In the Trenches

The Other Side of the Table

For more than fifteen years—through residency and surgical practice—I made records. I wrote progress notes, operative reports, and discharge summaries. I chose language when outcomes were not what anyone had hoped for—not to fabricate, not to conceal, but to contextualize, soften, and frame. Every physician who has practiced long enough knows the difference between documentation that reflects what happened and documentation that reflects what the provider needed the record to say about what happened. Those are not always the same document.

I also served on medical executive committees, credentialing committees, and peer review panels during my years in practice. Peer review meant reading other surgeons' documentation, assessing the clinical decisions reflected in those records, and providing honest feedback to hospital administration about what the records showed and what they meant. Through that work, I understood, from the inside, how institutions manage physician performance, how complaints and adverse events are handled at the departmental level, and how the gap between what happens clinically and what gets documented is navigated in real time. That experience is not incidental to what I do now—it is the same skill applied to a different context. Reading a defendant physician's records and identifying where the documentation diverges from the standard of care is something I have been doing, in one form or another, for most of my professional life. I understand how hospitals credential physicians, how adverse events move through institutional review, and how those processes work from the inside—what gets documented, what gets discussed in rooms that are not documented, and how institutional decision-making around physician performance and patient safety actually functions. That institutional knowledge is not something that appears in a medical record. It is the context in which the records were made.

I also sat in the deposition chair on the receiving end of litigation. I know what it is like to be prepared by defense counsel before a deposition—what they tell you, what they do not tell you, how they frame the questions that are coming, and what they coach you toward when the answers are complicated. I know what it feels like to sit across the table from a plaintiff attorney and answer questions about your own clinical decisions, in real time, under oath.

I am not raising any of this to relitigate my own experience. I raise it because it is the foundation of what I bring to the plaintiff side of this work. When I read a medical record and identify the language a provider chose in a difficult moment, I am not inferring what that language means from clinical experience alone. I have been that provider. I have made those choices. I know what the documentation says and I know what it was written to do—and in many cases, those are different things.

That is not a theoretical observation. It is something I learned from the inside of the documentation process, not from reviewing it afterward. An operative note that documents minimal blood loss in a case where the patient returned to the OR hours later with an iatrogenic vascular injury tells a different story than the one it was written to tell. A report that makes no mention of tissue fragility or technical difficulty, followed by an emergent return for an anastomotic leak, raises questions the documentation was not designed to answer. A templated operative note that refers to the patient as "she" when the patient is male is not a minor clerical error—it is evidence that the note was not written from memory of that specific case. These are the kinds of discrepancies that surface when someone who has written operative notes reads operative notes. I know what those documents are supposed to say, how they are constructed, and what it looks like when the construction does not match the clinical reality. And I know how a plaintiff attorney can use that gap.

What Seven Years on the Plaintiff Side Taught Me

When I came to this work, I understood the clinical side of medical malpractice cases well. What I did not fully appreciate—what I could not have appreciated without living it—was the human dimension on the plaintiff side of these cases.

I did not appreciate what patients go through long after the clinical events have ended. The injury that brings a case to a plaintiff firm is almost never the end of the story. It is usually the beginning of a much longer one—years of treatment, adaptation, loss, and the particular exhaustion that comes from trying to hold a life together after something went wrong that should not have. Families carry this too, in ways that do not appear in any medical record and do not resolve when the litigation does.

I also did not appreciate, at the beginning, what plaintiff attorneys are actually doing when they take these cases. The good ones are not constructing a story. They are finding the truth—the clinical truth that the records contain, the human truth that the client carries, and the legal truth that connects them. That distinction matters because it changes the nature of the work. A medicolegal consultant who understands that plaintiff attorneys are after the truth, not a narrative, brings a different kind of engagement to the relationship than one who sees their job as building a case regardless of what the records actually show.

That realization was a turning point. This work, at its best, is more rewarding than surgical practice was—in the specific way that matters most. Surgery offers the satisfaction of a technical problem solved. Plaintiff medicolegal work, when it is done honestly and the right cases get taken and pursued, offers something different: it gives people who deserve to be heard the clinical foundation they need to actually be heard. That is not a small thing. For a physician who has spent a career inside the medical system, helping someone navigate it from the outside—with an honest accounting of what the records actually show—is work that carries its own particular weight.

What the Trenches Actually Look Like

After seven years and hundreds of cases in active litigation at any given point, I have a clear view of what makes this working relationship function well.

When it works, it is a genuine collaboration. The attorney brings the legal strategy, the client relationship, the litigation judgment, and the understanding of what a jury needs to hear. The physician brings the clinical analysis, the record review, the causation framework, and the expert network. Every role on the team—attorney, paralegal, physician consultant—contributes something the others cannot fully replicate. The work is strongest when each person is doing what they do best, and when everyone on the team understands and respects what the others bring.

The physician's role in a case does not have to end when the records have been reviewed and the analysis delivered. I have sat in mediation conferences and watched how the clinical picture holds up under settlement pressure. I have helped draft mediation statements. I have done trial preparation with attorneys—working through the medical testimony, the expert cross-examination, the clinical narrative the jury needs to follow. I have been present for verdicts. That full-lifecycle experience changes what I bring even to the earliest stages of a case, because the analysis is built with the end of the road in mind, not just the beginning of it.

The working relationships that hold up over time are built on mutual trust—the attorney trusting the physician's clinical read, and the physician trusting the attorney's legal judgment. When that trust is present, the collaboration runs naturally. The physician brings clinical investment to every case, not just clinical knowledge, and the attorney recognizes the difference. That combination—genuine investment on both sides, each person operating where their expertise is strongest—is what makes the work as good as it can be.

The attorneys who build the most durable working relationships with their physician consultants are the ones who think carefully about how they deploy that resource—particularly during the high-pressure stretches when cases are moving fast and the temptation is to ask everyone to do everything. Keeping the physician focused on the clinical analysis, even when the calendar is compressed, is what keeps that analysis at the level the case actually needs.

On the Work Environment

Plaintiff litigation moves fast and the stakes are real. What makes the working relationship durable under that kind of pressure is the same thing that makes any good team function: mutual respect for what each person brings, and a genuine investment in a shared outcome.

The thank yous matter. That is not a soft observation—it is a practical one about how long-term working relationships stay productive. When the physician knows that the analysis they built contributed to an outcome that mattered for a client who needed it, that closes a loop that keeps the work meaningful over time. Plaintiff litigation can be an isolating kind of work for everyone involved. Sharing the outcomes—the ones that went well and the ones that did not—keeps the team oriented around the same thing: the clients and what they went through.

The Bottom Line

The medicolegal consultant who has only ever been on the plaintiff side of these cases brings clinical knowledge to the work. The one who has also been on the receiving end of litigation—who has made records under pressure, been prepared by defense counsel, and sat in the deposition chair as both a defendant and a fact witness—brings something additional. It is the perspective of someone who has been inside every part of this process and has chosen, with full knowledge of what each side looks like, to do this work on the plaintiff side.

That choice is not arbitrary. It reflects a conviction that developed over years of watching what happens to patients after the clinical events end, and learning what it means to give someone who deserves to be heard the honest clinical foundation they need to actually be heard.

That is what the trenches taught me. It took both sides of the table to learn it.