Breaking Up the Legal Industrial Complex
In 1918, Britain’s Hilaire Belloc published a book entitled The Free Press. Buried within was his commentary on the two large guilds in British society, those of doctors and lawyers. Though strong, the medical guild was no match for the legal guild, due to the latter’s administrative, legislative, executive and governing power. And as it went in Britain, so it would go in America.
Today nearly all our interactions, whether direct, or indirect, are controlled by the law, with the law controlled by lawyers. Our law is divided into constitutional, statutory and administrative branches, with approximately 20 sub-branches. Due to hundreds of years of mounting bureaucracy, and with the usurpation of power by the legal guild, the law and our lives have become what lawyers wish it to be.
Reform of our law will never occur if lawyers remain the sole gatekeepers of it. The chance to change this is in greater pressure on the legal guild, starting from outside and boring within. The outsider with the greatest chance to accomplish this is its old nemeses, the medical guild, through greater knowledge of the law.
A friend once said to me: "Any physician can become a lawyer but few lawyers can become physicians." This anecdote was recently confirmed during my own discussion with a law school’s screening admission advisor. “You will have no problem being admitted.” “Why, I asked?” “Because you are a physician and can think logically.”
‘The ability to think logically;’ but practice medicine is much more. And that is why few lawyers become physicians. So the question is: ‘should more, or all, physicians become lawyers, or something of a hybrid, and why?’
The practice, standards, and accountability required of a physician, are unlike any other profession. It is claimed that physicians possess a unique fund of knowledge; however to many of us, it resembles the Sword of Damocles. That sword dangles in the form of second guessing, use of ‘retro- spectacles,’ Monday morning quarterbacking, and a disproportionate responsibility for unforeseen or poor outcomes.
So if physicians possess a unique fund of knowledge, don’t lawyers as well? And don’t lawyers possess a unique fund of knowledge that just happens to regulate society? Can these two unique funds of knowledge somehow be combined for the protection of physicians, patients and society? I believe it’s possible and will propose why it should be considered.
The medical school curriculum currently runs over four years. The first two years, with a bit of clinical observation thrown in, encompass the basic sciences, the scientific foundation of medical education. The third-year curriculum consists of clerkships, which are rotations of two-to-three months, through five specialties, that include general surgery, medicine, OB/GYN, pediatrics and psychiatry. The fourth year is a combination of additional course requirements and electives.
Law school in comparison is currently spread over three years. The first year is devoted to the foundations of law and includes civil procedure, contracts, torts, criminal, property, and constitutional law. The second and third years essentially hone the basic knowledge acquired in year one.
So is it possible to produce, en masse, medical students with a foundation in the law, while maintaining their medical ability? I believe it is since the majority of physicians today train to become clinicians rather than enter a physician/scientist track as designed for MD/PhD candidates. My proposal will therefore apply to the majority of practicing physicians, and is as follows:
First, several medical school courses can be taken during college. As is, there are too many science majors entering medical school, and there is ample proof that even a lowly history major can bring excellent care to a community, especially rural areas spurned by former biology majors. Next, delete the summer vacations of the first two years since that’s a relic of less advanced education. Finally, since the fourth year of medical school often consists of three or four months of requirements, with the rest of the year being electives, much time can be freed up but still allow time for an elective or two, if needed.
My proposal reduces the medical school curriculum to three years, but what to do with the fourth year? It’s called the first year of law school and it can actually be interspersed with the third-year clerkships, and thus combined, be integrated into the last two years of medical school. So now, every physician obtains the basic knowledge of the law that is the essence of a lawyer. But to what end, you ask?
First, medical malpractice lawsuits will be substantially reduced once physicians apply the legal knowledge they acquired in medical school. This will occur because physicians, now versed in another "unique fund of knowledge,” will understand the legal ramifications of their medical acts and better protect themselves and their patients through improved documentation.
Lawyers will be much more cautious in tangling with a medical profession that is not only expert in medical care but also has the same foundation of legal education that they do. Medical malpractice insurers will see a decline in inquiries, less need to mount a defense of their insureds, or force unjust settlements on physicians. A resultant downward trend in physician malpractice premiums will ensue.
Physicians with a greater understanding of the law will be in a position to head off the legal misadventures inflicted on their profession such as: mandated child abuse courses for maintenance of professional licensure, required even of physicians who don’t treat children; mandated drug abuse courses for physicians who don’t prescribe controlled substances; query of medication databanks to play mommy and daddy for drug seekers. The latter is especially egregious since alcohol is purchased without a prescription and recreational marijuana is becoming legally sanctioned by leaps and bounds.
The second and greater effect will be on society. The idea is not to create more lawyers but rather to have more citizens with a greater knowledge of our basic law. With physicians now trained in the law, legislatures on the state and local level, disproportionately represented by lawyers, will be put on notice. With their knowledge base now not held in exclusivity, they will be more wary of, and take greater care, in enacting and attempting to enforce unwise and unconstitutional laws.
Fear is a great motivator to prevent misadventure. Perhaps some of what is needed today is for the legal realm to acquire some of that. My solution is to distribute the knowledge base that has been within the exclusive domain of the legal profession. Physicians are in quantity and aptitude well positioned to add balance to what has been monopolized for too long by the legal guild.