Emergency physician, Charleston. Building Palmetto Medical Defense Consultants. Defense only. Also shipping RefAssess for referee coaches and mentors.

Charleston, SC, USA
Joined January 2009
An $84M chest pain verdict, and most of the takes blame the PA. From the ER side, I'd look at the schedule first. 20+ patients a day, two visits, and chest pain in a 53-year-old man. The system set that clinician up to miss it. Defense lawyers, how often does the schedule get as much scrutiny as the clinician?
Ughhhh they had a clinic PA seeing over 20 patients a day and this led to provider missing ACS (acute coronary syndrome) in a 53 year old male patient (who happened to be an exec at Ernst & Young). Patient was evaluated twice for chest pain … and both times the PA appears to have misdiagnosed him with something benign.
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Two weeks ago I started posting as an ER doc who still works shifts. Since then: 1 podcast episode out, 1 more podcast invite, and 1 video interview on prior auth. Nobody asked about a pitch. They asked what prior auth and liability look like at 3 a.m.
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In an ER malpractice defense, which record does the most work?
0%Triage Note
100%Physician MDM
0%Nursing Notes
0%EMR Audit Log
1 votes • Final results
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Looking for 5 soccer referee assessors or mentors to test RefAssess this fall. You log events live, tag each one to the official who owned it, then score the criteria after. Free. I want blunt feedback more than users. Reply or DM me.
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The ER Version: the federation of state medical boards is drafting guidelines for AI that works with little or no physician supervision. At 3 a.m., the tool suggests the order. I sign it. When it's wrong, the board complaint has my license number on it. Not the tool's.
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I can't enter this one, but I love that it exists. I'm a full-time ER doc. I built RefAssess, a soccer referee assessment app, myself between shifts. No CS degree, no team, a lot of late nights. A program like this would have saved me months. Physicians with an idea: submit it!
Calling all physicians attending #HLTH2026. Have an idea that could improve healthcare? We want to help you build it. We're teaming up with @OpenAI and Physician Side Gigs for the Physician Builder Challenge. Submit your idea by October 20 for a chance to build a working prototype with us and present it live at Physicians at HLTH on November 16 at 5 PM. → abridge.com/hlth2026?utm_sou…
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Short version: a coworker likes to say you don't rise to the occasion, you fall to your training. That's what keeps the ER calm when the world is in crisis. Full episode: youtube.com/watch?v=Hazp1HKH…
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Tomorrow I'm on Tales from the Shift, a show about what jobs actually do to the people who work them. We talked about working in the ER. Episode drops Sunday. @TheShiftTales
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RefAssess. Center and assistant referees don't get the same form. Center: match control, game management, positioning, movement, teamwork, participants. Assistant: offside, involvement, positioning, movement, teamwork. Same match, different job. A generic report misses both.
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The AMA's agentic AI framework asks the question these cases will turn on: who is responsible for the risks and outcomes? ER version: an agent orders a head CT from triage before I've seen the patient. For the defense, the chart has to show who held authority at each step.
Patients deserve the benefits of increasingly capable AI without compromising the safety, accountability, and clinical judgment at the heart of good medical care. As agentic AI assumes increasingly consequential clinical functions, clinical authority must be earned through evidence and maintained through demonstrated performance. We need a clear framework for determining what these systems should be permitted to do, under what conditions, and who is accountable for their actions and outcomes. Today, the AMA is setting out that framework and committing to advancing its broad adoption. This fall, the AMA Center for Digital Health and AI will prioritize work with physicians, policymakers, regulators, and technology developers to translate these principles into practice, with a particular focus on liability, licensure, and regulation. spr.ly/6013BHESoc
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LLMs talking patients through their wearable data is coming fast. ER version: a patient arrives post-seizure and says "the app told me to wait." Now the timeline includes a chatbot. Who answers for that advice is the question nobody's settled.
Imagine large language models (LLMs) serving as an interface between patients and all the wearable devices they use! A study just proved that it works effectively. "A new AI-driven platform could allow people to interact with their medical devices by sending messages using a smartphone application and receiving feedback in real time. Participants in a proof-of-concept study undergoing monitoring for seizures could ask questions about their brain activity, receive personalized alerts, report symptoms and behaviors, and help train the system to better recognize seizure-related patterns." You wear a health sensor and can ask questions about the data and the insights derived from that, like talking to ChatGPT. This is going to boost the already huge population (around 1 billion people) using health wearables. Source: penntoday.upenn.edu/news/pen…
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Learning day: deviation is not causation. A review can find care that fell short and still owe the defense the harder answer: would the right care have changed the outcome? If I can't answer that, the review isn't finished. #PMDC
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Unscheduled drills test the system, but the real patients pay for it. One shift, a drill pulled two nurses from triage and the chest pain in the waiting room sat 25 minutes. Drills should run with backfill staff, not borrow the front door.
🚨 Mass casualty drills in a busy adult ED: patients arriving during a drill waited longer for triage (20.6 vs 15.8 min) and were more often under-triaged. The effect showed up only in unscheduled drills, so it may be fixable by design. 🔗 bit.ly/4qfxUBK
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Grassroots referee education getting real investment is good news. The question I keep asking: how does a mentor see whether feedback from match 3 is gone by match 10? Classroom content is the easy part. Tracking development across a season is the hard part.
ICYMI | We are proud to have launched a new referee development curriculum to transform our approach to referee education across grassroots football in England. 🙌 More ➡️ buff.ly/NWNOvpS
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Cigna told a 37-year-old her heart-attack ER stay wasn't medically necessary. ER version: chest pain at triage. The cath confirms later. The chart has to show why it looked like an emergency then. For coverage fights, that first note is the evidence.
American is 37 years old, she had a heart attack 2 weeks ago She has Cigna for her health insurance and they just mailed her a letter saying “after carefully reviewing the information, we determined the service is not medically necessary.” Her bill is $110,000 for staying in the ER for 2 days “They don't think that saving my life was medically necessary — My total bill so far is currently at $110,000, is how much it costs to save my life. I'm sure there's more bills coming still, but Cigna doesn't think that it was medically necessary” We need health insurance reform and we need it right now in America. Our entire medical system has been turned into a for profit scam Just know if something like this happens to you, there is Federal Law that essentially says it has to be covered Federal law under the ACA and No Surprises Act rules requires coverage of emergency services based on the prudent layperson standard: whether a reasonable person with average knowledge of health and medicine, looking at the symptoms at the time, would believe immediate care was needed to avoid serious harm This just shows that coverage for this woman should have never been denied Health insurance companies are out of control
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How I read an ER chart for the defense, in five posts. Short version: every entry is a decision someone made before the next fact arrived. 🧵
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A timeline built after the fact makes every gap look like a choice. Sometimes it was. Often the result simply wasn't back yet. The timestamps tell you which one, and they're already in the record.
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So a useful defense review starts with a simple table: what was known, what was pending, what was done, in order. Standard of care comes after that. Argue it before the table exists and you're arguing with hindsight.
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