AANS Neurosurgeon | Volume 27, Number 4, 2018

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Neurosurgeons Go Back to School: Medicine and Law: Seeing the World with New Eyes

There is a touch of irony in a neurosurgical periodical dedicating an issue to going back to school. For individuals, like neurosurgeons, who have already dedicated fifteen years or more to post-secondary education, school is not a hard sell. It is in our comfort zone. A place dedicated to learning in the company of like-minded people where rules and metrics are clear is a touch different from the realities of practicing neurosurgery. My education outside of medicine and neurosurgery was a true blessing that not only gave me new knowledge, but also allowed me to see the world with new eyes.

I completed a joint medicine and law degree program at Case Western Reserve University (CWRU) just over twenty years ago. The program was organized in two-year blocks – two years of basic science, two years of law school and the final two years of clinical science. I did not start my neurosurgery journey in the joint program. I was a traditional medical student, learning the basics of anatomy and physiology during my first year. But I also found myself drawn to the political issues of that time. 

The Presidential election of 1992 was between President George H.W. Bush, Bill Clinton and Ross Perot. Amongst the biggest issues of that election was medical coverage. President Bush espoused the use of tax incentives to encourage employers to offer health insurance to their employees, while Governor Clinton advocated for legislation to make coverage mandatory with financial penalties for employers who did not comply. I was struck by the inherent political nature of healthcare. While medical school emphasized the humanitarian and altruistic values of medicine, the real world of healthcare seemed more harsh and complex. Anatomy and physiology were clearly important, but so was the cost of health care, who would pay for it and who got to make those decisions. I was curious about those issues and held some hope that I could influence their outcome. Law school seemed like the best way to put that curiosity and hope into action.      

Law school, like any education, is a slow reveal of our ignorance. It is a way to see the world from a new perspective. Stories and issues that once appeared straightforward and dull become more complex and nuanced with the acquisition of deeper knowledge. There was a quote in the law library at CWRU that said, “The lawyer is the conscience of the community.” At the beginning of my legal education that quote held much less significance to me than it did at the end. The study of the law forces a student’s mind to take an issue and look at it from the viewpoint of others and take it away from the bias each of us holds in order to see it in a fuller context.

Much of the mechanics of law feel very similar to that of medicine. Lawyers research precedent, examine facts, take accounts of witnesses and put together a plausible story on which to build a case. In essence, this is the same thing physicians do when diagnosing a patient. While our initial diagnosis may not be correct, it is a means to an end. It is a way to take the information available, package it together and see if it can stand on its own or if it needs to be adjusted when new information is gathered.

Physicians and lawyers are also in the same business of managing people and their expectations. Good attorneys, just like good physicians, anticipate problems and have a plan in place when those problems arise. Both are there to calm their clients or patients when they become irrational and instill confidence when spirits are low.

But there are aspects of law that feel foreign to the practice of medicine. Negotiating the details of business agreements, writing threatening allegations and condescending insults disguised as civil remarks, sitting in a courtroom for hours in order to be heard by a judge for a few minutes or confronting those who are trying to harm a client are not part of a physician’s routine. There is also a natural pessimism in the practice of law that feels foreign in medicine. The best attorneys constantly think of what can and will go wrong. They do not tell themselves flattering stories or dwell on past success. To be a great attorney is to constantly worry, knowing that successful outcomes ultimately lie in the minds of others – judges and juries, who see what they believe and can unwittingly filter out facts or evidence that do not fit their opinion. That does not seem as useful in the world of medicine; facts are important, but persuasion and influence are the means to create the results that legal clients desire.

A return back to school can be a very powerful tool for a neurosurgeon. For those who have a curiosity that will not go away or want to change some aspect of their world, education is the only path to walk. Choosing an interdisciplinary route, such as law and medicine, will spark unique ideas and create new ways of looking at old problems. If you are considering law school, I strongly encourage you to look within yourself and be clear about changes you want to see happen or issues you want to influence. When done for the right reasons, a legal education can reveal a world that your old eyes will not recognize, but will adore.

Calendar/Courses

2019 Mayo Clinic Advancements in Surgical & Medical Management of the Spine
Jan. 13-17, 2019; Kohala Coast, Big Island, Hawaii

Pituitary Education Day
Jan. 16-18, 2019; Orlando, Fla.

Innovations in Endoscopic Minimally Invasive Brain Surgery
Jan. 16-19, 2019; Celebration, Fla.

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