Who do you defer to, Doctor?

I was asked the question, "Who do you defer to, Doctor?" by a lawyer in a court case.  It caused me to pause.  I was being asked about the care of my patient.  I was a generalist, a specialist and a sub specialist.  I knew that the lawyer seemed to consider some 'hierarchy' applied to doctors as it presumably does among lawyers and certainly is a matter in the military.
It probably pertained when I was an Assistant Professor at the University too.
But it wasn't relevant in that way to clinical medicine.
I said, "I don't defer to another doctor, unless he is willing to take responsibility for the patient and assume full accountability."
Indeed, that's what clinical practice is about. It's all in the relationship.
I thought about the question overnight.  Clearly I defer to God.  I defer to authority in a governmental sense but in regards to patient care, again it's different.
The lawyer asked specifically about someone who is high profile in the court system.  I found that interesting because again clinically the lawyer couldn't grasp that 'big guns' and 'little guns' weren't a matter of much substance in my clinical world.
I do have a constellation of characters who I admire and respect and would on specific questions seek their advice and probably accept this though in the end it would be a consultation. In a consultation I can disagree and go my own way with greater risk and responsibility once I'd asked for advise and chose not to follow it.
I have a host of doctors, though fewer as I've grown in years and experience, who I consider have more specific experience than I do in a particular area.
I am a psychiatrist in the general sense but am a subspecialist in the area of addiction with certification and extensive experience.  I routinely seek advise of colleagues who have more experience with a particular kind of patient. I have a half dozen doctors who are certified in addiction medicine, some of them psychiatrists even, but I don't think of them as 'superior' to me.  I think of their individual training as comparable in many instances as mine but think more about them in terms of numbers of cases diagnosed and treated.  I also think of their outcomes and most importantly the complexity of cases.
One fellow is particularly good with heroin addicts, but of two doctors I know one is more experienced with abstinence while another is more experienced with harm reduction therapies.  Another doctor has far more experience in sex addictions than me and there is one character locally and another in the next province who know more about gambling addiction than I can ever hope to know. Yet I don't think any of them know more about 'addiction' and the diagnosis and treatment of addiction than I do in my addiction psychiatry work.
In my psychotherapy practice I have subspecialised in trauma and especially with those in recovery, the 'dual diagnosis' group and don't really know another psychiatrist who shares my particular approach to this group, a mixture of 12 step facilitation, dynamic spiritual therapy focussing on the anxiety and isolation components.  I know others who work with a similiar population but their particular approaches to treatment are often different but I think they may get similiar results.
I have another niche where I am commonly sought for advise and that's where patients have major medical problems coupled with psychiatric disorders. The psychopharmacology of this subset of patients is particularly difficult.  Patients with head injury and an anxiety disorder or depression and a seizure disorder, kidney disease and psychosis.  These are a particular group of patients who I found that a colleague was also commonly seeing and I've benefitted from his specific insights.
I don't 'defer' to these colleagues in a 'deferential' sort of way except one lady doctor who has specialised in the treatment of pregnant patients with psychiatric disorder.  And come to think of it I would defer to her and do. It's an area of psychiatry that I really have limitted experience to hers.  There's definitely some areas in psychiatry in which I probably do 'defer' now that I think of it but they're areas like that.  Child psychiatry and Geriatric Psychiatry. The latter is a subspeciality area that requires more training certified geriatric psychiatrist would see far more patients over 75 years old than I do. Right now I only have a half dozen in my practice and may have seen less than a hundred in my lifetime.  In contrast my female colleague in geriatric psychiatry is not only a great clinician but she's my age and has being seeing old people as long as my other colleagues has been focussing solely on children.
So yes I do 'defer' in these cases and would surely and do surely defer to other specialists outside my own area of specialization. Hence I'm forever deferring to orthopods, surgeons, cardiologists, endocrinologists, rheumatologists, and urologists etc.  There are however some areas of overlap in neurology for instance. I do defer to neurologists commonly but there's some areas where my own experience and expertise cause me to feel that the area of overlap might be more in my peculiar bailiwick than that of a neurologist. This is true for pain specialists and occupational health specialists.  There are little overlapping territories where I acknowledge that the two of us might have equal expertise despite coming from wholly different backgrounds.
The matter of responsibility and accountability is always at play. There are commonly alot of 'adjunctive' players in the field but when the ball is dropped I'm very much aware of whether I'm going to be stuck holding the ball.  Alot of people who refuse to carry the ball really want to tell you how a ball should be carried. I'm more aware of these with age and experience.  Monday morning quarter backs and and arm chair philosophers.
The question was a good one. Lawyers are astute and I am thankful for the questions they raise and the opportunity their questions give me for self examination and further learning.  When personally I've need a lawyer I've been rather deferential to him or her though know that in the end I'm going to be the one who is ultimately accountable.