The physician’s role in medical legal work

October 2, 2018
Heidi Moawad, MD

Dermatology Times, November 2018 (Vol. 39, No. 11), Volume 39, Issue 11

When complicated medical-related legal issues arise, physicians are often asked to provide expert opinions.

When complicated medical-related legal issues arise, physicians are often asked to provide expert opinions. Primary care doctors as well as specialists are valued in these situations. Physicians who have worked in a consultative capacity in the medical legal field are good resources for insight about how to look for opportunities, the anticipated time commitment and reimbursement, how the process works and whether medical legal work is stressful for physicians.

Getting started 

Timothy Wiebe, MD, a neurosurgeon in Bakersfield, Calif., was not looking for medical legal work when he was first asked to provide his expert opinion about a patient. Subsequently, parties familiar with his work contacted him with additional requests for consultations.

Wiebe suggests that doctors who are interested in medical legal consulting maintain board certification, attend continuing medical education (CME) courses, and participate in meetings and presentations to highlight their professional abilities to the community. In addition to being qualified, the way a physician expert manages time and availability is an important aspect of getting and keeping clients. “Your candidacy as an expert might be more attractive if you are flexible in a way that helps clients meet their deadlines,” Wiebe suggests. 

Nancy Hammond, MD, a neurologist in Kansas City, Mo., also did not seek out medical legal work initially, but says that she received a cold call when an expert was needed for a case. She suggests that one way to get started as an expert witness is to reach out to contacts. “Specifically, reach out to anyone you know in the medical or legal field doing this type of work. You could consider taking a course on being an expert witness, such as the Skills, Education, Achievement, Knowledge  (SEAK) course. There are also several online directories in which you can list, “ Hammond says. 

Sharon Peach, MD, a critical care specialist in Missoula, Mont., started in expert witness work by attending a conference to learn about expert witness practice. She had her name listed in a directory, but her first case was obtained through networking, not through the directory. 

Jordan Grumet, MD, an internist in Evanston, Ill., says that companies such as American Medical Forensic Specialists (AMFS) hire physicians to do medical expert work and connect lawyers with qualified physicians. “Often, a physician is contacted out of the blue by a lawyer who is looking for help with a case. If the physician does a good job, the lawyer passes on their name to other law firms,” Grumet says. He began by emailing lawyers in the Chicago area to see if they needed experts, while also signing up for AMFS.

What a physician medical expert does

Hammond explains that the bulk of medical legal consultation consists of examining medical recordsand writing a well-annotated report specific to the case, with the possibility that a physician may be asked to give a deposition and testify at trial. A core part of the work involves understanding the medical benchmarks and identifying deviations from the norms. “Generally, you are looking to see if the standard of care was breached and then testifying at either depositions or trials,” Grumet says. 

According to Wiebe, doctors who provide expert opinions need to consider multiple explanations that could conceivably explain a clinical scenario, stay up to date with relevant literature and different methods of practice, consider and acknowledge all the relevant facts, and remain dispassionate.

Stress

Hammond acknowledges that giving a deposition and testifying at trial can be stressful, but that attorneys spend a significant amount of time preparing the physician. “I had 4 full days of prep work for my last deposition,” she says. 

According to Peach, any case in which an expert witness participates becomes a matter of public record and is discoverable during further cases. This lack of anonymity can add to the stress for some physicians. 

Grumet provides a personal example of the type of stress that a physician can face at a deposition or trial.  “The opposing lawyer can and will do anything they can to debunk you. I have had lawyers yelling at the top of their lungs at me in deposition trying to get me to slip up,” he says. 

Time commitment and reimbursement

The physicians interviewed all agree that rates are negotiable, and that $500 per hour is considered a reasonable rate for a physician who is just getting started as a medical legal expert. Wiebe explains that doctors who keep rates in a market range may be more likely to be chosen for an expert opinion. 

Experienced experts or those who are in high demand can charge more than those who are new to the field.  “During my first cases, I did not charge the maximum fees since I felt strongly that a client should not have to pay for my learning curve,” Peach says. 

The time commitment varies by case. A simple case can include several weeks of work, while a complicated case may extend to over a year, with up to 10 hours per week spent on preparation, or more if a case goes to court. All of the doctors interviewed say that medical legal work is sporadic and that requests for expert opinions come up only a few times per year. And doctors do not necessarily accept all medical legal opportunities. Peach explains that there are many reasons to refuse a case, including a conflict of interest or an inability to scientifically support the assertions of retaining counsel.

Physicians can benefit from medical legal work in ways beyond the extra income. Hammond says that she enjoys the work. Wiebe feels that he is contributing to the medical field as a whole. “I think that physicians who do this work with integrity add quality and value to the medical field,” he says. And Grumet has used some of the knowledge gained throughout his own clinical practice. “Being involved in medical malpractice cases has improved my documentation and made me much more careful when counseling patients,” he says. 

Heidi Moawad MD, is a neurologist, author of Careers Beyond Clinical Medicine and manages nonclinicaldoctors.com. Dr. Moawad teaches at Case Western Reserve University and John Carroll University in Cleveland, Ohio.

 

 

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