What makes a letter of recommendation fake

So this past summer I worked under a renowned surgeon who is quite old at this point. He doesn’t really use email and his assistant handles most trivial tasks such as submitting this letter. He will sign it himself and can confirm the authenticity with a letterhead, but will a flag go off for admissions if I put his assistant’s email for the email on the application just for submission purposes?

I think letters of rec that come from teachers or guidance counselors are given the most weight. An email that can’t be verified probably won’t help or hurt much in my opinion.

What do you mean by “doesn’t really use email”?

Does this person have an email account, but never checks it? Then the assistant can check the email.

It’s unlikely to be a problem as long as the assistant’s email domain matches the hospital or university or practice that the surgeon is associated with. If the email is a generic gmail (or worse, aol.com) account, then I think it would be better to simply not put anything in that field. But, if the surgeon has an email address, you should use it. You could list the assistant’s as a backup or alternate address.