How reviewing medical malpractice claims made me a better gastroenterologist [PODCAST]

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“When a patient is dissatisfied with his or her care, he or she can consult an attorney, who will enlist a physician ‘expert’ to determine if a doctor has deviated from the standard of care and whether that deviation caused a negative outcome. Over the past decade of reviewing cases involving medical malpractice, I have identified five categories of medical error, which has improved how I care for my patients.”

Scott Choi is a gastroenterologist.

He shares his story and discusses his KevinMD article, “How reviewing medical malpractice claims made me a better gastroenterologist.”

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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. Today on the show, we have Scott Choi. He’s a gastroenterologist, and he wrote the KevinMD article “How reviewing medical malpractice claims made me a better gastroenterologist.” Scott, welcome to the show.

Scott Choi: Thank you for having me, Kevin. Nice to meet you.

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

Scott Choi: Sure, I’d be happy to. So I started practicing gastroenterology in 2001. I started in private practice in the greater New Haven area, then moved to New York City when my wife matched for a radiology fellowship there, and moved back to Northern Virginia, where I’m from. I’m currently in a nine-person independent GI group. I serve as the CEO of my group and also director of endoscopy for a hospital system. I’ve been an expert witness and consultant for about 14 years. I manage a Facebook page called Gastro Doc MD, and I’m married to a radiologist and have a son and a daughter.

Kevin Pho: Wonderful. And over the past year, during COVID, what are some of the challenges that you face as a gastroenterologist?

Scott Choi: So our practice, like any other medical practice, was affected by COVID. We’re procedural-based, and so a lot of our elective stuff dropped off in the first two months. So we had to quickly adopt policies to make it work. We had pre-procedural testing we had to set up, and we had to get that streamlined. We had to adopt all the COVID policies for our practice, just like any other medical practice, and convince our patient population that they are safe to come back. So a year later, we’re really back to where we need to be as a group, but it took a lot of hustling and group thinking to get us to the point where we are today.

Kevin Pho: And you mentioned in your biography that you also did a lot of work as an expert witness and consulting with medical malpractice cases. How did you get involved with that?

Scott Choi: So I enjoy the process of writing, reading, and speaking. I learned about expert witness work through just kind of a cold call. I think someone found me somehow through word of mouth, and that’s how I started. And I really liked that interaction with a lawyer, and reviewing cases, and learning as I was doing it. So that’s how I started, about 14 years ago. It was never a big deal in the beginning, and I just kind of built my practice on the side through time and just meeting different lawyers. And it really, over the past two years, has become a business. So I have a separate LLC where I do all my work through that, and it’s become very rewarding for me. So that’s pretty much my story with that.

Kevin Pho: Now, did you have any training before going into this line of work, or did you learn along the way? And if you did, how challenging was that?

Scott Choi: Yeah, a lot of it was learning on the fly. I did a lot of cases where, you know, the work was good, but I didn’t really know exactly what I was doing other than my own knowledge. And over time, I was able to craft reports that were backed by the relevant medical research. I consulted colleagues along the way who were doing it, and actually took a course about two years ago through a group called SEAK to become a better expert witness. And there are a lot of resources now that weren’t available when I was around. And, you know, I feel like if you want to get started in this side gig, it’s not as daunting as it was before, because of the resources that are available for you.

Kevin Pho: All right, so let’s talk about the KevinMD article that you wrote. It’s titled “How reviewing medical malpractice claims made me a better gastroenterologist.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Scott Choi: Sure. So I’ve been doing expert witness testimony for over a decade. I’ve reviewed hundreds of cases for plaintiffs and defendants, and there are common themes that have emerged when I review these cases. And I found that by reviewing these cases, I was learning about all the errors that were part of everyday care. And I feel like those errors are often made when we’re rushed and don’t have time to pause and think. And so it really made me pause and think when I practice.

So I grouped these errors into categories. You know, the first grouping I termed the three C’s, which is consent, chart review, and communication, communication probably being the most important. And then number two was poor documentation. Number three, practicing on an island, and what that means is not really consulting colleagues and researching the relevant medical literature online when you have a complex case. And four, failing to recognize when a patient is sick, so really timely intervention and attention to detail. And then five is a properly trained staff, which can really make or break you.

And just a personal story: I was managing a patient who had chronic diarrhea. I did a colonoscopy, did the standard biopsies, and told the patient and his wife, “You know, give us a call in a week. We’ll have the results back.” So unfortunately, the patient had bad diarrhea that week afterwards. I was off, but my staff, being well trained, documented everything, got the patient the results, and made sure that everything was done appropriately. The patient and the wife perceived a lack of care. They reported their care to the state board of medicine, and it landed on my doorstep, to my surprise. But when I looked back, I realized my staff had documented everything correctly, which really protected me from any further action. So I think that fifth point, of properly trained staff, is very important.

Kevin Pho: So up top, in terms of your top tips, is communication. Now, what are some common communication errors that you see physicians making that potentially could lead to a liability suit?

Scott Choi: I think it’s really communicating expectations and showing empathy. I mean, it’s just a simple conversation that you have when the patient hits the door. So I reviewed a case of a patient who had a colonoscopy at an endoscopy unit, and she had a right arm issue where she couldn’t really move it that well. She awakened from anesthesia with the right arm behind her back, and, according to her, it caused some short-term and long-term injury. But even though the standard of care was acceptable, I feel like her main complaints were related to how she was treated when she hit the door. She was not taken seriously as far as her prior injury. So I think a lot of that communication is really just expectation and empathy. And, you know, it seems easy to do, but when we’re rushed or tired, we can forget to do those things.

Kevin Pho: Now, a lot of doctors, of course, across the country, and I’m a primary care doctor myself, we’re under so much pressure to see more patients or do more procedures in less and less time. And, of course, that can open ourselves to potential liability. So what would you say are some of your top tips to help prevent liability in an environment where more doctors are forced to do more in less time?

Scott Choi: Taking time, a couple of minutes, to do those things that are basic and common, to prevent hours of future litigation. And I really just get back to the idea of pausing. Understand when you are rushed, and those settings, I find, are typically at the end of the day or the end of the week. So just being mindful: “Hey, I’m at the end of my day. I’m really tired. I just want to get this last patient seen.” For some reason, that’s typically when you see your most difficult patients, at the very end, and maybe they’re getting worked into your schedule, and you just, you know, don’t have the time or patience to really do things the way you normally do it. And we’re all good doctors, but we’re all human, right? There are certain points. So that would be one thing: end of the day, end of the week.

The other thing I see is hospital-based care. So if you are still doing hospital-based medicine, which we are as gastroenterologists, the acuity and the volume are unpredictable. So it hits you like a wave, and it could be the end of the week once again, and you’ve got, you know, a full schedule, and they add on two ERCPs, and you’re not really thinking things through the way you should. And so you don’t document things well, you don’t communicate the risk to a patient well, and so those are basic things that get lost when we get busy. But I think taking the time to pause and recognizing where your pitfalls could come is the most important.

Kevin Pho: We’re talking to Scott Choi. He’s a gastroenterologist, and he wrote the KevinMD article “How reviewing medical malpractice claims made me a better gastroenterologist.” Scott, I want to take a step back and talk about the liability system as a whole. There’s a perception among physicians that the liability system is out to get them, that there are a lot of frivolous malpractice lawsuits, for instance. Now, after your years as an expert witness and reviewing hundreds of liability cases, what are some misconceptions about the medical malpractice system that you want to convey to physicians?

Scott Choi: I think one of the misperceptions is that, you know, there are a lot of doctors doing a lot of bad things out there, and there really aren’t. In fact, in most of the cases, there is no deviation from the standard of care. And even if there is, it’s hard to show that the deviation from the standard of care led to a bad outcome. So I rarely find fault in many of the plaintiff cases, and I do work on both sides, so I do defendant work as well, and also in those cases, I don’t find much in the way of malpractice.

Now, the other thing I would say is, for an expert witness, it’s not up to us to determine whether someone is negligent or not. It’s really just a deviation from the standard of care. And so for a doctor to approach that standard, it is usually something pretty obvious. You know, it’s not so subtle. So I don’t think we as doctors need to practice in fear of being sued all the time. I think that’s kind of something that hangs over our heads when we practice: “Oh my God, I’m so scared of getting sued.” It’s really just doing the basics, like I outlined in my article: the idea of communication, of consulting others, of recognizing when someone’s sick. Those aren’t things that are really complex, but I think it’s the times that we’re busy that we’re most vulnerable to doing things that are going to sometimes end up in a courtroom or, you know, in adjudication.

Kevin Pho: Now, from a side business standpoint, I know a lot of doctors have an interest in doing medical malpractice consulting and becoming an expert witness. Now, is that a viable opportunity for a side business for physicians?

Scott Choi: I think early on, you’ll find it’s hit or miss, because you just haven’t built up your reputation and you haven’t developed, you know, a catalog of lawyers that know you. And so you tend to use agencies and vendors, and it can be frustrating in the beginning. I experienced that; the first five years, it was very sporadic. But I think with time, and getting to know the lawyers in your area that develop trust in you, it can become quite a rewarding side gig.

Now, you know, I would say that at this stage, where I’ve been concentrating on building it, it is definitely helping, especially when COVID hit and our practice suffered. There were a couple of months there where, you know, I wasn’t making my salary like I was, so I needed something to supplement it. It just seemed at that time, as you may have heard from other experts, that there was a whole list of cases that were waiting on backlog that were just, you know, being presented to experts. So I found that this past year has been very fruitful for the expert witness business.

And I would say that if a doc is interested in starting in this area, to consult other docs that are doing it. And there’s a Facebook group that I’m on. It’s called Physician Expert Witness, and it has about 1,500 members that you can get advice from, other experts. Actually, there’s an Expert Witness Academy that’s run by Dr. Gretchen Green. I think she’s been on your show, and she actually takes you from day zero to getting your business up and running, and she has an online tutorial, which I think is awesome. So there are ways you can get started. It can be profitable.

Is it enough where you can retire? I know academics and other docs who, later in their career, decide, “Hey, this is what I want to do. I can supplement my entire salary by doing this.” I’m not there yet, and I still practice GI and love it. So, you know, it’s a nice way for me to be engaged and make some side income.

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

Scott Choi: Other than your spouse, always have a plan B. I think that the plan B that you have should fit what you like to do and who you are. So my side gig as an expert witness and consultant not only helps my salary, like I talked about, but it really helped me pursue my passions of writing, reading, and speaking, helping me and hopefully other docs practice safer and better for their patients. So that would be my take-home message.

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

Scott Choi: Thanks, Kevin, for having me.

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