Learning to be a Lawyer?

(Part one of a two-part post. The second post can be found here.) Think back to the first days of your second year of law school. In your first year, you covered the basics of civil procedure, property, torts, and contracts; in your second year, you’re ready to buckle down and learn how to practice in areas of interest to you. You know how to brief a case; you know how to spot issues. Now that you know how to discern legal problems from fact patterns, isn’t it time to learn how to deal with such problems, how to file a complaint, submit an answer, or draft a contract? Maybe it’s time to learn how to practice law, but that doesn’t mean you will. Law schools, especially the so-called “national” schools that hold the top rankings in U.S. News & World Report, train their students to “think like lawyers” and do precious little training in actual lawyering. Students from these schools often graduate with no practical experience, other than that gained at summer jobs or optional clinical programs, and precious little understanding of state law, despite the fact that most will practice in state, not federal, courts. Within six months of graduation, these students swell the ranks of law firms across the country, earning annual salaries as high as $160,000 in some markets, and yet they have virtually no experience in the practical application of the law. Imagine, for a moment, if medical school were like law school . . . Professor: “Welcome to the first day of Lung Diseases and Abnormalities. Before we get to discussing the reading assigned for today, a few things about grades. Your grade for this class is based entirely on the exam. It’s a three-hour, in-class, open-book exam, with two questions. The first will involve a description of a disease or abnormality; this will be a typical spot-the-illness type question that you had all during your first-year exams and will be worth 60% of your grade. The second question will involve theories of illness and treatment; that will be 40% of your grade. Now, turning to the reading for today. Ms. Garcia, can you tell us what was happening in the first case?” Ms. Garcia: “The patient was diagnosed with small-cell lung cancer.” Professor: “Yes, that’s true. But what happened before that?” Ms. Garcia: “The patient, who had smoked cigarettes regularly for her entire adult life, began noticing trouble swallowing in June of 2004. A cough developed shortly after that, and the patient thought she was fighting a summer cold. She didn’t seek medical attention until a month later, when she began seeing evidence of blood in her sputum.” Professor: “Excellent. And the first diagnosis?” Ms. Garcia: “Her chest X-ray did not reveal abnormal growths in the chest cavity, nor did the doctors see evidence of emphysema. The preliminary diagnosis was asthma.” Professor: “And then?” Ms. Garcia: “Symptoms grew worse and the patient asked for another series of tests. At that time, it was found the first set of slides was faulty. The patient had a large mass in her left lung, which later tests revealed was small-cell carcinoma.” Professor: “Good. Now, suppose the slides hadn’t been defective. Mr. Thompson, how would that have changed the situation?” Mr. Thompson: “The diagnosis would have been made sooner.” Professor: “OK. So?” Mr. Thompson: “Uh . . . Treatment could have began sooner?” Professor: “Is that a question, Mr. Thompson?” [Mr. Thompson looks blank. Nervous titters from the class.] “Ms. Rose, can you tell us what would have changed if the diagnosis was made at the time of the first set of slides?” Ms. Rose: “Yes. Nothing would have changed.” Professor: “Why?” Ms. Rose: “Because the five-year survival rate for small-cell carcinoma is approximately 25%. The time difference in diagnosis reduced her chances of survival from about 35% to 28%. Either way, in five years, the patient would have been dead.” Professor: “Mr. Yuan, do you agree?” Mr. Yuan: “I don’t think so. This patient didn’t die after five years; she died after two. The seven percent difference in the five-year survival rate resulting from the mistaken diagnosis might have meant that the patient survived three years instead of two. So the mistaken diagnosis did matter.” Professor: “Ms. Rose, can you address that?” Ms. Rose: “Ultimately, her chances of survival were so low, the couple weeks it took for the mistake to come to light didn’t mean that the patient had a greater chance of recovery. The difference in five-year survival rate odds doesn’t mean that if a patient begins with a slightly higher rate, they’ll necessarily last longer in that five-year period.” Professor: “Mr. Yuan, any response?” [He doesn’t answer.] “Okay, what about the fact that the mass was in her left lung? Suppose it was in her right lung. Would that have changed the course of treatment? Mr. Greene?” Mr. Greene: “A mass of the same size would take up a smaller percentage of the right lung, because the left lung is smaller than the right. The patient might not have noticed symptoms as early as a result, which would mean that later treatment would have to be more aggressive.” Professor: “What treatment would you recommend in that case, Mr. Greene?” [He doesn’t answer.] “You have no idea, Mr. Greene? Nothing occurs to you?” Mr. Greene: “Um, chemotherapy and radiation?” Professor: “Mr. Greene, we’re looking for answers more involved than what we would learn by watching ‘ER.’ Does anyone else have an answer? Yes, Mr. Miller?” [Later, as discussion is winding down] Professor: “Any questions about the discussion today? About the exam? Yes, Ms. Rose?” Ms. Rose: “Are we going to have any lab time in this class?” Professor: “No, just as in your first year classes, there will be no lab time, and there will be no physiology on the actual exam. You’ll pick up the practical knowledge your first year on the job. Here, the real goal of the medical school program is to get you thinking like a doctor.”

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