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Scrutiny for doctors as expert witnesses?

Physicians at a CEJA open forum discussed accountability for bad medical testimony and disparities in and access to health care.

By Damon Adams, AMNews staff. July 7, 2003.

Chicago -- A. Bernard Ackerman, MD, believes giving bad expert witness testimony is akin to practicing bad medicine.

"This is a widespread problem," Dr. Ackerman told physicians gathered at the Council on Ethical and Judicial Affairs open forum during the AMA Annual Meeting. "Do you think that doctors who lie in court do that only in court? They lie to patients."

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Dr. Ackerman, a dermatopathologist in New York City and founder of the Coalition and Center for Ethical Medical Testimony, was asked by the council to speak at the forum about expert witness testimony.

Dr. Ackerman discussed a few cases in which he questioned testimony given by medical experts. He shared his concerns in the cases and said doctors should be sanctioned for bad testimony, just as they would for practicing bad medicine.

"It's nothing less than fraud against the public," he said later. "The only way this can be stopped is if we physicians do something about it. Can't we really police ourselves?"

Several doctors at the forum agreed that medical testimony should be closely scrutinized.

"Physicians who give false testimony should be brought to task," said psychiatrist Robert Phillips, MD, a representative of the American Academy of Psychiatry and the Law.

But Stuart Gitlow, MD, MPH, said talking about medicine on the stand is not the same as practicing medicine.

"How can we have the practice of medicine when the physician has not seen the patient?" said Dr. Gitlow, a delegate for the American Society of Addiction Medicine.

Dr. Ackerman urged doctors to press the AMA on the matter. "I fear that nothing is going to be done here," he said. "The AMA isn't highly committed to doing something on this issue."

Reducing disparities in care

Two other topics were discussed at the forum: disparities in health care and access to care.

Naheed Rehman, a CEJA member and a medical student in San Francisco, talked about studies that addressed racial and ethnic disparities in care, including a 2002 Institute of Medicine report that found racial and ethnic minorities received lower quality health care than whites.

Several doctors said physicians need to understand the culture of their patients, and they stressed the importance of language services to improve communication.

"It's important not only to talk about access but to be able to react culturally to your patient," said delegate Kathleen Weaver, MD, an internist in Oregon.

Mena Mesiha, a medical student in New York, said diversity in medical schools helps students relate to other races and cultures. Those experiences will improve interaction with patients when the students become doctors. "To a certain extent, we're on our way" to reducing disparities, Mesiha said.

Dr. Phillips added: "It is not necessary that you see someone of the same race, but you must have an understanding of that person's culture. Hopefully, we will reach a point in all of our practices that competence is color- and ethnic-blind."

Concerning access to care, doctors talked about how some patients lacked insurance and were unaware of free care that's available. They said emergency departments provide access but often become congested.

Delegate Jeremy Lazarus, MD, a psychiatrist in Colorado, expressed concerns about physicians not accepting new Medicare patients because of low reimbursements.

Dr. Weaver said focus also should be placed on funding Medicaid. "It's asked to do many things, but it doesn't do any of them very well," she said.

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Copyright 2003 American Medical Association. All rights reserved.

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