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“To a reasonable degree of medical probability, it was my opinion that the long hours the client spent typing, in addition to the poor ergonomics of his workstation, contributed to him being pre-disposed to a cervical injury sustained after lifting heavy boxes for several days. I was able to back up my opinions with evidence from the medical literature.”

Armin Feldman is a medical consultant to attorneys.

He shares his story and discusses his KevinMD article, “An example of 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. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we welcome back Armin Feldman. He is a medical consultant to attorneys. His most recent KevinMD article was published back in May, “An example of medical-legal consulting.” Armin, welcome back to the show.

Armin Feldman: Thanks, Kevin. A pleasure to be here. Nice to see you again, and happy to talk with you and your listeners.

Kevin Pho: So for those who didn’t listen to our first few episodes together, just go to KevinMD.com/podcast and search for Armin Feldman’s shows, and he talks about his story. But before we jump straight into this article, just briefly give us an overview of what you do as a medical-legal consultant.

Armin Feldman: Sure. So for the past 15 years, I’ve been consulting to attorneys pretrial, pre-litigation, so I’m working on those approximately nine out of 10 cases that the attorneys negotiate and settle. I’ve been training other physicians how to do this for the past 13 years, and other physicians all over the country are now doing this. So we’re helping the attorneys to better negotiate and settle their cases for better value with less attorney time. We’re helping them get the appropriate medical care for their clients. We’re educating them on the medical issues in their cases. We’re ultimately helping their clients to get the treatment that they need and helping them get back up on their feet.

Kevin Pho: So in your most recent KevinMD article, which is titled “An example of medical-legal consulting,” we talk about a specific case. Before getting into the case itself, tell me how this came across your desk.

Armin Feldman: So all these medical-legal consulting businesses tend to be local businesses, so I work with attorneys primarily in the Denver and Colorado Springs area, but really all through Colorado. I was asked to consult on this case by one of my ongoing clients. And by the way, the work that we do is primarily in personal injury and workers’ compensation cases, although a physician in any specialty can learn how to do this and be quite successful at it. This particular attorney does both workers’ comp and PI, and I had done a number of workers’ comp consultations and a number of PI consultations for them, but this happened to be a workers’ comp case.

Kevin Pho: All right. So tell us about the case and what they asked you to do.

Armin Feldman: Sure. So there are 15 or 16, maybe 17, different types of specific services that we offer these kinds of attorneys, and we do a lot of different things. We do medical summary reports with our medical opinions that attorneys use as part of settlement demand letters. We can actually physically sit in and observe independent medical exams and write IME rebuttal reports. We can write reports that answer specific medical questions in cases, which often are helping the attorney to prove up particular medical theories in cases. But this case was a case where the attorney wanted a causation opinion.

So one of the cornerstones of what we do is we help the attorney to prove up the issue of traumatic causation in their clients’ injuries. As I’m sure you’re aware, and most of your physician listeners are aware, talking about causation really doesn’t come up in ER notes, hospital notes, office notes, and op notes, because for treating doctors, typically this just isn’t an issue. But proving up causation is really the cornerstone to helping these attorneys get the care that their clients need. So this attorney specifically just wanted an opinion letter based on the circumstances of the case.

Kevin Pho: So walk us through what you did in this case in terms of trying to find causation.

Armin Feldman: Sure. So here’s how it works, by the way, Kevin, in every case. Obviously the attorney will get a hold of us, or get a hold of me, and we’ll discuss the case by phone. Then typically they will send the medical records. Of course, in the olden days, they came as hard copies; now they come digitally. I’ll review all the medical records, and after reviewing all the medical records in the case, then I’ll typically interview the client of the attorney. Now, 95 percent of the time, I can do that interview by phone, or these days by Zoom. If I really feel I need to eyeball the client, I can interview them in the conference room in the attorney’s office to help clarify the issues, the medical records, and so forth. Then I’ll do whatever medical research is needed, and then I’m in a position to write a cogent report. So that’s what I did in this case.

This is a case of a 29-year-old man who worked as an administrative assistant in a firm. The first thing that happened, and some of this was in the records, but most of it I got from my interview with him, is he reported to me that he was working very long hours. He was sitting at a desk in front of a computer. He mentioned the ergonomics of the way he was sitting and the way the desk was positioned, particularly the way the computer screen was positioned, so he was looking up at an odd angle at the computer screen, and he was doing this consistently for months.

Then his employer gave him the job of moving very heavy boxes with files in them from a storage room where the boxes were. Most of these boxes were stored on shelves that were above this guy’s head, and he was doing this by himself. It took him several days to move these boxes. So he devised this method where he started at the very top shelves, and he would take these heavy boxes off the shelf, he would temporarily, quickly balance them on his head, and then he would move them over to a table. From the table, he put them on the floor, he put them on a dolly, and he’d move them into the area where they were shredding everything and disposing of these old records.

Well, shortly after finishing that job, he started to develop neck pain at the base of his neck, which was radiating down both arms, primarily on the right side, but that was accompanied by paresthesias and actually some weakness in his hand. So he was sent to the workers’ comp clinic where this particular business had an arrangement, and he went through conservative treatment. He was not getting better. He ultimately had a cervical MRI. It was found that he had ruptured discs at C5-6 and C6-7, and he ultimately had to have surgery, and he made a nice recovery.

So the question that the attorney wanted to know was, was this work-related? The next thing to do, obviously, is go to the literature, right? So there were some very good articles. The first set of articles had to do with the ergonomics of the situation and how being in an improper position for long hours in front of a computer screen can cause a spondylosis, which this guy had. It was putting pressure, obviously, on the discs. And then, once he was balancing these boxes on his head, there’s actually an article that talks about this very specific thing in people in certain sports, in certain occupations. If you’re balancing heavy weights on your head, especially if you have this predisposing condition, it can precipitate the ruptured discs. So in the letter I wrote, it was my opinion, to a reasonable degree of medical probability, that with these two factors, backed up by the evidence from the literature, I could make the opinion that yes, this was work-related, and this man was entitled to the treatment that he needed to return to a pretty normal life.

Kevin Pho: So you wrote this report, obviously, for the attorney. Tell me how that influenced the outcome of the case.

Armin Feldman: Right. So in these areas of the law, in most cases, it’s probably best for the client, the attorney, our legal system, and the insurance companies if these cases can be settled, and most of these cases are settled. Now, if a settlement can’t be reached and the case is going to go, in a PI case, to trial, or in a workers’ comp case, to an administrative hearing, then at that point the attorney is going to need medical experts in every area of injury. But for the purpose of negotiating and settling the case, what the attorney needs are typically well-reasoned, well-written medical opinions and reports backed up by evidence from the medical literature. At trial, you need a medical expert, right? But for the purpose of negotiating and settling the case, the way our legal system works is that a physician can render these medical opinions, and they carry weight in the negotiation process. You don’t have to be an expert in this particular field.

I recently did a case where a guy developed diabetes after a traumatic injury, and in the diabetes case, without bringing in experts, but based on the opinions in my reports, these issues were able to be negotiated into the settlement, which obviously raised the settlement amount but also provided the future medical costs for the client to get the appropriate medical treatment.

Kevin Pho: Now, from beginning to end, from when you started reviewing the case, doing research, and then writing a report, approximately how long did that take you?

Armin Feldman: Yeah, that’s a good question. So this case probably was eight hours. As opposed to doing medical expert work, the average case for a medical consultant, a medical-legal consultant, is typically maybe five to 12 hours. And this case, I think the reason it came in around eight hours is it was only a two-page report, right? So the report didn’t take that long to write. Most of the time was spent on the other things, the research, the interviews, and so forth.

Kevin Pho: We’re talking to Armin Feldman. He is a medical consultant to attorneys. His latest KevinMD article is titled “An example of medical-legal consulting.” Armin, what are some of your take-home messages that you want to leave with the KevinMD audience?

Armin Feldman: Yeah, so as you know, and as all of your listeners know, private practice is probably dead. Almost all physicians now are employees. And so what’s the biggest trend among physicians? Many, many physicians, maybe even most, want a side gig that’s all their own, right? Something that can be stimulating, interesting, help people, be lucrative, and something that isn’t dictated by some big corporation or some big hospital system.

So one of the take-home messages is if you really love all aspects of medicine, if you got a kick out of medical school and really enjoy being a physician, and you like to learn and you’d be interested in learning a lot about a lot of various aspects of medicine, if you want something that is all your own, if you want to do something that provides you with some non-clinical work and some additional income, and that’s how most physicians do medical-legal consulting, on a part-time basis. You really need, at a minimum, about eight hours a week in order to do this justice and make it fly. If you don’t have that much time, I don’t suggest you do it. But if you have that much time available and you want something really stimulating, interesting, and rewarding, and the case today is an example of that, it helped the client, helped the attorney, helped our system, and I don’t mean to be too grandiose about it, but in a small way it helped our society, then this is something that you can look into.

Kevin Pho: And for those physicians interested in taking that next step and exploring medical-legal consulting, I know you have some resources for that.

Armin Feldman: Yes. So I have a training program, my medical-legal consulting coaching program. If a physician would be interested in that, they can reach me at MDBizCon, B-I-Z, C-O-N, short for MD Business Consultants, so MDBizCon.com. That training program is available, and they can start any time of the year. Also, starting August the 8th, I have the next run of my online training course. That training course is over eight weeks. There are four modules in the training course, four videos per module, along with downloadable materials and a live Q&A with me at the end of each section. That starts August the 8th, and if you want information about that, same thing, go to MDBizCon.com.

Kevin Pho: Armin, thanks again for coming back on the show and sharing your time and insight.

Armin Feldman: It was a pleasure. Thanks, Kevin.