Putting a Microscope on Specialty Testifying Experts: A Conversation About How Consulting Experts Reduce Work for Testifying Experts
May 04, 2023
Elisa Collins, NP
In this special episode my guest and I discuss his super-specialty. Dr. Oami specializes in dermatopathology and cytopathology. Dr. Oami is a board-certified and fellowship-trained dermatopathologist and board-certified and fellowship-trained Cytopathologist as well as a board-certified and residency-trained n anatomic and clinical pathologist with over 25 years of clinical experience, and 20 years of experience reviewing medical-legal cases. We discuss how consulting experts can help testifying experts like Dr. Oami to spend less time on the case, dramatically reducing case expenses for attorneys.
In this special episode my guest and I discuss his super-specialty. Dr. Oami specializes in dermatopathology and cytopathology. Dr. Oami is a board-certified and fellowship-trained dermatopathologist and board-certified and fellowship-trained Cytopathologist as well as a board-certified and residency-trained n anatomic and clinical pathologist with over 25 years of clinical experience, and 20 years of experience reviewing medical-legal cases. We discuss how consulting experts can help testifying experts like Dr. Oami to spend less time on the case, dramatically reducing case expenses for attorneys.
Elisa:
Welcome to episode 17 Of your MedMal podcast, discovering the needle nurse consultants help you discover what you didn't know that you didn't know about how to win your medical malpractice case. If you're new to our podcast, welcome, you can learn more about how behind the scenes legal nurse consulting can improve your firm's win rates and profitability. By following us on LinkedIn or visiting our website@wwwdotnplegalconsultants.com. It's time to discover the nurse consultant advantage. Let's get started. today we have a special episode. I just really wanted to highlight Dr. Shimon Oami, and his testifying expert specialty, and just focus on the testifying expert: how that consulting expert can be helpful in priming things in preparation for the testifying expert. But I also wanted to focus specifically in highlight Dr. Oami's specialty experience and where, sometimes outside-the-box testifying experts can come into play. We think of testifying experts as people who have face-to-face clinical experience with the patient, but I felt like this was an outside-the-box testifying expert role because Dr. Oami specializes in--sort of the"micro world" of Dermatopathology and Cytopathology. Dr. Oami, you are our very first testifying expert and physician to come on the show. Dr. Oami is a board certified and fellowship-trained dermatopathologist and board certified and fellowship-trained Cytopathologist as well as a board certified and residency-trained n anatomic and clinical pathologist, and he has over 25 years of clinical experience, and 20 years of experience reviewing medical-legal cases. Attorneys can find Dr. Shimon Oami on his LinkedIn page. That is S h i m o n O a m i. So glad to have you on the show.
Dr. Oami:
Likewise. Thank you.
Elisa:
So I wanna talk a little bit about some of those experiences with you. What is a dermatopathologist?
Dr. Oami:
A dermatopathologist Is a pathologist that specializes in diseases of the skin: be they tumors; be they inflammatory conditions of the skin rashes, et cetera. And they're the ones who provide the diagnostic information that the clinicians, most commonly dermatologists and dermatology specialists, use in treating patients.
Elisa:
Yeah, and that's what I wanted to understand a little bit more about is... of course we're all familiar with dermatologists, but that differentiation between a dermatologist and a dermatopathologist.
Dr. Oami:
So some dermatologists are actually dermatopathologist as well. A dermatologist usually sees patients clinically. They examine the patient-- sometimes they do a full body exam-- and they attempt to address the patient's chief complaint. And the patient might have a complaint,"oh, I have a mole on my shoulder", or"I've developed this rash on my chest." And the dermatologist takes a look at the mole, or the rash and they develop a clinical differential diagnosis of what the lesion or the rash might be. And sometimes, but not always, they send a biopsy to a dermatopathologist. The specialist and the dermatopathologist will review the tissue and render a histologic diagnosis based upon their findings and a good dermatologist-- a good pathologist in general-- will attempt to correlate the clinical findings with the histologic findings.
Elisa:
So when a dermatologist sends you a sample, they'll often send it with some clinical background and history to help you guide your own-- sort of-- differential diagnosis of what you're looking at on the slide.
Dr. Oami:
Absolutely. The dermatologist might say"rule out melanoma" or"rule out pityriasis rosea".
Elisa:
Are they just going to send you a"rule out" list? Or are they gonna send you the actual presenting clinical symptoms?
Dr. Oami:
It really depends upon the clinicians. Sometimes the clinicians will go into great detail in the history. Sometimes they'll just say,"rule out nevis, rule out melanoma", et cetera. So the onus oftentimes falls upon the dermatopathologist, to figure it out what is going on with a patient.
Elisa:
Do you testify in cases where the defendant is a dermatologist? Or only where the defendant is a dermatopathologist? Or in both?
Dr. Oami:
Both. I've done both.
Elisa:
I would imagine that most of the cases that you get involved in with dermatopathology are cases where there was an alleged misdiagnosis or missed diagnosis of life-threatening cancer-type cases. Is that...
Dr. Oami:
The majority of the cases, oftentimes, in dermatopathology involve missed melanomas.
Elisa:
Sure. Because melanoma is one of the main diagnoses as it relates to the skin that is life threatening. Absolutely. So you're looking at whether a reasonable and prudent provider should have seen that melanoma?
Dr. Oami:
That's correct. I'm looking to see whether the provider deviated from the standard of care, whether there was an actual miss or not.
Elisa:
I wanna understand a little bit more about when your services as a testifying expert would be what an attorney would look for. Does an attorney usually need a dermatologist and a dermatopathologist to be testifying experts? Or one or the other?
Dr. Oami:
Usually I, I would say in order to build the case, you would probably need a specialist in both fields.
Elisa:
I'd also love to understand a little bit more about that second piece, which is cytopathology. What is that exactly? When does that come into play in the clinical world?
Dr. Oami:
A cytopathologist reviews tissue samples from various. body parts that are sent to them from a variety of different clinicians. For example an endocrinologist or an interventional radiologist might send a fine needle aspirate from a nodule that's sitting on the thyroid in order to determine whether it's malignant or benign.
Elisa:
So they're literally gathering a sample of the organ tissue in, in a syringe and sending that off for what they call a"biopsy". We've all heard the word biopsy. I'm not sure if that's something that's commonly understood, but... tell us exactly what that sort of life cycle is of that sample.
Dr. Oami:
For example, Cytopathologists are the ones that review pap smears and thin preps in order to determine whether there's dysplasia, whether there's HPV infection, et cetera. The life cycle of a cytopathology specimen goes something like this: A lady goes in to see her gynecologist. The gynecologist examines her takes a sample. Those cells are subsequently placed either in a medium or they're actually spread directly onto glass slides. And they're fixed onto those glass slides. And then the tissue samples are processed in the laboratory and are presented to the cytopathologist for review. The cytopathologist reviews these samples, determines whether he or she are dealing with either a malignant or a benign sample and reports them using whatever classification schema that they're used to reporting. Then they generate the report. The report is sent to the clinician's office for their review. Other applications are: someone has a urine exam and they find blood in the urine and they attempt to define whether they're malignant cells within the urine, whether there's dysplasia, whether there are crystals, et cetera.
Elisa:
Is there always images taken of what they're actually looking at in case it needs to be reviewed retroactively and analyzed whether something may have been missed?
Dr. Oami:
It really depends on the reporting software. Some reporting softwares provide a space for images to be taken. In the past, some forms of software have given fixed samples of what this tissue might look like. But they don't actually send you the actual photograph of that particular
Elisa:
case. So do they make it pretty clear on there that this is not an image of the patient's actual tissue? This is just an example.
Dr. Oami:
They would need to document that on
Elisa:
the report.
Dr. Oami:
So invariably the expert witness pathologist would need to take a look at either the patient's image, if that's the type of software system that they use, or go back to the original slide or other prepared laboratory materials and see if indeed
Elisa:
something was missed.
Dr. Oami:
I tend to wanna see the hard materials. I want, I wanna see the slides.
Elisa:
What is a n anatomic and clinical pathologist.
Dr. Oami:
Clinical pathology really entails everything that's not solid biopsy-based. For example, if a patient were to go into a clinician and they needed to have their blood drawn. A clinical pathologist often is the one who ends up signing off on what the blood results were. A CBC, for example. Is it a normal CBC? Is it normal red blood cells, et cetera. So that's one aspect of clinical pathology. That's hematology. Other aspects of clinical pathology include clinical chemistry for example if someone's got an elevated calcium or potassium or vitamin D. So reviewing what those abnormalities may entail. Most of clinical pathology nowadays is machine driven. The machines go through their algorithms, their tests, and they pop out an answer. But, invariably if there are any abnormalities a pathologist has to be the one who reviews the materials.
Elisa:
Yeah. Ultimately a human being that has the right training has to lay eyes on. Yeah, that's exactly correct. So it sounds like you have spent the majority of your career in a microscopic environment and some, and occasionally at five o'clock, you pull back into the macro world and join the rest of us
Dr. Oami:
One would think. Yes.
Elisa:
That sounds really fascinating, and it sounds-- depending on the case, that having someone like yourself with that kind of very specific background would be very helpful to determine whether there was or was not a missed diagnosis or whether a reasonable and prudent pathologist could have, would've or should have seen what was going on. Thank you for helping me understand a little bit more about that. I'd love to hear what kinds of experience have you had with cases that involved consulting experts? A motif of our show is helping attorneys to see how individuals in the medical field can help attorneys who are taking these kinds of cases. Have you worked on cases with consulting experts and what's been your observation in that? Absolutely
Dr. Oami:
I've had cases where the consulting experts have approached me working closely with the attorney in attempting to determine whether a case was legitimate, and in those instances The consulting experts have been instrumental in gathering the necessary materials in order to build the case, as well as in putting together the timeline of events, the chronology of events. And I work with the team of attorneys and legal nurse consultants in attempting to figure out the timeline. I had a case recently where the legal nurse consultants timeline was crucial for making the case that it eventually led to settlement. And if they didn't have the right timeline, then one of the other expert witnesses would not have been able to give appropriate testimony that would've sealed
Elisa:
the case. Have you ever been handed a case where you felt that the quantity of records that you were given seemed like it was inappropriate for the degree of specialty that you have?
Dr. Oami:
Seeing the whole file helps me confirm the chronology of events, but oftentimes it's not necessary. And a pathology report basically stands on itself or the laboratory findings stand on their own.
Elisa:
..."Confirms the timeline"? So you're talking about cases in which a timeline has been more-or-less established by a consulting expert prior to you coming on...? Exactly correct. you're able to then take those line-itemed, micro-events that occurred through the course of this case and follow along in the medical record and kind of line those up and say,"Yes, I can corroborate and see that this happened and this happened..." Just helps to organize yourself when approaching a case.
Dr. Oami:
That's correct.
Elisa:
Dr. Oami, I really appreciate having you come.
Dr. Oami:
Pleasure was all mine.
Elisa:
Thank you again. Thank you. You've been listening to discovering the needle nurse consultants help you discover what you didn't know that you didn't know about how to win your medical malpractice case. This podcast is a production of discovery, NP legal consultants. Discovery is the largest unified growing force of specialty nurse practitioners offering consulting services to medical malpractice attorneys who take cases for the plaintiff
Heidi:
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