At the UC Davis Medical Center, we are formalizing a partnership between doctors and lawyers that aims to explore and address the root causes of the illness we see in our patients.
Tonya Fancher, the associate residency director for internal medicine, has laid the foundation for this interprofessional collaboration. Her pilot project with Legal Services of Northern California, a local non-profit family law organization, has brought medical students, residents, and attorneys together on an interactive team.
The traditional Medical-Legal Partnership model is an attorney integrating into the daily patient flow of an ambulatory clinic setting. The legal partners confer with their medical counterparts to identify social determinants adversely affecting a patient’s health.
The classic scenario is a patient with a respiratory condition requiring frequent clinic visits. The physician hears the wheezing lungs and sees the compromised mobility. With a MLP, he uncovers that the patient lives in a facility infested with mold due to building codes and zoning laws infractions. The staff attorney can contact the landlord seeking assistance in the spirit of improving health rather than threatening litigation.
Now, both the disease and its source are treated. Eradication of the mold benefits individuals who are the neighbors of our patient and we can improve community health even though we may never directly treat them.
The partnership also assists patients by screening their eligibility for programs providing employment, shelter, food, and health insurance coverage. Physicians now ask what percentage of a patient’s monthly income is dedicated to shelter and food, and understand this question is as important of asking how long has the coughing been occurring.
We plan to have an MLP presence in our family and internal medicine clinics, and in our emergency department. The goal is to reduce the burden of the emergency room as a primary care entity. Our patients come from our communities and will return to our communities after we treat them. We can strengthen our communities by establishing professional interactions, working side-by-side, and sharing missions and visions.
Legal Services of Northern California is headquartered in the Alkali Flats neighborhood; the UCD Medical center is located in Oak Park. The State Capitol lies between us. Once the MLP is in place, we will have a corridor of community connectivity.
As physicians, we are aware of social determinants in a population context. However, when we are confronted with these influences in individual patients, we lack the expertise and resources to address them sufficiently and efficiently. A legal partner attenuates health disparities by widening the lens physicians use to view their patients. With the MLP, we can make the personal global and the global personal.
Dr. Fong is director of the UC Davis Family Medicine Residency Network. His opinions are his own and do not represent UC Davis.