Using Doctors to Teach Law Students
by
W. Dent Gitchel

Ten years ago, I left private practice as a trial lawyer to teach litigation-related courses such as Trial Advocacy and Evidence at the University of Arkansas at Little Rock School of Law. While I still teach those courses, I have added a Law and Medicine Seminar to my repertoire. I utilize physicians as expert witnesses in Trial Advocacy workshops to give my students an opportunity to examine real doctors in a simulated courtroom setting. My Law and Medicine students observe doctors at work and spend time communicating one-on-one with physicians.

The philosophical basis

The years I spent dealing with physicians as expert witnesses in bodily injury and medical negligence cases have given me some appreciation of the problems that physicians and lawyers experience when forced to communicate with each other. I have listened many times as lawyers attempted, without success, to elicit technical information from medical witnesses in a way that jurors could comprehend. Also, I have experienced first-hand the difficulty lawyers and physicians encounter when they are forced to converse across the chasm that separates the two professions' approaches to solving problems.

Doctors and lawyers have trouble communicating. Each profession speaks its own peculiar dialect. Doctors and lawyers have different objectives. More significantly, the members of each profession are trained to approach problems in different ways. The physician seeking to diagnose and cure a patient's illness has no use for an adversary system of problem-solving. The physician seeks data empirically and adopts no preconceived, desired diagnosis or treatment regime. The physician rejects no fact because that fact does not support a desired diagnosis. On the other hand, the lawyer-advocate always has a predetermined goal -- the client's victory. The lawyer utilizes facts that support that result and rejects facts that do not.

The situation is complicated by the fact that lawyers and doctors often simply do not like each other. Many physicians believe that most of the problems with America's health care system can be attributed to lawyers who file frivolous suits against doctors. Conversely, some lawyers see physicians as overpaid, self-indulgent egotists, and virtually all lawyers agree that injured patients should have recourse against physicians' negligent blunders.

Despite these difficulties, doctors and lawyers are frequently thrown together in a courtroom, where it is critical that they overcome their inability to communicate and set aside their mutual aversion in order to convey vital information to a jury. One of the basic premises of my efforts to foster interaction between my students and practicing physicians is that medical evidence will be more effective -- and further the goal of achieving fairer trial decisions -- if the lawyers who ask the questions and the doctors who answer them have some elemental appreciation of the operational methods, the professional goals, and the semantic peculiarities of one another's professions.

Overview of our programs

Our law school is located in the same city as the University of Arkansas for Medical Sciences (UAMS) and the state medical examiner's office. This proximity makes frequent visits easy. The faculty and staff of UAMS, as well as the state medical examiner and his staff, have offered their unreserved cooperation and encouragement in our efforts.

Both the Trial Advocacy and Law and Medicine courses lend themselves well to using physicians to teach law students. The Law and Medicine Seminar is unique in the extent to which law students are allowed to participate on the job with members of the medical profession. The doctors cooperate enthusiastically. They seem to feel that the experience is as beneficial to them as it is to the law students.

Trial Advocacy

Our interdisciplinary efforts began when I telephoned the chairs of the Pathology and Psychiatry Departments at UAMS, seeking physicians to role-play expert witnesses in Trial Advocacy workshops. Much to my surprise, several residents and even some staff physicians volunteered. For a couple of years I continued that system of recruiting volunteer witnesses each year.

One day, the residency director in the Family Practice Department contacted me and suggested that UAMS require every Family Practice resident to participate as an expert witness in a Trial Advocacy workshop. This was music to my ears. I collaborated with a couple of UAMS physicians to develop a problem based on an actual patient's medical records. Since that day seven years ago, every Trial Advocacy workshop group has devoted a three-hour session to examining a "treating physician" in a mock bodily injury suit. The residents approach the experience eagerly, because they know it prepares them for the day when they will be called upon to serve as expert witnesses in real cases. These same residents later have an opportunity to show my Law and Medicine seminar students how they work in their natural habitat.

The next major step was when the director of Clinical Pathology Laboratories, a physician who has often testified as an expert witness, agreed to deliver a lecture to my Trial Advocacy class. After the lecture, he agreed to furnish pathology residents and staff physicians each year to testify as pathologists in Trial Advocacy workshops. He has continued to lecture to each Trial Advocacy class, and we have devoted one workshop session to the examination of forensic pathologists.

Law and Medicine Seminar

The Law and Medicine Seminar is, on its face, a rather ordinary, two-credit law school elective. Enrollment is limited to twelve students in their final semester of law school. Each student is required to submit a paper for the final grade. There is no final examination.

However, our course is unique in that it allows each student to share in the working experiences of physicians. These field trips give my students an appreciation of the practice of medicine that no amount of reading or discussion could achieve.

One of our first field trips -- not exciting, but essential to an understanding of the practice of medicine -- is an afternoon each student spends in the Family Practice Clinic at UAMS paired one-on-one with a resident. The law student accompanies the resident, sitting in the room as the resident takes patient histories, performs physical examinations, and prescribes treatment. Of course, the Clinic obtains prior patient approval of the law student's presence. Between patient appointments, students observe the physicians entering notes in patient records and also converse informally with the doctor to whom they are assigned. Each student then tours a hospital ward with the resident on call.

Another field trip requires students to visit the UAMS Gastroenterology Department for "morning rounds" and a roundtable discussion, at which the director of the department reviews cases with the attending physician, the residents, the fellows, and medical students. Afterward, the students observe an endoscopy procedure.

Students also spend a busy evening shift in the Emergency Room at University Hospital. The students often stay all night, and are sometimes pressed into service to help hold down violent patients, to wheel gurneys, or to sop blood. This experience gives students an appreciation for the sometimes heroic nature of a physician's work that no other experience imparts.

Students also spend a morning in the operating room observing surgery. After standing at surgeons' sides during operations, students typically emerge with a new understanding of the technical and physically demanding nature of surgery, as well as the high level of tension in an operating room.

Finally, I take the students in small groups to the state medical examiner's morgue to observe an autopsy. The medical examiner selects cases of suspected homicide or other particular interest to future lawyers. The students usually approach the morgue with some trepidation, expecting to undergo a grisly ordeal. They are frequently surprised by the clinical, non-gruesome atmosphere that surrounds post-mortem examinations.

Observation of an autopsy often is something of a metaphysical experience. These visits usually stimulate discussion, in and out of class, of the mystical nature of life, of the overwhelmingly obvious absence of the spark of life in corpses, of violence in society, and of the need to control the availability of guns. To see death helps us appreciate life.

Conclusion

My interdisciplinary efforts are based on an abiding belief that when lawyers and doctors have opportunities to meet and share experiences in nonadversarial situations, greater mutual understanding and respect usually result. Mutual understanding and respect can only benefit our patients and clients.