Medical Director for Quality Improvement Service at Nationwide Children's Hospital in Columbus, Ohio. To all appearances, he and I could not be in more different lines of work, and yet, over the last few years, we have noticed that our conversations about the legal and medical businesses have overlapped a great deal.
I often drone on and on about this correlation with my fellow 3 Geeks, and they generally nod politely, give each other a knowing sideways glance, and order another round of beers. Geek #1, Greg, recently tweaked my little pet topic by forwarding a tweet from fellow blogger, and legal industry pundit, Jordan Furlong.
As we reform the legal system, let's ensure at least one thing: it never remotely becomes the US health-care system: on.tnr.com/15xVddmAs usual, I mostly agree with Jordan. However, I want to make a distinction between the legal and healthcare systems and legal and healthcare businesses. Both systems are unquestionably flawed, difficult to navigate, and in desperate need of reform. But the systems are merely the environments in which the businesses operate, not the businesses themselves. Law firms and hospitals are like exotic fish in a dirty aquarium. While many hospitals have begun to take a scientific approach to changing the way they work in order to improve the functioning of their ecosystem, most law firms are comfortably swimming in their own filth and complaining about the view.
— Jordan Furlong (@jordan_law21) April 25, 2013
This is the point where many people pipe up and say, "Other than both being professional service providers, doctors and lawyers have nothing in common." I will concede that the law and medicine are very different practices, but I think it's a mistake to conclude from that that the businesses of law and medicine are so wildly different that one cannot learn anything from the other.
First, doctors and lawyers aren't so different. They are both highly educated professionals that use impenetrable language to practice their generally poorly understood "dark arts", and are therefore simultaneously revered and despised by the general public. A lot of physicians bristle at the idea of performing "cookbook medicine", while most attorneys can't stand the thought of producing "commodity" legal work. Hospital medical staffs have historically been made up of solo and small private practice physicians, while most BigLaw firms are partnerships in name only and are more closely akin to solo practitioners sharing support staff and office space. Physicians are extremely intelligent and trained to look for problems; since they can imagine all of the difficulties down the road, they will often reject potentially innovative solutions out of hand. For many doctors, the patient relationship is proprietary, with some insisting that no one else should see or treat their patients, even at the expense of the patient's own health. Physicians often fall prey to the circular logic that because they are successful, they must be doing things correctly, because they are successful, etc. (I stopped with the analogous attorney behavior, but drop me a line if you don't see the correlations.)
In addition to the personal similarities between physicians and attorneys, the businesses of law and medicine are both currently undergoing extreme changes caused by forces largely outside of their control. Jordan Furlong, Bruce MacEwen, and our own Toby Brown, among many others, have written extensively about the outside forces affecting firms - I won't reiterate their points here - but many similar forces have been acting upon hospitals and doctors. As recently as ten years ago, even if they were affiliated with a hospital, most physicians were self-employed or in private practice. The rising cost of insurance, the needs to invest in technology (including Electronic Medical Records and complex billing systems), and new requirements to account for performance quality, have led many solo and small practice doctors to join large conglomerate medical groups or become full-time hospital medical staff. Doctors are not "owners" of these companies in the same sense that law partners are "owners" of a firm, but the management of these newly affiliated, formerly autonomous actors is remarkably similar to that of a law firm.
While physicians and hospitals are fundamentally different entities than attorneys and firms, I believe the modern relationships, interactions, and struggles between Hospital, Doctor, and Patient are very analogous to those between Firm, Attorney, and Client. The medical profession is enduring its own New Normal and they are dealing with it very differently than we are. It would be well within character, but we would be sorely remiss if we were to ignore their activity, and fail to learn from their experiences, simply because they are not attorneys.
In tomorrow's installment I will discuss one particular innovative concept in medical care that I believe we could and should adapt to the practice of law.