3 Things You Should Know About Being An Expert Medical Witness

Expert medical witnesses are critical to the US legal system.

Q: What gear were you in at the moment of the impact?   A: Gucci sweats and Reeboks.

We all have our favorite lawyer joke. Lawyers have their favorite doctor joke. That aside, probably the most common non-clinical job for doctors is participating as a consultant or expert witness in medical malpractice or product liability cases (Disclosure: I've done this several times representing both plaintiffs and the defense in both medical professional liability and product liability cases).

There are several "how to's"http://expertpages.com/news/how_to_be_a_successful_expert_wi.htm and seminars http://www.seak.com/ and www.medicalfusionconf.com that will give you plenty of information and guidelines. Here are some tips :

Make sure you know what you are signing up for

The engagement process goes something like this. A lawyer has been presented with a case. They need a domain expert to render advice about the facts of the case and the issues involved. They ask you to review the records, spot any inconsistencies, red flags or discrepancies, and then render an opinion, in the  case of a medical malpractice action, about whether there was a violation of the standard of care or not. Remember the four elements of torts...duty, breach , causation, and damages?

So far, you are a confidential consultant. Once officially designated as disclosed or designated, you become an expert witness.

Be sure you understand who pays for what and how much and when

Typically the lawyer who hires you pays the fee and any retainer. Fees for medical legal consulting vary from person to person. How much you charge will depend on how you value your time and expertise, whether you charge extra for depositions and court appearances, and what the market will bear. During the initial conversations with a legal office, be prepared to answer 1) Are you willing to review a case for plaintiffs and defendants, 2) How much do you charge and what are the terms, and 3) Have you done this before and how often ?. You should not be embarrassed by how much you charge and should be able to justify the amount during testimony.

The legal definition of an expert is somewhat different than the medical definition of an expert.

While the medical definition of an expert usually refers to a leading researcher, thought leader or award winning scientist, the legal definition of what qualifies someone as an expert differs. http://legal-dictionary.thefreedictionary.com/expert+witness  In general, qualifying an expert involves demonstrating that the doctor has the necessary qualifications , training and experience to render an opinion on the facts and issues presented by the case. Typically, the minimal requirement is board certification in a given specialty or sub-specialty.

You might be reluctant or hesitant about being an expert witness or consultant. The choice is yours. I do it because I learn a lot about the literature and the standard of care, it makes me a better doctor and raises my radar about the mistakes I  might make and prevent, it supplements my income, and, I feel both sides are entitled to their day in court with knowledgeable experts at their sides. Finally, the world is round and some day I might be asking for your help.

I invite you to share your experiences and comments.

Non-Disclosure Agreements For Physicians

Non-disclosure agreements are common in medicine. Here's what you should know.

When I was asked to sign my first NDA (or CDA, confidential disclosure agreement), I freaked and had a lawyer look it over. He added or subtracted a few things around the edges, adding nothing very substantive, but I felt better. Since, then I've become experienced with the language and generally don't consult a lawyer unless I see a glaring red flag. I compare it to surgery...see one, do one, teach one.

As long as we are talking about not showing yours if you don't show mine, here are a few other tips:

1. NDA's can be unilateral or bilateral. Take for example executing an NDA between myself, an inventor who wants to work with a medical device company to further develop my product and the company, that wants to disuss my product. In that case, we signed a biliateral NDA.

2. I've been presented with NDA's that vary in length from a single page to 17 pages. The basic disussion points have to do with the definition of "confidential information", due diligence and retained rights, term and termination (when and how the agreement ends), and other CYA legalese topics like severance and assignability.

3. All contracts are negotiable. You might feel powerless or insecure about negotiating terms because of your inexperience, but be sure to make your concerns known. For example, being asked to keep something secret for 10 years is unreasonable. Most of the time, contracts stipulate 3-4 years as the time window.

4. If there is a breach of contract, your medical professional liability insurance in unlikely to cover the costs of any legal proceedings. Get an umbrella liability policy that will cover you.

5. If you have ideas or intellectual property you want to protect , and you want to share your idea with others,I'd have a lawyer draft the agreement and have clients sign it before you give away the recipe for the secret sauce.

6. In general, without an NDA in force, talk about the "what" not the "how"

7. Be sure you have the authority to sign an NDA. For example, if you are a faculty member at a major research university, you generally don't have the authority to represent the university when it comes to agreements concerning intellectual property that the university might own or potentially own. I get the signature of the Associate VP for Technology Transfer to sign it. The Supreme Court has recently agreed to hear a case concerning a faculty assignment of IP to Stanford, so stay tuned.

8. If you are in doubt, spend a few bucks to get someone to hold your hand.

I'd be interested in hearing about the experience of others.

Zoo MD: Another Nontraditional Medical Career

It really is a jungle out there.

All of us have had cases we never forget. Mine was a 12 year old female who I was asked to see in consultation for noisy nasal breathing.

It seems the patient was unable to talk about her problems, so her caretaker, dressed in a loud green coat with bright white buttons, told me that for the past several months she had noticed the patient had left sided noisy nasal breathing, irritability, and a change in appetite. The patient, Sally,  had no previous history of surgery or similar complaints and was taking no medications.

The patient's past medical history was otherwise unremarkable.  She was not sociable, usually playing by herself. She had an extensive family history and review of symptoms was otherwise non-contributory.

Physical exam showed a hirsute, overweight, female with abnormally long fingers and toes. She had significant craniofacial dysmorphosis. On ENT exam, I could hear noises coming from her left nostril. The remainder of the exam was normal.

My initial clinical impression was some kind of symdromic abnormality or an intranasal cause of her problem.

Because the patient was uncooperative, we scheduled her for fiberoptic nasopharyngolaryngoscopy  under general anesthesia. Endoscopic exam was normal except for a shiny white object in her left nasal cavity that I extracted without difficulty. The object was a button that looked remarkably similar to one on the coat of her caretaker.

Follow up with Sally's primary care physician indicated complete resolution of Sally's nasal obstruction, but the foreign body removal did nothing to resolve her hirsutism or abormal facies.  But, then again, I wouldn't have expected it to. You see, Sally is a Pongo pygmaeus abelii, a Sumatran Orangutan at the Denver Zoo, where I am a consulting otolaryngologist in the primate division.

The convention wisdom has always been that 98% of the DNA between chimps and humans are the same. It turns out that is not true. It's only 95% similar and there are many other differences. For example, apes have 24 pairs of chromosomes, not the 23 pairs in humans.

Despite that, I am amazed at how similar the endoscopic anatomy of our forebearers is compared to humans.

Orangs are an endangered species with only 9200 left in the wild, so it is unlikely that I'll be reporting a case series.

I've provided a lot of uncompensated care in my career, as I'm sure almost all you have, and I've never regretted helping those who couldn't pay the freight. This was no exception. The patient seemed extremely grateful and , every now and then when I make a housecall to see her at the Zoo, I can't help think Sally remembers me and occaisionally gives me a smile. Every now and then she'll offer me a banana in exchange for her care.

My nontraditional medical career, consulting to the Zoo, has been a kick. And here you thought your last clinic day was a zoo.

10 New Year's Physician Blogging Resolutions

I've decided to make some changes.

Blogging is new to me and, as my friends and editors will admit, I've made a lot of mistakes. So, with a chance to wipe the slate clean in the new year, here are my biggest blogging resolutions.

1. Don't use pithy, clever, one word titles for posts that a search engine will never find.

2. Keep the length of the post right. Not too long, not too short, juuuust right.

3. Know when to comment and when to post.

4. Don't write posts like term papers. They are conversations with my online readers, not a treatise

5. Set the hook in the beginning. Each post , like your elevator pitch, has 3 parts: the hook, the meat, and the call to action.

6. Invite comments from my readers.

7. Connect the dots by using streaming services and links from other social networking sites to boost readership.

8. When an idea comes, write it down. I won't be embarrassed by a 3:52AM time stamp on the posting

9. Give my readers detail, not abstract musings or theory. They read my posts to get answers

10. Thank my readers .

I encourage your comments, appreciate your interest and look forward to our conversations in 2011 at Freelance MD.

I wish you a healthy and prosperous Happy New Year.

Freelance MD: 30 Days In

Freelance MD was launched one month ago today. There have been a few changes.

Greg and I launched Freelance MD after meeting at the Medical Fusion Conference in Las Vegas at the beginning of November. We'd already had a number of discussions about the need but I wanted to talk to physicians outside of my usual cosmetic medicine contacts and listen to what they wanted, and gauge their reaction to what we were thinking about. Well, whatever doubts I had about the need for this type of community were quickly assuaged. I could see that the opportunity to provide a very broad, horizontal platform that focused on providing physicians information, products and services was growing and we were in a unique position to address it.

The conference ended on the 7th and on the 17th we launched Freelance MD in it's current iteration. Now, one month later, we've been astounded by it's growth and it's resonance with physicians. I've been involved with a number of online communities but the speed with which Freelance is growing is more than unusual, it's astounding. Here are a couple of notable milestones from our first thirty days;

• We've grow to almost twenty authors that include experts on topics as wide ranging as physician entrepreneurs, non-clinical careers, wealth planning, investing, and writing. We've passed 100 posts from our own authors, had our first guest post. It's actually been difficult for Greg to get back to everyone as fast as we'd like—but we're trying.
• We're growing fast. Take a look at the growth curves below. For a community site that's just one month old and hasn't launched with an existing network this is phenomenal. As a point of reference, when I started Medical Spa MD it took me more than a year (maybe two) to reach this number of unique monthly visitors. Fast growth often comes with volatility but this trajectory is better than we could have hoped for.
     
  

  Freelance MD traffic From November 17th — December 17th, 2010

  
  10,319 page views an more than 2,000 unique visitors in the last 30 days and 1,500+ unique visitors so far this month! ; )
• We're sticky. Take another look at the image above and you'll see a wide gap  between unique visitors and page views. This shows that the average visitor views slightly more than 4 pages each time they visit. For anyone who knows something about user behavior online, this is a key indication of how 'sticky' a site is and how interested visitors are in the content. The fact that we're seeing 5 page views per visitor literally blows the doors off of most sites, especially since there are 20 blog posts that are visible on the first page. This indicator—even more than the growth curve—is something to get excited about since it denotes that readers are heavily engaged.
• Readers are recommending us with 500 Facebook likes, more than 1,000 stumbles, and an unknown number of tweets. (You can do us a solid by helping out here and posting a recommendation to our favorite social networks.) If you look up in the right corner of the site you can see the number of times that we've been referred through popular social networks. (The Twitter number will change because it relates to the specific page you're on, not an aggregated total. That's why you'll see changing numbers under different posts.) We've also just added the new LinkedIn 'share' button. To be honest, I'm not sure exactly what to think about what's going on there since I've never seen numbers like that appear so fast before.
• We've partners with some fantastic organizations. You'll notice that our Select Partners list is growing and we're also excited about that. With partners like Health 2.0, ExpedMed, and the Medical Fusion Conference, we're tapping in to a number of other communities and events that we can add value to.
• We've expanded our community to include Freelance MD groups on LinkedIn, Facebook pages, Twitter feeds... You can connect with the community through any or all of these. (You'll get bonus karma for connecting with them all.)
• We're building out promotions for some of our partner organizations. If you haven't visited the ExpedMed CME Polar Bear Adventure to investigate your adventurous side or thought about attending the Health 2.0 Spring Fling in San Diego, you should take a look.

The numbers above are pretty impressive, but we're not going to be resting on our laurels any time soon. There's too much to do. We'll undoubtedly have some issues as we grow, but we're committed to pushing through these obstacles and making Freelance MD the single best community for action-oriented physicians on the web.

In the very near future we'll be adding memberships, downloads, a non-clinical physicians jobs board and even more authors to the mix.

If you're appreciative of our efforts here on Freelance MD, please give us a Facebook 'like', share us on LinkedIn. You can also ask a question in our forums. Better yet, help us out and write a guest post or leave a comment to let us know what you think.

The 5 Top Needs For Medical Travel To Succeed

5 things will need to happen before medical travel gains enough traction to be a real player in healthcare.

Despite the research reports, eco-devo white papers, industry analyses and industry marketing hype, medical travel/medical tourism is still an early stage industry looking for the right formula for success.

In my view, five things will need to happen before medical tourism and global healthcare referrals get real traction: 1) the creation of a sustainable business model, 2) global healthcare IT connectivity and integration, 3) a physician generated global healthcare referral network, 4) a global regulatory, legal and socioeconomic ecosystem, and 5) patient awareness and acceptance.

The creation of a sustainable business model

Industry players including payors, providers, partners and facilitators are still looking for the the most successful way to make a profit and scale the business. With an eye towards what happened when Expedia disrupted the travel agency business, participants understand that margins for travel arrangement services are thin and that there is high price elasticity for global medical care. Few have found the magic key that fits the lock that opens the doors to profits. Payors and employers are hesitant to accept the value proposition without a better way to reduce their risk and demonstrate tangible, meaningful cost savings to their insureds and employees.

Global healthcare IT connectivity and integration 

The US national healthcare information architecture is evolving. Eventually, the network will be a portal to the world and will allow for seemless, secure, confidential transfer of personal health information thus assuring some continuity of care and quality improvement. Similarly, it will take a while for health information systems to evolve in host countries that can talk to non-host systems. Short term solutions, like personal health records or mobile health applications, might fill the void temporarily.

A physician generated global healthcare referral network

Most medical tourism  models  connect patients to healthcare facilities, bypassing doctors in the initial stages. Docs will get in the game when the model feels better, and they have the resources and ability to make referrals to consultants directly, like they do now. Given the rise of international members, professional medical societies should be more proactive in building global referral networks, rather than seeing them as threats to existing domestic members.

A global regulatory, legal and socioeconomic ecosystem

The barriers to adoption and penetration of medical travel are many and include liability, reimbursement, quality assurance and impediments to continuity of care. As healthcare goes global, so will the rules and regulations that facilitate or obstruct its use. How about a World Trade Organization Treaty on Medical Travel?

Patient awareness and acceptance

According to the most recent polls, 50% of consumers understand the meaning of the term "medical tourism", leaving home for care. Social network buzz and media stories find the medical travel story sexy, particularly given all the noise about escalating healthcare costs and consumers, employers and payors are hungry for more information. Moving patients from awareness to intention to decision to action, however, will take more time and use innovative marketing approaches directed towards granular market segments.

Global medical travel  is projected to be a $1B industry by 2012. While the bones are in place, it wll take more time to add the flesh. Until then, to quote Karl Mauldin, people won't leave home without it.

Leaving Your Clinical Position for the Corporate World...

So you've done it. You're leaving your clinical post to enter the corporate world.

You’ve gone through the career transition phases - from dreaming about the possibilities of a different work-life, to doing your research, networking, making plans, taking action, and finally landing the new job that you’ve been hoping and planning for. You’re thrilled (but nervous), your family is supportive, and your colleagues (the ones you care about) are happy for you and perhaps even a little jealous. Congratulations! It’s onward and upward from here.

Now that you’ve got your start-date nailed down and are taking whatever actions you need to do to wrap things up at your current position, you are ready to go, right? Ready to make that change happen and start your “new professional life”, with all of its opportunities and open doors…. Correct? I hope so!

But for many physicians who have made the move from the clinical into the corporate world, there is a learning curve that they are not expecting, one that can – if they are not quite prepared for it - side-swipe them when they least expect it.

This “learning curve” is a combination of new career orientation – things you would expect you need to know, such as:

• How the industry and your specific company works
• Expectations for your role
• Specific training on methodologies, tools, processes

But it also includes more unspoken expectations, things which have tripped up many a physician who jump into a corporate role without fully understanding the critical success factors – and how they measure up to these - for anyone in the corporate world. These include, but are not limited to:

• The fact that they, the physician, are now measured on – and only as successful as - how much value they bring to the organization on a daily basis – i.e., in things such as added revenue or decreased costs

• That they will be expected to act in a team capacity and to demonstrate highly effective skills in leadership, accountability and communication

• That they are well-skilled in building and maintaining interpersonal relationships with people at all levels of the organization, and have a highly honed level of professionalism

• That they have the basic proficiencies expected within a corporate environment – including technical (e.g., MS Office – Word, PowerPoint, Excel, MS Project, Email, etc.), project / time management, effective presentations/speaking, people management / mentoring, teaming, etc.

Often it is these pieces of the puzzle which can “make or break” a physician’s venture into a new career path and the success of their new position. At minimum these unspoken expectations – and the physician's ability (or inability) to tackle them - can cause high levels of stress during the transition, and make the learning curve steeper and longer than it needs to be.  At worst it can derail an individual's ability to be successful and/or their longevity within the new organization.

Being prepared for this learning curve – both the new career orientation and unspoken expectations – is literally your first transition task. And it should happen long before you enter the door of your new company on day one. With any job or career change you want to hit the ground running, and set yourself up for success from the beginning

So how do you do that? What are the steps you can take to make sure that you have the most successful “First 100 Days” on your new job as possible?

Next time I'll bring you some tips and strategies for making this critical time a personal and professional success... stay tuned.