Practice Development for Medical Expert Witnesses
Beryl Vaughan, Consultant
Nationwide
Email go@forensicexpertpro.com or Call (415) 302-9589
Run your practice like a lawyer does.
A Guide to managing a forensic case consistent with methods used by lawyers in the Back office. They’ll thank you for it.
By Beryl Vaughan
Complementary: “serving to fill out or complete” as in “their economies are more complementary than competitive.” Merriam-Webster
Doctors manage their business suited to clinical care. Doctorly. Lawyers do things lawyerly. It might not be able to hear what one another is saying with accuracy or ease.
This is about behavior, not linguistics.
Avoidable being the source of hassle. Whenever effort is needed to interpret what someone else is doing–at the level of common everyday practices–there is room for hassle that is avoidable. You don’t want to be *that* person.
Conducting business like a lawyer is so unusual among forensic experts that lawyers remember, and return to Experts that “get it.”
In fact, it’s harder for a lawyer to do business with you when your top-to-bottom enterprise runs like a clinical practice, right down to parsing time in 45-minute blocks of time.
You can adapt
In my experience, attorneys run a firm with greater efficiency and profitability than doctors.
Taking a page from the attorney’s book might teach you a more cost-effective approach to your own work. So, how do lawyers do it? I’m going to show you with examples about first calls, time management, case-flow, document management and billing.
Keeping clinical notes taught you to be thorough. Your med-legal documentation should reflect the attorney’s own standards.
Things you can do right off the bat
Managing Calls
Returning calls at the end of the day? That’s the habit of a provider who sees patients in a clinical practice.
Attorneys, on the other hand might expect you to act like other business people and take the call, or call back promptly.
Solution: Train a staff member with a script that explains A. when you see patients, and B. precisely the absolute earliest you can return the call. Promise. Keep the promise!
Invoicing
Lawyers don’t care how you bill insurance providers in a clinical practice.
Ask your billing department or bookkeeper to be on track for this very different type of work: as a forensic consultant/Expert.
Tax ID. Ask your lawyer or accountant about the IRS TAX ID. If you obtain one, print it on every invoice. You may be asked for an IRS Form W9 by the attorney because the attorney will need to report to the IRS payments to you. The form asks for either a TAX ID or a SSN. Don’t ever provide your SSN. Get a Tax ID, available on the IRS.gov website easily.
Flags, Post-Its
The most common choice among doctors. Note: flags and post-its fall out and you can’t tell what is most important and why. Color coded tags or another options if t his is your preference. Fig 1
2 Prong Top Assembly
It looks tight and clean, but is awful if you need to pull a page farther down from the top. Fig 3
Redwells aka Buckets
Pro: Lawyers have thick files. Redwells are the choice among attorneys to assemble a single client’s file. Con: You have to have hard copies OR a single page referencing the location of the filename and a summary for future reference. “Do it like a lawyer” is the redwell. Fig 5
Tabbed and Indexed Binder
An indexed, side-tabbed binder makes it easy to find records you’ve reviewed, for reports and in deposition. However, they need shelf space and staff to do the indexing.
For Hard copies, this is my favorite solution. Fig 2
Color Systems
Binders can be color-coded by the case for easy visual access. Without tabs, however, you will have to guess what’s where. Fig 4
MANAGING DOCUMENTS: THE LAWYER WAY
Document management is an acquired skill in law. Done right, it can save hours, even decades (cumulatively).
Eliminating the stress alone is good for your mental health.
Case paperwork is so cumbersome for attorneys, that organization methods are embedded into the brain of every administrative assistant, paralegal, junior associate, and partner.
Paperless in law is tricky; evidence is documentary. A jury will never ever receive a thumb drive.
Here’s how lawyers track a case:
- Keep an index much like the Court Clerk’s docket.
- Documents and the index are either in a chronological list. Bates Number may be used. In the papered world, Bates stamping is done with an amazing rubber stamp. Bates stamping has been in use since 1891. Warning: there is no context to the numbers. They are just an ever increasing page by page numeric.
- Numbered tab (cross-reference Bates Stamp # if that is how the attorney provided the documents to you.) There is paperless Bates Stamping with software applied to the electronic document.
- Adobe Acrobat and Word can both help with organizing records.
- Note: chronological refers to the document’s date. It is a history of the evolution of information. E.g. an older hospital record precedes the discharge order.
The index includes, at a minimum
- the corresponding tab number,
- description of the document, and
- effective date of the document.
The whole shebang is assembled sequentially.
Other Popular Choices
Binders – 3 ring, D rings are easiest to manage (image lower right and upper right). Fig. 4
Redwells or buckets (same thing: an expanding file bucket container. Redwells are universal tools among lawyers. Fig. 5.
Prongs in a cardboard cover (trickier to pull out a page later) (upper right). Fig. 3
Color coding by binder, file, file label, flags–whatever works. Be neat. Be consistent. The color coding creates a quick visual method to organize material. E.g., flags: yellow for medical records, red for key points used in your report, green for legal records, blue for examinee statements–whatever works for you personally. Color coding works on binders, file labels, file folders and more. Fig. 1, 2 and 3 and 4
The goal is to quickly and accurately put your finger on what you need. As a result, it will be easier to produce a report and prepare for testimony.
Attorneys need this level of organization in their own practice. The attorney has to manage documents for a team of attorneys, a variety of expert witnesses, discovery requests and, ultimately, trial. There are legal consequences as well.
Keeping clinical notes taught you to be thorough. Your med-legal documentation should reflect the attorney’s own standards.
E-Tools are discussed in Software and E-Tools for Records Review.
My guide to best practices. What’s in your file? What’s in your attorney-client’s file?
Signed retention contract.*
Detailed invoices.
Everything dated, including the year: yellow pad tear sheets, phone messages (use carbonless duplicates), date-received stamps!
Every communication self-explanatory or explanation attached.
Pleadings and records indexed. (See below)
Emails confirm conversations: “as we discussed by phone earlier today….” “To be sure we’re on the same page, it’s my understanding…,” etc.); signature blocks or handwritten notes identify the author (you or otherwise.)
Events and conversations are recorded in a memo with orienting language. This includes staff exchanges if they’ve had a conversation or email you didn’t. Especially relevant to psychiatry and psychology: staff might experience a call from an examinee that is unexpected, odd or disturbed/disturbing. They should take note–literally.
Attorney communication advising you to stop work, and case resolution, dated and time-stamped, because it will impact case-management and billing.
Being complementary has practice-wide impact.
* The right attorney to draft your retention contract is knowledgeable about Expert Witness contracts.
Because this is so specific, query contracts attorneys before retaining them. Be wary of forms for sale; boilerplate in a unique profession can cause a world of pain.
I have been lucky to work with the only seasoned attorney in this niche I have ever found, Dan Sandman, Esq. He’s been working in the medical expert witness space for more than a decade.
A tale of an obvious fail, and a simple solution.
Law and medicine, a billing disconnect. A micro-view to demonstrate that even the tiniest irritant impacts the success of your practice.
Attorneys gauge their charges in 1/10ths of an hour (6-minute increments.)* Clinical psychiatrists and psychologists record time based on complicated and inconsistent requirements by Medicare, private insurance, Worker’s Comp. and private full pay, including some mandated by law or contract. I’ve found increments of 15-minutes, 8-minutes, 39-minutes, 5 minutes, and rates CPT linked. If you use any of these in billing your forensic work it will be a hassle for your attorney-client.
Here’s why: logically, attorneys routinely tabulate case costs. For a fraction of a second, he or she has to factor in your charges that aren’t tenths of an hour, resulting in a mental pause. A few minutes difference isn’t the relevant problem. It’s the mental pause that creates a negative “opportunity” to (1) give the vague impression you are charging more than you should (even if it was less,) and (2) generate a small hassle.
Note the ever-so-whispered sigh of discontent coming from your attorney-client’s direction.
A better scenario
The attorney asks you to bill your time in 6-minute increments, which you are happy to do. Now you’re no longer a hassle. You’re an accommodator. Better still, shift your billing methods now to 10ths of an hour, (if you haven’t already.) Your practice is moving from the hassle column to the helpful column.
Helpfulness is an asset with financial impact
Don’t underestimate the value of helpfulness as a business asset. I’ve put it to the test and it impacts return business, collections, goodwill and the, more ephemeral, business personality you present your client. Being complementary, a customer service model, accommodating your clients, are all helpfulness.
I can’t say strongly enough: your expert opinions cannot be “helpful.” They are objective, perhaps not helpful at all. Business methods are a different element of your practice.
