An introduction to medical-legal consulting [PODCAST]

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“There is a unique non-clinical consulting opportunity any physician can learn to do full-time, as part of your existing practice, or in lieu of retiring.  I’m Dr. Armin Feldman, and I’m a full-time medical-legal consultant in legal cases.  A little over 13 years ago, I started and now, through the years, have been refining a new subspecialty of forensic medicine.   I’ve trained over 1,600 physicians to do this consulting work.

When doctors and lawyers think about lawyers hiring doctors, they only think of one thing: Hiring doctors to be expert witnesses.   It’s important to know, you won’t act as a medical expert, and you won’t participate in medical malpractice cases.  There is a big difference between a medical-legal consultant and a medical expert witness in legal matters.  In fact, they are two completely different things.”

Armin Feldman is a medical consultant to attorneys.

He shares his story and discusses his KevinMD article, “An introduction to medical-legal consulting.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. On today’s show, we have Armin Feldman. He is a physician and a medical-legal consultant. He wrote the KevinMD article “An introduction to medical-legal consulting.” Armin, welcome to the show.

Armin Feldman: Hi, Kevin. It’s a pleasure to be here with you.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Armin Feldman: Sure. I’m trained as a psychiatrist and psychoanalyst, and it turns out that my area of specialty turned out to be mild traumatic brain injury. I wound up owning outpatient head injury rehabilitation clinics around the country, with a treatment program of my own design, and I was very fortunate to eventually sell those clinics. But prior to that time, I testified as an expert witness really more times than I want to remember, on behalf of my patients who were either being cut off of their medical care or offered some pittance of a settlement.

So after I sold those clinics, I was thinking about, well, what could I do next? And I thought, well, maybe what I could do is just answer any kind of medical question that an attorney had in a case. That turned out to be a good thing. It filled a niche, and I’ve been doing this now full-time for 13 years, and it’s now evolved into a new subspecialty of forensic medicine.

Kevin Pho: And how difficult was that transition, being a psychiatrist and now regularly consulting on medical-legal cases?

Armin Feldman: Yeah, actually, I’ll tell you, it’s been a pleasure. One of the things that I’ve found so interesting, fun actually, about doing this kind of work is that, first of all, I work primarily in personal injury and workers’ compensation cases. All that work is pre-trial, pre-litigation, so I never work as an expert witness. I never work in medical malpractice cases. But to answer your question, I answer any kind of medical question that comes up in a case, and one of the joys of doing this work is I’ve learned a tremendous amount of medicine. I’m certainly a more well-rounded and, I think, better doctor for it.

With the attorneys, certainly in every case, almost every case, I need to do medical research, and I get paid to do that research. I’m not in any position to do any orthopedic or neurosurgery, but I certainly would put my knowledge base of spine injuries, rotator cuff injuries, all kinds of things that were outside of my specialty, my knowledge base now, up against anyone. So it’s been a real pleasure to do this kind of work.

And one other thing I’d just say is the other thing I enjoy about this work is I know I’m helping people, and that’s always been important to me, like most doctors, in my work. It’s a non-clinical field where you really get to see how you’re helping injured people get back up on their feet.

Kevin Pho: All right, so let’s transition now into your KevinMD article, “An introduction to medical-legal consulting.” Now, for those who didn’t read the article, can you just walk my audience through it and share why you decided to write it?

Armin Feldman: Even though I’ve been doing this for 13 years, and I’ve been training physicians for the past 11 years in how to do this, and a physician in any specialty can learn how to do this, it’s still a new field. It’s a new field to physicians. It’s a new field to attorneys. So I wanted to put something out there, and I knew through KevinMD there would be a broad ability to have a large number of physicians take a look at it. I wanted to put something out that would give physicians some basic understanding of what this is all about.

Kevin Pho: What are some misconceptions that physicians have when it comes to medical-legal consulting, or some challenges that they face if they want to pursue this line of work?

Armin Feldman: The first misconception is that all this really is, is doing medical expert work, which it’s not. I don’t do any medical expert work. And when I first started, I certainly ran across some physicians who were disgruntled with me, thinking that I was working against them in med mal cases. So that’s the first misconception.

Another misconception is that this might be limited to certain specialties, but really a physician in any specialty can do it.

And I think the third biggest misconception is, well, I’m asked by physicians, “Well, actually, just a hired gun?” One of the great things about being on this side of the fence, that is, working for plaintiff and claimant attorneys, is these attorneys want and value our straight-up medical opinions. They don’t want to be carrying loser cases with their time and with their money. So I am never faced with some secondary gain issues that some other physicians may face, for example, if they’re working on the insurance side.

Kevin Pho: Now, what are some challenges that you yourself face, or other physicians that you’ve seen face, if they want to tackle some medical-legal consulting?

Armin Feldman: The first challenge is you’re making that leap, not only to doing consulting but to doing non-clinical consulting. You have to understand that you’re still using your medical knowledge, you’re still helping people, you’re still doing meaningful work, and fortunately you’re doing quite rewarding and lucrative work as well.

Kevin Pho: Now, can you walk us through a typical case, from, say, beginning to end, to give the audience a sense of what exactly this entails, how long it takes, how many hours it takes, and what kind of questions they’re being asked? Give us an example of a typical case.

Armin Feldman: Sure, I’d be happy to. Let me say this first: You really need about eight hours a week in order to do this business and this kind of consulting justice and make it go.

Let me tell you about the service that I perform most, which is providing comprehensive medical summary reports with my medical opinions that attorneys use in settlement demand letters. The thing that runs a close second is I actually physically sit in and observe independent medical exams done by other physicians, which then puts me in a position to write IME rebuttal reports, if that’s appropriate.

Something else, and I’m getting to the case, something else that I do is I answer specific medical questions in cases. That’s kind of shorthand in attorney lingo for helping the attorney to determine, based on the medical fact pattern in the case, whether a particular medical theory for the case will hold up.

So I had a very interesting case of a man who lived in a mountain town here in Colorado. He was walking home from his son’s bachelor party. He was not intoxicated or anything. He walked past a construction site. It wasn’t marked at all, actually. He fell into a five-foot-deep hole that was unmarked and had rebar and rocks on the bottom. This was in January, the middle of winter, very cold. He hit his head and was rendered unconscious for some period of time. He wasn’t discovered until the next morning. He was found essentially frozen in a fetal position.

He got very, very good care at this small-town hospital where he was taken, and he was taken by Flight for Life to a bigger hospital in Colorado. One of the things that happened while he was being treated for multiple injuries in the hospital is they noticed his blood sugars were up, and he was diagnosed with diabetes, type 2 diabetes. So the attorney asked me, “Can you render an opinion on whether the diabetes was related to the trauma?” Certainly that was something I knew off the top of my head. I did my research on that, and I’ve learned that either physical trauma, interestingly, and/or emotional, mental trauma can precipitate type 2 diabetes in certain predisposed individuals.

He had family, he never, he had good primary care, had good care his whole life. His blood sugars were normal and were elevated after this event. I was able to show through his history and through the literature, and it was my opinion that the accident was the immediate, proximate cause of the onset of his diabetes.

So that would be typical of a case where there was some negligence. An individual was injured, he subsequently got some medical problems, in legal language, there were some damages, medical damages, and the attorney wanted to see if he could pursue the diabetes as a damage in the case.

Kevin Pho: Now, before getting into medical-legal consulting, did you have any special training before you entered this arena?

Armin Feldman: Well, as I said, through my work as a specialist in mild traumatic brain injury, I testified a great deal and got to learn about how medicine is delivered in this corner of medicine, the legal system, the adversarial nature of things. That really was my training ground to then take my own leap into doing this new kind of consulting to attorneys. It’s medical-legal consulting, where you’re working on cases that don’t go to trial. You’re working on those nine out of 10 cases that are negotiated and settled.

Kevin Pho: And how viable is it as a second source of income for physicians? Can just any physician do something like this? Are there a plethora of cases to choose from? So how easy is it to generate a viable source of income?

Armin Feldman: Quite viable. I’ve had the pleasure of training now about 1,600 physicians over the past 11 years. There are physicians all over the country who are now doing this, who have been trained by me. Some physicians do it full-time, others do it in lieu of retiring, but the largest group are physicians who do this as part of an existing practice. It’s actually quite viable. It can be quite lucrative, quite interesting, and it makes a great part-time pursuit in a consulting business that the physician owns. With so many physicians now being nothing more than employees of big corporations or hospital systems, it’s kind of refreshing for physicians to own their own consulting business these days.

Kevin Pho: We’re talking to Armin Feldman. He is a physician and medical-legal consultant, and he wrote the KevinMD article “An introduction to medical-legal consulting.” Are there any misconceptions that attorneys have about physicians that you had to help clear up?

Armin Feldman: I don’t think so. I don’t think so. I think the only misconception is, when doctors and lawyers think about lawyers hiring doctors, they really only think of one thing, and that’s hiring doctors to be expert witnesses. So one of the jobs of the medical-legal consultant is to help educate the attorney as to what a medical-legal consultant can bring to help the attorney, help the client, and help the case.

But what I was saying just a moment ago is I think there are misconceptions about the attorneys, you know, particularly PI attorneys, workers’ comp attorneys, that maybe they’re just ambulance chasers. I found these people to be very dedicated, very smart, really great to work with, and very interested in making sure their clients are properly taken care of.

Kevin Pho: And what’s your take-home message that you want to leave with the KevinMD audience?

Armin Feldman: You know, I read an interesting article just recently: One of every four physicians currently doing clinical work is looking to do some non-clinical work. So if a physician wants to do some very interesting, very rewarding, meaningful non-clinical work that’s quite lucrative, that they can do clearly on a part-time basis, by the way, I’ve worked out of a home office for the entire 13 years that I’ve done this, something that they can easily get into, then this would be something to seriously consider.

Kevin Pho: And how can people reach you?

Armin Feldman: Yeah, thanks. You know, I’ve got a conference coming up. I do a two-day conference, and I have my eighth annual one coming up. It is a two-day crash course in how to do this. In fact, one of the first things that I say is, “When you leave the conference, you will have all of the tools and instruction that you need in order to go home and do this.” The conference is by live stream only, and for interested physicians, go to medlegal2021.com, medlegal2021.com.

Kevin Pho: Wonderful. Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Armin Feldman: Thanks. It was a pleasure.

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