Being A Pre-Litigation Expert with Jeff Willis, MD の全文書き起こし

00:03:38,749 jeff-willis_1_01-28-2026_090207: So I stumbled into it, right? 67 00:03:38,749 --> 00:03:42,196 So I, did emergency medicine, like I said, for about 20 years total. 68 00:03:42,196 --> 00:03:45,306 I was the medical director of a level one trauma center seeing 69 00:03:45,306 --> 00:03:47,136 about 90,000 patients a year. 70 00:03:47,166 --> 00:03:49,356 So, did that for many years. 71 00:03:49,356 --> 00:03:53,346 And then I finished off my career in a rural critical access 72 00:03:53,346 --> 00:03:57,623 hospital, little six bed ER, 24 hour shifts through and after COVID. 73 00:03:57,983 --> 00:04:02,783 And as I was finishing that up, I realized that my time in emergency 74 00:04:02,783 --> 00:04:04,113 medicine was probably done. 75 00:04:04,143 --> 00:04:07,443 I, I'd enjoyed it, but I, I wasn't really that excited by it anymore. 76 00:04:07,473 --> 00:04:09,393 And so I just started looking for other things to do. 77 00:04:10,048 --> 00:04:12,308 Really, I just stumbled on this idea. 78 00:04:12,368 --> 00:04:17,258 Like a lot of ER docs, I was sued a couple times in my career and going 79 00:04:17,258 --> 00:04:21,818 through that process, I realized that both the plaintiff's counsel and the 80 00:04:21,818 --> 00:04:26,188 defense counsel, I didn't feel really understood the medicine very well that 81 00:04:26,188 --> 00:04:29,518 they were litigating this case, but really didn't have a grasp of what 82 00:04:29,518 --> 00:04:30,988 was going on and what was important. 83 00:04:31,768 --> 00:04:37,263 so I had originally intended to create a consulting business where I 84 00:04:37,263 --> 00:04:41,033 was helping defense firms understand the medicine better and defend 85 00:04:41,033 --> 00:04:45,903 physicians and quickly learned that there's not much of a market there. 86 00:04:45,953 --> 00:04:49,613 I think what a lot of us don't understand is that these defense firms, they 87 00:04:49,613 --> 00:04:53,048 work for insurance companies, right? 88 00:04:53,048 --> 00:04:57,368 They work for the malpractice insurance companies, or they work for the hospitals 89 00:04:57,398 --> 00:05:00,218 directly or somewhere in between, depending on, you know, if they're 90 00:05:00,218 --> 00:05:05,198 self-insured and so the attorneys don't have much control over their budget 91 00:05:05,198 --> 00:05:06,338 and what they spend their money on. 92 00:05:06,338 --> 00:05:06,638 So 93 00:05:06,654 --> 00:05:10,734 If they want to hire a consultant for help, they don't just have 94 00:05:10,734 --> 00:05:11,904 an open budget to do that. 95 00:05:11,904 --> 00:05:16,074 They have to go back to the insurance carrier and ask permission every time to 96 00:05:16,074 --> 00:05:18,084 hire a consultant or to hire an expert. 97 00:05:18,444 --> 00:05:22,674 And so that layer of friction made it very difficult for attorneys who were 98 00:05:22,764 --> 00:05:27,304 even interested in hiring me on as a consultant to get that work done. 99 00:05:27,354 --> 00:05:33,408 And so I quickly learned that the better way to both make a business of the medical 100 00:05:33,408 --> 00:05:38,808 legal consulting as well as still be helping physicians was actually to work 101 00:05:38,808 --> 00:05:42,468 with plaintiff attorneys and look at cases in pre-litigation before anything 102 00:05:42,468 --> 00:05:47,598 was filed and make sure that the cases that were moving forward actually had 103 00:05:47,598 --> 00:05:51,708 viability and actually had merit to move forward, rather than the frivolous 104 00:05:51,708 --> 00:05:54,978 cases that we hear so much about in the throwaway journals and, that we talk 105 00:05:54,978 --> 00:05:56,298 about online and that sort of thing. 106 00:05:56,668 --> 00:06:00,871 And so I really just locally here went to a local attorney and said, Hey. 107 00:06:01,486 --> 00:06:03,196 Mind if I take a look at a couple cases? 108 00:06:03,196 --> 00:06:04,396 And he was like, yeah, sure, why not? 109 00:06:04,396 --> 00:06:04,996 And I did. 110 00:06:05,486 --> 00:06:07,388 and he said, wow, that was really helpful. 111 00:06:07,388 --> 00:06:10,784 And neither of the cases that I looked at moved forward, and he was very thankful 112 00:06:10,784 --> 00:06:15,434 and saved him a lot of time and money and expert retainer fees and litigation. 113 00:06:16,124 --> 00:06:21,344 And he started using me quite a bit then started referring me to other folks. 114 00:06:21,404 --> 00:06:25,374 And then I said, okay, I can make a business of this and hung up the 115 00:06:25,374 --> 00:06:29,264 stethoscope after about six months of dabbling without a client base 116 00:06:29,484 --> 00:06:30,834 and just said let's give this a shot. 117 00:06:30,834 --> 00:06:33,924 If I'm gonna do it, let's, let's give it a shot for a year and see what happens. 118 00:06:33,924 --> 00:06:36,384 And over the course of a year, it grew and grew. 119 00:06:36,384 --> 00:06:39,804 And now I've been doing it for a couple years and have clients 120 00:06:39,804 --> 00:06:42,564 in 29 different states, and I'm about as busy as I can handle. 121 00:06:43,364 --> 00:06:47,624 sam_1_01-28-2026_100207: Because you do reviews in pre-litigation, you don't 122 00:06:47,624 --> 00:06:52,554 have to be licensed as a specialist in whatever state is that the case 123 00:06:52,554 --> 00:06:56,714 occurred in or even be in the specialty for the case that's in question. 124 00:06:57,434 --> 00:06:57,974 jeff-willis_1_01-28-2026_090207: Exactly. 125 00:06:57,974 --> 00:06:58,214 Yeah. 126 00:06:58,214 --> 00:07:01,814 So I am a consultant, so everything that I do is behind the scenes. 127 00:07:01,814 --> 00:07:03,854 It's confidential work product with the attorney. 128 00:07:03,854 --> 00:07:06,194 So I'm not a testifying expert. 129 00:07:06,258 --> 00:07:09,438 You know, To be a testifying expert in virtually every state, you have to 130 00:07:09,438 --> 00:07:14,688 be an active clinical practice, or at

least 51% clinical practice or clinical 131 00:07:14,688 --> 00:07:16,338 practice within the last three years. 132 00:07:16,338 --> 00:07:20,908 Every state has its own set of rules for who can be a testifying expert. 133 00:07:21,438 --> 00:07:24,851 but yes, I am disqualified from being a standard of care expert. 134 00:07:25,091 --> 00:07:28,241 Now, technically, I could still be a causation expert where 135 00:07:28,241 --> 00:07:29,861 you're testifying on causation. 136 00:07:29,861 --> 00:07:34,536 I'm actually in one case like that right now where I am actually a testifying 137 00:07:34,536 --> 00:07:38,303 expert, but nothing to do with standard of care, just describing causation and how 138 00:07:38,303 --> 00:07:42,253 A leads to b more of a science expert, if you will than the practice of medicine. 139 00:07:42,516 --> 00:07:43,056 sam_1_01-28-2026_100207: Interesting. 140 00:07:43,056 --> 00:07:47,196 And so for our listeners purposes, if you're a causation expert as you just 141 00:07:47,196 --> 00:07:52,206 mentioned, you're testifying that you know this event A could have led to event 142 00:07:52,206 --> 00:07:57,106 B, but you're not really touching on the practice of medicine as far as who did 143 00:07:57,106 --> 00:08:00,421 what or what labs they ordered or whether or not there was malpractice involved. 144 00:08:01,156 --> 00:08:01,696 jeff-willis_1_01-28-2026_090207: Exactly. 145 00:08:01,696 --> 00:08:03,316 So let's take one step back, Sam. 146 00:08:03,316 --> 00:08:07,516 So for a medical malpractice case to have merit and viability, 147 00:08:08,316 --> 00:08:09,876 it has to have four components. 148 00:08:10,176 --> 00:08:14,406 It has to have what we call duty breach causation and damages. 149 00:08:14,646 --> 00:08:17,916 And so duty is usually just a check box, you know, was there 150 00:08:17,916 --> 00:08:21,176 an established physician patient relationship of some kind. 151 00:08:21,566 --> 00:08:22,706 So that's usually a check box. 152 00:08:22,736 --> 00:08:25,466 'cause there almost always is if it's, you know, if the case is brought and there's 153 00:08:25,466 --> 00:08:28,929 a, physician or nurse or someone involved usually there was a duty to provide care. 154 00:08:29,409 --> 00:08:34,824 The standard of care is what a similarly trained healthcare provider would do 155 00:08:34,824 --> 00:08:36,924 in similar clinical circumstances. 156 00:08:37,298 --> 00:08:39,358 so that's your standard of care, right? 157 00:08:39,358 --> 00:08:43,228 So did this physician in this case, it can be anything but let's say physician, 158 00:08:43,418 --> 00:08:46,478 did the physician practice in a way that a similarly trained physician 159 00:08:46,478 --> 00:08:48,708 would practice in that setting? 160 00:08:48,828 --> 00:08:52,618 And that setting can be, in a rural critical access hospital or in a 161 00:08:52,918 --> 00:08:56,774 academic center or on an airplane, you know, whatever that may be. 162 00:08:56,774 --> 00:08:57,014 Right? 163 00:08:57,014 --> 00:09:00,994 Like given the situation presented to them, did they practice reasonably? 164 00:09:01,024 --> 00:09:02,194 That's standard of care. 165 00:09:02,994 --> 00:09:05,514 Then there are, there's damages, right? 166 00:09:05,754 --> 00:09:07,644 What harm did the patient suffer? 167 00:09:07,704 --> 00:09:12,554 And that can be emotional, physical, financial, death, a whole host of things. 168 00:09:12,944 --> 00:09:15,224 And then the thing linking those two is causation. 169 00:09:15,284 --> 00:09:19,874 So did the breach and standard of care did the thing that that physician do 170 00:09:20,644 --> 00:09:23,974 incorrectly actually lead to the outcome. 171 00:09:24,284 --> 00:09:26,384 And you have to have all four of those components to 172 00:09:26,384 --> 00:09:27,944 have a viable case to pursue. 173 00:09:28,094 --> 00:09:31,604 And that's why so many cases don't actually move forward. 174 00:09:31,604 --> 00:09:35,979 Sometimes there's a clear duty, a clear breach, and even clear 175 00:09:35,979 --> 00:09:40,409 causation sometimes, but the damages are just so small that it's not 176 00:09:40,409 --> 00:09:42,063 worth for the attorney to, pursue. 177 00:09:42,063 --> 00:09:44,743 So that's what I do every day, is I look at all four of 178 00:09:44,743 --> 00:09:46,723 those components of the case. 179 00:09:47,398 --> 00:09:51,448 Analyze them and then using the experience that I've gathered doing this for the 180 00:09:51,448 --> 00:09:55,018 last few years, bring that back to the attorney and say, Hey here's why I think 181 00:09:55,018 --> 00:09:59,278 it's probably a case, probably not a case, not my decision to make, but based 182 00:09:59,278 --> 00:10:02,308 on everything that I know and have looked through on the records and my experience, 183 00:10:02,408 --> 00:10:03,728 this would be my recommendation. 184 00:10:04,528 --> 00:10:04,978 sam_1_01-28-2026_100207: Interesting. 185 00:10:04,978 --> 00:10:10,828 And then if that case ends up moving forward to court, would you ever 186 00:10:10,828 --> 00:10:14,728 need to show up there and testify to your opinion regarding causation 187 00:10:14,728 --> 00:10:15,593 or would somebody else do that? 188 00:10:16,408 --> 00:10:17,218 jeff-willis_1_01-28-2026_090207: Nope, not at all. 189 00:10:17,248 --> 00:10:20,998 No I'm completely behind the scenes and that allows me to be completely 190 00:10:20,998 --> 00:10:25,488 candid with my clients about everything, Hey, this is a terrible case. 191 00:10:25,488 --> 00:10:26,168 Don't touch it. 192 00:10:26,748 --> 00:10:29,693 And if they elect to go otherwise, that's fine. 193 00:10:29,693 --> 00:10:32,343 But you know, that way everything that I say is, confidential 194 00:10:32,403 --> 00:10:33,963 uh, confidential work product. 195 00:10:33,963 --> 00:10:37,803 But no, none of the cases that I do any type of pre-litigation work on 196 00:10:37,803 --> 00:10:39,649

would I ever be a testifying expert. 197 00:10:39,649 --> 00:10:44,179 Now, there are some clients for whom I will stay on the matter for 198 00:10:44,179 --> 00:10:47,719 the duration of the case and be a consultant throughout the case and 199 00:10:47,719 --> 00:10:52,374 help them look at depositions and help prepare for depositions and, assess, 200 00:10:52,374 --> 00:10:54,114 expert reports, that sort of thing. 201 00:10:54,164 --> 00:10:55,244 But I don't do a ton of that. 202 00:10:55,244 --> 00:10:57,074 Almost everything I do is in pre-litigation. 203 00:10:57,329 --> 00:10:58,169 sam_1_01-28-2026_100207: So interesting. 204 00:10:58,349 --> 00:11:01,379 And then you're not limited to just emergency medicine. 205 00:11:01,379 --> 00:11:06,783 Then in that arena, you're comfortable reviewing all forms of medical cases that 206 00:11:06,783 --> 00:11:08,253 one of your clients might bring to you. 207 00:11:08,958 --> 00:11:09,228 jeff-willis_1_01-28-2026_090207: Right? 208 00:11:09,533 --> 00:11:09,853 Absolutely. 209 00:11:09,953 --> 00:11:14,298 So, as an emergency physician, we're familiar with and interact with just 210 00:11:14,298 --> 00:11:16,658 about every specialty in medicine. 211 00:11:17,018 --> 00:11:21,688 And, the more that we've broadened our expertise over the decades, right? 212 00:11:21,968 --> 00:11:24,398 We've sort of become the experts in lots of things. 213 00:11:24,498 --> 00:11:28,398 And through those interactions with consultants and other specialties 214 00:11:28,398 --> 00:11:31,578 and just through the practice of emergency medicine, we're comfortable 215 00:11:31,578 --> 00:11:34,218 enough being able to figure it out. 216 00:11:34,218 --> 00:11:34,638 Right. 217 00:11:34,668 --> 00:11:35,958 We figure it out on the fly. 218 00:11:35,988 --> 00:11:39,418 And so over the course of the last three years I've become better and 219 00:11:39,418 --> 00:11:41,308 better at assessing other specialties. 220 00:11:41,368 --> 00:11:43,898 So, are there things that I'm not great at? 221 00:11:43,898 --> 00:11:49,578 Like, can I determine whether or not an orthopedic surgeon used the exact right 222 00:11:49,638 --> 00:11:52,878 angle on the implant that caused X, Y, Z? 223 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.