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May 2, 2001

Legal Medicine: A Professional Option

Author Affiliations

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JAMA. 2001;285(17):2251. doi:10.1001/jama.285.17.2251-JMS0502-4-1

"Legal medicine" and "medical jurisprudence" are terms used to describe a professional discipline that has been evolving for more than 200 years in the United States. Early works about medical-legal affairs such as Samuel Farr's Elements of Medical Jurisprudence (1788) and Thomas Cooper's Tracts on Medical Jurisprudence (1819) testify to the intellectual interest surrounding this field in the post-Revolutionary United States. As early as 1804, legal medicine was taught at Columbia College of Physicians and Surgeons in New York, where James Stringham, MD, was the first to integrate legal medicine into medical education. By 1877, Harvard University had established a professorship in legal medicine, thereby consolidating the field's position in the medical academic community.

In spite of this, few individuals attempted to combine the 2 professions of medicine and jurisprudence until the middle of the 20th century. The American College of Legal Medicine (ACLM), for example, created to provide continuing legal education to attorneys and physicians, was not founded until 1955. Changes in medical practice during the second half of the 20th century eventually led to a new demand for persons with medicolegal knowledge. Increasing malpractice litigation created a new awareness of medicolegal affairs, for example, as did changes in the law such as the Federal Emergency Medical Treatment and Labor Act, which regulates interhospital transfers of patients, an area fraught with legal and financial consequences.1 The increasing interest in legal medicine has resulted in several thousand persons currently holding both degrees2 and the availability of dual-degree programs in several medical schools.3

A review of directories of attorneys suggests that most dual-degree holders choose to practice one profession or the other, rather than both.2 As an example, 5 of the 6 physicians who attended law school with the author of this article returned to the practice of medicine. Physicians with law degrees presumably return to medical practice with an enhanced understanding of the relationship between medicine, law, and society. Physicians with legal training may also provide consultative services for practicing attorneys, especially in the medical malpractice arena. Several companies exist that act as brokers, matching clients who may have valid claims with physician-attorneys who practice the same area of medicine, to impartially evaluate the claim's validity.

Those who choose to practice law may engage in medical malpractice law, either as plaintiffs' attorneys or as members of the defense bar. Others are engaged in assisting physicians and other health care professionals with credentialing and licensing issues. Physician-attorneys can be found as medical directors of insurance companies and managed care organizations, as well as staff people in policy thinktanks and political organizations. I practice Social Security disability law, using medical knowledge to advance the claims of persons seeking disability benefits pursuant to the Social Security Act. Workers compensation law is another fruitful field for the medically trained attorney, who is able by virtue of his or her training to judge the validity of medical evaluations prepared by employers or employee-hired medical consultants.

Individuals interested in the medical-legal professional's world can view the ACLM Web site4 or the Web site of the American Society of Law, Medicine, and Ethics5 or review Legal Medicine, a textbook produced by the ACLM that provides an excellent grounding in legal medicine.6 Medical students should understand that law school requires 3 additional years of education, a significant commitment for people already facing protracted training. Those who enter law after medicine may find the transition unsettling. From a world focused on the scientific method, the physician enters a world focused on construction of logical linear arguments that are "good" if they support the client, sometimes with scant regard for whether they are "right." In the end, it is not difficult to reconcile these 2 views, but it can be an adjustment.

What is the future of the medical-legal profession? In my view, the future of legal medicine is inextricably tied to the evolution of US health care as a whole. From a cottage industry practiced by independent small-business people through the 1950's, medicine may be on the verge of becoming a government-regulated utility, with both practice guidelines and pricing established by government fiat. Such an environment can only fuel the need for people with the combination of medical and legal knowledge.

As I facetiously tell my patients, I went to law school more than 10 years ago so I could have more flexibility when making mistakes—I could choose whether to sue myself or to defend myself. In the future, there will be a need for professionals who are able to provide medically grounded advice, counsel, and defense for health professionals, as well as expert knowledge and guidance to policy making and regulating bodies.

Not Available, Not Available 42 CFR 489.24
Not Available, Martindale-Hubbell Law Directory. Available at: http://www.martindalehubbell.com. Accessed March 3, 2001
Not Available, AAMC List of Combined MD/JD Programs. AAMC Web Site. Available at: http://www.aamc.org/students/applying/programs/mdjd.htm. Accessed February 16, 2001
Not Available, American College of Legal Medicine Web site. Available at: http://www.aclm.org. Accessed February 16, 2001.
Not Available, American Society of Law, Medicine, and Ethics Web site. Available at http://www.aslme.org. Accessed February 16, 2001.
Not Available, Sanbar SS and the American College of Legal Medicine Textbook Committee. Legal Medicine. 4th ed. St Louis, Mo Mosby-Year Book1998;