Cardiologist on trial: reflections on credible evidence.

During a recent medical malpractice lawsuit brought against me, I was forced to confront the fundamentally different ways in which physician scientists and litigation attorneys assess and utilize clinical evidence. The plaintiff alleged that I failed to diagnose myocardial sarcoid in her husband and that my failure to do so resulted in her husband's death. Her case was based largely on the testimony of one expert witness, who had been involved in more than 300 other medical malpractice actions, and who had never performed any kind of peer-reviewed research or systematic reviews on myocardial sarcoid. None of the evidence that he presented against me was based on randomized trials, high-quality observational studies or even published practice guidelines, yet the judge saw fit to introduce his testimony as valid evidence to be considered by a lay jury. I conclude by proposing a voluntary system whereby expert witnesses would subject their reports to external peer review, much as is done at top-tier medical journals. Those experts who are able to have their reports pass peer review would be presented to the jury as having a greater level of credibility.