Medgadget editor Dan Buckland is in training to become a physician while trying to remain an engineer. Here he interviews a person cross-trained in Law and Engineering to get a broader perspective on how education in different thinking styles leads to different problem solving strategies.
In my previous articles about the problem solving skills of Physicians, Scientists, and Engineers I was not able to address some of the other professions that are clearly involved in the Med Tech industry, mostly due to my lack of knowledge and training in these other fields. Lawyers are involved in both successful and unsuccessful medical technology projects, with a lot of frustration arising from the lack of knowledge by non-Lawyers about the legal world. Even apart from the differing experiences of people involved I think some of this lack of understanding comes from the very different ways each group was trained to solve problems and even how each group formulates problems themselves. As you can see from the interview below with Anthony Wicht, Lawyers start from a very different place than the other professions we have discussed so far. Mr. Wicht is a former lawyer and engineer who now works on policy for the Australian Government. He holds degrees in Law and Civil Engineering from the University of New South Wales in Australia, and a Masters of Science in Aerospace engineering from MIT in the United States. Via email I asked Mr. Wicht about the cases from my problem solving article and his thoughts on the differences between Physicians’, Scientists’, Lawyers’ and Engineers’ approaches to problem solving. The previous caveats about discussing these diverse professions as homogeneous groups still apply.
1) Patient A started coughing this morning, what should she do about it?
A lawyer would instantly think about responsibilities for action. As a start, a lawyer would recognize the danger of advising Patient A as to what she should do without being properly qualified to do so.
After a moment’s reflection, however, legal methods of thinking suggest possible courses of action. A lawyer is likely to look to rules as to how to behave in this situation. Are there workplace policies at Patient A’s workplace which guide whether she should or shouldn’t come into work? And how do the consequences of breaching these actions compare to Patient A’s preferences to go to work or stay home? Perhaps there is a precedent, by which lawyers mean known previous outcomes which suggest answers. If Patient A visited the physician last time she had a cough and was told “you did well to come and see me because as an asthmatic you are susceptible to complications”, then seeing a physician is indicated by precedent.
On a third layer, a legal analysis would look for desired outcomes. Does Patient A want to find a way to stay at home, in which case finding a friendly physician to excuse her from work becomes the priority? Or does Patient A want to work so she gets paid, perhaps in spite of company policy which says she should stay home, in which case finding a cough suppressant is more important.
2) Patients B,C, D, E, and F all have a form of slow growing cancer no one has seen before. They are all related, but the inheritance pattern is not one that has been observed in other cancers. What should be done?
A cynical analyst would suggest that a lawyer would look to allocate blame in this case. What is the cause of the cancer, and can someone be sued because of it? Perhaps a class action can be mounted on behalf of all of the patients. On the face of the matter this is an attractive way of thinking for the patients, because the financial windfall may cover the patients’ cost of treatment.
In truth, though, a good lawyer looks beyond the allocation of blame to a broader idea of ‘society’s rules’. Arrangements from health insurance to the writing of a will to the obligations of their employers are affected by their illness. In parallel with the treatment process, these aspects of the patients’ lives may make the difference between a recovery to a life very like the one they had previously, and a recovery beset by worries of debt and eventual poverty.
You will notice that the legal analysis does not touch the patient’s treatment, a matter of science. The lawyer knows that that is not their place. The lawyer immediately thinks of the social context of the patient’s illness, and about whether benefits, under the rules that govern the interaction between the person and society, have been triggered as a result of the illness.
3) Patient G had her gallbladder removed by Dr. H. Dr. H performs the procedure laparoscopically, but the tools she uses don’t work the way she wants them to, and she feels that she spends too much time struggling with the equipment rather than doing the procedure. Other surgeons say they have the same problem too. What should be done?
This problem can be approached from two angles. The obvious one is from the perspective of Dr. H and her colleagues, who want equipment which works better. What did the manufacturer promise to deliver? Under those agreed rules (‘contract’), can the manufacturer be made to improve the product? Or is Dr. H’s machine faulty (and her colleagues clumsy), in which case the manufacturer could be forced to replace it?
Assuming the manufacturer is not in breach of contract, lawyers can still help their clients. Many lawyers will try and facilitate mutually satisfactory agreements even when there is no compulsion for the parties to act by law. A win-win situation here might be to have Dr. H and her colleagues become a focus group for the manufacturer, trialling and critiquing new equipment so that it works better for them and so the manufacturer can sell more units.
The second angle is the perspective of Patient G. Did they get the standard of care they were reasonably entitled to? If not, was Dr H at fault for performing the procedure with tools she knew were below par? Or is the manufacturer at fault? Is the patient prepared to endure the stress of litigation for the potential payout of a successful lawsuit?
4) What is a stereotypical law school problem, and how do you solve it?
I was taught the answer to every law school problem on my first day in law school: ‘it depends’. My professor was very clear about that. And it applies to many real world law problems as well.
A law school problem is solved (in general) in the following way.
Identify (or agree on) the facts which give rise to the problem
Identify any legislation or previous judgments (‘case law’) which dealt with a similar fact situation
Apply the legislation or the case law to the facts in this case. Is it clear that the legislation applies, or is it arguable? Were there differences between the facts in the previous judgement which made the case law and the facts now?
Draw a conclusion, and say how strongly that conclusion can be supported. For example, it is likely that the defendant would be found guilty.
After law school the only difference is that the order in which the questions are answered usually starts with 4 (the preferred conclusion) and moves in reverse order thought the steps, searching for ways to support that conclusion.
Invariably, in law school, the application of the law to the facts is not straightforward – hence, it depends. The fact situations are usually a laughably improbable compilation of the facts underlying the key cases taught through the semester, with slight variations to make the application of the law to the facts not straightforward.
For example, if the semester had included a case about environmental pollution by a factory pumping chlorine into a creek, the fact situation may include a caveat where a factory thought they were pumping chlorine into a creek but in fact, due to a mistake by the construction company, were pumping water. Do the facts of the original case still apply? Why or why not?
This approach places a premium on really understanding the cases, rather than simply remembering them. In fact most law schools run open book or take-home exams to emphasize understanding over memorization.
5) As someone who is trained in both the JD and engineering way of thinking, what do individuals only trained in one way not know about the thinking process of the other? Are there any words/phrases/concepts that have differing meaning in both fields?
Law is fundamentally different to engineering, science and medicine in one important way. Law is completely a human construct. In engineering, science and medicine, as Richard Feynman famously said, “nature cannot be fooled” (1). Bridges fall down, chemicals react, and people become sick according to physical processes irrespective of human preferences, agreements or desires. In law, human perspective is everything. People make laws, interpret laws and enforce laws, and if there is total agreement to act contrary to a law, then the text of the law is irrelevant. Laws are different from state to state and country to country. Physics is invariant.
This difference means that lawyers put a premium on being convincing (as opposed to being right). The engineer, on the other hand, puts being right well ahead of being convincing (2). Is it any wonder then that both lawyers and engineers can’t believe the other “doesn’t understand the real world”. In a way, both are right.
(2) Or at least convincing to non-engineers. “Right” is the same as convincing to another engineer.
How Physicians, Engineers, and Scientists Approach Problems Differently; How Physicians, Scientists, and Engineers Approach Unexpected Results Differently; How Surgeons and Engineers Can Communicate Better