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Over several decades, U.S. physicians, medical ethicists, and policy-makers have worked to enhance patient decision-making at the end-of-life. States have passed laws allowing patients to express their preferences through advance directives and to appoint a surrogate to make decisions if they are unable to do so. Both the federal and state governments have provided incentives to encourage patients to complete advance directives and discuss their care preferences with their physicians. Despite these efforts, for a variety of reasons, few people actually complete an advance directive or appoint a health care surrogate. However, real world medical decision-making frequently deviates from the ideal of the empowered patient with capacity exercising her autonomy over what happens to her body. In this paper, we explore how the legal and ethical frameworks that have developed around end-of-life decision-making in the United States may fail in the case of the most vulnerable patients. We argue that it is time to shift the focus from patients to providers and the health care system to achieve the goal of improved end-of-life decision-making, and suggest specific ways toward making this transition. [ABSTRACT FROM AUTHOR]

Medical-legal partnerships (MLP) are inter-professional community collaborations among physicians, lawyers, healthcare providers, healthcare organizations, and other professionals. Medical-legal partnerships seek to improve health and address the social determinants of health by integrating lawyers and legal services into the daily practice of healthcare delivery. This article will demonstrate how medical-legal partnership enhances a healthcare organization’s ability to address the “six aims for improvement” identified by the Institute of Medicine’s report, Crossing the Quality Chasm: A New Health System for the Twenty-first Century. In addition, by incorporating medical-legal partnership quality indicators into an organization’s scorecard, both the healthcare organization and the medical-legal partnership work in concert to reduce health disparities, and increase productivity and performance. [ABSTRACT FROM AUTHOR]

Patient and client-centered practice and accurate problem diagnosis require that we understand the context within which the patient/clients' problem originated. Effective problem solving depends upon context-specific solutions. This article describes the interaction of a medical clinician/educator and two legal clinicians/educators who work and teach together as part of an interdisciplinary community collaboration. We demonstrate how a pediatric hospital and two medical schools that treat acutely and chronically ill children collaborate with a legal services clinic based in a law school to provide interdisciplinary clinical education for students and engage in interdisciplinary problem solving for the benefit of patients and clients. Pediatric residents and medical students partner with law students, as well as treating physicians to evaluate and interpret case facts and develop strategies for addressing patient/client problems. A case study demonstrates the opportunities for interdisciplinary problem solving among the collaborators and the benefits of viewing patient/client issues through the lens of other disciplines. The article describes how the medical and legal professions each view a particular case scenario, and how professionals can work together to diagnose and treat a problem, thereby addressing the social determinants of health and wellness that affect the patient/client. A physician can provide better care when he/she understands the legal issues faced by the parent and how those issues can impact the family's ability to access health care or to follow a care plan. Likewise, a lawyer representing a parent with a sick child can be a better advocate when he/she understands the patient's medical diagnoses and needs. [ABSTRACT FROM AUTHOR]

Background: At Georgia State University, the Health Law Partnership (HeLP) Legal Services Clinic is part of the Health Law Partnership, which is a medical-legal collaboration among Georgia State Law, Children's Healthcare of Atlanta (CHOA), Emory University School of Medicine, Morehouse School of Medicine and the Atlanta Legal Aid Society. HeLP clinic law students learn alongside residents and medical students. Law students work on cases involving childhood asthma, housing conditions, education, and access to healthcare. Clients are low income residents of the metro Atlanta area, whose children are receiving care at Children's Healthcare of Atlanta. Methods: following IRB approval, the collaboration of law students, medical students and residents serving in the HeLP clinic, a short two-part survey was distributed to assess the knowledge and understanding of the National Asthma Education Prevention Program (NAEPP) guidelines. Two sections: 1. the knowledge level of law students, medical students and residents serving in the HeLP clinic for effective asthma management; and 2. the use of an AE-C as credentialed by the NAECB. Data obtained was analyzed using SPSS, version 23. Descriptive analysis (frequency tables), and t-tests of significance were utilized. Results: 34 HeLP clinic members, 44% medical residents and 32% law students completed the survey. 64% of the HeLP clinic members have 1 year or less than 1 year of experience serving in the clinic. Current data suggests that 85% of HeLP clinic members, law students and medical residents alike, would utilize the resources of an AE-C if available within the clinic. Our results revealed no significant difference of the knowledge of asthma management between law students and medical residents. Medical resident responses to the NAEPP guidelines were higher than the law students. When reviewing individual answers of the asthma self-management guidelines, law students answered more correctly than medical residents. Discussion: this study was to determine the knowledge of asthma and the use of AE-C's within the HeLP clinic amongst law and medical students, and residents. No known studies have compared the knowledge of asthma and use of an AE-C. Further education and needs-awareness is needed for physicians and those who advocate for individuals with this incurable, yet, manageable pulmonary disease. The utilization as well as awareness of AE-Cs is also strongly suggested. [ABSTRACT FROM AUTHOR]