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Clinical Approaches to Teaching Legal Medicine to Physicians: Medicolegal Emergencies and Consultations

Published online by Cambridge University Press:  24 February 2021

Park Elliott Dietz
Park Elliott Dietz*
Affiliation:
A.B. cum laude 1970, Cornell University; M.D. 1975, Johns Hopkins University School of Medicine; M.P.H. 1975, Johns Hopkins School of Hygiene and Public Health; Candidate for Ph.D. 1977, Johns Hopkins University, Department of Social Relations; Johns Hopkins Hospital and School of Medicine; Johns Hopkins School of Hygiene and Public Health
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Abstract

Physicians-in-training generally have insufficient exposure to legal medicine to prepare them for the medicolegal problems they will encounter in practice. This Article outlines the current structure of the field of legal medicine in America, and sets forth two strategies with clinical orientations for teaching legal medicine to physicians-in-training: (1) providing a didactic course offering accurate and practical information on medicolegal emergency situations; and (2) establishing a consultation service in legal medicine capable of providing clinical information or training in such settings as the emergency room, the outpatient departments, and the inpatient wards.

Type
ASLM Annual Rattigan Essay
Information
American Journal of Law & Medicine , Volume 2 , Issue 1 , Summer 1976 , pp. 133 - 145
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 1976

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Footnotes

*

This Article was awarded First Prize in the 1975 John P. Rattigan, M.D. Student Essay Contest of the American Society of Law & Medicine.

References

1 Beresford, , The Teaching of Legal Medicine in Medical Schools in the United States, 46 Journal of Medical Education 401-404 (1971)Google ScholarPubMed; Hirsh, , Forensic Medicine Teaching in Law and Medical Schools, 2 Medicolegal News 3 (1974)CrossRefGoogle Scholar. A third major survey was initiated in 1972 by Drs. A. W. B. Cunningham and Herbert E. Thomas of the University of Pittsburgh School of Medicine and Dean Thomas O. White of the University of Pittsburgh School of Law. The present author derived many of his opinions on medicolegal education from the replies received from 70 medical schools and 78 law schools while he worked as a research assistant on that project.

2 Throughout this article, the terms “legal medicine,” “medicolegal,” “forensic pathology,” “forensic psychiatry,” and “legal psychiatry” are used in the manner proposed by Professor William J. Curran, the Frances Glessner Lee Professor of Legal Medicine at Harvard University, in his publication Titles in the Medicolegal Field: A Proposal for Reform, 1 A. J.L.M. 1-11 (1975) [hereinafter cited as Curran].

3 Letter from Professor Jon R. Waltz, Northwestern University School of Law, describing instruction in legal medicine at Northwestern University School of Medicine to Dr. A. W. B. Cunningham, University of Pittsburgh School of Medicine, April 10, 1972. A copy is on file at The Johns Hopkins University.

4 Letter from Dr. Page Hudson, Chief Medical Examiner, North Carolina State Board of Health, describing instruction in legal medicine at the University of North Carolina School of Medicine to Dr. A. W. B. Cunningham, University of Pittsburgh School of Medicine, July 20, 1972. A copy is on file at The Johns Hopkins University.

5 Professor Curran proposes that the term “forensic psychiatry” be used to specify these evidentiary aspects of psychiatry and law. See Curran at 10.

6 See Rappaport, The American Academy of Psychiatry and the Law: A History, 2 Newsletter Am. Academy Psychiatry & LAW 23-32 (1971).

7 Professor Curran proposes that the term “legal psychiatry” be used to designate the broad medicolegal relations areas of psychiatry, including the narrower field of “forensic psychiatry.” He defines legal psychiatry as “a sub-specialty of psychiatry concerned with both the clinical and the forensic aspects of psychiatry in relation to law, law enforcement, and corrections*” Curran, supra note 2, at 11.

8 Pollack, Forensic Psychiatry—A Specialty, 2 Bulletin of the American Academy of Psychiatry and the Law 1-6 (1974).

9 Curran, The Medical Witness: Availability, Willingness to Testify, and Some Comments on Medico-Legal Training of Physicians, reprinted in W. Curran & E. Shapiro, Law, Medicine & Forensic Sciences (1970) at 15.

10 F. Camps, Gradwohl’s Legal Medicine (2d ed. 1968); K. Simpson, Taylor’s Principles and Practice of Medical Jurisprudence (12th ed. 1965).

11 C. Wecht, Legal Medicine Annual 1969 (1969).

12 Helpern, Development of Department of Forensic Medicine at New York University School of Medicine, 72 New York State Journal of Medicine 831-833 (1972).

13 Dietz, Ethics and Lazo in Medical Education, 5 Private Practice 65 (1973).

14 In the progression from medical school through internship and residency, the young physician gains considerable experience in presenting clinical case histories and in teaching extemporaneously about clinical problems as they arise. Only rarely is the young physician called upon to deliver a lecture or to prepare a systematic review of a subject. Yet these same individuals, upon achieving prominence in some field, are expected to deliver formal lectures to groups of overlectured and highly critical medical students.

15 R. Reece & J. Chamberlain, Manual of Emergency Pediatrics (1974); Pearl, Obstetrical and Gynecological Emergencies, in C. Eckert, Emergency-Room Care (1971) at 145 [hereinafter cited as Reece 8c Chamberlain].

16 Heifer, Guidelines for the Emergency Care of the Battered Child, in S. Spitzer, W. Oaks, & J. Moyer, Emergency Medical Management: The Twenty-First Hahnemann Symposium (1971) at 401. Also see Reece & Chamberlain, supra note 15.

17 Addison, Professional Negligence, in H. Gardiner-hill, Compendium Of Emergencies (3d ed. 1971) at 350; American College of Surgeons, Early Care of the Injured Patient (1972); American Academy of Orthopaedic Surgeons, Emergency Care And Transportation of the Sick and Injured (1971).

18 Birch, Medico-legal and Other Non-Clinical Emergencies, in C. Birch, Emergencies in Medical Practice (9th ed. 1971) at 562.

19 J. Waltz & F. Inbau, Medical Jurisprudence (1971) at 329.

20 A vast literature exists on psychiatric emergencies, but no single work can be recommended on the subject of legal psychiatric emergencies. F. Kenyon, Psychiatric Emergencies and the Law (1968) is a research monograph with little direct applicability to the United States.

N. Chayet, Legal Implications of Emergency Care (1969) is an important source of material on the law as applied to emergency care, though it fails to address those situations in which the legal implications themselves constitute the emergency.

Notably, the program of the First National Conference on Legal Implications of Emergency Medical Care (Washington, D.C., June 8-10, 1975) sponsored by The American Society of Law Sc Medicine and co-sponsored by some 23 other national health related organizations addressed some of these situations, but did not devote an entire session to this subject.

21 There are, of course, books devoted to a single subject that cover multiple medicolegal facets. An outstanding monograph of this type is R. Helfer & C. Kempe, The Battered Child (2d ed. 1974).

22 H. Cushing, The Life of Sir William Osler, Vol. 1 at 387 (—).