Social Injustices, the Law, and Applying to Medical School


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PMY 399: Social Injustices, the Law, and Applying to Medical School

Session 399

You’re taking a stand against social injustices, but what happens if you find yourself in trouble with the law – how should you talk about it as a premed?

Larry Cohen is a lawyer who works a lot with healthcare workers and providers – vets, doctors, and other professionals – who find themselves running into issues with the law. I had Larry back in Episode 197 where we talked about whether you can get into medical school if you’ve been arrested or any legal issues and he’s been yielding a lot of calls from students because of that episode.

Even if you don’t have any criminal record, this is still a good episode for you, because what schools, credentialing bodies, and residency programs are potentially looking for when it comes to answering questions based on prior legal issues.

For more podcast resources to help you along your journey to medical school and beyond, check out Meded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:50] Changing the Premed Landscape

Mappd.com is a technology platform that I’ve wanted to do forever. I’ve partnered with Rachel Grubbs who has about 20 years of experience in the test prep world and student world.

We are bringing on Dr. Scott Wrightas the VP of Academic Advising. He’s the former director of admissions at UT Southwestern and the former executive director of TMDSAS.

Ask the Dean over at Facebook Live happens every Monday.

[05:27] The Legal Issue Question

A very important question that medical schools ask is whether or not you’ve had any prior contact with the police or the courts, or if you’ve ever had any convictions.

The most significant reason they ask this is that when someone then goes to get a license. Having been in medical school and graduated, they now have to try to get the board to approve them. The concern is that when they get to that point, they may have put in all of the five years in medical school and find that they are unable to get licensed anywhere.

“The schools are doing this to some degree as an initial check on potential practitioners to see if they're going to have a problem being in practice.”Click To Tweet

There’s also concern about the fact that this is a highly, highly competitive process. And it’s another way to sort of identify the people who are going to be more likely to be successful and less likely to quit or suffer issues once they practice medicine. 

Thirdly, it’s a measure of how ready people are to deal with the medical school environment and all the pressures associated with it. How well are they done with crises in the past and what can they do with in the future?

[06:51] How to Answer the Question Given the Current Circumstances

Given the kind of the climate that we’re in, in this country, with social justice and students are out protesting and potentially getting arrested. We have this huge disparity among disadvantaged people of color who may have a run-in with the law much more frequently than those who are white.

Larry recognizes what huge problem this is as these kinds of issues are distributed disproportionately by race and ethnicity and economic background.

One way to respond to these questions would be to challenge the appropriateness of asking in the first place. Whether it gets asked at this level or gets asked at the next level is ultimately a question that is asked and needs to be addressed. Larry’s work through the years has been to try to help people address it face-on, meeting on the merits of the issue presented.

But people who want to take on this issue as another way in which they are being treated unfairly and in a biased or prejudiced kind of way are certainly welcome to do so. 

This is a long term problem that needs to be addressed whether that happens in the next year or two or and longer. But the immediate problem is getting past these issues and overcoming the potential impediment to getting into medical school.

“The central takeaway here is whatever you do in the context of trying to respond to one of these inquiries, be honest and straightforward in your response.”Click To Tweet

The problem that you’re confronting in terms of a prior arrest or prior conviction is something that can be dealt with. For the most part, sometimes there are things that can’t. But most can be dealt with. What is a huge problem and will be an impediment throughout is someone not being honest and not being straightforward. 

When the boards have gone back and found out that someone made a false statement in a school application, a job application, or a credential application anywhere, they are prepared to revoke their licenses.

It is a very serious problem from the standpoint of the regulatory boards when they find that someone is not being honest. 

The reason for that is that it’s rows off believability or credibility everywhere along the way. So don’t respond by trying to hide the fact of a conviction or arrest and don’t respond by hoping that things will not be found. And the key is to respond honestly, in a way that will be productive, rather than counterproductive.

[11:29] How Are You Going to Make Them Understand Your Case?

People may have done a lot of things in the past, but the fact is that the past is what it is. And so going forward at this stage, when you’re applying for medical school, it’s a matter of going in and accounting for what happened.

Say what happened and how you processed it out. Give them a context in which it occurred and what you did to address that. Give them a picture of what your future will look like. And talk about how the future has been different than before.

“It's entirely about taking account of what happened and explaining it or reporting it… this event doesn’t define who you are.”Click To Tweet

[14:02] Minors Whose Records Have Been Expunged or Sealed

You can say no to the question of whether you’ve run into any legal issue. But the real issue here is the question. What is the question?

If the question being asked is, do you have any convictions as an adult? Then answer that question. If the question is, as a juvenile, have you ever been found irresponsible? Or have you been found to have committed a juvenile offense and been referred to whatever agency? If yes, then you have to acknowledge that you did that.

While it is assumed that files are always closed, the reality is that’s not necessarily the case. Even if you clean your own server or somebody else’s server, somewhere out there, there’s a server that has something and these things have a way of coming up. 

“The key is the question. You have to read the question very carefully and respond to the question.”Click To Tweet

One shouldn’t be dishonest but neither should one be accountable to the nth degree for what’s happened. So just respond to the question. If they have further questions, they’ll ask them there. But both extremes are a bad thing to do.

[18:25] Answering Very Challenging Questions

The most challenging ones that Larry has encountered are students who want to say that their record was expunged or sealed, or it happened as a juvenile and they don’t have to respond. And when he tells them what to do based upon the question asked, they get very frustrated and want to find some other way to do it.

“The issue is how do you come up with a way of showing that you're no longer that person.”Click To Tweet

Larry works with them to try to build a response that is self-explanatory of what took place and encouraging in the belief that someone has now moved on.

Another problem these students come across is they don’t really know who to listen to. Trying to get those people to focus on what they need to address notwithstanding advice they may receive from others can be challenging. In the end, all Larry can do is tell them what he thinks would be the best way to handle it.

[20:57] Why Do Lawyers Say Different Things?

Larry explains why students could be getting different pieces of advice from lawyers.

First, it’s a structural one. There are different states across the country. This issue on health is typically viewed as a state-level issue, not a national issue. But you see a lot of variances across the states and how the states put together the laws and regulations that they relate to all this. So if you talk to a lawyer in one state with one of the experiences that may be different than what’s going on in the place or within what’s called jurisdiction, that’s one level.

The second reason is that different lawyers have different experiences. A lot of people who assume that because they negotiate contracts or help people in criminal courts, or help people advocate for themselves and injuries or things like that, that they understand how these administrative processes work.

“Being a lawyer is not a unidimensional thing. Being a lawyer is something that involves not just training but experience.”Click To Tweet

The reality is that while they undoubtedly have a useful thing to say, they don’t have experience with these kinds of administrative proceedings, which tend to touch on the law but are often not driven by the law. So they are advocates, but maybe not advocates in these kinds of settings.

It’s a matter of identifying who the audience is and figuring out how to deal with it. And there’s both a category of audiences which are administrative people or regulatory types who look for and listen for and want to hear certain kinds of things. And so you need to be kind of sensitive to that.

Larry has worked on many hundreds of licensing cases involving a variety of different kinds of regulatory agencies. He has worked with people who have credentials or seeking credentials and talk about what’s involved in trying to successfully work their way through those proceedings.

[26:36] How Students Can Prepare for Their Response

The first thing to do is to look at the questions that are being asked. The question is likely to be “Have you been arrested for a felony?” “Have you been convicted of a felony?”

“It's important to see what the questions are and then determine based on your own experience, whether you fall into one of those categories.”Click To Tweet

Getting some guidance may be helpful. Larry has had situations where students have called him and said they were convicted of a certain kind of offense. They sent him the plea agreement form that they signed to see what they were convicted of. Larry looked at the state code involved and it’s different than what they think happened. So here they are 10 or 11 years later when they’re applying to medical school. They think for all these years they’ve pled to one thing, but it turns out they pled to something else. They may have thought they have pled to a felony, and it may turn out to be that they pled to a misdemeanor.

It’s very important in the first instance to see what the question is, and then relate it back accurately to the event so they can see what really went on. The response gets built around that and not simply from one’s good or not-so-good memory of what took place.

[28:47] Can a Student Run Their Own Criminal Record Report?

There is a whole industry of people out there who will run your “history.” Some of it can be found online, some of it can go through an agency and find out what’s in your background. Students can certainly try that.

The only thing Larry would caution is if you’re going to get on to an internet site and do it that way. It’s important to make sure the internet site is really as thorough and comprehensive as it claimed that it is.

Larry suggests to better call an investigative agency and interview them to find out what they’re going to do and then have the search done.

'The last thing you want is to pay a bunch of money to have someone do a search and have them miss something that someone else may find later.'Click To Tweet

Again, there are ways of doing it online or ways of doing it with individuals. Larry may not probably be able to help you with that directly, but they’re going to send you to somebody or identify somebody who can do that for you.

[30:04] What’s the Next Thing Students Should Be Thinking About

It’s really important to appreciate what a lasting impression your writing will be. What you write about is something that will stay with you for a long time and has a significant impact on your ability to get into medical school potentially. What you said when you applied is something that’s going to be there later.

“The written record you create is very important. And so it would be a good idea to go out and get someone to help you with drafting the document.”Click To Tweet

The two most common things Larry sees when people send him drafts of what they plan to submit is either they haven’t said enough, or they’ve said way too much and raised new issues that weren’t there in the first place. So it’s important to get help with the drafting documents.

Doctors are not trained to be advocates for themselves. They’re trained to become scientists, for lack of a better term. And as scientists, they can do loads of things that a lawyer could never do. But one thing that a lawyer or other people trained as a lawyer can do is advocate and understand how the written word creates an impression. 

Someone who’s trained as an advocate is probably your best bet if you can afford to engage someone to do that.

[32:41] How Technical Should You Get

From the legal side of things, a lot of students get scared to hire a lawyer because they don’t think their response has to be very “lawyerish” or that lawyer-writing is very scary and technical.

Larry thinks that the more complex the situation, the more it needs a lawyer or some other kind of advocate to help. The more simple the situation, the more the individual can deal with them. Or you could get someone to participate who’s not immediately involved to deal with the problem of emotion and how that can play a role. Larry suggests offering a little bit of a narrative, some guidance on how to deal with the situation.

Second, if there’s a process involved, this is going to be submitted for review. And then it’s going to go to the next level or it’s going to go here or there. Make sure you know what the process is. It could just be as simple as submitting it with this application. Or you may be finding yourself walking into a process such that if there are felonies involved, they are going to have to do further things.

“Make sure what it is that you're responding to and what stage you're at and what kind of information they want at that stage.”Click To Tweet

Next, identify the audience who’s going to be reviewing. Is it going to be a single administrator or is it going to be a board? Or is it going to be a high-level individual within the process?

Then try to read up a little bit on who those people are to get a little idea of what they think is important. Look at things they may have written or whatever, so you know who it is you’re writing to, and what they’re expecting to see.

[35:10] Documentation and References You Need to Put Together

The next step of the process is to get all the documentation you might need. If you’re talking about a misdemeanor or felony, and there’s a plea agreement, try and get copies of whatever it is out there that is involved. That may mean going to the court and getting something out of the court file, an arrest record, it may mean going to the police department to see if you get access or a copy of that record, but get a copy of what it is you’re dealing with. That way, you actually know what it is, and you’re not guessing about it.

If there was a plea that was signed, get a copy of that so you know what it is you signed off, if you engaged in a training program, and completed it and got a certificate. If you participated in some activity that involved a probation officer who wrote a report, get that pulled together and all the documents that apply. 

And then if going forward, you did some things to try and put yourself on a better path, put all those together. If it was an alcohol issue involved and you went into a treatment center, you might get something like a discharge summary that shows they successfully treated the rehabilitation. Put all of those together if they’re applicable.

“The more severe it is, the more beneficial it may be to have people who can vouch for you.”Click To Tweet

Get a family member, Get a friend or people who are in the ministerial worlds like ministers or rabbis or priests or whatever who can vouch for who you are. They can be people in an education program who know you or who were part of a treatment program, a guidance counselor, or a social worker or someone like that.

In fact, probably not very often will references be appropriate. But in the right situation where there’s been a series of events, and you’re trying to say that you’ve moved on or in a different path that can be helpful.

With regard to the document itself, the length and details depend upon what’s being asked. It may call for fairly short and simple, a few sentences, and may call for some paragraphs. But make the content and layout responsive to the issue that’s been raised and focus again on what’s being asked. Don’t get off to things that are aren’t being asked.

Finally, review what you’re going to submit. If it looks sloppy if they’re a misspelling, or it has bad grammar, you’re sending the message that you’re someone who’s not a very careful and precise person. And if you’ve had these things in your background, that feeds the idea that you’re a risk. If on the other hand, it’s clean, straightforward, and it’s well written and articulate, you send the impression that you’re someone who’s thoughtful and in control of your life.

If medical schools are asking different questions, they’re providing different parameters for the analysis of what falls within and what falls without. You’re dealing with very different circumstances and the need to respond in very different ways. So it really depends on the school you’re applying to.

[41:35] Don’t Act Defensive

Another takeaway from all this is when you respond to things like whether there was an institutional action from the school, the more defensive you sound, the more guilty, you’re presumed.

'When someone comes in very defensive, the assumption is you're being defensive for a reason.'Click To Tweet

The better course is to be forthcoming about what occurred. Be honest in describing what took place. Be respectful of the process that you were in and respectful of the situation you’re in now. Be humble. Your goal here is to get someone to look past something that’s obviously a matter of concern and they wouldn’t have asked about it.

You want them to think of you as someone who had an experience, learned from it, and moved on. That’s what they’re looking for more than anything else. And if they can be satisfied with that, you got a shot.

If they think that you have not learned from the experience and they think you’ve not moved past it, they think you’re at risk of doing it again in the future. They think you’re arrogant. And as a result, don’t think that the rules apply to you. They’re going to look at you in a way that’s not going to be productive of the outcome that you’re looking for, which is to be admitted or get the credential or whatever it may be.

Links:

If you want to connect with Larry Cohen, email him at [email protected].

Mappd.com

Meded Media

The Premed Years Podcast Session 197: Can You Become a Doctor if You’ve Been Arrested?

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