[lg policy] Training Doctors to Speak the Language of the Law

Harold Schiffman hfsclpp at GMAIL.COM
Tue Nov 15 14:08:59 UTC 2011

Training Doctors to Speak the Language of the Law
Posted: 11/14/11 03:32 PM ET

According to a recent study by Thompson Reuters and HC Plexus, 65
percent of doctors believe the Patient Protection and Affordable Care
Act (PPACA), otherwise known as the Health Care Reform Act, or, to
some, "Obamacare," will cause a decline in the quality of patient

Even more doctors, as many as 78 percent, believe their medical
practices will be negatively impacted by the legislation. This
pessimism may be the result of a lack of buy-in from doctors who in
simpler times in our history were highly influential in discussing,
debating and ultimately shaping health care policy.

Only 16 of 535 members of the Congress that enacted the PPACA had
medical degrees. Despite intense lobbying, there was little meaningful
dialogue between doctors and Congress in the process. Meaningful
health care reform -- reform that has the buy-in of all of the
critical stakeholders in the process -- is nearly impossible without
meaningful dialogue. And, meaningful dialogue is nearly impossible
because the two sides do not speak the same language.

Doctors are increasingly frustrated that their elected
representatives, oftentimes lawyers, enact laws that affect health
care policy, and every aspect of patient care, yet these elected
officials generally lack any medical training. As a result, doctors
view the law as creating obstacles to effective patient care, rather
than a guide to quality patient care. Medical education, moreover, has
not equipped students and residents with the tools necessary to become
involved in the legislative process to effectuate meaningful change.

As an academic who works both in legal and medical education, I have
seen the negativity from doctors, who may be understandably
dissatisfied with the tort system, trickle down to medical students
and residents, who then become negative about the legal profession in
general. In addition, in this day and age of media sound bites and
rumors about death panels gone viral, there seems to be increasing
animosity and fear between the professions, as well as a significant
amount of misinformation about medico-legal issues.

I wanted to help combat the problem by providing a meaningful
educative experience that would teach medical students the language of
the law, and the theory of how different legal doctrines work together
in the health care arena. My goal was to provide future doctors the
tools necessary to become meaningfully involved in the dialogue and
help change that which does not work. That concept became reality this
past year when Wake Forest University School of Medicine offered
fourth-year medical students a month-long rotation in legal education
housed at the Wake Forest University School of Law.

Language immersion is generally considered the optimal way to become
fluent in a new language. Likewise, medical students need legal
education immersion if we want them to achieve a level of fluency in
their understanding of the language and process of law. The month-long
rotation allowed these medical students the time to become immersed in
the law, just as they do in their other medical school rotations, such
as orthopedics or pediatrics.

During the rotation, the medical students studied jurisprudential
theory such as natural law, positive law and legal realism. They
learned about the importance of the rule of law in civilized society.
Further, because health care law is an amalgam of many legal
doctrines, the medical students were taught about the theories
underlying basic legal education doctrine, such as constitutional law,
contracts, torts, and property, all with an eye toward how these
doctrines play out in medical research and their future medical

In addition, I wanted to make sure that my students would never form
an opinion about a piece of health care legislation without reading
the actual bill or law. Thus, during the rotation, the medical
students learned how to research and find the law, how to read and
interpret case law, statutes and regulations, along with the process
needed to change the law.

According to a 2011 study of medical students' experience with the
medico-legal curriculum in medical schools in the U.K., "A greater
focus on law in clinical practice, rather than learning in the
abstract, appears necessary to facilitate knowledge, skill retention
and development." We used this principle in designing an experiential
component to the afternoon session of the course.

There, the medical students joined law students in learning about
health law and bioethics and participating in realistic legal/medical,
biotechnical and research-related scenarios, such as a clinical ethics
consultation, an investigational review board meeting, an appellate
argument, as well as a medical malpractice negotiation and mediation.
The students were assigned roles (patient, doctor, judge, lawyer,
congressional representative, agency representative, ethics committee
members, etc.) opposite their field of study. So, for example, the law
students were assigned to be medical providers, and the medical
students performed the role of lawyer, in-house counsel, judge, etc.

The students were required to resolve the medico-legal conflict and
discuss the valid competing professional and social interests at play.
Also, the students had to consider the humanistic element -- how would
a person in a certain role react, and what ethical choices might he or
she have to make?

As the authors of the U.K. study opined, "If future doctors are to
uphold and advocate effectively for legal rights of patients they must
have a sound grasp of the law and the confidence to apply that
understanding." This finding again seemed to play out in our course.
The medical students indicated that they began to view the law as a
guide to quality patient care, rather than an obstacle. Some indicated
that they took their role in advocating for a better health care
system more seriously, and they would be more likely to become
involved in the legal/political process if they experienced a law as
being unfair, unworkable or contrary to best practices.

It was announced today the U.S. Supreme Court will weigh in on the
issue of the health care reform mandate as early as next summer. Until
we have clarity about the PPACA and how our future health care system
will operate, however, pessimism will abound in the medical
profession. My hope is that through programs like ours at Wake Forest
University we can provide future doctors with a voice to enter the
debate, along with the confidence of knowing that they can positively
affect the legal system to ultimately provide better patient care for


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