Adding a Lawyer to the Health Care Team: Addressing Social Determinants through Medical-Legal Partnerships

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By: Elizabeth Tobin-Tyler, JD, MA, assistant professor of family medicine, Warren Alpert Medical School, and assistant professor of health services, policy and practice, School of Public Health, Brown University

As a lawyer who has taught medical students for many years about the role of law and policy in health disparities and the social determinants of health, I am well acquainted with the question, “but what can I do about it?” What can a doctor do if a patient is being evicted or has her utilities shut off, lives in a house with mold that is exacerbating her child’s asthma, or is financially dependent on an abusive partner? These questions are neither rhetorical nor uncommon; a survey by the Robert Wood Johnson Foundation found that 4 in 5 doctors view social needs as critical to patient health but are not confident in their ability to address those needs.

What is clear is that doctors cannot be expected to address these complex patient needs alone. To address the complexity of medical care and patient health, many medical schools and residency programs are increasingly incorporating interprofessional education (IPE) into their curriculum. IPE curriculum tends to focus on the interface between doctors and other health professionals–nurses, physician assistants, and pharmacists. But to effectively address the social determinants of health, health professionals need to know how to tap the expertise of social workers, lawyers, and community organizers concerning how to improve the social conditions that make their patients sick in the first place.

For more than fifteen years, I have been engaged in the promotion of medical-legal partnerships (MLPs). MLP is an approach to health care delivery that embeds civil legal services into the spectrum of health care services provided to low-income or otherwise vulnerable patients and communities. By integrating lawyers into the health care team, the team can more effectively identify and address the social and legal barriers to health for vulnerable patients and populations.

The MLP approach is built on the understanding that social determinants often manifest in the form of legal needs caused by systemic failures or inadequately enforced legal protections (such as housing health and safety code violations, unlawful denial of benefits like SNAP or Medicaid, or inadequate protection for victims of intimate partner violence), and that civil legal aid lawyers have the requisite training and expertise to address these needs.

As Joel Teitelbaum and I describe in our recent Academic Medicine article, MLP is a particularly effective means for teaching medical students and residents many of the skills the nation should want in the 21st century doctor: one who provides patient-centered care that is sensitive to social context, integrates population health into clinical care, is adept at systems thinking, and is skilled at working as part of an interprofessional team.

At the Alpert Medical School of Brown University, where I teach, we have integrated MLP into the curriculum in multiple ways. Undergraduate medical students can take a preclinical elective, along with students from law, social work, and nursing called “Poverty, Health and Law,” and they can gain hands-on experience at the Rhode Island Medical-Legal Partnership at Hasbro Children’s Hospital through clerkship and volunteer opportunities. Through a new Health Resources and Services Administration training grant, we will begin training family medicine residents at the Family Care Center, a patient-centered medical home, to identify unmet social and legal needs and to work collaboratively with an MLP attorney and other partners to address those needs.

As MLPs continue to develop across the country (there are currently 276 in the United States), medical schools and residency programs are using MLP curriculum to prepare future doctors in effective interprofessional strategies for addressing the social and legal needs of their patients and the populations they serve.

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