Episode Transcript
[00:00:01] Speaker A: You're listening to the Doc Lounge Podcast. This is a place for candid conversations with the healthcare industry's top physicians, executives and thought leaders.
This podcast is made possible by Pacific Companies, your trusted advisor in physician recruitment.
Welcome back to another episode of the Doc Lounge Podcast. I'm your host, Stacey Doyle, senior director of marketing at Pacific Companies. And today we have an exciting conversation.
[00:00:30] Speaker B: Lined up with a guest who has.
[00:00:32] Speaker A: Truly mastered the art of blending clinical expertise with the legal world. Dr. Jordan Romano is a board certified internal medicine physician with over 14 years of clinical experience at some of the nation's most prestigious institutions, including Massachusetts General Hospital, Harvard Medical School, and Dartmouth Hitchcock Medical Center. But beyond his incredible work in patient care, Dr. Romano has carved out a unique niche in the world of medical malpractice law. With nearly a decade of experience as a highly sought after medical expert witness, he provides expert testimony and consultation to law firms nationwide, helping to shape the outcomes of complex legal cases, while also mentoring other physicians looking to step into this space.
[00:01:17] Speaker C: Thanks for having me.
[00:01:19] Speaker B: Thanks for joining us. So we have, you know, obviously our audiences are full of residents and fellow physicians. Tell us a little bit, how did you decide to get into medicine and what brought you to internal medicine as your specialty?
[00:01:35] Speaker C: Medicine was sort of going after the highest, you know, terminal degree you can.
That sounds kind of morbid to say a terminal degree, but, you know, it was sort of a challenge. It wasn't something I, as a child, I had dreamed of being a physician that, you know, I don't have some grand.
I didn't have some grand plan. It was more of the adventure of a challenge. And I enjoyed science and so that's what I went after.
[00:02:05] Speaker B: Nice. Love that. Well, it sounds like you've definitely practiced at some, you know, really kind of impressive places anywhere. You know, we talked about medical, you know, Harvard Medical School, Dartmouth Hitchcock. Tell us a little bit about, you know, your experience there and how that shaped your approach to patient care when you, you know, you were a practicing physician.
[00:02:27] Speaker C: Yeah, I was fortunate enough to get into Dartmouth for my internal medicine residency. I would say there's nothing like getting your. Your face kicked in. It was, it was trial by fire. I mean, you certainly, I would say, push yourselves. I mean, that's sort of the lesson I would give. I was, in hindsight, I was out of my league at Dartmouth.
I matched there, but the individuals that I was there, I have a lot of respect for my colleagues that I went through training with. It's sort of like in a military sense. It's like Going through boot camp. So those folks you have a bond with probably for life, just because you went through intense training and stressful times and happy times with them. But it was, it was a tough time. I mean, these were, you know, the nation's best and brightest. That, I guess I was part of that group, but I was certainly out of that group. I was not the strongest person. But after, you know, it's a three year residency, so by the end of it, I was definitely a lot stronger than when I, when I started. And some of that came through suggestions based on the leadership there at Dartmouth. They had plugged me into having a faculty mentor and going to see a psychiatrist. And there was all this wraparound services to make me the best physician I could possibly be. So I would say, I don't know how many programs are doing those sorts of things these days.
We're pushing almost 20 years since I did my residency. And what I would say is the medical training at its core is about the same, but how you implement it and the wraparound services that are provided certainly have changed over time. You know, we weren't using smartphones when I was in my residency. And so, you know, obviously that has changed things a lot, just in, in and of itself. But I would say pushing myself and being in instances where you are with individuals who are practicing, you know, at the top of their game and at the best of the best in the nation and in the world is definitely something that I'd show up to work every day and there's, you know, what do they say? The only easy day was yesterday. Right. Like it was a tough environment. But that's what made me who I am and the physician that I am now tell us.
[00:04:48] Speaker B: I know there obviously is a nationwide shortage of physicians and there really is a concentration around, you know, internal medicine and family practice. Give a little insight there about what, you know, what made this exciting for you? I know a lot of other people listening might be trying to figure out, okay, what do they want to focus on when they're in medical school?
[00:05:10] Speaker C: Yeah, you know, my decision between the way I saw it was medicine or surgical. Like I was either going to do general surgery or internal medicine because I really wasn't sure what I wanted to do beyond the initial residency. And so I wanted to pick either a procedure based track or a cognitive based track.
I was on a rotation in rural Pennsylvania and it was the weekend and I was on call. This is a rotation for me. And I was living, essentially living in hospital housing on the hospital campus. And it was like a Friday at like 3 in the morning. And I saw the attending, blurry eyed come in to perform the surgery. And that stuck with me. And I was just like, huh, you know, maybe this is not for me. I will say.
And I haven't reached out to thank him, but my letter, one of my letters of recommendation for internal medicine was written by a chief medical resident, sorry, chief surgical resident at that hospital. And so I actually got questions about that during my interview. Like, wait a second, you know, why is your internal medicine application being supported by a surgeon? And he basically said, you know, if he can't come to surgery, you know, we just want him at the best possible place. So it was a close one. I almost picked surgery and perhaps had been accused from time to time of having the mentality of a surgeon. I take it as a compliment, but some folks find it, find it not, not a compliment, but I almost went into surgery.
[00:06:40] Speaker B: Oh, neat. We love hearing that, the kind of, the stories and why, you know, different doctors pick the specialty that they do. So that, that's great, great insight.
[00:06:49] Speaker C: You know, one, one thing I would say is you, I would challenge what you said about there is a doctor shortage. Well, first of all, the one way you could say you could look at it is technology is going to fix a lot of those shortages. I'm going back 15 plus years now, but here's a story from Dartmouth. There's a leader there. He was actually, his name's Elliot Fisher and he worked on a lot of outcomes and data science in the, in the Medicare and Medicaid space. And one of the things he taught us in, in a lecture was he asked a simple question. The audience is there, all, all the physicians and residents are there. And he said, you know, imagine you have a patient who has simple. He's in, he's 50 years old, has one medical issue is high blood pressure. He's on one medication. How, how many times a year do you need to see this patient? Do you see him? Zero. This is 15 years ago. So telemedicine was, was maybe starting to come up, but it wasn't really a big thing like it is now post pandemic. But he said, how many times would you see him a year? Raise of hands. One time a year, two times a year, three times a year, four times a year, or not at all. And he showed what the distribution was and he said, look, here we are at one of the nation's top institutions and we can't even find agreement on how frequently we need to see this one simple patient. And so what his argument and a lot of his research was. And this is stuff, you can look it up. Elliot Fisher.
A lot of his research was, you know, there wasn't actually a physician shortage. It's a utilization issue. And much of our issues in medicine is that you can imagine if you have an outpatient practice and you're seeing that simple patient four times a year and somebody else is seeing them one time a year, that other physician, that second physician is going to have a lot more white space on his calendar than somebody who's seeing patients more frequently. And they don't need to. So I would argue that it certainly feels like there is a physician's shortage. There are long wait times to see providers. A lot of that is going to be solved by technology and doing things, unique things. Like at Mass General, I was part of what we call home hospital. So individuals who are hospitalized with a simple infection or just straightforward heart failure, these people can be monitored at home with remote monitoring and visits from nurses and occasional visits from physicians. But I think as we start seeing hospitals move care outside of the hospital and moving care and leveraging technology more, what appears to be a shortage is really just a utilization or misutilization of. Of individuals, time.
[00:09:28] Speaker B: That's a great insight. And I think, yeah, there are so many advances that we're obviously learning about with AI and technology. So, yeah, I think there's obviously room for optimization across the board.
Tell me now. I know a lot of physicians will spend their entire careers in clinical practice. You've really been successful at expanding, and now you're obviously in the medical legal space. What inspired you to take that leap and explore opportunities beyond the typical hospital or clinical setting?
[00:10:03] Speaker C: Yeah, it's a great question. I would say it wasn't really a leap. It was more of a serendipity bumping into a colleague who one day about a decade ago, looked a little harried. And I said, what's going on? He said, I have a case. And then he said, wait a second, how long have you been out of residency? And he's like, you can help me. You can do this. And so that was my first case.
And, you know, then it was almost another year, and then I had a second case. And so I would say it was. It was certainly not a leap. Some people nowadays will do things like that because there are individuals like myself who are being a little bit more vocal about this space and introducing physicians to it and trying to bring more physicians to this space because it's really Necessary, I would say I didn't even know this was possible.
I didn't know anything about this space. And over time, I learned not only is it essential and important, but it's something that over time, because I had done it enough, I became quite good at. And I felt like it was my responsibility, and it certainly is. I see it as my responsibility to open up the tent, invite in as many as my colleagues around the country as I can, because the medical legal space and the medical malpractice space is moving forward with your participation or not, and having skilled physicians in every specialty to comment on the standard of care. And I don't. Honestly, I don't have a dog in the fight in terms of plaintiff or defense. It's really just talking about and upholding the standard of. And we need as many clinicians as possible to participate in this, to make sure that we are withholding with upholding our standard of care across the medical legal space.
[00:11:55] Speaker B: That's fascinating. So tell us a little bit about how this plays out, like how many hours you're devoting to this and how it really would look if. If a physician is interested in doing this as well.
[00:12:11] Speaker C: I would say it comes in fits and starts. First, when you first start out, nobody knows about you, right? So the biggest thing is, how do you get your first case, and then how do you get your second case? Typically, work begets more work. As you testify and you're out there, more people recognize you and they see the work that you're doing. I frequently tell a story of how in my first trial, one of my first trials, I was retained by the plaintiffs. I testified this was a cancer diagnosis that was delayed, it was missed, and shortly thereafter, after the case settled, within the next year, the defense firm in this jurisdiction had retained me a couple times because they felt my testimony and my composure on the stand was impressive to them. And so I would say, if you're doing that, if you want to do this, start doing it and then see if you like it.
It's like anything else. You become better at it the more you do it, and so. And the longer you do it. So I would say once you know that you enjoy this work, it's important to. To network and to attach yourselves and connect yourselves to individuals like myself who've been doing this for a while so that you can get your name out there and so that you can grow your exposure in the space.
[00:13:35] Speaker B: I'm assuming that this has changed your skills as a clinician. I mean, are you now, do you approach care or documentation differently. Tell us a little bit about that.
[00:13:47] Speaker C: I mean, certainly it makes me a better clinician. Anybody who does this work. You'll find that if you're spending your free time reading about how care can go sideways, and again, keep in mind, just because you're reviewing a case, it's something untoward happen. The question is whether or not the standard of care was breached. Meaning would a clinician of same and similar training in the same or similar circumstance, would they have done the same thing or should they have done something different? And you could be looking at that from the plaintiff's side, but or from the defense side. And what I would say is if you're just reading about bad things that happen in hospitals or untoward things that happen to individuals, again, it doesn't mean that somebody was, you know, something bad happened, but you don't know if the individuals are blaming were actually at fault. If you take that to the aside for a moment and you're just reading about post surgical complications or missed cancer diagnoses, you will be a better clinician for sure because you can see how things went sideways. Whether it's communication or documentation, as you pointed out, it definitely will make you a more careful and thoughtful clinician. And to my colleagues out there that say, no, no, no, I'm already there.
I will challenge you that when you actually spend the time reading these things and put your care under the microscope, there is always room for improvement. For sure.
[00:15:19] Speaker B: Love that sounds like it's something that has benefited you. And then just the way that you're viewing everything and looking at when you're reading about these cases as being the legal expert now tell us, it sounds like a lot of this has to do with reputation and building up your credibility. The more cases the better, I'm assuming.
Tell us, is there a way that physicians interested in this can get more exposure? Is there ways to get started? What have you found to be effective?
[00:15:54] Speaker C: I suffered the old fashioned way, which was just through trial and error, which can be very challenging. And as you pointed out, these are high stakes environments, both plaintiff and defense. There are physicians who are being accused of doing something they shouldn't have done or they didn't do something and should have done something. And you know, on the defense side for the insurance companies, there's a lot at stake and there's a lot at stake for the clinicians and for the plaintiff, there's a lot at stake. And so to your point, if you're new in this space, it can be hard to at times to get your foot in the door because of the, the reputational risk and the risk that of not doing a good job pretends on the insurance company or on for the plaintiffs. And keep in mind also a lot at risk also includes, you know, the dollars at risk. And so they are less likely to put that responsibility to somebody who's brand new.
So what can you do? There are lots of companies, several companies out there that, that do education, so their courses. There are individuals like myself who do one on one mentoring and coaching. And I think that those are things that if I was starting over again, I would take advantage of wholeheartedly. I know it can be challenging when you're first starting out to make that investment because you're not sure if this is something you're gonna be one good at or two do for a long time. But I would say the second you know that this is something you're going to do for a long time and that you, you enjoy doing it and want to commit to getting better. Engaging those individuals I think is very important because it will help you ramp up your skill set much faster. I took a long time kind of trudging it out by myself and kind of suffering alone, if you will. And nowadays there are a number of us who are out there who are, you know, and I appreciate you for giving me time on your platform to talk about this sort of thing. You know, they're. A decade ago people just didn't talk about this space. Physicians don't really enjoy speaking about this space. But I think physicians are finding themselves in a place now where they really want to advocate for their care and for, for their specialty.
And this is a process and a, and a opportunity for them.
[00:18:16] Speaker B: Love that and love you giving us insights into, you know, really how you, you know, a new physician could get started in this space. Tell us if they wanted to, you know, contact you or have your mentorship or one on one guidance. What is the best way to do that?
[00:18:32] Speaker C: You can find me atmedicalexpert witness.com. there's a spot there where you can set up a 30 minute conversation with me. I'd love to hear about you and your story, whether you've done work or you're just contemplating doing it. I speak to physicians, hundreds of physicians every year, and I mentor many people and I also have an agency to help individuals grow their expert witnessing in addition to the coaching that I do. So do me a favor, go to medical expertwitness.com, set up a time to chat and I look forward to Having that conversation.
[00:19:05] Speaker B: Thank you so much for that. Now tell me, I want to know what you have been doing. You know, obviously reputation is important. How do you vet certain cases or attorneys to make sure that, you know, your credibility remains intact and it's somebody that you know, you want to partner with.
[00:19:23] Speaker C: Yeah, it's a great question. I think it's one of the challenges new expert witnesses go through. I've certainly had time to know if there are any hiccups along the way. Okay, that's somebody I'm not going to work with before. But when you're new, you don't even know what a hiccup is. You know, a lot of people say, oh, it takes a long time to get paid. And that is, is a barometer. And it might be, but it also could just be that you're working for a defense firm and they have four levels that have to approve something and that's the delay in getting paid. So again, I think that's why having that mentorship can be helpful. Usually you can feel it. I mean, there are individuals who represent themselves in a certain way that I think you'll be able to understand who you're comfortable working with.
And what I would say is those individuals, often through no fault of their own, probably don't do medical malpractice that frequently. I tend to avoid working with individuals who are either representing themselves or don't do much medical malpractice. That it's just something they're doing to help out a friend. That's something I would avoid. Certainly if you're contacted by a plaintiff themselves or someone who's not a lawyer, I would avoid speaking to them, you know, politely. Just say reach out to a lawyer first and then if you're interested in, in retaining me, go through proper channels. But again, I think it's, you have to just be there, you have to go through it to know if it's somebody that you would avoid. Obviously, if somebody's asking you to do something that makes you feel uncomfortable, changing your opinions, misrepresenting you, you know, asking you to say things that you're. You don't certainly believe that's, that is could be career ending and certainly unethical, I think that as a clinician it would be and a physician, it's easy to identify these things. Some of them can be subtle and you don't even know. I would say last minute work can be a double edged sword. You know, I've had even in recent weeks, I had a lawyer reach out with some last Minute work and just ask them why. Like, you know, what is it that. Is this a sign of them being disappointed, Disorganized. Right. Is this their procrastination and them missing deadlines? Or is it, my colleague just left the firm and I got all these cases dumped into my lap, or I had a expert witness, we just found out he had died. I mean, that happened to a case that I was asked to step into. And so just be curious and ask questions. I think that's the. And if you feel uneasy about taking a case, another. Another bellwether that I use is not all cases move down the line. But let's say there's enough evidence there. This is from the plaintiff's side. It could be from the defense as well that you're going to be deposed. And a deposition is an interrogation under oath where you sit most of these days, it's under zoom. And it could be anywhere from one to four hours where they're asking you questions about your background, your expertise, your training, your experience, but also the details of the case. And so one barometer that I use is, is this a case that I would feel comfortable answering questions about for hours on end? And if I hesitate at that, it is probably not the best for me to be involved in that case. It doesn't mean there is a case or not a case.
You know, you just. I just think communicating that to the attorneys involved, plaintiff or defense, is just, you know what, you know, Attorney Smith, catch me on the next one. You know, I. I just, you know, for X, Y and z reason, I just don't feel I'm the best fit for this case. And I think they will feel. They will feel so much better knowing that you were upfront and honest, and that will not disqualify you from doing future work with them in other cases. But I think to withhold that or to withhold that feeling and not comment on it. I know this is a long answer to a short question, but this is important because I think too many people, when they're new, are excited to get a case, but have some of these feelings of apprehension. And so without a coach, how much of this apprehension is just, I'm new and this is normally how it works. Or you know what? I'm being asked to comment on some things that really, it's just not. It's not my area of expertise. But I'm afraid to tell them because I may not get more business. And I think that's an area where I can help. Because your issue there isn't this case, your issue is that you don't have other cases, meaning if you had three or four other cases that you were working on, you wouldn't care about saying no to this case. And so I would encourage individuals to have that honest conversation with the potential or retaining lawyers to bow out of this case, but to catch you on the next one for sure.
[00:24:21] Speaker B: That's great advice for first timers or anyone just looking to get into this field. And I think it also really brings home why it is so great to work with a mentor like yourself when you're getting ramped up. And obviously there's going to be some questions. This is a whole new really kind of, you know, industry in a way that, that you're, you know, jumping into, obviously using all the expertise that you've learned and that you're practicing from a day to day perspective. But yeah, I think that is great insights. I want to just wrap up for our audience today if you would give, you know, kind of your best tip. I mean, you just gave some great tips for somebody, you know, what they should be looking out for and ways to approach, but kind of any first time tips when you're, you're giving the testimony that you think is useful for our listeners?
[00:25:13] Speaker C: Yeah, certainly if you're being deposed, spend your time in preparation. Make sure that also that preparation is not only by yourself, but also with retaining counsel and understanding the logistics of the space that you're about to operate into. Is it going to be zoom? Is it going to, how long do you think it'll last? Who is going to be deposing me? I mean, think of it like a sports game, if you will. You know, some people are just like, well, I, I know how to play football. I'm just going to show up to the stadium. Okay, but, but who are you, who are you playing? What time of day is it? You know, how long is the game going to last? You know, what, what am I going to do for, for water breaks and meals? I mean, you know, the logistics matter. So I know it sounds trivial, but these are important aspects and it can help you prepare because yes, it is about the facts of the case, but there is game film ahead of time. For instance, frequently the person taking your deposition may have deposed other people in the case. And so while a nurse's deposition might have been taken and you would not have necessarily focused on that, the person who took that deposition is the person going to be deposing you. And, and so you can look at the types of questions they've asked and the rebuttals and maybe the tradecraft, if you will, that they used in that deposition to prepare yourself better to answer those questions. So I think, again, depositions are an open book interrogation. So it's totally fine and permissible to have the records there and refer to the records. But it's still important to know where things are and, and not just have a searchable PDF where you can. Well, I'll just, I know I can look it up.
During the deposition, you really should be intimately aware of all of the activities that took place in the course of the questions at hand.
[00:27:14] Speaker B: Thank you for these insights. I mean, this just really opened up a whole new world, I'm sure, for some of the physicians that are listening and building awareness around this really, this, this whole other industry that they can get involved in to, you know, better medicine, better patient care. I'm assuming, obviously, you know, have another additional, you know, income revenue stream and just really like you're saying, hone your own craft and kind of apply that as you are a practicing physician. So I really want to thank you, Dr. Romano, for coming on today. I want to just let you close out with the best way once again for anyone interested to get in contact with you and your mentorship program.
[00:27:56] Speaker C: Of course, you can find me@medical expertwitness.com There's a link there where you can connect with me, set up a time, you'll see my schedule set up. 30 minutes. I'd love to hear whether again, this is for anybody, physicians, nurses, physician assistants, anybody who is thinking about doing this or who is already doing it but wants to grow their exposure to the medical expert witness space. Definitely reach out. Looking forward to it.
[00:28:23] Speaker B: Thank you so much for joining us.
[00:28:26] Speaker C: Thanks for having me.
[00:28:27] Speaker A: Thank you to all of our listeners. If you would like to be notified when new episodes air, make sure to hit that subscribe button. And a big thank you to Pacific companies. Without you guys, this podcast would not be possible. If you would like to be a guest, Please go to www.pacificcompanies.com. thank.
