MLP Grand Rounds

A key component of many Medical-Legal Partnerships is the legal education of healthcare staff. This serves numerous functions within the partnership, including:

1. Improving the overall legal literacy of the healthcare participants, giving them a better grasp of the legal issues that their patients experience.

2. Promoting the work of the partnership throughout the healthcare organisation.

3. Equipping healthcare workers to issue-spot and make more appropriate and timely referrals for legal assistance.

4. Reinforcing the principles and practice of holistic health care delivery.

5. Demystifying the law and overcoming the cultural barriers and antagonism that sometimes exists between lawyers and doctors, especially.

While many legal service providers have extensive experience in delivering legal education to a range of professions, delivering it within a health context, especially to doctors, can present a range of challenges. These include getting buy-in from senior medical staff, speaking a language that transcends cultural barriers, providing tangible and detailed case-studies, adopting the use of mnemonics (learning devices that aid memory), and accommodating the rhythms and patterns of medical-training and ongoing professional development.

Let me just touch on the last two of these.

Mnemonic devices are simply  systems that make memorisation easier, by using a process of consolidation. In the Medical-Legal Partnership context, the I-HELP mnemonic is a useful prompt for doctors and other health workers when scanning for the presence of legal issues and has been used as the foundation for sophisticated legal screening tools at many MLP sites. I-HELP stands for  Income, Housing and utilities, Education and employment, Legal status/immigration and Personal safety.

As for accommodating the rhythms and patterns of medical-training and ongoing professional development, two things spring to mind having visited numerous sites engaged in this activity.

First, lawyers and doctors are trained very differently. By and large law students receive very little practical training during their college education, where as medical students are very hands on from an early stage. Medical students also tend to have shorter chunks of intense education about particular subjects and do not necessarily adhere to general university semester schedules, given the need to undertake significant practical training. This can cause some logistical challenges for educators wishing to teach poverty law to medical students, and more challenging still when that education is combined with other course participants (such as law or social work). Second, and this is related to the first, educators must be highly flexible, fitting into teaching and learning regimens that are well established within the medical work environment. Grand Rounds are an example of this.

LegalHealth Grand Round Presentation at Beth Israel Hospital

I was lucky enough to observe LegalHealth (a division of the New York Legal Assistance Group) present to over 35 health staff (including doctors and social-workers) at an early morning Grand Round at New York City’s Beth Israel Hospital, division of Obstetrics and Gynaecology. LegalHealth is long-standing, effective and well-respected MLP, with partnerships at over 17 sites, including 15 hospitals.

Essentially, Grand Rounds are both a teaching method and custom of both medical education and inpatient care, whereby a medical problem and the treatment options of a particular patient are presented to an audience usually comprising doctors, residents and medical students. Most hospitals have regular Grand Rounds (usually weekly). These sessions help participants keep up to date in important evolving areas which may be outside of their core practice and are an important supplement to medical school and on-the-job resident training.

Randye Retkin (Director of LegalHealth) second from the left discusses medical-legal issues with health and legal staff from the MLP following the Grand Round.

I was extremely impressed by the punchy and effective presentation provided by LegalHealth at Beth Israel, delivering material on key legal issues faced by actual patients (with identifying information modified to ensure confidentiality). Presenting such case studies, rather than a disembodied presentation of the law or legal principles clearly enabled the participants to understand and apply the issues in tangible scenarios.

It’s clear that for MLPs to take root within institutions, the partners must be willing to inhabit one another’s worlds to some extent, learning new rhythms and languages, enabling services to operate effectively for patients and clients.

Peter Noble

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