Lawyer Helps Doctors Navigate the Perilous Legal Terrain

Nicholas Genes, MD, PhD


October 19, 2006

Bob Coffield comes from a long line of physicians. So even when he became a lawyer, the lure of medicine was irresistible. He now uses his expertise to make his state more friendly for doctors and hospitals. I had the chance to correspond with him recently, to get his perspective on how doctors interact with the law and technology.

Dr. Genes: You're a lawyer who helps physicians! How do most docs seem to you -- wary of your fellow lawyers? Frustrated or afraid of the Byzantine regulations out there? What do you recommend doctors do to better protect and prepare themselves for practice?

Bob Coffield: I always make it clear when I introduce myself to doctors at cocktail parties that I'm a lawyer who defends doctors and other healthcare professionals. If I don't, I'm concerned that someone might take a swing at me before I start my second sentence. West Virginia is well known nationally as a state where the scales of justice lean strongly toward the plaintiff (West Virginia hits the top 5 "judicial hellhole" locations and has the distinction of being the only entire state on the list).

Recently, our state has made major legislative changes curbing some of these problems, but the perception still exists. It's a major barrier to attracting qualified healthcare providers to our state, where there is a great need for medical professionals due to the age and health status (actually, unhealthy status) of the state's population. My goal for West Virginia's healthcare system is to create an environment where health professionals and businesses want to come, practice, and start healthcare-related businesses. My job is to help doctors and other businesses wade through the regulatory system, make their day-to-day operations easier, and help them avoid liability; or, if they find themselves sued, to get them through the process without total disruption to their business or practice.

Most doctors I talk to are frustrated by the regulatory environment but have accepted it as a part of today's modern healthcare environment. Many of them have disengaged themselves somewhat from the technical details, which I think can be dangerous. I often hear doctors say, "I don't know anything about that and don't plan to." Today's regulations are so difficult to understand and apply in a practical sense. But we need to keep professionals engaged in understanding the regulatory environment to help improve and change the system. It is one thing to be the engineer who designs the engine, but it's a totally different ballgame when you are the mechanic having to work under the hood every day.


Bob Coffield at Health Care Law Blog hosts Grand Rounds
October 24, 2006

Dr. Genes: Do you think doctors are getting an increasingly poor deal, with respect to Medicare reimbursements, malpractice insurance, and the regulatory environment? Many of the doc bloggers I read sound like a jaded, victimized lot; are they just being selfish? If not, is there any hope?

Bob Coffield: Yes, reimbursement is going down and expenses are going up. There are fewer dollars to spend on a system that is about to be overwhelmed by the baby boomers -- what I've referred to as the pig in the python.

Will the healthcare crisis that we are facing lead to innovation? Out of necessity, something is going to change. The convergence of more people aging in the system, the increased desire of people to want healthcare services at whatever cost, and the increased life expectancy of the population due to amazing developments in medicine will require us to confront ethical questions that might be uncomfortable: Who should receive care? How much care? How long?

Your question highlights a similarity between doctors and lawyers. Both legal and medical professionals are feeling victimized these days due to the commoditization of their professions. It's no longer a purely professional pursuit. It is difficult for today's doctors and lawyers to lose control and accept that there are other drivers controlling the profession that they chose to pursue. More and more the profession has become a business.

Dr. Genes: How did you come to be interested in healthcare? What about your complementary interest in technology and Web-logs?

Bob Coffield: My interest in healthcare comes from genes. My grandfather practiced medicine on horseback in West Virginia from 1900 to 1936. My dad and uncle then continued the tradition as country doctors from 1940 through 1990. Although I didn't follow in their direct footsteps, I was attracted to healthcare by the experiences I had growing up. During the early years of my legal career, I was involved in representing corporate clients in the coal, oil, and gas industries. In the mid-1990s, I started doing some healthcare work, liked it, and have continued focusing my practice largely on healthcare areas.

As for technology, I view it as a way to reduce the separation -- the lack of collaboration and disconnectedness in healthcare -- that has occurred largely as a result of increased specialization of practice and mobility of the public. My grandfather, father, and uncle served the same patient families for over 90 years. If a rare disease or condition was seen in one family member, they might see it manifest itself in a future generation. If there was a family history of heart disease, they could advise the younger generations to focus on better eating, exercise, and the need to monitor their likelihood of having similar problems. The vision of the electronic medical record system should strive to mirror these older healthcare community systems -- a system that gives doctors and other healthcare providers better, more useful information which will allow better decision making and treatment.

Like lawyers, doctors are skeptical and cautious about change in the profession. Again, I think much of this stems from the fact that we view ourselves first as professionals rather than businesses. Technology seems to be more easily adopted and accepted in the business world. Business is built around the product, not the professional who is involved in the process.

Dr. Genes: I'm a fan of your blog, "Health Care Law Blog." What does blogging do for you? Has it helped your career?

Bob Coffield: I'm always experimenting with my healthcare blog. Sometimes I provide more analysis on cases or regulations. Other times I just use it as my personal reference page for regulations, rulings, or announcements that might be valuable in the future. One unintended benefit of blogging has been the ability to share a past post which contained information about a topic that a new client has asked about. I also use it personally to post about my family and to promote the positive aspects of life in West Virginia. It's as much pleasure as business.

One problem that I think all bloggers face is finding the time to spend blogging. There has to be a good balance between work, home/life, and feeding the blogging bug. There is never enough time to think about topics and refine blog posts.

Blogging has opened up a new network of friends, business contacts, and colleagues. Also, blogging has helped me attract clients who are looking for specific things that I've posted about. The partners in my firm know about my blogging (I think), but I don't think they fully understand the concept and value.

Dr. Genes: Bob Coffield also sees value in "Grand Rounds," the weekly collection of the best in online medical writing. Each week, a different host solicits posts from health industry bloggers and links to these posts from his or her site. On October 24, 2006, Bob Coffield hosts Grand Rounds (the link goes "live" on October 24). He had this to say about the upcoming edition: "I'm looking forward to hosting Grand Rounds. I'm constantly amazed at the quality and depth of the posts that are highlighted via Grand Rounds; it allows me to stay in touch with the health industry."


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