For a description of the model, see ZuckermanB.SandelM.LawtonE.MortonS., “Medical-Legal Partnerships: Transforming Healthcare,”The Lancet372, no. 9650 (2008): 1615–1617.
3.
ZuckermanB., “Why Pediatricians Need Lawyers to Keep Children Healthy,”Pediatrics114, no. 1 (2004): 224–228, at 224–225.
4.
There has also been a change in faculty since we began the joint course. Brown medical school faculty Dr. Alicia Monroe and Dr. Jay Baruch helped me to develop the course in 2003. After Dr. Monroe left Brown Medical School in 2008, Dr. Patricia Flanagan joined us as a teaching partner for the course.
5.
For a more extensive discussion of our course, see Tobin TylerE., “Allies Not Adversaries: Teaching Collaboration to the Next Generation of Doctors and Lawyers to Address Social Inequality,”Journal of Health Care Law & Policy11, no. 2 (2009): 249–294.
6.
This is not to suggest that there were no models for joint medical-legal courses. There is a long history of bringing medical and law students together in the classroom. See, for example, NaitoveB. J., Comment, “Medicolegal Education and the Crisis in Interprofessional Relations,”American Journal of Law & Medicine8, no. 3 (1982): 293–320, at 304; WilkinsD. B., “Redefining the “Professional” in Professional Ethics: An Interdisciplinary Approach to Teaching Professionalism,”Law Contemporary Problems58 (1995): 241–258. Nonetheless, the focus of our course on the role of law in the social determinants of health and medical-legal partnership was new. Thus, we found no ready syllabi to help guide us.
7.
For discussion of the frustrations doctors face in trying to treat patients with complex medical and social problems, see PiscellaK.EpsteinR. M., “So Much To Do, So Little Time: Care for the Socially Disadvantaged and the 15-minute Visit,”Archives of Internal Medicine168, no. 17 (2008): 1843–1852.
8.
See Tyler, supra note 5, Part II. For more recent discussion of how medical education should address these issues more directly, see WalkerB.MoultonC., “Medical Education in the 21st Century,”Journal of Health Care for the Poor and Underserved20, no. 3 (August 2009): 617–624 (commenting on a report by the Josiah Macy Foundation, Revisiting Medical School Mission at a Time of Expansion, 2009, available at <www.josiahmacyfoundation.org> [last visited August 11, 2010]).
9.
For a discussion of the relationship between preventive medicine and preventive law, see MortonS., “Advancing the Integrated Practice of Preventive Law and Preventive Medicine,” in BartonT., ed., Preventive Law and Problem Solving: Lawyering for the Future, (Lake Mary, FL: Vandeplas Publishing, 2009).
10.
See CharonR., “Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust,”JAMA286, no. 15 (2001): 1897–1902; GilkersonC. P., “Poverty Law Narratives: The Critical Practice and Theory of Receiving and Translating Client Stories,”Hastings Law Journal43 (1992): 861–945.
11.
By “ethics” I mean both how legal and medical practice are shaped and governed by professional ethical rules, and also the moral ethical issues that arise for lawyers and doctors in practice. The ideas and expertise of one of my co-teachers, Dr. Jay Baruch, an emergency room physician and director of the ethics curriculum at Brown medical school, has been critical to our integration of these types of ethical issues into the course.
12.
For a helpful discussion of the need to teach interdisciplinary collaboration in legal education, see ConnellyK. D., “Elucidating the Elephant: Interdisciplinary Law School Classes,”Washington University Journal of Law and Policy11 (2003): 11–61; WeinsteinJ., “Coming of Age: Recognizing the Importance of Interdisciplinary Education in Law Practice,”Washington Law Review74 (1999): 319–366.
13.
In developing my understanding of teaching problem-solving, I found Linda Morton's articles very instructive. See MortonL., “Teaching Creative Problem Solving: A Paradigmatic Approach,”California Western Law Review34 (1998): 375–388; MortonL., “A New Approach to Health Care ADR: Training Law Students to be Problem Solvers in the Health Care Context,”Georgia State University Law Review21 (2005): 965–992.
14.
We focus our course and case simulations on issues of child health. Medical-legal teaching can just as easily be geared toward health law issues affecting adult populations, such as those with HIV/AIDS or cancer, or the elderly.
15.
One class involves using the Community Action Poverty Simulation created by the Missouri Association for Community Action in which students must spend a “month” role playing a poor family's attempt to make ends meet on a limited budget. Information about the simulation is available at <http://www.communityaction.org/Poverty%20Simulation.aspx> (last visited August 5, 2010).
16.
All of the classes raise issues of the differences in professional ethical obligations of doctors and lawyers. The most overt discussion of these differences arises in the context of mandatory reporting of child abuse and exploring different professional obligations regarding confidentiality. For a discussion of the kinds of professional ethical issues that arise in medical-legal partnership, see TamesP., Commentary, “The Lawyer Is In: Why Some Doctors Are Prescribing Legal Remedies for Their Patients, and How the Legal Profession Can Support this Effort,”Boston University Public International Law Journal12 (2003): 505–527.
17.
For example, a survivor of domestic violence has shared her very personal story of the difficulties she found in both the health care and legal systems as she was deciding to leave her abuser and seeking custody of her children who were also abused.
18.
For an example of how we teach the class on substandard housing and lead poisoning, see Tyler, supra note 5, Part V.
19.
The students do not give legal advice. They help families and individuals with budget planning to see if they may be eligible for a budget plan through the utility company and/or inform them of the classifications under the regulations for protected status. Utility company representatives are on-site and the students help advocate for their “clients” with the company representative.
20.
See Frank, “Heat or Eat: The Low Income Home Energy Assistance Program and Nutritional and Health Risks Among Children Less than 3 Years of Age,”Pediatrics118, no. 5 (November 2006): 1293–1302.
21.
As part of the training, we also discuss and practice client counseling. I am grateful to Bonnie Roswig, Senior Staff Attorney at the Medical-Legal Partnership Project at the Center for Children's Advocacy in Connecticut, for introducing me to the utility clinic as an effective experiential learning experience for law and medical students in advocating for low-income individuals and families.
22.
Under Rhode Island regulations, a family with a child under 24 months of age that can show a financial hardship may qualify for protected status and may not have their utilities shut-off during the moratorium period of November 1st through April 15th. Rhode Island Public Utilities Commission, Rules and Regulations Governing the Termination of Residential Electric, Gas and Water Utility Service (February 1, 2007), available at <http://www.ripuc.org/rulesregs/commrules/termination.pdf> (last visited August 11, 2010).
23.
Unnatural Causes: Is Inequality Making Us Sick? (California Newsreel and Vital Pictures, Inc.2008). We show the first hour episode of the seven part series as part of our introduction to the social determinants of health.
24.
The role of the law in public health can be understood both for the importance of legal rules in shaping population health as a whole and for understanding “that a particular legal rule or policy that may appear to have a positive impact on one population may have a very different impact on another.” ParmetW., Populations, Public Health and the Law (Washington, D.C.: Georgetown University Press, 2009): At 54. We explore how particular legal rules (or the failure to enforce certain legal rules) on behalf of particular populations may lead to health disparities.
CookeM., “American Medical Education 100 Years After the Flexner Report,”New England Journal of Medicine355, no. 13 (2007): 1339–1344, at 1341–1342.
27.
For a discussion of the difference in the ways that we teach doctors and lawyers to think and explore “truth,” see GibsonJ. M.SchwartzR. L., “Physicians and Lawyers: Science, Art, and Conflict,”American Journal of Law Medicine6, no. 2 (Summer 1980): 173–182. Jennifer Bard's column for this journal, “What We in Law Can Learn from Our Colleagues in Medicine about Teaching Students How to Practice Their Chosen Profession,”Journal of Law, Medicine & Ethics36, no. 4 (2008): 841–848, also provides an excellent comparison/contrast of how we educate lawyers and doctors.
28.
See Association of American Medical Colleges Curriculum Directory, available at <http://services.aamc.org/currdir/> (last visited August 5, 2010).
