Ehab Akkary, MD, FACS, FAACS
Akkary Surgery Center, Morgantown, WV
Dr. Akkary started his practice in 2008 as an Academic Bariatric Surgeon and gradually shifted to Community based Cosmetic Surgery. He is Board Certified in General Surgery by the ABS and Board Certified in Cosmetic Surgery and Facial Cosmetic Surgery by the American Board of Cosmetic Surgery and the American Board of Facial Cosmetic Surgery. He practices in WV and PA where he performs wide variety of Cosmetic Surgery at AAAHC accredited facilities. Dr. Akkary is devoted to the field of Cosmetic Surgery, he is a Fellow of the AACS. He serves multiple committees at the AACS and the ABCS and he is a reviewer for multiple journals including JAACS.
It is not surprising that practicing medicine nowadays is very challenging. Physicians struggle to deliver proper patient care while fighting many adversaries. Unfortunately, medicine has become over-regulated by the government and some health oversight agencies placing paperwork and documentation ahead of actual patient care.
Do you ever recall trying to order something that the patient needed, and the nurse was being prohibited from taking a verbal order from you? You then needed to find a computer, log in, go through multiple screens to give one order. With multiple patients and recurrent daily routine, this represents a simple example of inefficiency secondary to regulations. Over-regulation, high overhead, low reimbursement in addition to a ridiculously litigious environment create a less than healthy work atmosphere for physicians. Yet, the same circumstances create an awesome work environment for malpractice attorneys that love that physicians walk around with a gigantic target on their back called malpractice insurance that can provide some easy money for the attorney and the patient even in a case of recognized and well-known complications.
Other challenges include high overhead that, with every regulation, would continue to go up and low reimbursement that, with more government interference, would continue to go down. When you see such a poor setting to practice medicine, you would think that physicians will get together, unite and fight against their adversaries that include but not limited to government regulations, low reimbursements, high overhead, insurance companies and attorneys. Unfortunately, some physicians do not see it this way. This article does not intend to generalize or stereotype a group of physicians. However, my intention is to point out a small group of physicians whose actions hurt us all.
This is the type of physician that I call Self Appointed Expert Witness (SAEW). Complications, while unfortunate, are normal part of practicing medicine and performing surgical procedures. Patients with a complication might seek a 2nd opinion. If they stay within the same community, then the 2nd opinion will likely be from a competitor who immediately might assume the role of the SAEW manipulating the patient.
The manipulation would include that going to the competitor (1st Surgeon) means that they are going to less of a qualified surgeon and that is why they have complications, have they gone to this superhero SAEW first, they would not have had any issues at all. The SAEW starts the famous game of poisoning the well and turning the patient against their colleague. At the same time, the patient who is concerned about the complication is starting to see big $ signs because we are a sue happy society!
A physician who acts as a real colleague would be honest with the patient and explain that recognized complications happen and help treat the patient rather than starting the SAEW game. I, myself, had an interesting experience with a physician who commented negatively about my surgery to the patient and pushed her to try to file a claim stating that some surgical steps were done wrong. Interestingly, in his own documentation, he admitted that he did not know exactly what surgery was done and did not read the operative report. These are the kind of physicians that live among us and are of great use to our opponents.
Let's assume that the patient fell for the manipulation of the SAEW and wanted to file a claim. The attorney will need to find a physician to sign an affidavit stating that the physician breached the standard of care. This will give the attorney the weapon to file the lawsuit against the physician. Now this Attorney Appointed Expert Witness "AAEW" will get money that he claims for his time not for his opinion. However, there is an obvious conflict of interest when reviewing cases for an attorney. If the AAEW does not give the attorney the report that he needs and subsequently prevent the attorney from filing a claim, the attorney might not use them again. There is an obvious conflict of interest right there. Some attorneys promise their AAEW that they won't need to testify in court and that after the claim is filed, they can get another expert witness. This usually happens when the initial expert witness is worried that there is really no case but at the same time, they are trying to maintain a business relationship with the attorney. Some attorneys even prepare the testimony for the Physician and all the AAEW needs to do is just to sign it in. Some physicians do not even read the affidavit that they sign and will be used to file a claim against a colleague of theirs.
Expert witnesses have legal protection of their opinion which serves them and the attorneys that hire them. However, they can frequently act against physicians and push cases through the legal system that are not real malpractice cases, and they are nothing more than a complication that it is well recognized.
So, the question is, how can we stop such behavior that hurts our community? This short-sighted approach from some physicians hurt the group as a whole including said physicians. Of course, some cases are real, and patient might deserve a compensation and an expert witness acting based on good faith has a very important role in this setting and also a well appreciated role to assist the patient. But we need to differentiate between good faith expert witnesses and bad faith expert witnesses. Physicians should be held accountable to their testimony. It is our duty to report affidavits that are based on bad faith. Appropriate entities would be the Physicians State Board of Medicine and the American Medical Association as well as the specific main society that such physician belongs to in their specialty.
Conclusion: While this talk might seem controversial, I have yet to meet a physician who did not encounter what we are discussing here in their practice. Even physicians fresh out of residency training encountered such behaviors during residency. I believe it is healthy to bring the issue out to light, discuss it and make sure that we, as physicians, work as colleagues and protect each other not work for our opponents. I am not saying by any means that we should not review legal cases and provide an expert opinion in malpractice disputes, but I am saying that we have to identify, report and take action against any physician that provides a substandard report claiming there was a breach of care when there was not.
Take Home Message
Physicians need to work as colleagues, identify their adversaries and understand the legal ramifications of their actions. Physicians that provide an expert witness opinion need to be held accountable to their opinion and know that it can and should be scrutinized.