> 00:19:30,744
Let's focus on emergency medicine because
obviously that's what I know best and
389
00:19:30,744 --> 00:19:32,664
what people are listening, know best.
390
00:19:33,084 --> 00:19:38,544
And the one thing that we're always
taught in our documentation is
391
00:19:39,344 --> 00:19:41,444
typically revolved around coding, right?
392
00:19:41,654 --> 00:19:44,894
And it's changed over the years, but
here are the things that we need, right?
393
00:19:44,894 --> 00:19:48,224
And it used to be this many points
in your HPI, this many points in
394
00:19:48,224 --> 00:19:50,594
your review of systems, this many
points in your physical exam.
395
00:19:50,804 --> 00:19:53,474
And it created bloated, terrible
charts that were terrible
396
00:19:53,474 --> 00:19:54,524
for medical-legal defense.
397
00:19:54,524 --> 00:19:57,074
Right those things are gone, right?
398
00:19:57,224 --> 00:19:58,799
You can still have a level five chart.
399
00:19:59,249 --> 00:20:03,989
Without all these HPI review systems,
exam documentation, but now we've
400
00:20:03,989 --> 00:20:05,519
added all this other garbage, right?
401
00:20:05,519 --> 00:20:06,779
Social determinants of health.
402
00:20:07,109 --> 00:20:08,969
So that has bloated up the chart.
403
00:20:09,769 --> 00:20:13,369
What really matters is a
well-documented history.
404
00:20:13,749 --> 00:20:18,519
Like what did you know when the
patient came in, who was there
405
00:20:18,879 --> 00:20:20,469
right document who was there?
406
00:20:20,499 --> 00:20:24,069
Was it was the patient obtunded
and you were just talking to
407
00:20:24,069 --> 00:20:25,304
EMS and doing the best you can.
408
00:20:26,064 --> 00:20:27,444
Make sure you write that down.
409
00:20:28,244 --> 00:20:31,964
grandma alone and from the nursing
home and the family showed up later?
410
00:20:32,054 --> 00:20:35,924
Write that down and write down who
told you what and what they told you.
411
00:20:36,104 --> 00:20:39,494
And more than anything, it's your
medical decision making, right?
412
00:20:40,294 --> 00:20:45,334
What I see so much is that we're so busy
and we're so glad to have a disposition
413
00:20:45,394 --> 00:20:49,114
and we're so ready to move on to the next
patient that we ignore the importance
414
00:20:49,114 --> 00:20:53,956
of describing why we did what we did,
Most of us are phenomenal physicians.
415
00:20:53,956 --> 00:20:57,046
We're doing a good job, we're doing
the right things, and it's in our head
416
00:20:57,046 --> 00:21:00,946
like, we know why we did it, but if
you don't write down why you did it,
417
00:21:01,066 --> 00:21:04,216
guys like me don't know why you did
it because it might not be the right
418
00:21:04,216 --> 00:21:06,486
decision, we make mistakes all the time.
419
00:21:06,486 --> 00:21:07,926
It just, it is what it is, right?
420
00:21:08,166 --> 00:21:11,208
But if your logic and thought
process at the time was reasonable.
421
00:21:12,008 --> 00:21:12,908
You're not gonna get sued.
422
00:21:12,938 --> 00:21:14,758
And if you do get sued,
you're not gonna lose.
423
00:21:14,808 --> 00:21:17,998
So getting back to your original question,
sorry, I went off on a tangent there.
424
00:21:18,798 --> 00:21:21,528
The primary question is communication
and making sure everyone
425
00:21:21,528 --> 00:21:23,958
understands what's going on and why.
426
00:21:24,198 --> 00:21:27,888
The patient and the family member,
and making sure that's communicated.
427
00:21:28,688 --> 00:21:30,548
Communication between team members.
428
00:21:30,638 --> 00:21:37,288
So often I see poor communication
between ED physicians and admitting
429
00:21:37,288 --> 00:21:43,286
hospitalists ED, physicians and
consultants, hospitalists and consultants.
430
00:21:43,586 --> 00:21:44,966
Physicians and patients.
431
00:21:44,966 --> 00:21:48,386
Physicians and nurses and things just
aren't communicated well because we
432
00:21:48,386 --> 00:21:49,886
live in an electronic health record.
433
00:21:49,886 --> 00:21:54,001
We do everything through the
EHR now the phone calls and
434
00:21:54,001 --> 00:21:59,201
conversations that happen aren't
nearly as robust as they used to be.
435
00:21:59,351 --> 00:22:02,801
And things aren't communicated well
between caregivers and things get
436
00:22:02,801 --> 00:22:05,101
dropped and things get lost along the way
437
00:22:05,454 --> 00:22:05,694
sam_1_01-28-2026_100207: Yeah.
438
00:22:05,824 --> 00:22:07,654
jeff-willis_1_01-28-2026_090207:
that's the primary thing that I see.
439
00:22:07,944 --> 00:22:11,694
We were taught this through residency
and, and everywhere after shift
440
00:22:11,874 --> 00:22:13,704
handoff, shift work is awful, right?
441
00:22:13,984 --> 00:22:16,554
For that, you hand off and
just say, Hey, check the CT.
442
00:22:16,554 --> 00:22:17,664
If it's negative, send them home.
443
00:22:17,664 --> 00:22:18,829
You get that check out and you're like.
444
00:22:19,629 --> 00:22:22,539
Sounds good, and it comes back
and it's mostly normal, and
445
00:22:22,539 --> 00:22:24,089
you're like, what do I do?
446
00:22:24,509 --> 00:22:25,439
Get your ass back in.
447
00:22:25,439 --> 00:22:27,809
You see the patient, you go
put your hands on the patient.
448
00:22:28,229 --> 00:22:30,449
If you are the one clicking
discharge, if you're the one
449
00:22:30,449 --> 00:22:34,039
dispositioning a patient, you talk
to that patient before they leave.
450
00:22:34,249 --> 00:22:36,079
You never just click discharge.
451
00:22:36,289 --> 00:22:37,729
That is never the plan.
452
00:22:38,249 --> 00:22:41,446
If the repeat, you know, X, Y,
Z is normal, they can go home.
453
00:22:42,246 --> 00:22:43,676
That should never be your plan.
454
00:22:44,456 --> 00:22:46,296
Your plan is to go back
and talk to the patient.
455
00:22:46,326 --> 00:22:47,916
'cause you're the one
that's discharging them.
456
00:22:48,336 --> 00:22:49,596
You don't have to take a full history.
457
00:22:49,596 --> 00:22:50,916
You don't have to do a full physical.
458
00:22:50,916 --> 00:22:52,566
You go talk to 'em, you
tell 'em the results.
459
00:22:52,566 --> 00:22:54,426
You find out what questions they have.
460
00:22:54,606 --> 00:22:58,626
You find out what questions the family
members that have showed up in the interim
461
00:22:58,721 --> 00:23:02,681
Now have, because they always show
up right before discharge when
462
00:23:02,681 --> 00:23:05,171
the patient's walking out the door
and they're like, what the hell?
463
00:23:05,171 --> 00:23:06,851
Why are you sending Steve home?
464
00:23:07,241 --> 00:23:08,351
And you're like, I don't know.
465
00:23:08,991 --> 00:23:11,561
My partner told me when a CT
was negative, it's time to go.
466
00:23:11,561 --> 00:23:14,661
So, hit the road, Jack, never the answer.
467
00:23:14,711 --> 00:23:16,271
It's always communication.
468
00:23:16,451 --> 00:23:19,101
Communication is the
biggest pattern that I see.
469
00:23:19,251 --> 00:23:22,921
And lack of communication between
caregivers, between patients and
470
00:23:22,921 --> 00:23:25,021
providers and family members.
471
00:23:25,831 --> 00:23:28,221
sam_1_01-28-2026_100207: Yeah, so
interesting because shift handoff
472
00:23:28,251 --> 00:23:33,886
really in the 20 years of practice,
I can recall was never good.
473
00:23:34,196 --> 00:23:35,456
And always involved.
474
00:23:35,796 --> 00:23:37,266
Yeah, I've ordered this.
475
00:23:37,266 --> 00:23:39,386
Just, if it's normal, send them home.
476
00:23:39,576 --> 00:23:42,016
Or you know, I guess it
progressed at one point too.
477
00:23:42,016 --> 00:23:46,036
I've told the nurse if this result
is normal, they can go home.
478
00:23:46,226 --> 00:23:50,126
So the nurse will only come tell
you if the result isn't normal.
479
00:23:50,366 --> 00:23:53,306
And then sometimes I'll get the
nurse come up to me and hand
480
00:23:53,306 --> 00:23:54,911
me a normal report and say.
481
00:23:55,386 --> 00:23:56,466
Is this normal?
482
00:23:56,466 --> 00:23:58,536
And I'll say, why are you asking?
483
00:23:58,776 --> 00:23:59,856
And she'll say, well, because,
484
00:24:00,176 --> 00:24:00,466
jeff-willis_1_01-28-2026_090207: Yeah,
485
00:24:00,816 --> 00:24:01,206
sam_1_01-28-2026_100207: because,
486
00:24:01,261 --> 00:24:02,251
jeff-willis_1_01-28-2026_090207:
That's a loaded question.
487
00:24:02,406 --> 00:24:04,596
sam_1_01-28-2026_100207: Dr.
X said this patient could go
488
00:24:04,596 --> 00:24:06,486
home if the study was normal.
489
00:24:06,486 --> 00:24:08,376
And I went, oh, okay.
490
00:24:08,416 --> 00:24:12,166
Are you about to go and put that we
had this conversation in your nurse's
491
00:24:12,166 --> 00:24:15,766
notes and say, I ran this by Dr.
So-and-so and the study's normal.
492
00:24:15,766 --> 00:24:18,556
So he said they could go home 'cause I
don't know anything about this patient.
493
00:24:18,556 --> 00:24:20,956
Let's go find this patient
and figure this out.
494
00:24:20,986 --> 00:24:24,656
So, yeah, checkout has
always been a problem.
495
00:24:24,986 --> 00:24:28,866
And really if you're listening, this
is one more fair warning that the way
496
00:24:28,866 --> 00:24:30,696
you're doing it is probably not great.
497
00:24:30,986 --> 00:24:34,116
And, you know, we're all overwhelmed
and busy But an appropriate sign
498
00:24:34,116 --> 00:24:35,866
out is worth its weight in gold.
499
00:24:36,116 --> 00:24:39,176
And yeah, unfortunately, the
person you check it out to is
500
00:24:39,176 --> 00:24:40,346
gonna have to do something.
501
00:24:40,446 --> 00:24:41,556
You have to go home.
502
00:24:41,646 --> 00:24:44,376
We all know you have to
go home and it's okay.
503
00:24:44,436 --> 00:24:46,716
I'll just go back and talk to the patient.
504
00:24:47,046 --> 00:24:49,116
But then on the flip side, I'm
gonna have to know something.
505
00:24:49,186 --> 00:24:52,456
About the patient to go in and talk
to them and the family and counsel.
506
00:24:52,456 --> 00:24:55,576
So I've gotta read the chart, I've gotta
figure out why these tests were ordered.
507
00:24:55,576 --> 00:24:57,106
I've gotta figure out
what they all showed.
508
00:24:57,346 --> 00:25:00,586
I've gotta corroborate that
the plan was a good one and,
509
00:25:00,761 --> 00:25:01,111
jeff-willis_1_01-28-2026_090207: Right.
510
00:25:01,366 --> 00:25:03,616
sam_1_01-28-2026_100207: and that
indeed if the study is normal, then
511
00:25:03,616 --> 00:25:05,206
yes, I agree they could go home.
512
00:25:05,266 --> 00:25:07,636
And then I've gotta go and defend
all of that in front of the
513
00:25:07,636 --> 00:25:10,696
family and the patient after I've
decided that I agree with it.
514
00:25:10,696 --> 00:25:12,989
So, yeah, that none of
that is just a quick here.
515
00:25:12,989 --> 00:25:15,209
If this urine is negative,
send them home kind of thing.
516
00:25:15,834 --> 00:25:16,104
jeff-willis_1_01-28-2026_090207: Right.
517
00:25:16,104 --> 00:25:18,819
That's why 12 hour shifts
are they convenient and is
518
00:25:18,819 --> 00:25:19,779
that what most people do?
519
00:25:20,579 --> 00:25:23,549
Yeah, but that's why 12 hour shifts
are just terrible, because at the
520
00:25:23,549 --> 00:25:27,159
end of a 12 hour shift, you are
not your best by any means, right?
521
00:25:27,164 --> 00:25:28,064
None of us are.
522
00:25:28,324 --> 00:25:29,224
And you need to leave
523
00:25:29,224 --> 00:25:32,764
you, you can't be staying 13,
14 hours, especially if you're
524
00:25:32,764 --> 00:25:34,024
coming back the next day.
525
00:25:34,054 --> 00:25:34,444
sam_1_01-28-2026_100207: Yeah.
526
00:25:34,474 --> 00:25:36,514
jeff-willis_1_01-28-2026_090207: And
that, that's why 12 hour shifts in
527
00:25:36,514 --> 00:25:41,068
modern emergency medicine are just
so much less safe than the, Maybe
528
00:25:41,068 --> 00:25:43,948
the nine hour shift where you stop
picking up new patients after eight.
529
00:25:43,948 --> 00:25:47,038
And I realize it's just not viable
in most community EDs where they're
530
00:25:47,038 --> 00:25:48,508
single or maybe double coverage.
531
00:25:48,508 --> 00:25:52,108
And it's difficult, but it's
just, it's a setup for badness.
532
00:25:52,428 --> 00:25:55,178
And the other pattern
I see is bounce backs,
533
00:25:55,403 --> 00:25:55,673
sam_1_01-28-2026_100207: Hmm.
534
00:25:56,228 --> 00:25:59,428
jeff-willis_1_01-28-2026_090207: and
ED bounce backs, whether that be within
535
00:25:59,428 --> 00:26:05,078
24 hours or 72 hours, they always get
more workup, even if they don't need it.
536
00:26:05,348 --> 00:26:09,068
Just do something else and describe why.
537
00:26:09,591 --> 00:26:13,251
give a good description of exactly why
they were here before and why they're
538
00:26:13,251 --> 00:26:15,351
here now and what happened in the interim.
539
00:26:15,691 --> 00:26:18,841
Because it's rare that I see a
medical malpractice case that
540
00:26:18,841 --> 00:26:20,106
revolves around one ED visit.
541
00:26:20,506 --> 00:26:24,736
If it's ED related, it's almost
always the second or third ED visit
542
00:26:25,076 --> 00:26:29,456
where they just kept coming back with
maybe related complaints or similar
543
00:26:29,456 --> 00:26:31,076
complaints, or the same complaint.
544
00:26:31,486 --> 00:26:34,606
And there wasn't enough of
additional workup done or enough
545
00:26:34,636 --> 00:26:37,576
at least thought process put
into the second or third visits.
546
00:26:37,886 --> 00:26:41,996
And so if somebody's bouncing
back, do something else.
547
00:26:42,806 --> 00:26:43,136
sam_1_01-28-2026_100207: Yeah.
548
00:26:43,136 --> 00:26:45,851
And that, thought process
needs to get documented.
549
00:26:45,971 --> 00:26:46,991
They gotta write it down.
550
00:26:47,046 --> 00:26:47,276
jeff-willis_1_01-28-2026_090207: Yeah.
551
00:26:47,276 --> 00:26:51,578
You have to always write down, you've
got plenty of space in the chart.
552
00:26:51,578 --> 00:26:54,688
Now you can have a three
word physical exam.
553
00:26:54,928 --> 00:26:56,548
You can have zero review assistant.
554
00:26:56,598 --> 00:26:58,068
None of that matters.
555
00:26:58,248 --> 00:27:00,468
It's the history and the
medical decision making.
556
00:27:00,798 --> 00:27:01,338
That's it.
557
00:27:01,488 --> 00:27:02,688
That's the only thing that matters.
558
00:27:02,688 --> 00:27:06,198
You don't even have to write down all the
labs or like, none of that stuff matters.
559
00:27:06,438 --> 00:27:08,088
'cause we all know you
looked at it, right?
560
00:27:08,398 --> 00:27:10,432
But you have to write your
medical decision making.
561
00:27:10,854 --> 00:27:13,789
sam_1_01-28-2026_100207: Now along those
lines, when you get a case that somebody
562
00:27:13,789 --> 00:27:18,267
wants you to review for, pre-litigation,
you mentioned the term like 200 pages.
563
00:27:18,417 --> 00:27:22,527
Is that about average for the amount
of just volume of information you're
564
00:27:22,527 --> 00:27:24,387
having to review for a typical case?
565
00:27:25,092 --> 00:27:27,976
jeff-willis_1_01-28-2026_090207: Oh,
I wish no, it's the modern electronic
566
00:27:27,976 --> 00:27:33,896
health record is so bloated now and most
cases involve at least one admission and
567
00:27:33,896 --> 00:27:38,666
some primary care visits and ED visits
and specialist visits and maybe rehab.
568
00:27:39,026 --> 00:27:44,086
So I would say my average is
probably 2000 pages or so,
569
00:27:44,716 --> 00:27:45,526
is the average.
570
00:27:45,526 --> 00:27:47,776
I've had as high as 30,000 pages.
571
00:27:48,066 --> 00:27:52,906
Now, granted, you're not reading every
single one of those pages, right?
572
00:27:52,906 --> 00:27:56,986
Of those thousand pages, 300 of
them might be nursing flow sheets
573
00:27:56,986 --> 00:28:01,136
where they're, checking off all
the, random boxes that mean nothing.
574
00:28:01,166 --> 00:28:05,546
You still have to filter through and
figure out which pages are important.
575
00:28:05,916 --> 00:28:10,266
But no, the electronic health record is
unbelievably bloated, which is one of the
576
00:28:10,266 --> 00:28:13,896
reasons that I've been able to create a
business out of this because an attorney
577
00:28:14,696 --> 00:28:20,282
gets 3000 pages and it's difficult for
them to understand which of those pages
578
00:28:20,679 --> 00:28:22,579
have any relevance to the matter at hand
579
00:28:22,654 --> 00:28:23,014
sam_1_01-28-2026_100207: Yeah.
580
00:28:23,474 --> 00:28:25,664
jeff-willis_1_01-28-2026_090207: 'Cause it
can stretch over 10 years worth of care.
581
00:28:25,664 --> 00:28:27,489
And they're like I don't
know, Jeff, figure it out.
582
00:28:27,909 --> 00:28:29,292
So that's where I've, created a business.
583
00:28:29,292 --> 00:28:29,592
Really.
584
00:28:30,147 --> 00:28:32,847
sam_1_01-28-2026_100207: I mean, even
in the course of a typical ED visit with
585
00:28:33,207 --> 00:28:37,977
electronic health records, there's tons
and tons of data being input, maybe not
586
00:28:37,977 --> 00:28:42,507
really medically relevant, but it's being
input by nurses and techs and others.
587
00:28:42,507 --> 00:28:45,817
So , for an ED visit, if you
were to get the records, you're
588
00:28:45,817 --> 00:28:50,257
getting all of that dumped into a
document and sent to you for review.
589
00:28:50,467 --> 00:28:55,167
It's like every person who touched the
health record in that timeframe and
590
00:28:55,167 --> 00:28:58,197
everything that they documented in every
box they checked, and then you've gotta
591
00:28:58,197 --> 00:29:00,147
decide what's relevant and what's not.
592
00:29:00,947 --> 00:29:01,767
jeff-willis_1_01-28-2026_090207:
In general, yes.
593
00:29:01,912 --> 00:29:02,512
So.
594
00:29:03,312 --> 00:29:09,796
When an attorney submits a medical record
request on behalf of a patient, they can
595
00:29:09,822 --> 00:29:11,802
request it in lots of different ways.
596
00:29:11,802 --> 00:29:15,432
Like, just give me the progress
notes or just give me the op note,
597
00:29:15,462 --> 00:29:20,412
or give me everything you have from
this time period to this time period.
598
00:29:20,637 --> 00:29:20,757
sam_1_01-28-2026_100207: Mm-hmm.
599
00:29:20,952 --> 00:29:23,292
jeff-willis_1_01-28-2026_090207:
Electronic health records are not
600
00:29:23,292 --> 00:29:26,512
built to produce paper and PDFs, right?
601
00:29:26,512 --> 00:29:29,602
They're built to be an electronic
health record with which you interact.
602
00:29:30,002 --> 00:29:36,282
The law is still designed around paper
and is still designed around pages.
603
00:29:36,312 --> 00:29:42,639
So health records have to produce PDFs and
so it is just a vomiting of information.
604
00:29:43,039 --> 00:29:46,482
And so to your point, let's take
one ED visit, right, like one
605
00:29:46,482 --> 00:29:49,062
standard ED visit for appendicitis.
606
00:29:49,642 --> 00:29:52,272
In general that's gonna
be about 150 pages.
607
00:29:52,322 --> 00:29:57,302
Seems to be about what gets
produced from registration to labs,
608
00:29:57,302 --> 00:30:02,142
to imaging to progress notes, to
nursing notes, to vital signs, to
609
00:30:02,515 --> 00:30:04,020
ER timelines, to all those things.
610
00:30:04,870 --> 00:30:10,840
And then the one thing that I don't do but
a lot of nurses are doing this work, are
611
00:30:11,200 --> 00:30:14,707
navigating and, analyzing audit trails.
612
00:30:15,507 --> 00:30:19,617
And so your electronic health records
can all produce an audit trail.
613
00:30:19,827 --> 00:30:25,437
And that's thousands of pages of an Excel
file that show literally every click
614
00:30:25,437 --> 00:30:28,487
that you made in that patient's record.
615
00:30:28,487 --> 00:30:34,357
So if you jumped back and looked at a
primary care visit from a year before
616
00:30:34,357 --> 00:30:39,197
just to see, hey, what meds were they
on that audit trail will say, Jeff
617
00:30:39,197 --> 00:30:46,714
Willis was looking at that office note
for four seconds at exactly this time
618
00:30:46,789 --> 00:30:47,239
sam_1_01-28-2026_100207: Wow.
619
00:30:47,474 --> 00:30:49,514
jeff-willis_1_01-28-2026_090207: And it
will know everything that you clicked.
620
00:30:49,574 --> 00:30:53,894
So if you end up in a deposition
and we're like, I had no idea that
621
00:30:53,894 --> 00:30:57,544
they were on coumadin, you know or I
wouldn't have recommended they have tpa.
622
00:30:57,544 --> 00:31:00,664
And they're like, well, you, you clicked
on the chart and you were in it for 30
623
00:31:00,664 --> 00:31:02,434
seconds and you clicked on the medicines.
624
00:31:02,494 --> 00:31:02,944
sam_1_01-28-2026_100207: Hmm.
625
00:31:03,274 --> 00:31:03,994
jeff-willis_1_01-28-2026_090207:
How'd you not see it?
626
00:31:03,994 --> 00:31:05,784
Like it knows.
627
00:31:05,904 --> 00:31:10,329
It knows everywhere you click it knows
if you're jumping back and forth to the
628
00:31:10,329 --> 00:31:13,149
track board and looking out in the waiting
room to see what's sitting out there.
629
00:31:13,549 --> 00:31:14,839
it knows everything that you're doing.
630
00:31:14,839 --> 00:31:18,019
It knows which computer you
looked at the imaging file on.
631
00:31:18,019 --> 00:31:22,579
So if you say, Hey, I, I went to CT with
the patient and I looked and I saw, that
632
00:31:22,579 --> 00:31:24,429
they had, free air in their abdomen.
633
00:31:24,699 --> 00:31:30,065
And so I called the surgeon from
the CT room and got it started.
634
00:31:30,865 --> 00:31:34,165
But actually during the time you
said you were doing that, you
635
00:31:34,165 --> 00:31:35,305
were in another patient's chart.
636
00:31:35,305 --> 00:31:35,965
It knows that.
637
00:31:35,965 --> 00:31:37,735
So all of that is recorded.
638
00:31:37,765 --> 00:31:40,135
And that's becoming a big
part of litigation as well.
639
00:31:40,325 --> 00:31:42,195
Because , it's just something
you can't hide from.
640
00:31:42,195 --> 00:31:43,735
It's, raw data and it's there,
641
00:31:44,485 --> 00:31:46,975
sam_1_01-28-2026_100207: So have
you had cases that you've reviewed
642
00:31:46,975 --> 00:31:49,705
where that trail has become relevant?
643
00:31:50,505 --> 00:31:52,120
jeff-willis_1_01-28-2026_090207:
not that I reviewed the trail
644
00:31:52,120 --> 00:31:54,760
itself, but peripherally and.
645
00:31:55,560 --> 00:31:56,910
I will make recommendations.
646
00:31:56,910 --> 00:32:00,720
You need to go get the audit trail
and find out when this happened
647
00:32:00,720 --> 00:32:04,450
because what I'm seeing and what's
written down doesn't make sense,
648
00:32:04,585 --> 00:32:04,795
sam_1_01-28-2026_100207: Okay.
649
00:32:04,795 --> 00:32:05,155
Gotcha.
650
00:32:05,710 --> 00:32:07,990
jeff-willis_1_01-28-2026_090207: something
is not lining up and then I will receive
651
00:32:07,990 --> 00:32:10,060
the feedback of, hey, yeah, you're right.
652
00:32:10,060 --> 00:32:11,920
We had the audit trail analyzed and.
653
00:32:12,320 --> 00:32:15,590
He was in this patient's
room doing this thing when he
654
00:32:15,590 --> 00:32:16,790
said he was doing this thing.
655
00:32:17,030 --> 00:32:19,780
So, yeah, no, it's definitely relevant
and it's only going to become more
656
00:32:19,780 --> 00:32:23,920
relevant the better AI gets at
analyzing those audit trails and
657
00:32:23,920 --> 00:32:28,030
putting pictures together of what
was happening and breaking that down.
658
00:32:28,030 --> 00:32:29,650
It's, only going to be more relevant.
659
00:32:30,450 --> 00:32:30,930
sam_1_01-28-2026_100207: Wow.
660
00:32:31,730 --> 00:32:32,180
Wow.
661
00:32:33,050 --> 00:32:33,470
All right.
662
00:32:33,470 --> 00:32:39,275
And then have you ever had the
opportunity to review cases where, I
663
00:32:39,275 --> 00:32:41,930
mean, it's a pretty common occurrence
where, we're working in the emergency
664
00:32:41,930 --> 00:32:46,770
department, we've consulted someone
on a case, and, there's perhaps some
665
00:32:46,770 --> 00:32:51,090
disagreement about what the disposition
should be or what the next step should
666
00:32:51,090 --> 00:32:52,650
be between me and the consultant.
667
00:32:52,890 --> 00:32:56,760
And in my mind, there's always been
a question, you know, documentation
668
00:32:56,760 --> 00:33:01,970
is great and we gotta document more,
but at what point it becomes helpful
669
00:33:01,970 --> 00:33:06,490
or unhelpful to dive into the weeds
about, well, I asked the consultant
670
00:33:06,490 --> 00:33:10,660
about this and they're recommending
X, but I think it should be y and we
671
00:33:10,660 --> 00:33:13,060
disagreed, and how we handled all of that.
672
00:33:13,370 --> 00:33:16,800
How much of that is helpful to
document from your standpoint?
673
00:33:17,200 --> 00:33:18,200
jeff-willis_1_01-28-2026_090207:
I think it's helpful.
674
00:33:18,200 --> 00:33:24,024
Interestingly, no no I've not seen
a case where the disagreement was
675
00:33:24,894 --> 00:33:29,564
that clearly outlined having been
an emergency physician as long as I
676
00:33:29,564 --> 00:33:35,064
was, and understanding how we phrase
things and what we really mean.
677
00:33:35,804 --> 00:33:42,064
I do see lots of examples of where they
have softened that conversation, right?
678
00:33:42,064 --> 00:33:49,667
Where, call the hospitalist for admission
and after our discussion they feel
679
00:33:49,667 --> 00:33:52,637
the patient is safe to go home, or we
feel the patient is safe to go home
680
00:33:52,687 --> 00:33:53,117
sam_1_01-28-2026_100207: right.
681
00:33:53,447 --> 00:33:55,337
jeff-willis_1_01-28-2026_090207: And
then, you know, you're left to make the
682
00:33:55,757 --> 00:33:57,797
disposition plan or something like that.
683
00:33:57,967 --> 00:34:00,307
it's typically softened
for whatever reason.
684
00:34:00,367 --> 00:34:06,592
Probably just 'cause you're colleagues
and, such, but, I think that's probably
685
00:34:06,952 --> 00:34:11,542
okay, but understand that you're the
one dispositioning the patient and,
686
00:34:12,022 --> 00:34:15,892
if you feel strongly and you're not
swayed by a consultant's opinion,
687
00:34:16,792 --> 00:34:17,872
they need to come see the patient
688
00:34:17,947 --> 00:34:18,217
sam_1_01-28-2026_100207: Hmm.
689
00:34:18,617 --> 00:34:22,317
You know, one of the other things I've
commonly run into is, we'll consult
690
00:34:22,317 --> 00:34:26,457
somebody, but instead of them showing
up, their PA or nurse practitioner
691
00:34:26,457 --> 00:34:31,407
will show up and then redo their own
history and physical and transmit
692
00:34:31,407 --> 00:34:34,557
that information to the consultant
who then makes the determination
693
00:34:34,707 --> 00:34:36,357
based on purely those findings.
694
00:34:36,737 --> 00:34:39,857
And sometimes that's conflicting
with what I expected to occur.
695
00:34:40,207 --> 00:34:43,812
Has that ever been an issue in any of
the cases you've reviewed where you
696
00:34:43,812 --> 00:34:46,842
know, a consultant was called but never
actually saw the patient and it was a
697
00:34:47,002 --> 00:34:51,792
third party, maybe a nurse practitioner
or a PA involved and there wasn't good
698
00:34:51,792 --> 00:34:53,842
communication physician to physician.
699
00:34:54,642 --> 00:34:56,772
jeff-willis_1_01-28-2026_090207:
More times than I can even count.
700
00:34:57,572 --> 00:35:03,862
I would say of the cases I review
80 to 90% of them probably have
701
00:35:03,912 --> 00:35:07,062
an advanced practice provider
involved in one way or the other.
702
00:35:07,452 --> 00:35:10,932
Because nearly every hospital based
consultant has an advanced practice
703
00:35:10,932 --> 00:35:14,562
provider that's doing the majority of
their documentation, doing the majority
704
00:35:14,562 --> 00:35:21,067
of their patient interviews, primary
exams, histories, all of those things.
705
00:35:21,517 --> 00:35:27,227
Where I see it a lot is in the
physical exam and the general gestalt
706
00:35:27,227 --> 00:35:30,527
of the patient and how they look and
what needs to happen next, right?
707
00:35:30,527 --> 00:35:35,587
Because your advanced practice
provider shows up, does maybe an exam.
708
00:35:35,587 --> 00:35:41,847
There's an exam documented, and seems
like they want to make less work for
709
00:35:42,177 --> 00:35:46,727
the let's just call it what it is,
make less work for the surgeon or the
710
00:35:46,727 --> 00:35:51,027
cardiologist or the busy person that
they have to report this to and tends
711
00:35:51,027 --> 00:35:54,717
to soften things and make them seem not
as sick as they are when maybe you have,
712
00:35:54,777 --> 00:35:58,227
as the ED physician have recognized
that there's something not right and
713
00:35:58,227 --> 00:36:00,807
that tends to delay or slow care.
714
00:36:00,957 --> 00:36:05,487
And it's not until the surgeon shows
up and does the, oh shit we should
715
00:36:05,487 --> 00:36:07,664
have been on this six hours ago.
716
00:36:07,694 --> 00:36:08,204
You know?
717
00:36:08,274 --> 00:36:11,019
But I see that much more
often than I'd like to see.
718
00:36:11,789 --> 00:36:12,089
sam_1_01-28-2026_100207: All right.
719
00:36:12,089 --> 00:36:16,799
In your hindsight telescope, if, you
were going to recommend like, ways to
720
00:36:16,859 --> 00:36:20,759
avoid that trap I'm trying to think in
clinical practice ways that have tried
721
00:36:20,759 --> 00:36:24,499
to avoid that trap have been things
like , when the nurse practitioner or
722
00:36:24,499 --> 00:36:28,539
PA comes down, I'll go find them and
have a conversation with the nurse
723
00:36:28,539 --> 00:36:30,399
practitioner and PA and say, hey.
724
00:36:31,119 --> 00:36:35,409
Oftentimes what I've found is I told
the consultant X, the consultant
725
00:36:35,409 --> 00:36:40,899
sent you but told you Y. And now I'm
coming to tell you it's actually X.
726
00:36:40,959 --> 00:36:46,309
It's not Y, and this is why I think
it's X. Or this is appendicitis and
727
00:36:46,309 --> 00:36:47,929
this is why I think it's appendicitis.
728
00:36:47,929 --> 00:36:50,449
And the surgeon told you to come
down and see this person with belly
729
00:36:50,449 --> 00:36:53,929
pain, but I want you to know, I
think it's appendicitis and I think
730
00:36:53,929 --> 00:36:58,724
they should go to the OR so, if you
think otherwise before you go talk
731
00:36:58,724 --> 00:37:00,794
to your attending, come find me.
732
00:37:00,974 --> 00:37:04,364
that's a conversation I've had with
nurse practitioners and PAs before.
733
00:37:04,614 --> 00:37:05,874
, But I haven't documented it.
734
00:37:05,874 --> 00:37:09,534
It's just so that I say, look in my chart
I said, I think it's appendicitis and
735
00:37:09,534 --> 00:37:10,764
if you think it's something different.
736
00:37:10,829 --> 00:37:14,159
I want you to come tell me before you
have a conversation with the surgeon.
737
00:37:14,189 --> 00:37:17,545
'cause then I don't want to go and undo
everything that you are about to do.
738
00:37:18,095 --> 00:37:19,625
But I don't really know if
that's the best approach.
739
00:37:19,625 --> 00:37:23,135
Like, have you ever reviewed a chart and
said, oh, this is a really good example
740
00:37:23,135 --> 00:37:25,775
of how they could solve this problem?
741
00:37:25,775 --> 00:37:27,875
Or how, what, what good
communication would be?
742
00:37:28,605 --> 00:37:30,225
jeff-willis_1_01-28-2026_090207: I
could not have said it better myself.
743
00:37:30,235 --> 00:37:32,035
That would absolutely be best practice.
744
00:37:32,035 --> 00:37:34,165
Have I ever seen that properly documented?
745
00:37:34,225 --> 00:37:36,445
No, but that is exactly right.
746
00:37:36,445 --> 00:37:38,335
'cause you, you know exactly how it works.
747
00:37:38,335 --> 00:37:38,575
Right?
748
00:37:38,575 --> 00:37:41,935
And you gave the perfect example
of, yeah, CT is equivocal,
749
00:37:41,935 --> 00:37:42,670
but I think it's an appie.
750
00:37:43,335 --> 00:37:44,415
You tell that to the surgeon.
751
00:37:44,445 --> 00:37:47,445
The surgeon tells the PA, yeah,
they've got a belly pain down there.
752
00:37:47,655 --> 00:37:48,360
Go see what it is.
753
00:37:48,540 --> 00:37:49,155
CT is okay.
754
00:37:49,575 --> 00:37:51,735
And then all that gets
lost in translation.
755
00:37:51,735 --> 00:37:55,845
But exactly what you said to do
would absolutely be best practice.
756
00:37:55,845 --> 00:37:56,685
But document it.
757
00:37:57,165 --> 00:37:59,065
If you did it, document it.
758
00:37:59,120 --> 00:38:01,960
sam_1_01-28-2026_100207: So it would have
to be something like, consulted surgeon.
759
00:38:02,050 --> 00:38:03,520
I think it's appendicitis.
760
00:38:04,030 --> 00:38:05,560
Caught the nurse practitioner.
761
00:38:05,620 --> 00:38:07,870
Had the same conversation
with nurse practitioner.
762
00:38:07,900 --> 00:38:09,370
I think it's appendicitis.
763
00:38:09,460 --> 00:38:10,960
Like write both of those things down.
764
00:38:11,080 --> 00:38:11,320
jeff-willis_1_01-28-2026_090207: Yep.
765
00:38:11,320 --> 00:38:14,770
Absolutely nurse practitioner evaluated
the patient in the emergency department.
766
00:38:15,070 --> 00:38:18,320
I spoke directly with the nurse
practitioner, shared these findings.
767
00:38:18,570 --> 00:38:23,160
And also it's not just so much to cover
yourself, but also the nurse practitioner.
768
00:38:23,960 --> 00:38:25,710
He or she doesn't know the history, right?
769
00:38:25,710 --> 00:38:29,610
I mean, they don't know what you
know, and in general, they are very
770
00:38:29,610 --> 00:38:36,040
receptive to guidance and very receptive
to you helping them and kind of
771
00:38:36,040 --> 00:38:39,940
shepherding them along through that
case because it speeds their process up.
772
00:38:40,170 --> 00:38:45,600
And maybe they agree with you, but when
they got the call from the surgeon.
773
00:38:46,400 --> 00:38:48,290
They know what the surgeon already thinks.
774
00:38:48,620 --> 00:38:52,280
And so it's nice to have somebody back
them up in what they already think.
775
00:38:52,280 --> 00:38:53,450
So it's all communication, man.
776
00:38:53,450 --> 00:38:55,310
It's all talk to the people, right?
777
00:38:55,310 --> 00:38:58,190
Don't just click the button and
be glad that the patient's gone.
778
00:38:58,250 --> 00:38:59,270
Which we all are, right?
779
00:38:59,300 --> 00:39:00,380
Dispositions are great.
780
00:39:00,507 --> 00:39:01,917
but they're going upstairs
one way or the other.
781
00:39:01,917 --> 00:39:02,157
Right?
782
00:39:02,157 --> 00:39:04,564
You know, I'm done, but you're not,
you know, you gotta communicate
783
00:39:04,634 --> 00:39:05,054
.
sam_1_01-28-2026_100207: Yeah.
784
00:39:05,384 --> 00:39:05,564
Yeah.
785
00:39:05,564 --> 00:39:06,374
So interesting.
786
00:39:06,429 --> 00:39:09,819
I've even had nurse practitioners
or PAs turn to me and say, yeah,
787
00:39:10,469 --> 00:39:13,409
if that's the case, I need you
to write this in your chart.
788
00:39:13,829 --> 00:39:17,969
So when I go to present, I can say
X, Y, and Z. And I go, okay, I'll
789
00:39:17,969 --> 00:39:19,319
go put that in my chart right now.
790
00:39:19,669 --> 00:39:21,229
And , sometimes it's
just a telephone game.
791
00:39:21,229 --> 00:39:22,459
I tell the consultant one thing.
792
00:39:22,459 --> 00:39:25,639
They tell the nurse practitioner or PA
something else, and then a med student
793
00:39:25,639 --> 00:39:28,489
comes down and then it's like, now
we're just playing a telephone game.
794
00:39:28,489 --> 00:39:30,819
Three parties later, they've
gotten a different message
795
00:39:31,059 --> 00:39:33,129
jeff-willis_1_01-28-2026_090207: and don't
forget talking to the surgeon through
796
00:39:33,129 --> 00:39:36,399
the circulating nurse why they've got
their hands in somebody else's belly.
797
00:39:36,399 --> 00:39:38,589
How painful of a conversation is that?
798
00:39:38,829 --> 00:39:41,903
They're like well hold on, lemme put
the phone up to his ear, like, oh my,
799
00:39:41,903 --> 00:39:43,613
like, okay, this is gonna go great.
800
00:39:43,613 --> 00:39:45,203
Because he is, he's
really listening to me,
801
00:39:45,428 --> 00:39:45,818
sam_1_01-28-2026_100207: Yeah.
802
00:39:45,953 --> 00:39:49,553
jeff-willis_1_01-28-2026_090207:
he's saying CT belly.
803
00:39:50,108 --> 00:39:54,498
And that's all he hears and calls the
PA. And then that's all he got, right?
804
00:39:54,498 --> 00:39:57,248
And so I hate, hate those conversations.
805
00:39:57,998 --> 00:39:58,718
sam_1_01-28-2026_100207: yes.
806
00:39:58,898 --> 00:39:59,168
Yeah.
807
00:39:59,168 --> 00:39:59,948
So, okay.
808
00:39:59,948 --> 00:40:02,498
So let's play the devil's
advocate for that conversation.
809
00:40:02,498 --> 00:40:06,404
If I'm having that conversation with
the consultant, again, we have to be
810
00:40:06,404 --> 00:40:09,554
collegial and this is somebody I'm gonna
have to work with again in the future.
811
00:40:09,554 --> 00:40:14,424
So, any benefit to saying something
like, consulted Dr. X discussed with
812
00:40:14,424 --> 00:40:18,554
him while he was in the OR does, is
that a relevant piece of information?
813
00:40:18,799 --> 00:40:19,944
jeff-willis_1_01-28-2026_090207:
Yeah, no, absolutely.
814
00:40:19,974 --> 00:40:21,184
, And there's nothing wrong with that.
815
00:40:21,184 --> 00:40:23,984
I mean, it's, his or her job
to be in the operating room.
816
00:40:23,984 --> 00:40:24,224
Right.
817
00:40:24,224 --> 00:40:27,824
And it's nice that they took the time to
answer the phone and didn't make you wait
818
00:40:27,824 --> 00:40:29,414
two and a half hours to call you back.
819
00:40:29,414 --> 00:40:33,754
I think that's fine, but that
must be followed up with when
820
00:40:33,994 --> 00:40:35,904
you know PA Steve arrived.
821
00:40:35,904 --> 00:40:40,414
I also spoke with Steve and shared
the history with Steve and this is
822
00:40:40,414 --> 00:40:41,974
the plan that we think is reasonable.
823
00:40:42,244 --> 00:40:43,834
So you have to document what happened.
824
00:40:43,834 --> 00:40:45,484
But no, I think that's perfectly fine.
825
00:40:45,794 --> 00:40:47,654
And gives a guy like me or the.
826
00:40:48,644 --> 00:40:50,504
Let's say you're an expert
and you're reviewing a case,
827
00:40:50,504 --> 00:40:51,404
wouldn't you wanna see that?
828
00:40:51,434 --> 00:40:53,564
Wouldn't you wanna see how it
went down and not have to guess?
829
00:40:53,589 --> 00:40:54,009
sam_1_01-28-2026_100207: Yeah.
830
00:40:54,044 --> 00:40:55,921
jeff-willis_1_01-28-2026_090207:
It's so much easier to say whether
831
00:40:55,921 --> 00:40:57,121
everything was done properly.
832
00:40:57,121 --> 00:41:00,131
If, you're not having to guess , you
don't want your testifying experts
833
00:41:00,131 --> 00:41:02,981
and your consultants and your
attorneys guessing what happened.
834
00:41:04,281 --> 00:41:05,461
in with details.
835
00:41:05,461 --> 00:41:06,696
You don't want them to fill in with.
836
00:41:06,931 --> 00:41:07,741
sam_1_01-28-2026_100207: Yeah, for sure.
837
00:41:08,131 --> 00:41:09,461
All right, I have one last question.
838
00:41:09,511 --> 00:41:15,691
What do you do when you are reviewing a
case and you see that, for example, in
839
00:41:15,691 --> 00:41:20,051
our case, the emergency physician has
documented one thing perhaps the PA for
840
00:41:20,051 --> 00:41:25,121
the consultant has documented something
completely different, maybe even contrary
841
00:41:25,181 --> 00:41:29,151
in their history or physical exam, as
far as findings go , is that something
842
00:41:29,151 --> 00:41:33,781
that has occurred regularly and in
your mind, how do you resolve that?
843
00:41:34,666 --> 00:41:37,861
jeff-willis_1_01-28-2026_090207:
Yeah, it occurs all the time, mostly
844
00:41:37,861 --> 00:41:42,694
because of templates that are still
out in existence and people using like
845
00:41:42,694 --> 00:41:47,926
exam templates and review of systems
templates and those are terrible.
846
00:41:47,926 --> 00:41:48,991
Just get rid of 'em.
847
00:41:49,036 --> 00:41:51,946
I mean, you don't need them
for coding anymore, so just
848
00:41:51,946 --> 00:41:53,416
get rid of exam templates.
849
00:41:53,416 --> 00:41:57,546
I mean, give me one exam, but, belly soft,
non-tender, done like fine, don't care.
850
00:41:57,576 --> 00:41:57,816
Right.
851
00:41:57,866 --> 00:41:58,856
We know what that means.
852
00:41:58,906 --> 00:42:02,406
But you don't need like a full exam
template unless it's, relevant.
853
00:42:02,523 --> 00:42:05,443
So, that's primarily where
I see , the difference in
854
00:42:05,443 --> 00:42:07,303
objective things like an exam.
855
00:42:08,103 --> 00:42:14,143
Historical differences I see a lot as
well, and it's all situational, right?
856
00:42:14,173 --> 00:42:18,733
Sometimes it's because the history by
one person is being obtained directly
857
00:42:18,733 --> 00:42:22,603
from the patient, and then the next
person, the family member has shown up
858
00:42:22,603 --> 00:42:24,253
and they're getting the real history.
859
00:42:24,493 --> 00:42:26,173
Or sometimes, like for us, right?
860
00:42:26,608 --> 00:42:31,548
Our history comes from EMS, who got the
history from the nursing home staff, and
861
00:42:31,668 --> 00:42:35,148
then the family shows up a day and a
half later and gives the real history.
862
00:42:35,448 --> 00:42:37,398
And so there's a big,
big difference there.
863
00:42:37,398 --> 00:42:42,288
So there's nothing that I can say that,
you know, how do I reconcile those two?
864
00:42:42,498 --> 00:42:45,888
You just have to stand way back
and look and say, okay, here's how
865
00:42:45,888 --> 00:42:47,628
the history progressed over time.
866
00:42:47,868 --> 00:42:53,318
Does that progression make sense or
did doc Doc one, just not listen and
867
00:42:53,318 --> 00:42:57,314
completely blank, which happens a
fair amount in the ED, right?
868
00:42:57,314 --> 00:43:00,734
Like, oftentimes we'll anchor to a
diagnosis before we walk in the room based
869
00:43:00,734 --> 00:43:03,614
on the chief complaint and the fact that
we already know this patient 'cause we've
870
00:43:03,614 --> 00:43:05,174
seen him five times already this year.
871
00:43:05,174 --> 00:43:07,934
And so you anchor to a diagnosis
and so you don't pay much
872
00:43:07,934 --> 00:43:09,104
attention to what they're saying.
873
00:43:09,539 --> 00:43:12,479
Later on down the line, this is the
one time, you know, hot potato, right?
874
00:43:12,499 --> 00:43:12,979
sam_1_01-28-2026_100207: Hmm.
875
00:43:13,199 --> 00:43:14,789
jeff-willis_1_01-28-2026_090207: where
that history actually made a difference
876
00:43:15,089 --> 00:43:16,479
and you wrote the wrong thing down.
877
00:43:16,479 --> 00:43:20,139
And I guarantee I'm guilty of that
at some point over my 20 years.
878
00:43:20,449 --> 00:43:23,746
We all have been, but that's a
landmine from a med-legal standpoint.
879
00:43:24,184 --> 00:43:25,204
sam_1_01-28-2026_100207: Okay, good.
880
00:43:25,716 --> 00:43:27,696
One last question before I let you go.
881
00:43:27,726 --> 00:43:31,356
If there is someone listening who is
interested in doing this kind of work
882
00:43:31,416 --> 00:43:35,526
as well what's the best avenue would
you recommend, like, doing it like
883
00:43:35,526 --> 00:43:39,096
you did, finding a local attorney and
maybe getting connected with someone
884
00:43:39,096 --> 00:43:42,646
to get some experience first, or how
would you recommend they go about
885
00:43:42,796 --> 00:43:45,206
developing a experience profile?
886
00:43:45,606 --> 00:43:46,906
jeff-willis_1_01-28-2026_090207:
So there's two pathways.
887
00:43:47,626 --> 00:43:52,256
If I had this all to do over again,
because I was never an expert witness
888
00:43:52,256 --> 00:43:55,616
or a testifying expert before I
started doing pre-litigation work.
889
00:43:55,616 --> 00:43:59,426
So I was at a bit of a disadvantage
because I knew nothing about the industry
890
00:43:59,426 --> 00:44:04,506
and I had to teach myself quickly if
I had it to do all over again after I
891
00:44:04,506 --> 00:44:10,231
had been practicing for 10 to 12 years,
maybe 15 years 10 to 12 years probably.
892
00:44:10,681 --> 00:44:15,511
I would've started reaching out to
attorneys and marketing myself as a
893
00:44:15,511 --> 00:44:17,461
testifying expert in emergency medicine.
894
00:44:17,461 --> 00:44:22,621
And I would've done some of the actual
work as an expert witness first, to
895
00:44:22,621 --> 00:44:27,711
learn the industry and just to get a feel
for how it works because that would've
896
00:44:27,891 --> 00:44:33,841
much more easily transitioned me into
the pre-litigation work that I do now.
897
00:44:34,641 --> 00:44:36,781
But you have to be clinically
active to do that, right?
898
00:44:36,921 --> 00:44:41,926
So if you intend on continuing to be
clinically active for another, five
899
00:44:41,926 --> 00:44:45,976
years or so and you want to do this,
I would take an expert witness course.
900
00:44:45,976 --> 00:44:47,326
There's lots of 'em out there.
901
00:44:47,326 --> 00:44:48,466
Seek has a course.
902
00:44:48,776 --> 00:44:51,416
There's a physician named Amy
Fogleman who has a course.
903
00:44:51,446 --> 00:44:52,946
Gretchen Green has a course.
904
00:44:53,066 --> 00:44:54,356
There's several different courses.
905
00:44:54,356 --> 00:44:57,553
And I think, most of them you can
use CME dollars for, which is nice.
906
00:44:57,633 --> 00:44:59,313
So you can take expert witness courses.
907
00:44:59,523 --> 00:45:00,933
I would do that first.
908
00:45:00,933 --> 00:45:05,573
Get on a couple databases, you can join
my platform and get a few cases under
909
00:45:05,573 --> 00:45:07,093
your belt and, see, if you like it.
910
00:45:07,093 --> 00:45:07,873
That's what I would do.
911
00:45:08,563 --> 00:45:11,743
If you're at the end of your career and
like, you know what, I really don't want
912
00:45:11,743 --> 00:45:14,803
to go into that, but I, would kind of like
to do some of this pre-litigation work.
913
00:45:15,073 --> 00:45:18,823
If you are in a region that
is large enough to have five
914
00:45:18,823 --> 00:45:20,293
or six plaintiff firms.
915
00:45:20,713 --> 00:45:23,433
Just make some phone calls or emails
and don't be afraid of 'em and
916
00:45:23,433 --> 00:45:26,976
just say, Hey, I've been practicing
emergency medicine for 20 years, or,
917
00:45:26,976 --> 00:45:29,066
however long I find this interesting.
918
00:45:29,376 --> 00:45:30,636
Can I look at a couple cases for you?
919
00:45:30,636 --> 00:45:31,326
I'll do it for free.
920
00:45:31,566 --> 00:45:32,226
and just try it out.
921
00:45:32,276 --> 00:45:35,633
Don't ask for money first, just ask
'em if you can look at a couple cases
922
00:45:35,633 --> 00:45:39,053
and they'll be more than happy to let
you do it and find out if it's something
923
00:45:39,053 --> 00:45:43,213
you enjoy and then get some practice
and get good at it, and then decide
924
00:45:43,213 --> 00:45:44,353
if you wanna make a business of it.
925
00:45:44,413 --> 00:45:47,233
And then that's a whole different,
starting,, starting a business that's
926
00:45:47,233 --> 00:45:48,943
a whole, a whole different game.
927
00:45:49,043 --> 00:45:51,443
Marketing and all that nonsense,
which I knew nothing about
928
00:45:51,443 --> 00:45:53,003
and still probably don't.
929
00:45:53,313 --> 00:45:54,453
But that's a whole different game.
930
00:45:55,218 --> 00:45:57,528
sam_1_01-28-2026_100207: All right,
and then tell me about your platform.
931
00:45:57,618 --> 00:45:59,898
Where can people find
it and what's required?
932
00:46:00,588 --> 00:46:00,858
jeff-willis_1_01-28-2026_090207: Yep.
933
00:46:00,888 --> 00:46:04,188
So, you can go to my platform
at expertretainer.com.
934
00:46:04,688 --> 00:46:08,968
And the only thing, if you want to
sign up as an expert witness, it
935
00:46:08,968 --> 00:46:10,558
takes literally about five minutes.
936
00:46:10,778 --> 00:46:17,418
You can have as little information as your
name and your email or you can add as much
937
00:46:17,418 --> 00:46:22,838
information as your cv, your fee schedule,
a short one paragraph blurb about
938
00:46:22,838 --> 00:46:25,488
yourself a headshot as much as you want.
939
00:46:26,288 --> 00:46:29,948
No matter what you put into the
platform, it will never be public facing.
940
00:46:30,218 --> 00:46:31,808
No one will ever know that you're there.
941
00:46:32,058 --> 00:46:36,984
The only way that people know that
you exist is once an attorney submits
942
00:46:36,984 --> 00:46:41,324
a need or expert request need, you
will be notified if it's within your
943
00:46:41,324 --> 00:46:45,104
specialty, and then you can click
yes, I'm interested, or No, I'm not.
944
00:46:45,164 --> 00:46:48,614
And if you click yes, I'm interested,
then your name and email and any
945
00:46:48,614 --> 00:46:51,434
information that you've entered
goes directly to the attorney and
946
00:46:51,434 --> 00:46:53,024
they reach out directly back to you.
947
00:46:53,304 --> 00:46:56,814
But there's never anything public
facing, so you can do all of this
948
00:46:56,814 --> 00:47:00,374
incognito and I know how some
colleagues feel about this kind of work.
949
00:47:00,374 --> 00:47:03,824
And if you want to dabble in it
a little bit and, not have anyone
950
00:47:04,484 --> 00:47:06,304
know that you're doing it, this
is a very good way to do it.
951
00:47:06,894 --> 00:47:07,314
sam_1_01-28-2026_100207: Awesome.
952
00:47:07,739 --> 00:47:11,669
Well, Jeff, thank you very much for
being on the podcast and for sharing
953
00:47:11,669 --> 00:47:13,529
some of your experience and wisdom.
954
00:47:13,739 --> 00:47:16,649
Really, hopefully everybody who's
listening was able to take away
955
00:47:16,649 --> 00:47:20,579
something about improving their
practice and maybe reducing their risk.
956
00:47:20,639 --> 00:47:23,359
And if you're open to it would
really love to have you back on.
957
00:47:23,629 --> 00:47:26,989
We can continue the conversation and
I can plug away at more things we
958
00:47:26,989 --> 00:47:29,899
could do to improve our documentation
and practice in the future.
959
00:47:30,759 --> 00:47:31,279
jeff-willis_1_01-28-2026_090207:
Yeah, absolutely.
960
00:47:31,279 --> 00:47:31,519
I could.
961
00:47:31,519 --> 00:47:33,109
I could talk about this all day long, man.
962
00:47:33,109 --> 00:47:33,474
So anytime.
963
00:47:33,889 --> 00:47:34,279
sam_1_01-28-2026_100207: Awesome.
964
00:47:34,399 --> 00:47:34,884
Thank you so much.
965
00:47:35,684 --> 00:47:35,949
jeff-willis_1_01-28-2026_090207:
All right.
966
00:47:35,949 --> 00:47:36,159
Take care.
967
00:47:36,926 --> 00:47:37,706
Sam: And that's a wrap.
968
00:47:37,706 --> 00:47:40,326
Thanks for joining us for
this episode of EMPlify.
969
00:47:40,346 --> 00:47:44,973
I hope you found it informative, and I
want to remind you that ebmedicine.net
970
00:47:45,223 --> 00:47:50,083
is your one stop shop for all of your
CME needs, whether that be for emergency
971
00:47:50,083 --> 00:47:51,903
medicine or urgent care medicine.
972
00:47:52,183 --> 00:47:55,713
There are three journals, there's
tons of CME, there's lots of
973
00:47:55,743 --> 00:47:59,503
courses, there's so many clinical
pathways, all this information at
974
00:47:59,503 --> 00:48:02,343
your fingertips at ebmedicine.net.
975
00:48:02,743 --> 00:48:05,183
Until next time, everyone,
I'm your host, Sam Ashoo.
976
00:48:05,523 --> 00:48:06,083
Be safe.