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My Day at Jury Duty – The Similarities Between the Institutions of the Law and Medicine
My Day at Jury Duty – The Similarities Between the Institutions of the Law and Medicine
Recently, I was called up for jury duty. Although this is a very important responsibility for Americans – our civil duty - it’s also a colossal inconvenience for busy doctors, and in California, being a physician does not excuse one from serving. So, after postponing my jury duty summons twice, I bit the bullet and scheduled my service. Having never done jury duty before, I had absolutely no clue what to expect. What I found was an environment remarkably similar to the world of medicine, specifically that of the hospital. These similarities tell us something about human organizations and how two major pillars of our society, medicine and law, reveal fundamental truths about who we are.
Two major pillars of our society, medicine and law, reveal fundamental truths about who we are
My jury duty stint was done at the Santa Ana, California courthouse. As I approached the courthouse via surface streets, the first similarities to my local hospitals became strikingly clear. First, the courthouse, like many hospitals, is located in a rather undesirable part of town, and the building itself appears to tower above the local buildings. As I drove through this part of town, the number of law and business-oriented buildings struck me as remarkably similar to areas around hospitals. Where medical offices, pharmacies, and medical supply buildings huddle around hospitals, I noted law offices, the county recorder, and office supply companies conglomerating around the courthouse.
Now, I know what you’re thinking: “This is completely obvious, Shapiro. Of course that’s what anyone would expect. Law-related businesses would obviously locate themselves around the law center.” But if you think about this for a moment you might eventually end at the same question I did: “Does this structure really have to be the case? Not all businesses with a legal interest are located near the courts, and the same is true of hospitals. It may be more convenient to be near the court if you’re a lawyer, but with modern transit, this surely isn’t a requirement. I think there’s something deeper here beyond simple convenience.
After parking in the designated juror parking – just as one would expect at a hospital with its designated staff parking - and entering the building, I was again struck by the similarities with many hospitals. Institutional white linoleum tiles and 1970s brown wall paneling. Florescent lighting. An air of quiet, as if anyone speaking loudly would disturb the building’s occupants. Apparently law needs as much quiet as a recovering patient.
Emergent Social Structures
As discussed above, the social and physical structures of the legal and medical systems appear suspiciously consistent with each other. I see these constructs as similar to a hive of bees or group of ants. A specific social structure is created that, in the case of insects, is evolutionarily successful. Communities of insects work together to maximize not only survival but also overall success. This is very much the case in human anthropology. We have evolved various structures over time to address our social needs. From small communities and microstructures, such as the village constable or doc down the road, large macrostructures blossomed as our population and technologies have advanced.
These macrostructures were not required to evolve this way. There was no mandate or predestined command. We could have had, for instance, a legal system made up of decentralized judges making decisions for individual small communities. Similarly, we could have created smaller medical clinics to serve local neighborhoods or stayed with the doctor who did house calls. However, there are clear advantages to larger, more centralized institutions such as specialization, resource sharing, and cost reduction, among many others.
As it turns out, advantages of scale are so significant they have permitted insects to successfully subvert the individual (for example, sterile drones working to maximize reproductive success of a fertile queen) in favor of the group’s survival. This process has worked incredibly well for more than 400 million years.
Similarly, the history of medical education in the United States is another case in point where the advantages of larger scale organized structures caused a huge paradigm shift. During the late 1800s, medical education consisted of proprietary schools with their own rules and variable (mostly poor) quality. Clinical education was closer to an apprenticeship. Along came Johns Hopkins Medical School and Hospital in 1893 with its more formalized structure, including teaching rounds and residency training. With the publication of the Flexner Report in 1910, the low quality, decentralized medical schools disappeared, creating the consistent, powerful international medical education system that exists today.
But there are limitations to these social structures, as we see every day. Large centralized court houses and regional medical centers suffer from problems of scale such as depersonalization, often poor service, large costs, and a less flexible structure. As a result, our society creates alternatives. Mediation is increasingly used to solve civil disputes, eschewing the courthouse altogether. Similarly, urgent care centers are popping up to address the long wait times of many emergency rooms for patients with less high acuity situations, and surgery centers leverage new technologies and methods to tackle surgical problems of increasing variety and scope. There appears to be an almost organic reciprocal interaction between the large-scale institutions and smaller boutique endeavors. Is one superior to the other? Maybe, depending on the circumstances and societal pressures.
What will Emerge in the Future?
For a while it seemed private medical practices were doomed to disappear, casualties of an ever growing and administratively demanding medical arena – and they still might; who knows? But it appears this organic evolutionary process that created our large systems may also have a moderating effect as new online services and technologies allow boutique practices to successfully handle challenging administrative demands while continuing to provide personalized service.
Where will the Internet fit into the micro- and macrostructures of our society? What effect will it have on our large community centers like the courthouse or the hospital? Will our 21st century technologies lead to a further solidification of these community and civic centers or a movement toward smaller scale services? Will my future jury duty calls require me to drive to the courthouse or become a telecommuting juror logging in from the comfort of my home? Whatever happens, it’ll be fascinating to watch our societies continue to evolve.
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