What Serving as an Expert Witness Taught Me About the Practice of Medicine

During the pandemic, like many healthcare professionals, I sought additional income through chart review work. This led to an unexpected role as a defendant's expert witness in a medical-legal case involving a patient who claimed to have developed an autoimmune condition following a fall. While I cannot divulge specific details, this experience profoundly changed my perspective on medical practice.

And it left both positive and negative consequences for my career.

The case appeared straightforward at first glance—medical literature clearly indicates no established link between trauma and the autoimmune condition in question. However, what unfolded in the courtroom was an eye-opening lesson in how medical facts can be reframed and manipulated in legal proceedings. The plaintiff's legal team secured testimony from a highly credentialed physician expert at a prestigious university, and they made assertions that, while scientifically questionable, carried weight due to the expert's impressive credentials.

It served to create a halo effect where the authority of the individual overshadowed the underlying facts. They even cited a 40-year-old article suggesting a tenuous connection between trauma and autoimmune conditions, using the “cannot exclude” argument to plant seeds of doubt.

How My Expert Witness Work Changed My Mindset 

This experience led to several significant changes in my medical practice. First, I became acutely aware that every patient encounter, no matter how routine, could potentially become a legal matter. Simple oversights like copied-and-pasted text in electronic health records or incomplete documentation of off-label medication discussions could be weaponized in legal proceedings. The opposing counsel's attempts to discredit testimony by questioning my recall of basic details—such as referring to a physician's gender or their practice locations—highlighted the importance of meticulous documentation. The case was ultimately resolved through a settlement.

The experience also revealed the darker side of medical-legal proceedings. I witnessed how lawyers could twist routine medical decision-making into suggestions of impropriety, such as questioning diagnostic codes used for billing purposes or scrutinizing the documentation of informed consent for off-label prescriptions. I had been a solo rheumatologist in private practice for several years, frequently encountering ambiguous diagnostic scenarios that could persist for extended periods. The complexity of rheumatology often results in unclear diagnoses that can persist for extended periods.

This experience in the courtroom led me to implement several defensive practices: seeing fewer patients to ensure more thorough documentation, increasing non-clinical work, and being more cautious with complex cases that might benefit from specialist referral.

Perhaps most importantly, it highlighted the disconnect between the practice of medicine and its legal interpretation. While medical decisions are often made based on clinical judgment and experience, legal proceedings can reduce these nuanced decisions to black-and-white scenarios, where documentation becomes more important than the actual care provided.

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The Complexities of Modern Medical Practice: Lessons from the Courtroom

In the quiet aftermath of my courtroom experience, I found myself fundamentally reassessing my approach to medical practice. What began as routine documentation and standard patient care suddenly appeared fraught with potential legal implications. The seemingly straightforward aspects of medicine had transformed into a complex web of legal considerations, forcing me to navigate an increasingly challenging landscape.

Every day in clinical practice now carries new weight. Consider the simple act of ordering diagnostic tests—what once was a straightforward clinical decision has become an exercise in meticulous documentation. During my testimony, I watched in dismay as opposing counsel attempted to transform routine software limitations into suggestions of fraudulent billing practices. Such experiences have left an indelible mark on how I approach even the most basic aspects of patient care.

The practice of rheumatology, with its frequent reliance on off-label medications, has become particularly challenging. These medications, often crucial for patient care, now require exhaustive documentation of patient discussions. Every potential side effect, no matter how rare, must be detailed and acknowledged. The specter of future litigation looms over each prescription, leading to lengthy conversations that must be captured in precise detail within the medical record. However, reduced insurance payments make it difficult to balance the quality time spent with patients and the necessary documentation.

Perhaps most troubling is the documentation paradox we face as physicians. The conventional wisdom to “document everything” has proven to be a double-edged sword. Too much documentation raises suspicions of defensive medicine, while too little suggests negligence. Even perfect documentation can be dissected and scrutinized, with timestamps and chronology becoming crucial elements in legal proceedings. I've watched colleagues struggle with this balance, their patient notes growing longer while their patient interactions get shorter.

The impact on clinical practice has been profound. I find myself increasingly cautious, sometimes referring cases I would have confidently managed in the past. This defensive approach extends beyond documentation to the very nature of patient care. Complex cases that once represented interesting clinical challenges now appear as potential legal liabilities. The “safe zones” of medicine have become increasingly appealing, though this shift often comes at the cost of comprehensive patient care.

The financial implications of these changes ripple through the healthcare system. Defensive medicine, with its additional tests and specialist referrals, drives up costs while potentially delaying effective treatment. The administrative burden of enhanced documentation requirements reduces the time available for direct patient care. These challenges have led me to increase my non-clinical work, finding a safer harbor in administrative roles while maintaining a more selective clinical practice.

Still, I remain cautiously optimistic about medicine.

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Moving Ahead with My Career 

Looking forward, I see both challenges and opportunities. While the practice of medicine has become more complex, these experiences have also led to more thorough patient communications and more carefully considered treatment plans. The key lies in finding balance—maintaining high-quality patient care while protecting oneself legally, preserving the doctor-patient relationship while acknowledging the realities of modern medical practice.

As I reflect on these changes, I realize that medicine is evolving into something quite different from what I initially envisioned. I initially anticipated that patients would appreciate the care they receive from their doctors and that lawsuits would arise only in cases of gross negligence. However, I observe that there is a lack of respect toward physicians, indicating that financial motivations predominantly drive societal interactions.

Yet within these challenges lies the opportunity to develop better systems; more effective communication strategies; and, ultimately, safer patient care. The goal remains the same—to provide optimal care for our patients—but the path to achieving this goal now requires careful navigation through an increasingly complex medicolegal landscape.

This evolution in medical practice, while sometimes frustrating, represents a necessary adaptation to modern healthcare realities. As physicians, we must learn to balance the art of medicine with the science of documentation, the need for efficiency with the demands of that thorough documentation, and the desire to help with the need to protect ourselves professionally.

What do you think? Do you find yourself practicing differently because of a potential legal threat? Has that made you a better physician?