Plastic surgery is a somewhat unique subspecialty in the field of surgery. Plastic surgeons are trained to think creatively to solve patient's “unique” problems. Although during our training we are taught a set of “disciplines”, we are strongly encouraged to individualize the care and treatment of every patient we see. This way of thinking, as opposed to creating a “standard” method of dealing with clinical situations, make sense given that every patient's situation is somewhat unique. Furthermore, every patient's personality, psychology, and goals vary; it makes sense to individualize a treatment course to the patient's specific situation.
Given that there are many different ways to handle a specific clinical situation, it is not surprising that many plastic surgeons feel that there is a “best way” to treat a specific problem. In other words, it would not be surprising to find 5 different recommendations from 5 different plastic surgeons for a specific clinical “problem”. Each plastic surgeon will have a potentially different recommendation based on his/her training, experience, and/or preference.
Given this potential difference in opinions of how to handle specific clinical situations, it may be difficult to ascertain what is the “standard of care” for a specific clinical situation. This becomes important for medical expert witnesses who are asked to describe the standard of care relevant to a given case. By definition, the standard of care in a specific situation would describe the treatment protocols that experts would agree with as most appropriate, also called “best practice”.
This is where, in my opinion, the difficulty arises in the field of San Diego plastic surgery. Again, because of the nature of the field and the potential for differing opinions about the “best practice” in a specific situation, the standard of care may differ in one medical expert witness' opinion compared to another's.
This is why it is important for medical expert witnesses to recognize and report that a variety of acceptable treatment modalities may exist for specific clinical situation. This variety of acceptable treatment options available should be reported candidly and clearly. This ability to recognize and report the variety of treatment options available is an important part of an expert witnesses responsibility to provide a thorough, fair, objective, and impartial review of medical facts. I think everyone will agree that an ideal expert witness should remain fair and objective.
To summarize, the field of plastic surgery by its very nature encourages creative problem-solving to help our patients unique needs. It is not surprising therefore that a variety of “solutions” may be an acceptable modality of treatment for the same clinical situation. Any San Diego plastic surgeon who serve as expert witnesses should remember that there role is to, as objectively and fairly as possible, educate the non-plastic surgeons about the variety of treatment options available for the specific situation at hand.
In order to do so honestly and impartially, the plastic surgeon expert witness must set aside his/her personal preferences and acknowledge the variety of treatment options available (even if he/she or his/her colleagues would not have chosen the modality chosen by the treating physician). In order to be an effective and fair medical expert witness, plastic surgeons should (according to the American Society of Plastic and Reconstructive Surgery Code of Ethics for medical expert witnesses) “have recent and substantiate experience in the area in which they testify. They should thoroughly review the medical facts and testified to their content fairly, honestly and impartially and be familiar with the standards of practice prevailing at the time of the occurrence”. In my opinion, a recognition that a variety of modality treatments exist for any clinical situation is an important part of the plastic surgeons' expert witness ethical responsibility.
I am in total agreement with Dr. Mark Gorney's statement in the Plastic Reconstructive Surgery Journal Volume 122:1 (208) 6 that states that “thou shall not bear false witness and that one should be able to leave the witness stand with the respect of everyone in the courtroom and most importantly the respect for yourself".
Dr. Pousti is a diplomat of the American Board of General Surgery as well as American Board of Plastic Surgery (and has been recertified). Dr. Pousti has been involved in court testimony, depositions, and record reviews for the past 5 years. He is available for record reviews and consultations.