Croup fatality malpratice case aka the scourge of bad EM expert witnesses

[allantois]

I’d argue that other countries have better healthcare outcomes because physicians are not held at proverbial gunpoint by lawyers leading to unnecessary testing, doing everything possible, trying to reduce medicolegal risk, etc. I’d even argue lawyers and the judicial system are not competent to judge technical work that physicians do. We don’t get to have a say in the way they do things, yet somehow they want to insert themselves in the practice of medicine which is infinitely more complicated than the practice of law

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[thegenius]

What is this even supposed to mean? Yea, people get paid to do their job. Physicians get paid to treat patients too! Physicians also have a financial incentives that don't align with doing the right thing at times. Somehow people still manage to act reasonably ethical.


Weird, it's almost like demonizing physicians who do plaintiff work would keep ethical physicians from wanting to do the work because they actual care about their professional reputation more than money.

This is cartoonishly ridiculous. No one would argue that there are unethical lawyers and expert witnesses. Most people wouldn't even argue that there are a lot. But exaggerating the incidence and turning it into this weird fetish of demonizing anyone, anywhere who does any plaintiff expert witness work has no basis in logic. This is purely a weird need to circle the wagons and just makes physicians look corrupt and unprofessional.

Your use of words is way more cartoonishly ridiculous than mine. It's not even worth trying to get into this anyway. I'll let you guys continue to blather on. I disagree with a premise on this thread that the majority of cases are not frivilous, they are. A majority of them are. a mere single paper is not existential proof. What gets me and I bet a bunch of other people is how easy it is to find an expert witness who will say cartoonishly ridiculous things about a case against the defense, no matter what the topic is. And how seemingly immune expert witnesses are to the discovery of actually whether they are "expert" or not in whatever they are testifying on. Being board certified in Emergency Medicine doesn't make you an expert in Emergency Medicine (not in lay terms that is. maybe in legal ones though)

 

[thegenius]

I’d argue that other countries have better healthcare outcomes because physicians are not held at proverbial gunpoint by lawyers leading to unnecessary testing, doing everything possible, trying to reduce medicolegal risk, etc. I’d even argue lawyers and the judicial system are not competent to judge technical work that physicians do. We don’t get to have a say in the way they do things, yet somehow they want to insert themselves in the practice of medicine which is infinitely more complicated than the practice of law

I would argue that the majority of doctors certified as expert witnesses in EM are probably not even "experts", if we use the lay definition of expert. Lay definition of expert meaning having a special skill of knowledge derived from training or experience. There are 60,000 practicing ER doctors and assuming that x% are board certified, that doens't imply x% are experts.

 

[thegenius]

If someone has a long commute/nothing better to do with their life:

This is a good series to follow about an ER case

Well that was an utter waste of 30 minutes. I was expecting some juicy stuff

 

[Janders]

I would argue that the majority of doctors certified as expert witnesses in EM are probably not even "experts", if we use the lay definition of expert. Lay definition of expert meaning having a special skill of knowledge derived from training or experience. There are 60,000 practicing ER doctors and assuming that x% are board certified, that doens't imply x% are experts.

Sadly it does meet the definition of a medical expert. You don’t need much. Board certified in EM with active practice? That’s enough for most courts to certify you as a legal expert in the standard of care (of course the lawyers can argue their expert is better than yours yadada)

 

[ShockIndex]

There seems to be a perception the expert witness work is exceedingly lucrative. It’s not. While I can’t speak for everyone, my charges are pretty close to the average for EPs. I charge $400/hr case review and subsequent discussion, $500/hr + travel for depo testimony, $2000/day + expenses for court. All of this is independent contractor work that must have taxes paid and no benefits, bonus, etc. Thus, my hourly rate is slightly more but court fees significantly less than my net clinical salary on a per day rate - much less if you consider retirement contributions and healthcare benefits. Like I said earlier in the thread I review up to five cases per year - one or 2 will result in a claim of negligence. Since I just did my taxes last week, I can tell you that less than 10% of my income is derived from expert witness work. Again, I am the norm, not the exception.

Also, most lawyers seek out experts with some experience, but they don’t want someone who is a mill churning out cases. Every expert will be asked their breakdown in cases and how much of their time is spent in medmal. Juries do not like prostitutes.

Finally, my time is spent overwhelmingly telling lawyers that there is no case, and I’m paid to do it. It’s fun knowing that there are 50-60 colleagues out there who don’t know me from Adam, yet I was able to spare them a bad couple of years over a mistaken impression of their care. On the other hand, I’ve gotten to meet some of the victims of our colleagues. It’s not pretty. These cases are not frivolous and suggesting that they are only serves to diminish our hand at the table when we have opportunities to improve the system.

 

[ShockIndex]

I would argue that the majority of doctors certified as expert witnesses in EM are probably not even "experts", if we use the lay definition of expert. Lay definition of expert meaning having a special skill of knowledge derived from training or experience. There are 60,000 practicing ER doctors and assuming that x% are board certified, that doens't imply x% are experts.

If that is really how you feel, be sure to start every patient encounter with the disclaimer, “Well, I’m no expert, but…”

On a more serious note, you do touch on the direction for reforms that I support. The first being arbitration panels of select physicians AND patient representatives that review cases, referee violations of standards, and determine damages. The physician reps would come from certifying boards (ABEM), state medical boards, and professional societies such as ACEP/AAEM. Of course, they would be compensated. While this may sound acceptable now, I believe the same voices in this thread would eventually rise to the surface since I suspect that these reforms will only marginally reduce the number of referrals or claims.

The second alternative that I support and one that is far more realistic is to employ similar panels that review cases and issue a statement on the care. These statement would then be admissible to the court. The insurance for the physician being sued pays for the panel’s review and recommendations, but the recommendation is discoverable even if it goes against the ED. Think of it this way, very few lawyers are going to waste time on a case where a physician can present a letter from ABEM/ACEP/AAEM saying, “we reviewed the care, it was within our standards, we see no negligence.”

 

[WilcoWorld]

Both had neuro exams that left everyone wondering if there might still be residual deficits.

It is embarrassing when you get a bounce back and you read your colleague's note and can see that the exam is nothing but a template that has "A&O x 3, strength and sensation grossly intact" for a neuro exam AND has "regular rate and rhythm" just a couple lines below the charted vitals with a HR of 120 and a few lines above the ECG showing a fib.

I'm a vocal defender of the ED, but it's much harder to do that when our documentation contradicts ITSELF.

 

[DeadCactus]

Medical expert witnessing is solely a for-profit exercise with almost zero macro benefit to societal healthcare. It is not some noble calling. Lawsuits do not improve healthcare outcomes or even make healthcare safer. If it did, the US would be 1#. Other countries without malpractice litigation have far better outcomes than we do.

We should stop defending an unregulated industry with almost zero practice standards. Anyone with a pulse and medical license can be an expert witness. There is almost no barrier to entry. I've worked with NPs that did case reviews and gave expert opinions to law firms! The joke writes itself.

Ignoring that the data on tort reform is lukewarm and the healthcare system in the US is troubled by significantly more pertinent issues than malpractice law, you're just going on tangential rants.

You can rant all you want about the legal system but:

1. Negligent care exists
2. Patients deserve compensation for negligent care
3. The legal system deserves ethical expert witnesses

Hate scummy lawyers and expert witnesses all you want but pretending that you can't do it ethically and that ethical expert witnesses don't exist is just nonsense. Are you in a profession or a cult?

Your use of words is way more cartoonishly ridiculous than mine. It's not even worth trying to get into this anyway. I'll let you guys continue to blather on. I disagree with a premise on this thread that the majority of cases are not frivilous, they are. A majority of them are. a mere single paper is not existential proof. What gets me and I bet a bunch of other people is how easy it is to find an expert witness who will say cartoonishly ridiculous things about a case against the defense, no matter what the topic is. And how seemingly immune expert witnesses are to the discovery of actually whether they are "expert" or not in whatever they are testifying on. Being board certified in Emergency Medicine doesn't make you an expert in Emergency Medicine (not in lay terms that is. maybe in legal ones though)

You're just attacking a strawman and committed to your feelings instead of any rational discussion on this.

 

[VA Hopeful Dr]

Ignoring that the data on tort reform is lukewarm and the healthcare system in the US is troubled by significantly more pertinent issues than malpractice law, you're just going on tangential rants.

You can rant all you want about the legal system but:

1. Negligent care exists
2. Patients deserve compensation for negligent care
3. The legal system deserves ethical expert witnesses

Hate scummy lawyers and expert witnesses all you want but pretending that you can't do it ethically and that ethical expert witnesses don't exist is just nonsense. Are you in a profession or a cult?



You're just attacking a strawman and committed to your feelings instead of any rational discussion on this.

Our system doesn't reward ethical expert witnesses as its currently set up.

Are there bad doctors? Absolutely. Should patients be compensated for injuries resulting from professional negligence? Also absolutely. Are their doctors who don't do anything wrong who get sued and either lose or settle despite no errors whatsoever because of some POS expert witness who isn't particularly ethical? Also yes.

How do you suggest we balance all of that?

 

[ShockIndex]

How do you suggest we balance all of that?

The first step is to demonstrate that it is sufficiently out of balance to need fixing. There is a lot of talk around here about frivolous lawsuits being a majority but a paucity of data to support that it’s even a significant minority; more like a perception.

The second is to recognize that any system has error, injustice, and inequality. Thus, you need to prove that your new system is an actual improvement and isn’t simply going to shuffle the victims of injustice.

Once you do that, you need to get buy-in from elected leaders. Unfortunately, the medical community didn’t exactly build our credibility when selling the need for malpractice reform more than a decade ago. We promised lower costs, less testing, improved hair growth, longer erections, etc. that didn’t really materialize.

 

[anonperson]

The first step is to demonstrate that it is sufficiently out of balance to need fixing. There is a lot of talk around here about frivolous lawsuits being a majority but a paucity of data to support that it’s even a significant minority; more like a perception.

The second is to recognize that any system has error, injustice, and inequality. Thus, you need to prove that your new system is an actual improvement and isn’t simply going to shuffle the victims of injustice.

Once you do that, you need to get buy-in from elected leaders. Unfortunately, the medical community didn’t exactly build our credibility when selling the need for malpractice reform more than a decade ago. We promised lower costs, less testing, improved hair growth, longer erections, etc. that didn’t really materialize.

Your own linked paper indicated nearly 40% of cases had no medical error. Just a bad outcome.

Why does a malpractice lawsuit need to settled for a bad outcome when there was no error?

This feeds into the revenge mentality and the current game .

There has never been any meaningful malpractice reform so I'm not sure where any credibility was lost. Physicians can still be held personally liable if a verdict goes above their malpractice policy.

That's enough to scare any physician to over test and over treat.

It's funny. A judge can grant bail to someone accused of a dangerous crime and if they go out and harm or kill someone, the judge will never worry about any consequences. Just business as usual.

 

[ShockIndex]

The number was 37% but I understand why you want to round up.

There will always be more cases filed then there are errors. That is because the very nature of our system requires a lawsuit for full discovery to determine if an error exists. The important number is the payouts for cases where no error exists or no injury exists - that is something on the order of 10%. When dealing with a system where insurance indemnifies those losses, you will be hard pressed to find a sympathetic ear from the people who write these laws.

I’m not sure if you were practicing 15 years ago, but around that time several states passed malpractice reforms that capped damages and in some instances heightened the bar for breaches in the standard of care. This was done under the auspices that it would reduce testing, lower defensive medicine costs, etc. The resulting data shows that it lowered malpractice payments and premiums, so you will have a hard time showing that it wasn’t meaningful. It just didn’t live up to our hype for a cost savings to the system.

If you want to do this smart, stop playing into the lawyers hands. Having an EP put forth an argument that board certification does not confer expertise is increadibly dumb when the real battle for our jobs is fending off the mid-level onslaught that IS USING EXACTLY THAT ARGUMENT for Christ’s sake. Do what I mentioned earlier - petition out collages and professional societies to get involved by certifying certain actions and behaviors. Have them weigh in on cases, bad actors, etc. I will cost us something but make our dues more meaningful.

 

[anonperson]

The number was 37% but I understand why you want to round up.

There will always be more cases filed then there are errors. That is because the very nature of our system requires a lawsuit for full discovery to determine if an error exists. The important number is the payouts for cases where no error exists or no injury exists - that is something on the order of 10%. When dealing with a system where insurance indemnifies those losses, you will be hard pressed to find a sympathetic ear from the people who write these laws.

I’m not sure if you were practicing 15 years ago, but around that time several states passed malpractice reforms that capped damages and in some instances heightened the bar for breaches in the standard of care. This was done under the auspices that it would reduce testing, lower defensive medicine costs, etc. The resulting data shows that it lowered malpractice payments and premiums, so you will have a hard time showing that it wasn’t meaningful. It just didn’t live up to our hype for a cost savings to the system.

If you want to do this smart, stop playing into the lawyers hands. Having an EP put forth an argument that board certification does not confer expertise is increadibly dumb when the real battle for our jobs is fending off the mid-level onslaught that IS USING EXACTLY THAT ARGUMENT for Christ’s sake. Do what I mentioned earlier - petition out collages and professional societies to get involved by certifying certain actions and behaviors. Have them weigh in on cases, bad actors, etc. I will cost us something but make our dues more meaningful.

37% were injured but no error.
3% were no injury even.

So 40%. No rounding up required. That's a significant amount of bogus cases.

The caps are typically on pain and suffering which has always been a black hole for lawyers to exploit.

And my favorite, loss of consortium.

If that has resulted in lower malpractice premiums and nothing else, I still consider that a win. That is a savings right there.

 

[ShockIndex]

And my favorite, loss of consortium.

I suppose it depends on who I was consorting with, right? If I were Tom Brady consorting with Gisele, well that might be worth hundreds of millions. On the other hand, I might pay the doctor for doing me a favor if I were Bill Clinton…

 

[Janders]

I think you guys are touching on another piece of this issue which is hard to solve in our current system.

The occasional incredibly high awards ($10-100million) that some perceive to trigger a lottery ticket mentality regarding bringing cases foward… if there is a bad outcome, is there a draw to bring suit even if care is passable, because your expert can always find some issues, and then a jury has to sort it out.

Now of course, all of us here would suggest our lives, our livelihood, our ability to walk or talk are worth a LOT of money. A permanently disabled baby or dead person of college age is devastating. But where does $50million come from?

I would prefer (i know, i know) a more socialized system where, with fees from hospitals, physicians, insurance companies and general taxes a pool of money would be used to compensate these individuals, especially considering our society doesn’t have the best built in disability / social security protections. A panel of true experts (as mentioned upthread) including physicians, lawyers, and patient reps would review these cases. They would liaise closely with medical boards to monitor repeat offenders and recommend meaningful (systemic!) changes and education to perhaps actually prevent patterns of injury.

However this is somewhat philosophically opposed to our current individualist tort system. I think some European states have systems like this, and they seem to make more sense to me, not precisely to protect physicians, but also to provide the real protections and future improvements a lot of people think our current system has.

 

[thegenius]

Sadly it does meet the definition of a medical expert. You don’t need much. Board certified in EM with active practice? That’s enough for most courts to certify you as a legal expert in the standard of care (of course the lawyers can argue their expert is better than yours yadada)

Right I made it clear that there is the definition of expert in real life and in pseudo-fantasy legal land.

 

[WilcoWorld]

Well that was an utter waste of 30 minutes. I was expecting some juicy stuff

thanks for saving me a half hour...I'll watch an episode of The Good Place instead

 

[Rekt]

Why are you guys even wasting time. ShockIndex is a clown and a sell out. He’s so far removed from real world medicine he doesn’t even realize it.

If you do expert witness work against physicians, you’re disgusting and worse than the lawyers themselves.

 

[Birdstrike]

There seems to be a perception the expert witness work is exceedingly lucrative. It’s not. ...I charge $400/hr case review and subsequent discussion, $500/hr + travel for depo testimony, $2000/day + expenses for court.

You need to charge more. My fee schedule (defense work only):

Chart review for private attorney: $350/hr
Deposition preparation: $500/hr
Deposition: $1,000/hr
Court appearance as expert witness: $7,000/day + travel expenses
Telephone conference for deposition preparation: $300 first hour, $100 each additional 30 min
Review for federal or state agency: $250/hr

 

[ShockIndex]

You need to charge more. My fee schedule:

Chart review for private attorney (defense): $350/hr
Deposition preparation: $500/hr
Deposition: $1,000/hr
Court appearance as expert witness: $7,000/day + travel expenses
Telephone conference for deposition preparation: $300 first hour, $100 each additional 30 min
Review for federal or state agency: $250/hr

Nah, I’m good with where I’m at now.

Why are you guys even wasting time. ShockIndex is a clown and a sell out. He’s so far removed from real world medicine he doesn’t even realize it.

If you do expert witness work against physicians, you’re disgusting and worse than the lawyers themselves.

You cut me deep Rekt.

 

[Apollyon]

If you do expert witness work against physicians, you’re disgusting and worse than the lawyers themselves.

So, all doctors are good and blameless? Remember, if we don't police ourselves, non-doctors would be more than happy to do it.

 

[ShockIndex]

So, all doctors are good and blameless? Remember, if we don't police ourselves, non-doctors would be more than happy to do it.

It’s the same mentality that permeated law enforcement 30 years ago…except with much, much bigger egos and senses of entitlement.

 

[southerndoc]

I suppose it depends on who I was consorting with, right? If I were Tom Brady consorting with Gisele, well that might be worth hundreds of millions. On the other hand, I might pay the doctor for doing me a favor if I were Bill Clinton…

Please do not bring politics into this. Whether it's a political view or your comment about a political figure, it's not necessary and usually results in infractions. Thank you for your understanding.

 

[Rekt]

So, all doctors are good and blameless? Remember, if we don't police ourselves, non-doctors would be more than happy to do it.

Maybe you should put your thinking cap on. A lawyer being the police for physicians? The “expert witness” is motivated by money alone. A completely clueless jury with no medical training motivated by emotion?

How about a board of our peer physicians in the same specialty associated with the state medical board? There’s probably many options to determine competence but suing docs constantly for frivolous nonsense to catch an occasional bad actor is the incorrect answer.

 

[ShockIndex]

Maybe you should put your thinking cap on. A lawyer being the police for physicians? The “expert witness” is motivated by money alone. A completely clueless jury with no medical training motivated by emotion?

How about a board of our peer physicians in the same specialty associated with the state medical board? There’s probably many options to determine competence but suing docs constantly for frivolous nonsense to catch an occasional bad actor is the incorrect answer.

Just be careful what you wish for. It is highly likely that any panel of physicians that judges standards of care will be “multidisciplinary” in nature - much like the peer review committees at most hospitals. While wacky jury verdicts are out there, they are not the norm. Most juries are sympathetic to physicians and the overwhelming majority of verdicts break in the physician’s favor. I’d rather take my chances with lay jurors than many physicians who are going to apply their standards to my practice.

However, I suggest that you shed some of that contempt that you have for “clueless jurors” if you ever get sued and go to trial. That’s the types of arrogance that jurors pick up on and it makes them want to punish you with a hefty judgement.

 

[DeadCactus]

APEWAB!

I guess that has a ring to it. Makes more sense than the rambling rants about the medicolegal industrial complex in response to “There are legitimate cases of malpractice and ethical expert witnesses who testify in those cases”.

 

[Apollyon]

Maybe you should put your thinking cap on. A lawyer being the police for physicians? The “expert witness” is motivated by money alone. A completely clueless jury with no medical training motivated by emotion?

How about a board of our peer physicians in the same specialty associated with the state medical board? There’s probably many options to determine competence but suing docs constantly for frivolous nonsense to catch an occasional bad actor is the incorrect answer.

Maybe you should do the same. A jury of peers would understand the evidence, and a LOT more docs would be found at fault. As above, be careful what you wish for.

And, you are being concrete by saying the "expert witness" is motivated by money alone. That is your wishful thinking, but, on what do you base that? Sounds like emotion. It's not black and white, even if you say so. It is nuanced.

I applaud your passion, but, temper it with reason.

 

[ShockIndex]

Maybe you should do the same. A jury of peers would understand the evidence, and a LOT more docs would be found at fault. As above, be careful what you wish for.

And, you are being concrete by saying the "expert witness" is motivated by money alone. That is your wishful thinking, but, on what do you base that? Sounds like emotion. It's not black and white, even if you say so. It is nuanced.

I applaud your passion, but, temper it with reason.

APEWAB!

I guess that has a ring to it. Makes more sense than the rambling rants about the medicolegal industrial complex in response to “There are legitimate cases of malpractice and ethical expert witnesses who testify in those cases”.

I’ve been approached by several lawyers with cases that gave them concerns. Often their gut told them to decline but they wanted someone else’s eyes to take a look. On one of those cases, a very nice JD/RN sent me a CD with scanned copies of the records. In the margins were colorful commentaries and arrows pointing to various data within the chart. I distinctly remember one arrow in the nursing documentation pointing to a dose of dilaudid that read, “this is where the fool tried to overdose her.”

There was no case. I let the lawyer know this and, at the end of the discussion, asked about all the venom scribbled in the chart. It didn’t seem like her to do that. The lawyer then told me that the person wanting to file the lawsuit was a retired physician at the facility where the unfortunate outcome had occurred to his wife. He had gone through the chart and spent hours harassing her office with calls to take the case. Wowzers

When I said to the lawyer that it must take a lot of history and bad blood for a physician to want to sue another, she said, “not really.” Her firm gets a surprising number of “fratricide” cases (at least enough to have a nickname). Their firm tried their best to avoid these cases because physician-clients were among the most unrealistic and demanding.

She went on to say that many people who want to sue are just angry. They didn’t like their physician and then project the negative outcome of their natural disease progression on that negative interaction. She then joked that she had a sofa in her office and budgeted 1 hr of psychology with every prospective client so that they could get just their anger issues out.

I say this as a reminder. Try not to piss patients off. Also, other healthcare providers and especially other physicians do not share the sense of camaraderie on this forum.

 

[Franzd'Epinay]

When I said to the lawyer that it must take a lot of history and bad blood for a physician to want to sue another, she said, “not really.” Her firm gets a surprising number of “fratricide” cases (at least enough to have a nickname). Their firm tried their best to avoid these cases because physician-clients were among the most unrealistic and demanding.

…

I say this as a reminder. Try not to piss patients off. Also, other healthcare providers and especially other physicians do not share the sense of camaraderie on this forum.

This is what a lot of us have been saying all along, but you were pretending to put your head in the sand and singing a very different tune earlier:

They are permitted to practice by the attitude that permeates this thread (not necessarily by you) that expert witnesses for plaintiffs are “sell outs” or worse. It’s a well rooted culture in medicine that sustains the least among us and is about as ethical as the “blue wall of silence” that recycles the significant minority of bad cops.

This “blue wall of silence” culture does not exist in medicine. There isn’t and will never be a shortage of physicians (justifiably or unjustifiably) willing to go against their colleagues.

 

[WilcoWorld]

Just be careful what you wish for. It is highly likely that any panel of physicians that judges standards of care will be “multidisciplinary” in nature - much like the peer review committees at most hospitals.

This is a sobering point to consider. Nobody craps on Emergency Physicians more than "upstairs" doctors.

 

[bravotwozero]

This is a sobering point to consider. Nobody craps on Emergency Physicians more than "upstairs" doctors.

On a semi-related note, this is why the idea of federal tort reform for EPs gives me pause. May result in unforeseen consequences like increased criminal charges being brought against EPs...

 

[DeadCactus]

This “blue wall of silence” culture does not exist in medicine. There isn’t and will never be a shortage of physicians (justifiably or unjustifiably) willing to go against their colleagues.

And yet here we are with people literally arguing that doing any plaintiff work should be grounds for never being hired and automatically makes you a terrible person.

 

[WilcoWorld]

And yet here we are with people literally arguing that doing any plaintiff work should be grounds for never being hired and automatically makes you a terrible person.

 

[NYEMMED]

And yet here we are with people literally arguing that doing any plaintiff work should be grounds for never being hired and automatically makes you a terrible person.

But it’s true…

 

[ShockIndex]

Very early in this thread I made it very clear that I prey on the following types of healthcare “providers”:

1) Physicians and mid-levels who turn their practices into pill mills (ie fentanyl patches for acute pain and oxy/benzos/soma for teenagers with back pain).

2) Mid-levels, non-EPs, and the healthcare systems who seek to provide a less expensive alternative to our expertise and harm patients in the process (ie missed TIAs, missed appys, missed tubes).

3) EPs who compromise their integrity by providing mid-level supervision that is limited to the stroke of a pen or click of a mouse so that they can continue to harvest RVUs.

And I’m the one who is the pathetic sellout, eh? It looks like we are going to need a lot of Kool-Aid to quench the thirst in this thread’s cult.

 

[ShockIndex]

@thegenius, you took offense to my joke about you being a NP masquerading as an EP. I apologize for the offense. It should have been better written and made less personal. Moreover, you have been very kind to me in previous correspondence, and I should publicly acknowledge that even though we seem to strongly disagree on this particular issue.

However, my point that now is not the time for EPs to be using the language of the mid-level industry still stands. NPs and, to a lesser extent PAs, are using the concept that ABEM board certification does not exclusively confer expertise to justify replacing us as a low-cost alternative. I still maintain that EPs have no business suggesting that those of us who have board certification are anything less than experts in the field. Moreover, we certainly do not need “super experts” and all the baggage that would come with such a system.

To the rest of you in this thread calling me names like pathetic, sellout, etc. At least I have the integrity and class to publicly apologize for an offense when none was needed. Thanks for letting me provide an alternative perspective to this thread.

 

[RustedFox]

Very early in this thread I made it very clear that I prey on the following types of healthcare “providers”:

1) Physicians and mid-levels who turn their practices into pill mills (ie fentanyl patches for acute pain and oxy/benzos/soma for teenagers with back pain).

2) Mid-levels, non-EPs, and the healthcare systems who seek to provide a less expensive alternative to our expertise and harm patients in the process (ie missed TIAs, missed appys, missed tubes).

3) EPs who compromise their integrity by providing mid-level supervision that is limited to the stroke of a pen or click of a mouse so that they can continue to harvest RVUs.

And I’m the one who is the pathetic sellout, eh? It looks like we are going to need a lot of Kool-Aid to quench the thirst in this thread’s cult.

Unfortunately, many of us have no choice in (#3) above. I was named for a PLP case in which I wasn't even in the hospital at the time, but damn; that chart sure as **** came to me to sign, and had better be signed, fast.

 

[Birdstrike]

Very early in this thread I made it very clear that I prey on the following types of healthcare “providers”:

One's effectiveness as an expert witness, is equal to one's ability to be persuasive. Here's some feedback on your persuasion skills as they pertain to this thread.

In this post, you argue that you are an exception to the rule, implying you are one of the "good guys" in a sea of plaintiffs witnesses lacking ethics who are too quick to take cash to advance cases of questionable merit. That has a fair amount of persuasive power. I give you a B- for that one.

On the other hand, trying to defend most or all plaintiffs expert witnesses, and their ethics as a group, is dead-on-arrival from a persuasion standpoint. That what you've spent most of your words on in this thread. Even it it were true, it's a negative-infinity out of ten from a persuasion standpoint, if your audience is a group of physicians. I give you a D- on that one.

Using a predator-prey analogy, with you as the predator and any type of healthcare providers as the prey, is a very powerful, visual analogy. However, if your goal is to persuade an audience of healthcare providers you're on the side of good, it's a devastatingly bad choice for this thread. By saying you're the "predator" with a taste for "only three types" of healthcare-provider 'prey' only makes the physician audience wonder, if the predator gets hungry enough will you eventually sink your teeth into them? This one is a clear and definite F.

 

[ShockIndex]

Unfortunately, many of us have no choice in (#3) above. I was named for a PLP case in which I wasn't even in the hospital at the time, but damn; that chart sure as **** came to me to sign, and had better be signed, fast.

I’d argue that you have a choice. Perhaps you just don’t like the consequences of doing the right thing?

 

[ShockIndex]

One's effectiveness as an expert witness, is equal to one's ability to be persuasive.

Arguing that you are an exception to the rule, perhaps one of the "good guys" in a sea of plaintiffs witnesses lacking ethics who are too quick to take cash in exchange to get a case of questionable merit started, has a certain amount of persuasive power.

On the other hand, trying to defend most or all plaintiffs expert witnesses, and their ethical wholesomeness as a group, is dead-on-arrival from a persuasion standpoint. Even it it were true, it's a zero out of ten from a persuasion standpoint, if your audience is a group of physicians.

Also, using a predator-prey analogy, which happens to be a very powerful, visual analogy, with you as the predator and any type of healthcare providers as the prey, isn't going to have the desired effect of persuading an audience of healthcare providers you're on the side of good. By saying you're the "predator" and you only have a taste for three types of healthcare-provider 'prey' only makes the physician audience wonder, if you get hungry enough will you eventually sink your teeth into them?

I chimed in to provide my experience on why I do what I do. Notice in my first post that I proposed the question “why do I do this?” About the closest that I’ve come to justifying other people’s reason for participating in this line of work is to push back against a notion that I believe you floated re most lawsuits are frivolous. I do not believe that such notions are grounded in any evidence or reality, but I’m still happy to entertain evidence that you have. I’m also skeptical that you hyperbole about a “sea of unethical experts” is also accurate but I allow certain excesses since people can an do draw exceptions to my hunter-prey hyperbole.

Finally, I entered this thread as an alternative to the group think on the topic. While I’m not going out of my way to insult people, I’m not expecting to win a lot of hearts and minds. People are pretty grounded in their belief systems at this point. I’m am interested in providing an alternative perspective for students and lay public on this forum that not every physician views expert witness work as selling out.

 

[bravotwozero]

I’d argue that you have a choice. Perhaps you just don’t like the consequences of doing the right thing?

What would have been 'the right thing' to do in @RustedFox 's situation?

 

[ShockIndex]

What would have been 'the right thing' to do in @RustedFox 's situation?

Don’t sign a chart with poor care; don’t work for an employer who asks you to become an RVU mill at your patient’s expense; leave a speciality that demands you bend your ethics. Plenty of people have done all 3.

 

[BoardingDoc]

What would have been 'the right thing' to do in @RustedFox 's situation?

Clearly you should simply move to a different part of the country that has open jobs that aren't run by CMGs that require this behavior. Any personal / family / professional ties that you have to the area are utterly irrelevant and if you say you're staying for those reasons you're still an unethical doctor who deserves to be "preyed upon" by @ShockIndex. /s

 

[ShockIndex]

Clearly you should simply move to a different part of the country that has open jobs that aren't run by CMGs that require this behavior. Any personal / family / professional ties that you have to the area are utterly irrelevant and if you say you're staying for those reasons you're still an unethical doctor who deserves to be "preyed upon" by @ShockIndex. /s

So, now the ethics depend on whether CMGs require it or if you need to live near Auntie Emma?

Again, multiple people in this thread have done exactly what you’re mocking.

 

[ShockIndex]

Quick question to the group: is your opposition to expert witnesses limited to medicine or are you equal opportunity opponents to all industries?

In other words, are you so committed to your ideology that you would forgo any lawsuit against, say a contractor who burned down your home with faulty wiring?

 

[Birdstrike]

Quick question to the group: is your opposition to expert witnesses limited to medicine or are you equal opportunity opponents to all industries?

In other words, are you so committed to your ideology that you would forgo any lawsuit against, say a contractor who burned down your home with faulty wiring?

You're missing the whole point. No, we don't think "all expert witnesses are bad" in Medicine or in all industries. And no, we don't think people should be able to burn down our houses, without consequences.

The part you don't seem to understand, is that many of us have been targeted with meritless lawsuits or board complaints. There is a tremendous emotional power that comes with that. You'll never win hearts and minds by trying to dismiss that experience.

I've been falsely accused of malpractice for "missed UTI" even though the patient had a negative cath urine and a negative urine culture. I eventually won and cleared my name, but not before I went thorough a terrible, time consuming, emotional process I didn't deserve.

I was falsely accused of missing a spinal cord tumor because a CT tech put the wrong physician name (mine) on a CT myelogram order that I never ordered. It took me almost a year to clear my name with the state medical board and was a terrible, time consuming, emotional process I didn't deserve.

When you're talking to physicians who have lived with being falsely and unjustly accused of malpractice, saying "Show me the data" to prove it is, tremendously insulting. Perhaps that's your intention. Then, using a predator/prey analogy further implies you're not on the side of the wrongly-accused physician, but a predator looking for fellow-physician prey. That's aggressively insulting. Perhaps that's your intention. Would you walk into a room of fellow police or FBI and tell them you are "predator" and they are the 'prey'? Maybe you would. Would you dismiss harassment or mistreatment they've face in the line of duty, and say, "Show me the data or it didn't happen"? Maybe you would.

Not only have I been falsely accused, but like you, I have worked as an expert witness (defense only). I understand both the expert-witness side and the falsely-accused physician side. I understand how being persuasive, first to the attorneys we are consulted by, then to the jury, is paramount. I realize somebody is going to end up being consulted by plaintiffs attorneys to give opinion, and that it's much better if that ends up being a good, honest and ethical person. However, there are many ways to make that point to fellow physicians.

If you truly want to be persuasive with the point you say you're trying to make, without being insulted to fellow colleagues, this is how I would do it.

"I understand some of you have been harassed by accusations lacking merit. Reducing or eliminating meritless lawsuits is a concern to all physicians. While I can't be sure, with certainty, what percentage of lawsuits are meritless, if even one physician is falsely accused of malpractice, it's one too many. In some cases, that may be due to a bad or unethical physician expert encouraging an attorney to move forward with a case they shouldn't. But the only way to keep those false claims moving forward is to have more good, ethical expert physician-experts, like you and I, involved in the process. If we get to these meritless cases first, we can stop them. If good people refuse to do this kind of work, then the bad guys win, and those cases move forward. If you're a good, ethical person, get involved and make this process better. Take this industry back, for the good guys."

 

[ShockIndex]

You're missing the whole point. No, we don't think "all expert witnesses are bad" in Medicine or in all industries.

You seemed to have missed all the posts about ALL plaintiff witness should never be employed. Perhaps you don’t remember the ones calling ANY plaintiff witnesses slime, pathetic, or sellout. There was no exceptions or quarter given - those were absolute terms.

Others in this thread took your approach and pointed out that there are a few bad actors in this profession, and we need ethical witnesses to help address this problem. They too were dismissed as being illogical.

I don’t come here to be popular. I’m not anyone’s friend. You’ll find that I very occasionally post on topics of particular interest and almost always as a counter voice to what I perceive as physician group think. I do this because every good discussion deserves a contrarian opinion, and I do my best to reflect opinions that you will find outside of medicine. Of course I fall short of my own ideal at times.

However, if my opinions hurt or offend people who have been victimized by what they perceive as frivolous lawsuits or board complaints, then my advice is to stay off the internet or make liberal use of the site’s ignore feature. This is a place where we should expect a diversity of opinion and I do not particularly subscribe to intellectual safe spaces.

 

[Franzd'Epinay]

3) EPs who compromise their integrity by providing mid-level supervision that is limited to the stroke of a pen or click of a mouse so that they can continue to harvest RVUs.

You do realize that this is outside most people's control, right? There are not enough jobs without midlevel "pen supervision" to go around.

Every single lawsuit involving midlevels should also name the hospital system and staffing group for forcing this farcical "supervision" model on emergency physicians. Why isn't this standard if supposedly these lawsuits are filed under altruistic reasons to improve the system?

 

[CoolDoc1729]

You do realize that this is outside most people's control, right? There are not enough jobs without midlevel "pen supervision" to go around.

Every single lawsuit involving midlevels should also name the hospital system and staffing group for forcing this farcical "supervision" model on emergency physicians. Why isn't this standard if supposedly these lawsuits are filed under altruistic reasons to improve the system?

I don’t think anyone would seriously suggest most cases are filed to improve the system. I think most cases are filed a) if something bad happens, and patient/family member wants to be compensated and b) lawyer sees something in review of the case that is potentially malpractice so they can get paid. It would be great if the malpractice system weeded out bad physicians and inadequately trained providers, but it definitely doesn’t function that way.

There is only one place within 2 hours of me that doesn’t require midlevel cosignatures. It is a critical access that just staffs 1 doc on 24’s. Agree with many others that it is not possible for everyone to work a place that doesn’t require this.