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Nephrologist Saad S. Alshohaib discusses his article, “Why truth still matters in the courtroom: lessons from a physician witness.” The conversation provides a profound reflection on his decade of experience serving as a medical expert witness, a role he describes as walking a “narrow bridge between medicine and the law.” Saad shares his seven core principles for physicians called to testify, emphasizing that their ultimate loyalty must be to the truth, not the side that hired them. The discussion covers the importance of integrity over convenience, clarity over complexity, and honesty over comfort. He makes a compelling case for seeing the humanity in both the patient in the chart and the clinician accused of making an error, and using testimony not just to judge, but to heal the system. This episode is an essential guide for any medical professional on navigating the ethical complexities of the legal system while holding fast to the truth.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Saad S. Alshohaib. He is a nephrologist. Today’s KevinMD article is “Why truth still matters in the courtroom: Lessons from a physician witness.” Saad, welcome to the show.

Saad S. Alshohaib: Thank you very much. I’m very happy to be with you. Thank you for having me.

Kevin Pho: Alright, so I know you’re joining us from Cairo today. Thank you so much for taking time out of your busy schedule. Briefly share your story and journey, and then talk about why you wrote this article on KevinMD.

Saad S. Alshohaib: Well, I was nominated in Saudi Arabia to be a court witness for difficult cases. I have long experience and I welcomed that. In the beginning, I wasn’t sure I would accept that, but when I thought about it and saw the people around me, I thought I might be the most experienced and could do my best. I didn’t really regret it, but I would like to share my feelings with people and what they should do.

Kevin Pho: OK. Obviously, I’m not familiar with court cases in Saudi Arabia. As a physician, how do you get picked to be a witness in a court case in Saudi Arabia?

Saad S. Alshohaib: You get picked when people know about your integrity. Your work also nominates you. It depends on experience. You have to have experience, you have to be a balanced person with high integrity, somebody who has a good career, somebody who has never had problems like malpractice before or any bad records. Then you get nominated, and you accept the nomination. We spend a lot of time on these cases, but it’s worth doing. It’s really worth doing.

Kevin Pho: So tell us about your first case. Tell us about an experience as a physician in a court case in Saudi Arabia. What was that like?

Saad S. Alshohaib: Well, the court cases are sent to me by email, and I look them over. I interview the physicians, and it takes a lot of effort. But I always keep in mind that I have a patient who has been harmed, definitely had a harm, and a physician who might be in a very stressful situation. Then we have to balance that, and the balance is very, very difficult because I also look at where the doctors are practicing. If they are in a small hospital, it is very different from when you are in a tertiary hospital where you have all the facilities. That’s one factor.

The second one is I look over documents, and I found it’s very useful to use the nurses’ notes. They write better than the physicians. The nurses are more articulate; doctors, they don’t care about the note. I like to tell doctors, the best lawyer for you is your notes.

Also, I tell them to communicate well with the patient. Most people are sued because they don’t communicate, not because of their practice. Now, let me explain one case. A patient came to the emergency room with, let’s say, severe status asthmaticus, and then he arrested in the emergency room. The whole team came around, and they tried to resuscitate that young man, and he made it.

He made it, but because the whole team was trying to get IV access, the IV infiltrated, which caused damage to the hand. He required quite a few surgeries to help his hand go back to normal, and it didn’t really come back to normal, but there was some sort of repair.

The doctor said, “Well, I did the CPR. This is all I could do.” Then the patient’s parent said, “Well, yes, my son is alive. I am thankful for that, but he has a disability.” So we decided that the doctor would not be blamed. But the system would give a reward to the patient. OK. That’s what happened, and I think there should be a culture where there is no blame for the doctors. At the same time, everybody has to be accountable for what they do.

Kevin Pho: In your article, you talk about seeing the humanity both in the patient that was harmed and also in the clinician. Tell us why it’s important to have empathy for not only the patient, of course, but also for the clinician who is being accused or who experienced a bad outcome. Why is it important to have empathy for that physician as well?

Saad S. Alshohaib: I’ll tell you why. Because that physician, at the end of the night, was alone. It was a small hospital. He didn’t have much to help him. He did his best. The patient made it. At the same time, this patient is also young, and of course, he deserved a good life. When we interview the physician, we ask him, “What did you do? What were the guidelines? What did you follow?”

Physicians are accountable for following the guidelines, not for the outcome. The outcome could be a bad outcome or a good outcome. As long as the physician follows the rules, then he will not be blamed. On the other hand, the physician is also responsible for the rules, for the guidelines, and for managing the complication. Even if complications occur, we have to manage them. That’s where the balance is.

I want to say that patients usually come with tragedy. At the same time, physicians are really having fatigue. They are tired. They have problems. They feel alone. Most physicians experience loneliness. Most physicians are exhausted. Today, maybe with AI, the knowledge base has become better. It will help us more. It will also help me as a doctor. But now, it’s not only the lack of information we have; we have the information. What I’m trying to do now is to teach young people how to apply the information more than just the amount of information they have.

Mistakes do happen, and I think it’s a chance for the hospital to improve the system. I was in a position of authority also, and we applied some laws, learning from these cases. These cases will help us to build a better system, help us to establish the guidelines, and help us to do accreditation for the hospital. It’s an educational thing. I also teach students about what happens in the courtroom.

Kevin Pho: Do you have an example where a court case led to a change in the guidelines at the hospital or institution where you work?

Saad S. Alshohaib: Yes. We have examples. For example, the look-alike medications. When that happened, we immediately changed this in the hospital. We also made more than one checkpoint in the hospital to avoid these mistakes because you remember the Swiss cheese model? Yes, about the care. So, in these cases, you are taught how to avoid mistakes in the institution and improve.

I remember one case where the patient had a colonic perforation. It is a known complication of colonoscopy. But as a medical director, I reviewed the privilege of this physician. I reviewed it and put him on probation because I wanted to make sure that he did the right things. He was on probation for two years, and then we allowed him to go back. I would say that these things should empower people to change the privileges of the clinicians, to change what they do and observe them, and also to make the guidelines clear.

Follow all the international guidelines and try our best to avoid errors. I like to say that, unfortunately, the profession that has the most mistakes is medicine because it has a human factor. The least is aviation. What I learned from aviation, because my brother is a pilot, is that when they go to the cockpit, they check, check, check, check, check. That gave me a very good idea when I was with him for the first time. It gave me the idea that I should use checkpoints as much as I can.

So I have introduced clinical pharmacists. I’m trying to get nurse practitioners. I empower everybody to speak up and encourage people to report mistakes as much as they can without being disciplined when they do that. I also told them in my hospital, “Look, don’t wait for the patient to complain. Go ahead and address it because we want the best care for the patient.”

Kevin Pho: So tell us what other lessons you’ve learned from being a physician witness. I know your article talks about a few others. What other lessons can you share with the audience?

Saad S. Alshohaib: Well, the most important lesson I learned from this is that if you have the human touch, if you communicate well with people, they will forgive you if you make a mistake. If you communicate with them. Now, communication has to be coming from the inside, to have the passion. You also have to have compassion for the patients. You have to tell them. I learned that when there’s a mistake, I tell the patient.

I remember one day there were two look-alike medications the patient got from the pharmacy. I immediately called her and told her not to take the medication, and she was very happy I did so. I learned from this experience: good communication, consultation if necessary, and one message to the physicians: please, please, please avoid defensive medicine or practice. People are always worried about being sued.

Remember that being sued will happen to almost everybody, particularly neurosurgeons and retinal surgeons, and that should not make us frustrated and leave our practice. No. It’s a chance for us to change our attitude. In my experience, and also in the experience of medicine all over the world, in 80 percent of lawsuits, there is no blame on the doctor. That’s for sure.

So, I would say, and I have told my students, if you have a problem, don’t just talk about it; fix it. Let the patient know. Be transparent. Don’t worry. Tell them, and we in the administration will help you because I run a hospital, we have a lawyer for us. That will help us in getting the facts straight, and we will not hide anything. We should be transparent as much as we can.

Kevin Pho: Wonderful tips. I’m glad that you emphasize transparency, the human touch, and communication because all of those things also apply in the United States for clinicians who want to avoid lawsuits. I’m glad that these principles can be applied worldwide.

Saad S. Alshohaib: Yes. But I would like to mention also, it differs from one region to another. I did a study where we had a group of students from Saudi Arabia and a group of students in the United States, and we asked them about the hidden curriculum, which means, how do you learn from your superiors?

And I found it was different from one to the other. That lesson taught me that people sometimes make mistakes that they don’t know they are making in terms of education. They don’t mean to do bad, but they have not been taught by other people. Now, there are things that are taught in the curriculum that I learned as a student, but there are things hidden in the curriculum, like how to break bad news, how you talk to a patient, how you communicate well with them, how you treat a colleague, and so on.

And I found that most of the things that happened in my life… first, politics are not worth pursuing. Number two, the glory of medicine is not in the awards or in the international media; it’s the human touch with people. And thirdly, creating the culture in the hospital will make a big difference. It is the culture we really have to create, and that will make a difference in the care, in the human touch that we have.

The body language of the people is very, very important. But body language is not something you can fake. It is an artifact of what you really have inside. When you are really after the truth, when you are really after compassion, your body language will be adequate; it will be good. You don’t have to fake it. It will just be spontaneous.

That’s something I learned from there. Another thing is that there are so many physicians who are used to doing things without asking themselves, “Is this a true practice or not?” And that’s also a big problem. I would warn every physician, with my experience—I’m 65 now—your opinion is different from evidence-based medicine. We have to look for the facts to help the patient. We have to learn from each other. I learn from students, nurses, and everybody because I want the truth.

Kevin Pho: We’re talking to Saad S. Alshohaib. He’s a nephrologist. Today’s KevinMD article is “Why truth still matters in a courtroom: Lessons from a physician witness.” So Saad, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Saad S. Alshohaib: When you are a young physician, I know what you want. You want the white coat; you want to be recognized. You will get that. You’ll get that and you’ll put it in your office. But what’s most important is to be meaningful, to feel well, to get help to the people, and to love the people. And do not expect a reward. Do not always expect a reward. It’s the patients who, when they get better, they improve.

I remember a patient from another article who came in with cardiogenic shock from an electric shock. Almost the whole team was going to stop the CPR. I insisted not to because I remember one of my supervisors saying, “Saad, with electric shock, never give up.” I am so happy now when I remember that he walked away with his mom; though that was a long time ago. When I looked at the eyes of his mom, it is really a glory in my life. That young man made it.

And one day I looked at a 13-year-old girl whose father was in the ICU. She didn’t say anything. She just looked at me, and her eyes were saying, “Save my dad.” And we did save him. That was a real success. Though I have been awarded things, I have been invited to different media outlets and conferences, and I have presented talks, nothing is worth giving your whole, sincere self without expecting any reward.

Kevin Pho: Thank you so much for sharing your story, time, and perspective, and thanks again for coming on the show.

Saad S. Alshohaib: Thank you.