Improvement in cardiopulmonary function in mitral stenosis after percutaneous balloon mitral valvuloplasty.

compensation. The guideline states, “The witness should receive compensation that is appropriate to his or her expertise and qualifications. Acceptance of a fee that is disproportionate to those customary for such professional endeavors is improper and unethical. . . . ‘ Unfortunately, since many lawyers and legal firms have difficulty obtaining physicians, they often tempt physicians by their willingness to pay as a fee whatever the market will bear. Because of that, over the last few years customary fees for medical expert witness testimony may have already become inappropriately high for the time and effort spent on such activities. I feel that a good guideline to keep professional expert witness remunerative fees in perspective would be to equate the time and effort expert witnesses spend with the appropriate fees charged by most physicians for what they do best, ie, giving medical care. For example, if the pulmonary specialist charges $150.00 for an hour of time and effort expended for patient care or diagnostic consultation, this fee seems to be one that such a medical expert witness should charge and accept for an hour of expert medical witness testimony. To accept a higher hourly fee for expert medical witness testimony than one charges for the equivalent time expended in the care of a sick patient would seem inappropriate and potentially unethical. I have heard many medical expert witnesses state that they do not like to testify in the medicolegal process but when “pushed” for whatever appropriate reasons, they show their displeasure by charging a very high fee. This obviously very faulty and unethical reasoning and behavior cannot be condoned. In summary, I would suggest to the American College of Chest Physicians and to the Ethics Committee that they consider refinement of their fourth guideline on expert witness compensation, which relates the appropriateness of the fee to the fee physicians charge for what they do the majority oftheir time in practice, which is giving patient care and service.