jeff-willis_1_01-28-2026_090207: I look at all four of those components of the case.
Analyze them and then using the experience that I've gathered doing this for the
last few years, bring that back to the attorney and say, Hey here's why I think
it's probably a case, probably not a case,
Sam: Hi everyone, and welcome to another episode of EMPlify.
I'm your host, Sam Ashoo.
Before we dive into this episode, I want to say thank you for joining us.
I sincerely hope that you find it to be helpful and informative for your
clinical practice, and I want to remind you that you can go to ebmedicine.net
where you will find our three journals, Emergency Medicine Practice, Pediatric
Emergency Medicine Practice, and Evidence Based Urgent Care, and a multitude of
other resources, like the EKG course, the laceration course, interactive
clinical pathways, just tons of information to support your practice
and help you in your patient care.
And now I want to introduce our special guest for this episode, Dr. Jeff Willis,
who happens to be one of the expert voices behind safeguarding charting documentation
support that will stand up in court, an EB medicine video course with practical
courtroom tested strategies to help you chart with confidence and reduce
risk, and also an emergency physician.
And so let's jump into that episode.
sam_1_01-28-2026_100207: Welcome back to the podcast everyone.
Today we have a special guest with us, Dr. Jeff Willis, who is
here to share his experience and his knowledge about his craft.
And I'm excited to have him on the podcast, and I'm gonna actually let
him introduce exactly what he does.
Jeff, thanks for being on the podcast.
Tell me about what you do what you did.
Now you, you worked in the emergency department for how long?
jeff-willis_1_01-28-2026_090207: About 20 years, I guess, if you include residency.
Yeah.
So I, I finished residency in oh six and I did my last
clinical shift in October of 23.
So 17 years after residency.
sam_1_01-28-2026_100207: Great.
And then tell me now what you do.
jeff-willis_1_01-28-2026_090207: So now I do, I don't really know what you call it.
I call it medical legal consulting.
Primarily I work in the medical malpractice arena, doing pre-litigation
analysis for plaintiff medical malpractice attorneys, helping them determine
whether or not cases should move forward.
And then also, I do a lot of expert witness search and referral for both
plaintiff and defense attorneys, helping them find expert witnesses for cases.
And I do that in all specialties, not just emergency medicine.
So, across all of medicine, there's a few things I don't do just because it's so
specialized I, I really can't add value.
But yeah, that's what I do all day long, every day.
sam_1_01-28-2026_100207: And you have your own online expert retainer website
where people can register if this is something they're interested in doing.
Is that right?
jeff-willis_1_01-28-2026_090207: Yeah, absolutely.
Yeah.
I launched expert retainer last year, probably six to nine months ago, and so
it's, that part is very fresh and new, but that is an online platform that
directly connects testifying experts with attorneys both plaintiff and defense.
It's free for experts to sign up and it's completely anonymous.
So there are no public facing profiles.
So if it's something that physicians are wanting to get into or if they've
been in it for a long time and are maybe in academia and don't necessarily
like their name out there, as someone who does expert work this gives them
access to cases that they otherwise might not have without advertising
or marketing themselves in any way.
always free and completely anonymous for experts.
sam_1_01-28-2026_100207: All right, and this is such an
interesting area of medicine for me.
Tell me how did you get into doing this kind of work?
jeff-willis_1_01-28-2026_090207: So I stumbled into it, right?
So I, did emergency medicine, like I said, for about 20 years total.
I was the medical director of a level one trauma center seeing
about 90,000 patients a year.
So, did that for many years.
And then I finished off my career in a rural critical access
hospital, little six bed ER, 24 hour shifts through and after COVID.
And as I was finishing that up, I realized that my time in emergency
medicine was probably done.
I, I'd enjoyed it, but I, I wasn't really that excited by it anymore.
And so I just started looking for other things to do.
Really, I just stumbled on this idea.
Like a lot of ER docs, I was sued a couple times in my career and going
through that process, I realized that both the plaintiff's counsel and the
defense counsel, I didn't feel really understood the medicine very well that
they were litigating this case, but really didn't have a grasp of what
was going on and what was important.
so I had originally intended to create a consulting business where I
was helping defense firms understand the medicine better and defend
physicians and quickly learned that there's not much of a market there.
I think what a lot of us don't understand is that these defense firms, they
work for insurance companies, right?
They work for the malpractice insurance companies, or they work for the hospitals
directly or somewhere in between, depending on, you know, if they're
self-insured and so the attorneys don't have much control over their budget
and what they spend their money on.
So
If they want to hire a consultant for help, they don't just have
an open budget to do that.
They have to go back to the insurance carrier and ask permission every time to
hire a consultant or to hire an expert.
And so that layer of friction made it very difficult for attorneys who were
even interested in hiring me on as a consultant to get that work done.
And so I quickly learned that the better way to both make a business of the medical
legal consulting as well as still be helping physicians was actually to work
with plaintiff attorneys and look at cases in pre-litigation before anything
was filed and make sure that the cases that were moving forward actually had
viability and actually had merit to move forward, rather than the frivolous
cases that we hear so much about in the throwaway journals and, that we talk
about online and that sort of thing.
And so I really just locally here went to a local attorney and said, Hey.
Mind if I take a look at a couple cases?
And he was like, yeah, sure, why not?
And I did.
and he said, wow, that was really helpful.
And neither of the cases that I looked at moved forward, and he was very thankful
and saved him a lot of time and money and expert retainer fees and litigation.
And he started using me quite a bit then started referring me to other folks.
And then I said, okay, I can make a business of this and hung up the
stethoscope after about six months of dabbling without a client base
and just said let's give this a shot.
If I'm gonna do it, let's, let's give it a shot for a year and see what happens.
And over the course of a year, it grew and grew.
And now I've been doing it for a couple years and have clients
in 29 different states, and I'm about as busy as I can handle.
sam_1_01-28-2026_100207: Because you do reviews in pre-litigation, you don't
have to be licensed as a specialist in whatever state is that the case
occurred in or even be in the specialty for the case that's in question.
jeff-willis_1_01-28-2026_090207: Exactly.
Yeah.
So I am a consultant, so everything that I do is behind the scenes.
It's confidential work product with the attorney.
So I'm not a testifying expert.
You know, To be a testifying expert in virtually every state, you have to
be an active clinical practice, or at least 51% clinical practice or clinical
practice within the last three years.
Every state has its own set of rules for who can be a testifying expert.
but yes, I am disqualified from being a standard of care expert.
Now, technically, I could still be a causation expert where
you're testifying on causation.
I'm actually in one case like that right now where I am actually a testifying
expert, but nothing to do with standard of care, just describing causation and how
A leads to b more of a science expert, if you will than the practice of medicine.
sam_1_01-28-2026_100207: Interesting.
And so for our listeners purposes, if you're a causation expert as you just
mentioned, you're testifying that you know this event A could have led to event
B, but you're not really touching on the practice of medicine as far as who did
what or what labs they ordered or whether or not there was malpractice involved.
jeff-willis_1_01-28-2026_090207: Exactly.
So let's take one step back, Sam.
So for a medical malpractice case to have merit and viability,
it has to have four components.
It has to have what we call duty breach causation and damages.
And so duty is usually just a check box, you know, was there
an established physician patient relationship of some kind.
So that's usually a check box.
'cause there almost always is if it's, you know, if the case is brought and there's
a, physician or nurse or someone involved usually there was a duty to provide care.
The standard of care is what a similarly trained healthcare provider would do
in similar clinical circumstances.
so that's your standard of care, right?
So did this physician in this case, it can be anything but let's say physician,
did the physician practice in a way that a similarly trained physician
would practice in that setting?
And that setting can be, in a rural critical access hospital or in a
academic center or on an airplane, you know, whatever that may be.
Right?
Like given the situation presented to them, did they practice reasonably?
That's standard of care.
Then there are, there's damages, right?
What harm did the patient suffer?
And that can be emotional, physical, financial, death, a whole host of things.
And then the thing linking those two is causation.
So did the breach and standard of care did the thing that that physician do
incorrectly actually lead to the outcome.
And you have to have all four of those components to
have a viable case to pursue.
And that's why so many cases don't actually move forward.
Sometimes there's a clear duty, a clear breach, and even clear
causation sometimes, but the damages are just so small that it's not
worth for the attorney to, pursue.
So that's what I do every day, is I look at all four of
those components of the case.
Analyze them and then using the experience that I've gathered doing this for the
last few years, bring that back to the attorney and say, Hey here's why I think
it's probably a case, probably not a case, not my decision to make, but based
on everything that I know and have looked through on the records and my experience,
this would be my recommendation.
sam_1_01-28-2026_100207: Interesting.
And then if that case ends up moving forward to court, would you ever
need to show up there and testify to your opinion regarding causation
or would somebody else do that?
jeff-willis_1_01-28-2026_090207: Nope, not at all.
No I'm completely behind the scenes and that allows me to be completely
candid with my clients about everything, Hey, this is a terrible case.
Don't touch it.
And if they elect to go otherwise, that's fine.
But you know, that way everything that I say is, confidential
uh, confidential work product.
But no, none of the cases that I do any type of pre-litigation work on
would I ever be a testifying expert.
Now, there are some clients for whom I will stay on the matter for
the duration of the case and be a consultant throughout the case and
help them look at depositions and help prepare for depositions and, assess,
expert reports, that sort of thing.
But I don't do a ton of that.
Almost everything I do is in pre-litigation.
sam_1_01-28-2026_100207: So interesting.
And then you're not limited to just emergency medicine.
Then in that arena, you're comfortable reviewing all forms of medical cases that
one of your clients might bring to you.
jeff-willis_1_01-28-2026_090207: Right?
Absolutely.
So, as an emergency physician, we're familiar with and interact with just
about every specialty in medicine.
And, the more that we've broadened our expertise over the decades, right?
We've sort of become the experts in lots of things.
And through those interactions with consultants and other specialties
and just through the practice of emergency medicine, we're comfortable
enough being able to figure it out.
Right.
We figure it out on the fly.
And so over the course of the last three years I've become better and
better at assessing other specialties.
So, are there things that I'm not great at?
Like, can I determine whether or not an orthopedic surgeon used the exact right
angle on the implant that caused X, Y, Z?
But.
I have a network of about 900 experts across the country, and if there's
something I don't quite understand, they're more than willing to give me a
curbside consult and I can, give them the, just like the pitch you would
when you call the consultant, right?
You know, tibial plateau, fracture, stable, no compartment
syndrome, blah, blah.
Same kind of thing, right?
I can call up one of my testifying experts and be like, Hey man, here's what I got.
What do you think?
He'll give me the five minute blurb and I can add that in.
And then also the research capabilities that we have now, even just compared to
when I started doing this three years ago.
Through AI and, open evidence and UpToDate and all of those
resources, I'm really able to dissect down and, get a really solid
evidence-based answer for my clients.
And I do it in a way that is much more cost efficient than having a retainer
paid to a testifying expert, right?
Because a, retainer to a testifying expert.
Let's stick with the same example, A orthopedic surgeon, right?
You're probably not getting an orthopedic surgeon to look at a case
for less than five grand, you know, and it, might only be a couple hundred
pages of records and op note, or two, but those guys charge a lot, right?
'cause their time away from the OR is, expensive to them.
And most of those cases don't just involve one specialty.
There was probably an ER doc involved.
There was a hospitalist, and then there was an orthopedic surgeon who missed the
compartment syndrome, all of those things.
So it's much more cost effective and time effective for these attorneys
to bring it to me and say, Hey, Jeff, look at everything on a whole, look
at the ER care, the nursing care, the hospitalist care, the post-acute care,
look at everything, come back and gimme a general idea of what happened and
whether there's anything to move forward.
sam_1_01-28-2026_100207: Wow.
And now tell me in the years you've been doing this.
Is there a, pattern that develops?
Like how often are you looking at a case and going, oh yes, this is
a clear, yes, this is a clear no.
Or did the majority fall in a gray zone and then you're kind of giving
an opinion and you're not really sure.
How often is it very clear.
jeff-willis_1_01-28-2026_090207: I would say it's very clear on either
side, I would say about 80% of the time
sam_1_01-28-2026_100207: Wow.
Okay.
jeff-willis_1_01-28-2026_090207: and of that 80%, let's take a step back.
Of the cases that I review, I would say about 90% don't move forward.
There are cases that never get filed and.
I would say probably about 80% of those are very clear because so many
times patients or more often family members bring cases to an attorney.
And they're upset.
They want answers or they want justice.
They just, they don't understand what happened.
The communication wasn't good.
It was an unexpected outcome, and the attorney just doesn't
know where to go with it.
The story, the family or the patient is telling sounds horrible, right?
They did this to me.
Can you believe it?
No, I can't believe it.
That sounds terrible.
And then you get into the records, you're like, whoa, whoa, whoa.
The family wasn't even there.
Right.
you know, the family wasn't even there when things were going on.
This was what the patient said, this was what their decision was like.
There's nothing here.
Right.
So those things are extremely clear.
And then sometimes it's the other way around.
Sometimes it's just completely obvious.
Somebody came in with severe abdominal pain, out of proportion
to exam, the lactate was 12.
And they called it a, renal colic because there was a stone
floating around, in the kidney.
But everything else looked okay and they sent him home and missed, bowel ischemia.
Like sometimes you look at it and be like, there's nothing
I can do to defend this, bro.
It's like, it, it is what it is.
Right?
And so, and then those cases that are fuzzy.
Honestly, most of those don't go forward either.
'Cause attorneys just really don't want fuzzy cases 'cause they just
don't play well in court and they're really expensive to litigate.
And they're gonna drag on forever and it's gonna cost 'em a fortune.
And their likelihood of winning is low.
sam_1_01-28-2026_100207: Wow.
So that's a much higher percentage of cases not moving forward or a
much higher percentage that even that you're recommending not move
forward than I would've anticipated.
jeff-willis_1_01-28-2026_090207: Yeah.
Yeah.
So, the actual statistics across all plaintiff firms for every 100 cases
that come into a plaintiff firm, and they get them all sorts of ways.
They get them through referrals, web forms, walk-ins, phone calls, all sorts
of ways that the plaintiff firms get referred potential cases for every 100
cases that come through their door.
they filter out about 90 of those and just say, there's nothing here.
'cause it's the people that walk in and say, they didn't give
me enough pain medications, or This scar was ugly or like that.
There's just, there's no case there.
They filter those out.
Right.
And then of those 10 that they decide to investigate where they get records,
they look through them themselves, they send them off to experts or guys like me.
Of those 10 only about one or slightly less than one get filed.
sam_1_01-28-2026_100207: Hm.
jeff-willis_1_01-28-2026_090207: So the true data is that about 1% of
cases that people bring to a plaintiff attorney ever actually get filed.
Which I did not understand or believe until I started doing this work.
Because that's not what we're taught.
That's not how we, not how we interact with each other right?
sam_1_01-28-2026_100207: Yeah.
jeff-willis_1_01-28-2026_090207: They'll sue you for anything.
Look at this case, and you always hear the story of, can you believe
this guy lost this case, et cetera.
Yeah.
And there's those fringe cases.
But those are truly fringe cases.
It really is only about 1% of cases that are brought in that ever get filed.
And so it's much smaller than we're led to believe and certainly that I ever
believed for the years I was practicing.
sam_1_01-28-2026_100207: So interesting.
And so by the time a case is filed, say I'm the practicing physician and I'm
now being sued, and I've been notified already that this lawsuit has been
filed by the time that's occurred, it's already been examined by maybe someone
like you in pre-litigation, and then they've already got maybe some expert
witnesses who are willing to testify and have already reviewed the case.
So multiple parties have already looked at this and found merit
before this was even filed.
Is that right?
jeff-willis_1_01-28-2026_090207: Typically it's state dependent.
Some states have like certificates of merit that, before you can file the
matter, you have to have a physician that has reviewed the case in some
way or the other, and signed off on a certificate of merit saying
that , this has merit to pursue.
Now in reality, there are physicians that will sign certificates of merit
for any case that you want them to sign.
Like there are bad players out there that are just getting paid to
sign off on certificates of merit.
It's not common.
Right?
But it happens.
These are the fringe cases but it does happen.
There are some states that do not require that, that you can just file.
But any plaintiff attorney who knows what they're doing is not going to
waste time filing a case without having a standard of care expert
review the matter because they're gonna be wasting their time and money.
So yes, in general, if a case gets filed, someone within your specialty
has looked at it and said, yeah, there's probably something here.
sam_1_01-28-2026_100207: All right.
And now I'm curious.
So in the time you've been doing this, have you noticed common patterns
to cases that do move forward?
One of the things that I enjoy doing is actually learning from these things.
So, I have been involved in medical malpractice cases myself and it
was a highly unpleasant experience.
So, for someone in your position who is looking at many of these on a regular
basis, have you noticed a pattern, maybe things that you could say, oh,
this is a very common mistake that's made and maybe we could teach some
people about it and see if we could prevent this from occurring again.
jeff-willis_1_01-28-2026_090207: Yeah, absolutely.
And it's hard to quantify.
But ultimately communication and documentation of the communication
is absolutely everything.
Let's focus on emergency medicine because obviously that's what I know best and
what people are listening, know best.
And the one thing that we're always taught in our documentation is
typically revolved around coding, right?
And it's changed over the years, but here are the things that we need, right?
And it used to be this many points in your HPI, this many points in
your review of systems, this many points in your physical exam.
And it created bloated, terrible charts that were terrible
for medical-legal defense.
Right those things are gone, right?
You can still have a level five chart.
Without all these HPI review systems, exam documentation, but now we've
added all this other garbage, right?
Social determinants of health.
So that has bloated up the chart.
What really matters is a well-documented history.
Like what did you know when the patient came in, who was there
right document who was there?
Was it was the patient obtunded and you were just talking to
EMS and doing the best you can.
Make sure you write that down.
grandma alone and from the nursing home and the family showed up later?
Write that down and write down who told you what and what they told you.
And more than anything, it's your medical decision making, right?
What I see so much is that we're so busy and we're so glad to have a disposition
and we're so ready to move on to the next patient that we ignore the importance
of describing why we did what we did, Most of us are phenomenal physicians.
We're doing a good job, we're doing the right things, and it's in our head
like, we know why we did it, but if you don't write down why you did it,
guys like me don't know why you did it because it might not be the right
decision, we make mistakes all the time.
It just, it is what it is, right?
But if your logic and thought process at the time was reasonable.
You're not gonna get sued.
And if you do get sued, you're not gonna lose.
So getting back to your original question, sorry, I went off on a tangent there.
The primary question is communication and making sure everyone
understands what's going on and why.
The patient and the family member, and making sure that's communicated.
Communication between team members.
So often I see poor communication between ED physicians and admitting
hospitalists ED, physicians and consultants, hospitalists and consultants.
Physicians and patients.
Physicians and nurses and things just aren't communicated well because we
live in an electronic health record.
We do everything through the EHR now the phone calls and
conversations that happen aren't nearly as robust as they used to be.
And things aren't communicated well between caregivers and things get
dropped and things get lost along the way
sam_1_01-28-2026_100207: Yeah.
jeff-willis_1_01-28-2026_090207: that's the primary thing that I see.
We were taught this through residency and, and everywhere after shift
handoff, shift work is awful, right?
For that, you hand off and just say, Hey, check the CT.
If it's negative, send them home.
You get that check out and you're like.
Sounds good, and it comes back and it's mostly normal, and
you're like, what do I do?
Get your ass back in.
You see the patient, you go put your hands on the patient.
If you are the one clicking discharge, if you're the one
dispositioning a patient, you talk to that patient before they leave.
You never just click discharge.
That is never the plan.
If the repeat, you know, X, Y, Z is normal, they can go home.
That should never be your plan.
Your plan is to go back and talk to the patient.
'cause you're the one that's discharging them.
You don't have to take a full history.
You don't have to do a full physical.
You go talk to 'em, you tell 'em the results.
You find out what questions they have.
You find out what questions the family members that have showed up in the interim
Now have, because they always show up right before discharge when
the patient's walking out the door and they're like, what the hell?
Why are you sending Steve home?
And you're like, I don't know.
My partner told me when a CT was negative, it's time to go.
So, hit the road, Jack, never the answer.
It's always communication.
Communication is the biggest pattern that I see.
And lack of communication between caregivers, between patients and
providers and family members.
sam_1_01-28-2026_100207: Yeah, so interesting because shift handoff
really in the 20 years of practice, I can recall was never good.
And always involved.
Yeah, I've ordered this.
Just, if it's normal, send them home.
Or you know, I guess it progressed at one point too.
I've told the nurse if this result is normal, they can go home.
So the nurse will only come tell you if the result isn't normal.
And then sometimes I'll get the nurse come up to me and hand
me a normal report and say.
Is this normal?
And I'll say, why are you asking?
And she'll say, well, because,
jeff-willis_1_01-28-2026_090207: Yeah,
sam_1_01-28-2026_100207: because,
jeff-willis_1_01-28-2026_090207: That's a loaded question.
sam_1_01-28-2026_100207: Dr. X said this patient could go
home if the study was normal.
And I went, oh, okay.
Are you about to go and put that we had this conversation in your nurse's
notes and say, I ran this by Dr. So-and-so and the study's normal.
So he said they could go home 'cause I don't know anything about this patient.
Let's go find this patient and figure this out.
So, yeah, checkout has always been a problem.
And really if you're listening, this is one more fair warning that the way
you're doing it is probably not great.
And, you know, we're all overwhelmed and busy But an appropriate sign
out is worth its weight in gold.
And yeah, unfortunately, the person you check it out to is
gonna have to do something.
You have to go home.
We all know you have to go home and it's okay.
I'll just go back and talk to the patient.
But then on the flip side, I'm gonna have to know something.
About the patient to go in and talk to them and the family and counsel.
So I've gotta read the chart, I've gotta figure out why these tests were ordered.
I've gotta figure out what they all showed.
I've gotta corroborate that the plan was a good one and,
jeff-willis_1_01-28-2026_090207: Right.
sam_1_01-28-2026_100207: and that indeed if the study is normal, then
yes, I agree they could go home.
And then I've gotta go and defend all of that in front of the
family and the patient after I've decided that I agree with it.
So, yeah, that none of that is just a quick here.
If this urine is negative, send them home kind of thing.
jeff-willis_1_01-28-2026_090207: Right.
That's why 12 hour shifts are they convenient and is
that what most people do?
Yeah, but that's why 12 hour shifts are just terrible, because at the
end of a 12 hour shift, you are not your best by any means, right?
None of us are.
And you need to leave
you, you can't be staying 13, 14 hours, especially if you're
coming back the next day.
sam_1_01-28-2026_100207: Yeah.
jeff-willis_1_01-28-2026_090207: And that, that's why 12 hour shifts in
modern emergency medicine are just so much less safe than the, Maybe
the nine hour shift where you stop picking up new patients after eight.
And I realize it's just not viable in most community EDs where they're
single or maybe double coverage.
And it's difficult, but it's just, it's a setup for badness.
And the other pattern I see is bounce backs,
sam_1_01-28-2026_100207: Hmm.
jeff-willis_1_01-28-2026_090207: and ED bounce backs, whether that be within
24 hours or 72 hours, they always get more workup, even if they don't need it.
Just do something else and describe why.
give a good description of exactly why they were here before and why they're
here now and what happened in the interim.
Because it's rare that I see a medical malpractice case that
revolves around one ED visit.
If it's ED related, it's almost always the second or third ED visit
where they just kept coming back with maybe related complaints or similar
complaints, or the same complaint.
And there wasn't enough of additional workup done or enough
at least thought process put into the second or third visits.
And so if somebody's bouncing back, do something else.
sam_1_01-28-2026_100207: Yeah.
And that, thought process needs to get documented.
They gotta write it down.
jeff-willis_1_01-28-2026_090207: Yeah.
You have to always write down, you've got plenty of space in the chart.
Now you can have a three word physical exam.
You can have zero review assistant.
None of that matters.
It's the history and the medical decision making.
That's it.
That's the only thing that matters.
You don't even have to write down all the labs or like, none of that stuff matters.
'cause we all know you looked at it, right?
But you have to write your medical decision making.
sam_1_01-28-2026_100207: Now along those lines, when you get a case that somebody
wants you to review for, pre-litigation, you mentioned the term like 200 pages.
Is that about average for the amount of just volume of information you're
having to review for a typical case?
jeff-willis_1_01-28-2026_090207: Oh, I wish no, it's the modern electronic
health record is so bloated now and most cases involve at least one admission and
some primary care visits and ED visits and specialist visits and maybe rehab.
So I would say my average is probably 2000 pages or so,
is the average.
I've had as high as 30,000 pages.
Now, granted, you're not reading every single one of those pages, right?
Of those thousand pages, 300 of them might be nursing flow sheets
where they're, checking off all the, random boxes that mean nothing.
You still have to filter through and figure out which pages are important.
But no, the electronic health record is unbelievably bloated, which is one of the
reasons that I've been able to create a business out of this because an attorney
gets 3000 pages and it's difficult for them to understand which of those pages
have any relevance to the matter at hand
sam_1_01-28-2026_100207: Yeah.
jeff-willis_1_01-28-2026_090207: 'Cause it can stretch over 10 years worth of care.
And they're like I don't know, Jeff, figure it out.
So that's where I've, created a business.
Really.
sam_1_01-28-2026_100207: I mean, even in the course of a typical ED visit with
electronic health records, there's tons and tons of data being input, maybe not
really medically relevant, but it's being input by nurses and techs and others.
So , for an ED visit, if you were to get the records, you're
getting all of that dumped into a document and sent to you for review.
It's like every person who touched the health record in that timeframe and
everything that they documented in every box they checked, and then you've gotta
decide what's relevant and what's not.
jeff-willis_1_01-28-2026_090207: In general, yes.
So.
When an attorney submits a medical record request on behalf of a patient, they can
request it in lots of different ways.
Like, just give me the progress notes or just give me the op note,
or give me everything you have from this time period to this time period.
sam_1_01-28-2026_100207: Mm-hmm.
jeff-willis_1_01-28-2026_090207: Electronic health records are not
built to produce paper and PDFs, right?
They're built to be an electronic health record with which you interact.
The law is still designed around paper and is still designed around pages.
So health records have to produce PDFs and so it is just a vomiting of information.
And so to your point, let's take one ED visit, right, like one
standard ED visit for appendicitis.
In general that's gonna be about 150 pages.
Seems to be about what gets produced from registration to labs,
to imaging to progress notes, to nursing notes, to vital signs, to
ER timelines, to all those things.
And then the one thing that I don't do but a lot of nurses are doing this work, are
navigating and, analyzing audit trails.
And so your electronic health records can all produce an audit trail.
And that's thousands of pages of an Excel file that show literally every click
that you made in that patient's record.
So if you jumped back and looked at a primary care visit from a year before
just to see, hey, what meds were they on that audit trail will say, Jeff
Willis was looking at that office note for four seconds at exactly this time
sam_1_01-28-2026_100207: Wow.
jeff-willis_1_01-28-2026_090207: And it will know everything that you clicked.
So if you end up in a deposition and we're like, I had no idea that
they were on coumadin, you know or I wouldn't have recommended they have tpa.
And they're like, well, you, you clicked on the chart and you were in it for 30
seconds and you clicked on the medicines.
sam_1_01-28-2026_100207: Hmm.
jeff-willis_1_01-28-2026_090207: How'd you not see it?
Like it knows.
It knows everywhere you click it knows if you're jumping back and forth to the
track board and looking out in the waiting room to see what's sitting out there.
it knows everything that you're doing.
It knows which computer you looked at the imaging file on.
So if you say, Hey, I, I went to CT with the patient and I looked and I saw, that
they had, free air in their abdomen.
And so I called the surgeon from the CT room and got it started.
But actually during the time you said you were doing that, you
were in another patient's chart.
It knows that.
So all of that is recorded.
And that's becoming a big part of litigation as well.
Because , it's just something you can't hide from.
It's, raw data and it's there,
sam_1_01-28-2026_100207: So have you had cases that you've reviewed
where that trail has become relevant?
jeff-willis_1_01-28-2026_090207: not that I reviewed the trail
itself, but peripherally and.
I will make recommendations.
You need to go get the audit trail and find out when this happened
because what I'm seeing and what's written down doesn't make sense,
sam_1_01-28-2026_100207: Okay.
Gotcha.
jeff-willis_1_01-28-2026_090207: something is not lining up and then I will receive
the feedback of, hey, yeah, you're right.
We had the audit trail analyzed and.
He was in this patient's room doing this thing when he
said he was doing this thing.
So, yeah, no, it's definitely relevant and it's only going to become more
relevant the better AI gets at analyzing those audit trails and
putting pictures together of what was happening and breaking that down.
It's, only going to be more relevant.
sam_1_01-28-2026_100207: Wow.
Wow.
All right.
And then have you ever had the opportunity to review cases where, I
mean, it's a pretty common occurrence where, we're working in the emergency
department, we've consulted someone on a case, and, there's perhaps some
disagreement about what the disposition should be or what the next step should
be between me and the consultant.
And in my mind, there's always been a question, you know, documentation
is great and we gotta document more, but at what point it becomes helpful
or unhelpful to dive into the weeds about, well, I asked the consultant
about this and they're recommending X, but I think it should be y and we
disagreed, and how we handled all of that.
How much of that is helpful to document from your standpoint?
jeff-willis_1_01-28-2026_090207: I think it's helpful.
Interestingly, no no I've not seen a case where the disagreement was
that clearly outlined having been an emergency physician as long as I
was, and understanding how we phrase things and what we really mean.
I do see lots of examples of where they have softened that conversation, right?
Where, call the hospitalist for admission and after our discussion they feel
the patient is safe to go home, or we feel the patient is safe to go home
sam_1_01-28-2026_100207: right.
jeff-willis_1_01-28-2026_090207: And then, you know, you're left to make the
disposition plan or something like that.
it's typically softened for whatever reason.
Probably just 'cause you're colleagues and, such, but, I think that's probably
okay, but understand that you're the one dispositioning the patient and,
if you feel strongly and you're not swayed by a consultant's opinion,
they need to come see the patient
sam_1_01-28-2026_100207: Hmm.
You know, one of the other things I've commonly run into is, we'll consult
somebody, but instead of them showing up, their PA or nurse practitioner
will show up and then redo their own history and physical and transmit
that information to the consultant who then makes the determination
based on purely those findings.
And sometimes that's conflicting with what I expected to occur.
Has that ever been an issue in any of the cases you've reviewed where you
know, a consultant was called but never actually saw the patient and it was a
third party, maybe a nurse practitioner or a PA involved and there wasn't good
communication physician to physician.
jeff-willis_1_01-28-2026_090207: More times than I can even count.
I would say of the cases I review 80 to 90% of them probably have
an advanced practice provider involved in one way or the other.
Because nearly every hospital based consultant has an advanced practice
provider that's doing the majority of their documentation, doing the majority
of their patient interviews, primary exams, histories, all of those things.
Where I see it a lot is in the physical exam and the general gestalt
of the patient and how they look and what needs to happen next, right?
Because your advanced practice provider shows up, does maybe an exam.
There's an exam documented, and seems like they want to make less work for
the let's just call it what it is, make less work for the surgeon or the
cardiologist or the busy person that they have to report this to and tends
to soften things and make them seem not as sick as they are when maybe you have,
as the ED physician have recognized that there's something not right and
that tends to delay or slow care.
And it's not until the surgeon shows up and does the, oh shit we should
have been on this six hours ago.
You know?
But I see that much more often than I'd like to see.
sam_1_01-28-2026_100207: All right.
In your hindsight telescope, if, you were going to recommend like, ways to
avoid that trap I'm trying to think in clinical practice ways that have tried
to avoid that trap have been things like , when the nurse practitioner or
PA comes down, I'll go find them and have a conversation with the nurse
practitioner and PA and say, hey.
Oftentimes what I've found is I told the consultant X, the consultant
sent you but told you Y. And now I'm coming to tell you it's actually X.
It's not Y, and this is why I think it's X. Or this is appendicitis and
this is why I think it's appendicitis.
And the surgeon told you to come down and see this person with belly
pain, but I want you to know, I think it's appendicitis and I think
they should go to the OR so, if you think otherwise before you go talk
to your attending, come find me.
that's a conversation I've had with nurse practitioners and PAs before.
, But I haven't documented it.
It's just so that I say, look in my chart I said, I think it's appendicitis and
if you think it's something different.
I want you to come tell me before you have a conversation with the surgeon.
'cause then I don't want to go and undo everything that you are about to do.
But I don't really know if that's the best approach.
Like, have you ever reviewed a chart and said, oh, this is a really good example
of how they could solve this problem?
Or how, what, what good communication would be?
jeff-willis_1_01-28-2026_090207: I could not have said it better myself.
That would absolutely be best practice.
Have I ever seen that properly documented?
No, but that is exactly right.
'cause you, you know exactly how it works.
Right?
And you gave the perfect example of, yeah, CT is equivocal,
but I think it's an appie.
You tell that to the surgeon.
The surgeon tells the PA, yeah, they've got a belly pain down there.
Go see what it is.
CT is okay.
And then all that gets lost in translation.
But exactly what you said to do would absolutely be best practice.
But document it.
If you did it, document it.
sam_1_01-28-2026_100207: So it would have to be something like, consulted surgeon.
I think it's appendicitis.
Caught the nurse practitioner.
Had the same conversation with nurse practitioner.
I think it's appendicitis.
Like write both of those things down.
jeff-willis_1_01-28-2026_090207: Yep.
Absolutely nurse practitioner evaluated the patient in the emergency department.
I spoke directly with the nurse practitioner, shared these findings.
And also it's not just so much to cover yourself, but also the nurse practitioner.
He or she doesn't know the history, right?
I mean, they don't know what you know, and in general, they are very
receptive to guidance and very receptive to you helping them and kind of
shepherding them along through that case because it speeds their process up.
And maybe they agree with you, but when they got the call from the surgeon.
They know what the surgeon already thinks.
And so it's nice to have somebody back them up in what they already think.
So it's all communication, man.
It's all talk to the people, right?
Don't just click the button and be glad that the patient's gone.
Which we all are, right?
Dispositions are great.
but they're going upstairs one way or the other.
Right?
You know, I'm done, but you're not, you know, you gotta communicate
. sam_1_01-28-2026_100207: Yeah.
Yeah.
So interesting.
I've even had nurse practitioners or PAs turn to me and say, yeah,
if that's the case, I need you to write this in your chart.
So when I go to present, I can say X, Y, and Z. And I go, okay, I'll
go put that in my chart right now.
And , sometimes it's just a telephone game.
I tell the consultant one thing.
They tell the nurse practitioner or PA something else, and then a med student
comes down and then it's like, now we're just playing a telephone game.
Three parties later, they've gotten a different message
jeff-willis_1_01-28-2026_090207: and don't forget talking to the surgeon through
the circulating nurse why they've got their hands in somebody else's belly.
How painful of a conversation is that?
They're like well hold on, lemme put the phone up to his ear, like, oh my,
like, okay, this is gonna go great.
Because he is, he's really listening to me,
sam_1_01-28-2026_100207: Yeah.
jeff-willis_1_01-28-2026_090207: he's saying CT belly.
And that's all he hears and calls the PA. And then that's all he got, right?
And so I hate, hate those conversations.
sam_1_01-28-2026_100207: yes.
Yeah.
So, okay.
So let's play the devil's advocate for that conversation.
If I'm having that conversation with the consultant, again, we have to be
collegial and this is somebody I'm gonna have to work with again in the future.
So, any benefit to saying something like, consulted Dr. X discussed with
him while he was in the OR does, is that a relevant piece of information?
jeff-willis_1_01-28-2026_090207: Yeah, no, absolutely.
, And there's nothing wrong with that.
I mean, it's, his or her job to be in the operating room.
Right.
And it's nice that they took the time to answer the phone and didn't make you wait
two and a half hours to call you back.
I think that's fine, but that must be followed up with when
you know PA Steve arrived.
I also spoke with Steve and shared the history with Steve and this is
the plan that we think is reasonable.
So you have to document what happened.
But no, I think that's perfectly fine.
And gives a guy like me or the.
Let's say you're an expert and you're reviewing a case,
wouldn't you wanna see that?
Wouldn't you wanna see how it went down and not have to guess?
sam_1_01-28-2026_100207: Yeah.
jeff-willis_1_01-28-2026_090207: It's so much easier to say whether
everything was done properly.
If, you're not having to guess , you don't want your testifying experts
and your consultants and your attorneys guessing what happened.
in with details.
You don't want them to fill in with.
sam_1_01-28-2026_100207: Yeah, for sure.
All right, I have one last question.
What do you do when you are reviewing a case and you see that, for example, in
our case, the emergency physician has documented one thing perhaps the PA for
the consultant has documented something completely different, maybe even contrary
in their history or physical exam, as far as findings go , is that something
that has occurred regularly and in your mind, how do you resolve that?
jeff-willis_1_01-28-2026_090207: Yeah, it occurs all the time, mostly
because of templates that are still out in existence and people using like
exam templates and review of systems templates and those are terrible.
Just get rid of 'em.
I mean, you don't need them for coding anymore, so just
get rid of exam templates.
I mean, give me one exam, but, belly soft, non-tender, done like fine, don't care.
Right.
We know what that means.
But you don't need like a full exam template unless it's, relevant.
So, that's primarily where I see , the difference in
objective things like an exam.
Historical differences I see a lot as well, and it's all situational, right?
Sometimes it's because the history by one person is being obtained directly
from the patient, and then the next person, the family member has shown up
and they're getting the real history.
Or sometimes, like for us, right?
Our history comes from EMS, who got the history from the nursing home staff, and
then the family shows up a day and a half later and gives the real history.
And so there's a big, big difference there.
So there's nothing that I can say that, you know, how do I reconcile those two?
You just have to stand way back and look and say, okay, here's how
the history progressed over time.
Does that progression make sense or did doc Doc one, just not listen and
completely blank, which happens a fair amount in the ED, right?
Like, oftentimes we'll anchor to a diagnosis before we walk in the room based
on the chief complaint and the fact that we already know this patient 'cause we've
seen him five times already this year.
And so you anchor to a diagnosis and so you don't pay much
attention to what they're saying.
Later on down the line, this is the one time, you know, hot potato, right?
sam_1_01-28-2026_100207: Hmm.
jeff-willis_1_01-28-2026_090207: where that history actually made a difference
and you wrote the wrong thing down.
And I guarantee I'm guilty of that at some point over my 20 years.
We all have been, but that's a landmine from a med-legal standpoint.
sam_1_01-28-2026_100207: Okay, good.
One last question before I let you go.
If there is someone listening who is interested in doing this kind of work
as well what's the best avenue would you recommend, like, doing it like
you did, finding a local attorney and maybe getting connected with someone
to get some experience first, or how would you recommend they go about
developing a experience profile?
jeff-willis_1_01-28-2026_090207: So there's two pathways.
If I had this all to do over again, because I was never an expert witness
or a testifying expert before I started doing pre-litigation work.
So I was at a bit of a disadvantage because I knew nothing about the industry
and I had to teach myself quickly if I had it to do all over again after I
had been practicing for 10 to 12 years, maybe 15 years 10 to 12 years probably.
I would've started reaching out to attorneys and marketing myself as a
testifying expert in emergency medicine.
And I would've done some of the actual work as an expert witness first, to
learn the industry and just to get a feel for how it works because that would've
much more easily transitioned me into the pre-litigation work that I do now.
But you have to be clinically active to do that, right?
So if you intend on continuing to be clinically active for another, five
years or so and you want to do this, I would take an expert witness course.
There's lots of 'em out there.
Seek has a course.
There's a physician named Amy Fogleman who has a course.
Gretchen Green has a course.
There's several different courses.
And I think, most of them you can use CME dollars for, which is nice.
So you can take expert witness courses.
I would do that first.
Get on a couple databases, you can join my platform and get a few cases under
your belt and, see, if you like it.
That's what I would do.
If you're at the end of your career and like, you know what, I really don't want
to go into that, but I, would kind of like to do some of this pre-litigation work.
If you are in a region that is large enough to have five
or six plaintiff firms.
Just make some phone calls or emails and don't be afraid of 'em and
just say, Hey, I've been practicing emergency medicine for 20 years, or,
however long I find this interesting.
Can I look at a couple cases for you?
I'll do it for free.
and just try it out.
Don't ask for money first, just ask 'em if you can look at a couple cases
and they'll be more than happy to let you do it and find out if it's something
you enjoy and then get some practice and get good at it, and then decide
if you wanna make a business of it.
And then that's a whole different, starting,, starting a business that's
a whole, a whole different game.
Marketing and all that nonsense, which I knew nothing about
and still probably don't.
But that's a whole different game.
sam_1_01-28-2026_100207: All right, and then tell me about your platform.
Where can people find it and what's required?
jeff-willis_1_01-28-2026_090207: Yep.
So, you can go to my platform at expertretainer.com.
And the only thing, if you want to sign up as an expert witness, it
takes literally about five minutes.
You can have as little information as your name and your email or you can add as much
information as your cv, your fee schedule, a short one paragraph blurb about
yourself a headshot as much as you want.
No matter what you put into the platform, it will never be public facing.
No one will ever know that you're there.
The only way that people know that you exist is once an attorney submits
a need or expert request need, you will be notified if it's within your
specialty, and then you can click yes, I'm interested, or No, I'm not.
And if you click yes, I'm interested, then your name and email and any
information that you've entered goes directly to the attorney and
they reach out directly back to you.
But there's never anything public facing, so you can do all of this
incognito and I know how some colleagues feel about this kind of work.
And if you want to dabble in it a little bit and, not have anyone
know that you're doing it, this is a very good way to do it.
sam_1_01-28-2026_100207: Awesome.
Well, Jeff, thank you very much for being on the podcast and for sharing
some of your experience and wisdom.
Really, hopefully everybody who's listening was able to take away
something about improving their practice and maybe reducing their risk.
And if you're open to it would really love to have you back on.
We can continue the conversation and I can plug away at more things we
could do to improve our documentation and practice in the future.
jeff-willis_1_01-28-2026_090207: Yeah, absolutely.
I could.
I could talk about this all day long, man.
So anytime.
sam_1_01-28-2026_100207: Awesome.
Thank you so much.
jeff-willis_1_01-28-2026_090207: All right.
Take care.
Sam: And that's a wrap.
Thanks for joining us for this episode of EMPlify.
I hope you found it informative, and I want to remind you that ebmedicine.net
is your one stop shop for all of your CME needs, whether that be for emergency
medicine or urgent care medicine.
There are three journals, there's tons of CME, there's lots of
courses, there's so many clinical pathways, all this information at
your fingertips at ebmedicine.net.
Until next time, everyone, I'm your host, Sam Ashoo.
Be safe.