In the world of medical malpractice litigation, time is precious—for both attorneys and expert witnesses. That’s why, before diving into a new oncology-related case, I always recommend a short, initial phone call. Over the past 8-9 years and more than 100 cases reviewed, I’ve learned that this early conversation often saves everyone time, money, and unnecessary headaches.
The Value of a Preliminary Discussion
Last week alone, I had two such conversations with plaintiff attorneys. Before reviewing a single medical record or agreeing to take the case, we spent five to ten minutes discussing the clinical scenario. In both instances, that brief exchange was enough to help the attorneys reassess their case strategy.
One case involved a patient with a gastrointestinal sarcoma who unfortunately developed widely metastatic disease five years after the initial diagnosis. The plaintiff’s theory was that a missed liver lesion—visible on earlier imaging—had led to the spread. The allegation was that better surveillance could have prevented the metastases.
While I hadn’t reviewed the records in depth, I knew enough from our conversation to raise a key oncologic principle: distant metastatic disease is rarely the result of a single missed lesion. More often than not, that first visible spot is simply the earliest sign of widespread microscopic disease already at play. Even if we had treated that liver lesion aggressively—via surgery, ablation, or radiation—there’s little evidence to suggest the patient’s overall outcome would have changed. That’s precisely why we monitor with serial scans: metastatic spread is a systemic process, not a localized event.
Objectivity First, Always
Some attorneys hear that kind of feedback and assume I skew defense-oriented. The reality? About two-thirds of the cases I’ve accepted over the years have been for plaintiffs. I’m not here to tilt one way or the other. My role is to provide objective, evidence-based analysis—whether that supports the plaintiff or the defense. In fact, I prefer to approach every case as if I don’t know which side I’m working for. More often than not, by the time I finish my review and formulate an opinion, I still couldn’t tell you who the retaining attorney is without checking my notes.
That neutrality starts with our first conversation.
What Attorneys Gain from the Initial Call
Here’s what I believe every attorney should expect—and benefit from—in that first five-minute phone consultation with a medical oncology expert:
- Case Feasibility Check: Is this even a case worth pursuing based on the clinical facts as described?
- Identification of Red Flags: Are there immediate scientific or clinical hurdles to the theory of causation?
- Appropriate Specialty Referrals: Is this really an oncology case? Or would a pathologist, radiologist, or surgeon be more appropriate for your initial expert opinion?
- Conflict of Interest Screening: Do I have any professional ties to the treating physicians or institutions involved? This can often be spotted before records are even sent.
- Scope Clarification: Are you asking for a standard of care opinion, a causation opinion, or both?
- Expectation Setting: Real talk about timelines, costs, and how I work—including my commitment to objectivity and evidence-based testimony.
Lessons from Experience: When Cases Shouldn’t Move Forward
I’ve encountered cases over the years where the right answer was to walk away—on both sides of the aisle. Whether it’s a case built on flawed assumptions (like suggesting a GI procedure somehow caused a cardiac sarcoma recurrence) or one where causation cannot be reasonably established, it’s always better to recognize those pitfalls early.
Similarly, in a recent Ewing sarcoma case, the attorney was concerned about a six-to-eight-week diagnostic delay. But given the patient’s aggressive stage IV disease at presentation, even a perfectly timed diagnosis would likely not have changed the unfortunate outcome. In such situations, helping the attorney understand the natural history and biology of the cancer can clarify whether a delay was both clinically significant and legally actionable.
Why This Benefits Both Sides
For attorneys, this upfront conversation helps refine case strategy, manage client expectations, and avoid unnecessary expenses. For me, it ensures I’m spending time on cases where my expertise can truly add value. And let’s be honest—just as attorneys evaluate their expert witnesses, I’m also evaluating whether this is a case—and a legal team—I want to work with.
After all, expert testimony is not just about medical facts. It’s about credibility, clarity, and doing the right thing for the case, the court, the providers, and ultimately, the patient story at the heart of it all.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. He brings a wealth of expertise to the complex and challenging world of oncology.
Disclosures:
Dr. Thomas serves as a speaker for Bristol Myers Squibb (BMS), Merck, Ipsen, Natera, Immunocore, Pfizer, and SpringWorks. He also receives industry grants in support of numerous clinical trials.