Buying life insurance is important to protect loved ones. But consumers purchasing a policy may need to undergo a life insurance medical exam. Here's what's involved in a life insurance exam, as well as some insight into why this is a common requirement.

What is a life insurance medical exam?

A life insurance medical test is a physical that is typically requested by a life insurance company. It's part of the process of buying life insurance in most situations. The purpose is to provide insurance companies with the information they need to set premiums. Life insurers usually pay for it, and there is both a verbal questionnaire and a physical exam.

Medical questionnaire

How do life insurance companies check an applicant's medical background? Generally, by asking questions as part of the life insurance application process. During the life insurance exam, consumers will be asked about their past health status. They'll be asked questions about their lifestyle and social habits, as well as their general health.

Physical exam

A life insurance physical is part of a life insurance application process. During the life insurance physical exam, the medical professional performing the process will check weight, collect a blood and urine sample, and check blood pressure.

Why do life insurance companies require an exam?

Life insurers require an test because insurance companies want to assess the likelihood of paying out claims. To do this, the insurance company wants to know as much as possible about an applicant's physical health.

The insurer wants to see if the potential policyholder has medical conditions that could make their death during the term of coverage more likely. The insurance company also wants to make sure an applicant isn't hiding any possible health issues.

Is an test required for life insurance?

A life insurance medical test is required by most life insurance providers -- but not all. A small number of life insurers offer term life insurance with a reasonable amount of coverage without requiring a medical exam. They've harnessed new technologies and algorithms to determine who to cover.

There are also some guaranteed issue life insurance policies that provide coverage without mandating a life insurance medical exam. However, coverage limits are often low with these policies. There may also be restrictions such as a lengthy waiting period before the full death benefit is paid.

What do life insurance companies test for in the medical exam?

When a potential policyholder undergoes a life insurance health exam, the purpose is to identify red flags that could make insuring a policyholder too risky. While there may be slight variations in what different insurers test for when a consumer undergoes a life insurance exam, here are some common things insurers look for.

High blood pressure

High blood pressure is a common life insurance test, as high blood pressure can increase the risk of heart attack, stroke, or other cardiac issues.

Blood sugar

As part of a life insurance blood test, insurers may look for elevated blood sugar that could be indicative of diabetes. Diabetes also comes with health risks that could result in a higher risk of an insurer paying out a death benefit.

Nicotine use

Smoking increases the risk of many medical problems, including various types of cancer. As a result, a life insurance medical test will involve an assessment of current and past nicotine use. Many carriers offer life insurance for smokers, though premiums are significantly higher.

High cholesterol

There's a higher risk of a stroke or heart disease when a person has high cholesterol. A life insurance test will test cholesterol levels.

Recreational drugs

The use of recreational drugs is a major risk factor that life insurers consider. An test will look for evidence of recreational drug use. However, some insurers are willing to accept marijuana users, especially as more states have relaxed the laws on cannabis.

Serious diseases

Finally, life insurers use blood tests to look for serious diseases. This can include conditions such as HIV or AIDS, as well as hepatitis. While some insurers provide coverage for people with HIV, others don't -- and a serious illness could make it impossible or expensive to get life insurance.

How to prepare for the medical exam

It's important to follow the life insurance company's instructions when preparing for a life insurance medical exam. These may include fasting prior to the test to avoid skewing blood sugar and cholesterol levels.

Drinking water prior to the test can help flush toxins from the body and dilate veins, making it easier for the technician to draw blood for the blood test. It's also a good idea to avoid strenuous exercise immediately before the test to avoid elevated blood pressure.

Also, consumers should review their medical history to ensure they can provide accurate, honest answers when asked about their health status. Failing to provide accurate information could result in an insurance company denying an application, canceling the policy, or refusing to pay death benefits.

What happens during the life insurance physical?

During the life insurance physical, a medical professional is typically dispatched to the applicant's home or office. The process will take around 45 minutes or less and will include a nurse or medical technician asking questions, as well as a physical examination. The life insurance test usually includes:

• A height and weight check
• A blood pressure check
• The collection of blood and urine samples

Other ways life insurance companies get information about you

In addition to a life insurance medical exam, insurers may also employ other techniques to find out information about a potential policyholder's health status. This could include checking your records with the MIB (formerly the Medical Information Bureau), which includes information from past life insurance and health insurance applications. Other potential sources of information include your prescription drug history, driving records, and a criminal background check.

Do life insurance companies call your doctor?

Life insurers generally do not directly ask questions of a person's doctor. Instead, the insurer will ask an applicant for medical information and will arrange for a life insurance medical test to be conducted by a medical professional of its choosing.

In many cases though, with the permission of the policyholder, an insurer may request medical records from an applicant's doctor's office. It may request an attending physician statement (APS), which is a statement from your provider that gives context about any pre-existing conditions or your general health. However, doctors cannot just disclose patient information to a life insurer without the patient's permission, as doing so would violate federal laws protecting privacy.

Do life insurance companies check medical records?

Life insurance companies may request medical records during the underwriting process. They do this to determine if a policyholder was honest in their answers to medical questions and to look for red flags that could suggest an increased risk of providing coverage. They must obtain permission from the applicant first.

Do life insurers check your credit?

Life insurers may run a credit check. This is more common with life insurance companies that use algorithms and publicly available information to approve people for policies without a life insurance medical exam.

What happens after the exam?

In most cases, insurers will already be aware of any medical issues based on the information provided by the applicant. However, sometimes abnormalities will be uncovered and an insurer may request additional medical assessments. For example, if a life insurance test shows high blood pressure, the insurer may request a follow-up test to see if it has remained elevated.

Applicants can request a copy of their results after the exam. The information will be sent to the insurer's underwriting department, which will review the results of the life insurance medical exam. Based on this information, the insurer will set premiums. Applicants will then be notified of whether they are approved for coverage and what their premiums will be.

What if I'm not happy with the results?

If an applicant isn't happy with the results of a life insurance exam, there are a few options:

• Buy coverage anyway, even if the premiums are higher, and request reconsideration after some time passes. This has the benefit of allowing the applicant to get immediate protection.
• Shop for life insurance from another company. This may result in the same issues arising. But some insurers are more forgiving than others of various medical conditions.
• Request a follow-up exam. Often, an applicant will have to pay for this if the insurer is satisfied that the results of the initial testing were accurate.
• Work with a life insurance agent. Insurance professionals often know which carriers are likely to offer coverage to those with pre-existing conditions.

What if I'm denied coverage?

If an applicant is denied coverage after a medical exam, they can:

• Attempt to correct the issues resulting in the denial, such as by quitting smoking or getting high blood pressure under control with medication.
• Shop with other insurers that may have less stringent qualifying requirements for similar coverage.
• Obtain a guaranteed issue life insurance policy that doesn't require a medical exam.

How to get a life insurance medical exam

To get a life insurance medical exam, apply for insurance coverage. The insurer will arrange for the test to occur at its own cost. The medical test will take place at the applicant's home or workplace.

Options for life insurance without a medical exam

There are several options for no medical test life insurance, some of which are better than others. Note that even if you have an underlying health condition, undergoing a medical test could still help you obtain more coverage at a lower cost.

Simplified issue life insurance

With simplified issue life insurance, you can typically avoid a medical exam. Instead, life insurance companies base decisions on third-party records and your answers to a health questionnaire. Sometimes this is a good option for people who need coverage to begin right away and can’t wait for a life insurance medical test and full underwriting.

Guaranteed issue life insurance

Guaranteed issue life insurance is life insurance that is available to everyone regardless of medical status. Many insurers offer these policies, although they often have relatively low coverage limits. Many guaranteed issue policies have waiting periods, such as a two-year delay until the full death benefit pays out.

Group life insurance

Group life insurance may be available as a workplace benefit. It's often possible to obtain a set amount of coverage through an employer's group life insurance plan without a life insurance medical exam.

Final expense insurance

Final expense insurance is a small life insurance policy designed to cover funeral costs. Most final expense insurance policies are guaranteed issue policies. That means no life insurance medical test is required. However, these policies provide limited protection. They only help families cover a small amount of costs after a death.

RELATED: See The Ascent's guide to the best life insurance with no exam.

During a well woman exam, your doctor will review all of your current medical issues and determine if there is anything missing from care, says Dr. Marchand. It is important to note that medicine is constantly changing, so treatment that is recommended can vary a lot in just one year, he adds. The doctor should examine you from head to toe, check your vital signs, and assess if you are due for any vaccines. The visit generally includes the following:

Health History and Physical Examination

Upon arrival, you will undergo a routine physical test that includes taking your weight, pulse and blood pressure. A urine sample may be requested to test for sexually transmitted diseases (STDs) and rule out urinary tract infections, says Dr. Alagia. “You will be asked to change into a gown after being left alone in the examination room. Once your health care professional enters the room, they should take a few moments to review the test they are planning to perform and explain the reason for the specific exam,” he says.

You’ll have time before, after and during the test to ask and answer any questions you and your health care provider might have. It’s useful to prepare a list of questions in advance.

The questions that your doctor asks will be tailored to your age and medical history, says Dr. Swarup. For example, they may ask if you smoke, use drugs or alcohol, have any allergies or infections and whether you’ve had any surgeries, he says––all of these factors can affect your reproductive health.

Your doctor may ask the following questions, according to Dr. Swarup:

• How long ago was your last period?
• How often do your periods occur and how long do they last?
• Is there spotting between your periods?
• Is there any vaginal itching, pain or discharge?
• Are you experiencing any medical concerns?
• Do any members of your family have medical issues?
• How often are you sexually active, and do you have a new partner?
• What type of sex do you have? Is it painful? Do you ever bleed after?
• Do you use birth control?
• Are you concerned you might be pregnant?
• Are you trying to get pregnant?
• What do you use to prevent sexually transmitted diseases (STDs)?

It’s important to be completely honest in your answers because the questions are to benefit your health, says Dr. Marchand. “Remember that a doctor can never share any personal information about your visit (doing so could easily lead to medical board discipline or loss of licensure),” he says. Doctors can share your information with other members of their health team if it is necessary to provide your care or coordinate your care. Doctors can also share your information with your permission. Doctors can also share your information with law enforcement to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public. Dr. Alagia adds that having an honest dialogue with your health care professional helps them recommend guideline-based care such as STD screening, cancer screenings and other services.

You should also expect questions about your diet, life stressors and exercise habits, says Dr. Marchand. “Since screening for depression and anxiety is very important for all patients, you should be ready for questions about how you’re feeling,” he says.

Breast Exam

Starting at the age of 20, a breast test may be conducted every one to three years to identify any irregularities or lumps, says Dr. Swarup, but recommendations vary. For example, the ACOG advises that clinical breast examinations may be offered every one to three years in women ages 25 to 39, and once a year in women over the age of 40.

The American Cancer Society does not recommend clinical breast exams nor self breast exams at all due to lack of evidence that it contributes very little to early breast cancer detection when mammography is available. Currently, mammograms (x-ray images of the breast) are recommended annually in women over the age of 45 and once every two years in women over the age of 55.

The ACOG that women between the ages of 25 and 39 be offered a clinical breast test every one to three years, and that women over the age of 40 be offered them annually. In either case, the ACOG recommends women make the decision that’s best for them.

If your practitioner conducts a clinical breast exam, you will be asked to lift one arm behind your head, explains Dr. Alagia. This allows your doctor to better examine each breast, applying gentle pressure in circular movements. “They will look for abnormal lumps or cysts. If any lumps are discovered, a biopsy will be ordered to determine if they are cancerous or not,” says Dr. Alagia.

Pelvic Exam

A pelvic, or internal exam, is performed to check the vulva, vagina, cervix, fallopian tubes, ovaries and rectum for abnormalities. Adolescents don’t need a pelvic test unless they are experiencing abnormal bleeding, discharge, or pelvic pain. It’s unlikely that you’ll have a pelvic test before the age of 21 unless such symptoms are present. Although the test may be uncomfortable, it should not be painful. Keeping your body relaxed will help minimize discomfort.

During a pelvic exam, your doctor will also examine your vulva and rectum for irritation, redness or other signs of anything concerning, says Dr. Swarup. A lubricated speculum is placed into the vagina to look inside it, allowing the cervix to be evaluated for signs of disease. After removing the speculum, your doctor will gently insert one or two fingers (using a lubricated glove) into your vaginal canal while placing gentle pressure on the lower abdomen, explains Dr. Alagia. This allows them to check for abnormalities in the size, shape, and position of the uterus and ovaries.

You can expect to feel pressure, says Dr. Alagia, adding that it’s important to communicate any feelings of pain, heaviness, bloating or tenderness––this helps your doctor understand potential causes for concern.

Cervical Cancer Screening

Depending on your age, you may undergo cervical cancer screening via a Pap smear and/or human papillomavirus (HPV) test during your pelvic exam. A Pap smear looks for cellular changes in the cervix that may turn into cervical cancer, and an HPV test checks for the presence of the human papillomavirus, the virus responsible for causing these changes.

Current U.S. Preventive Services Task Force guidelines advise that women between the ages of 21 and 29 be screened every three years with a Pap smear alone; women ages 30 to 65 may be screened every three years with a Pap test only, every five years with HPV testing only or every five years with both.

For both HPV and Pap tests, your health care practitioner will insert a lubricated speculum into your vaginal canal to view your vagina and cervix, explains Dr. Alagia. “They will swipe your cervix with a swab and send it to a lab to ensure there are no signs of cervical cancer and ensure your cervix is healthy,” he says.

Sexually Transmitted Disease (STD) Screening

Even if you think you are not at risk, you should discuss STD screening with your doctor, says Dr. Alagia. Currently, the Centers for Disease Control and Prevention (CDC) recommends the following testing schedule for STDS:

• All adults and adolescents ages 13 to 64 should be tested at least once for HIV.
• All sexually active women younger than 25 should be tested for gonorrhea and chlamydia yearly, and women over 25 with new or multiple sex partners or a sex partner with an STD should be tested yearly.
• Pregnant women should be tested for syphilis, HIV, hepatitis B and hepatitis C early in their pregnancy, and those who are at risk (new or multiple sex partners) should also be tested for chlamydia and gonorrhea.

More than three decades ago, John E. Sarno, MD, published Healing Back Pain, a popular book that garnered something of a cult following. Looking at his own practice, Sarno, a rehabilitation medicine specialist in New York City, saw that most of his patients with chronic pain did not have evidence of acute injury or degenerative disk disease. Their persistent pain appeared to be independent of any structural damage to the spine. Sarno attributed the pain to what he called tension myoneural syndrome (TMS), or the body’s reaction to suppressed stress and emotional turmoil. Resolving that psychological conflict, Sarno believed, would lead to an improvement in pain.

Dr Ira Rashbaum

Sarno’s theory has met skepticism from the mainstream community, but glowing testimonies from patients who say they benefitted from his strategies fill the internet. Sarno wrote several books on his ideas before his death in 2017. But he published only one peer-reviewed study, a 2003 review in the Archives of Physical Medicine and Rehabilitation co-authored by Ira Rashbaum, MD.

Medscape Medical News spoke recently with Rashbaum, a physiatrist and chief of tension myoneural syndrome at NYU Langone Health, New York City, about TMS and how he manages patients with chronic pain.

This interview has been edited for length and clarity.

Medscape:  What is your theory of back pain?

Rashbaum: My null hypothesis is that back pain is not due to psychological issues, so as to not be a biased doctor, I try to accept the null hypothesis or reject the null hypothesis. In most cases chronic back pain is not due to structural etiology. My sense is it's a mind-body issue — the avoidance of feeling strong emotions like anger, rage, sadness, fear, shame, and guilt. Patients can embrace psycho-educational programs and if they don’t get better, we work with a psychotherapist or a or licensed mental health counselor to help work through the patient’s feelings. That's my experience over a number of years.

Medscape:  How do you determine if a patient has back pain from a mind-body issue or another cause?

Rashbaum: I do a very careful medical history, including a physical examination and review of any diagnostic studies they’ve undergone. In most situations, there’s not really a medical cause of the back pain. For instance, a lot of asymptomatic individuals have all sorts of horrible findings on medical imaging like CTs and MRIs, and the reverse is also true — many people with negative findings on imaging tests experience significant pain. My job as a diagnostician is to see how much of this is really a mind-body problem or something that stems from structural pathology.

Medscape:  How well do your patients react to being told that their back pain is, in a way, "in their head"?

Rashbaum: I have a skewed population. I'm sort of like a guru in mind-body back pain, so the people who come to me are already thinking along those lines. I ask, "What's going on in your life?" Maybe there are job issues, marital issues, health issues, and I'd say that it's certainly possible that stress can be causing this back pain.

Sometimes when I see a patient referred from another physician, I'm a bit hesitant to ask about what's going on in their life. Even earlier today, I'd seen a patient with back pain and I had a sense that they were not really going to be open to a mind-body approach. So I said, do physical therapy.

Medscape:  What do you recommend primary care clinicians do with patients with back pain?

Rashbaum: You have to do a proper neurological examination and musculoskeletal examination. It’s a tough situation because doctors in primary care have limited time to take care of patients. It's difficult to have a deeper dive just to kind of see what's going on in their life. But you can recommend useful agents like acetaminophen and muscle relaxants, which are sometimes okay.

Medscape:  What sorts of things do you tell patients to say to themselves when they're experiencing pain? 

Rashbaum: If the pain is severe, I recommend they take medication — over-the-counter analgesics or a muscle relaxant, if they have them — and take a warm shower or bath. I prefer acetaminophen up to three times per day, if that’s OK with the patient’s primary care physician, over nonsteroidal anti-inflammatory drugs because most pain is non-inflammatory in nature. Once the pain is more manageable, patients should journal about what’s going on in their lives and/or meditate, and try to feel any strong emotions, such as anger, sadness, or fear.

Medscape:  What do you say to clinicians who are dismissive of the notion that chronic pain may stem from emotional repression, and that addressing the latter can resolve the former — particularly those who point to a lack of peer-reviewed data for such a link?

Rashbaum: I would tell them they could be looking harder for that evidence. For example, in a patient page from JAMA from April 24, 2013, on low back pain, often the cause of back pain is unknown. There are data in spine surgical journals that patients with psychological issues do worse with spine surgery. And in 2016 JAMA published a study from Cherkin et al which found that among adults with chronic low back pain, treatment with mindfulness-based stress reduction or cognitive behavioral therapy resulted in greater improvement in back pain and functional limitations at 26 weeks compared with usual care.

My feeling is that these psychosocial interventions are easy to try, relatively inexpensive, noninvasive, and, in my experience, often can lead to marked improvements. I believe that, for the vast majority of people with chronic pain, it makes much more sense to start by addressing mind-body issues than turning to that approach as a last resort.

Rashbaum reports no relevant financial relationships.

For more news, follow Medscape on  Facebook,   Twitter,   Instagram, and  YouTube.

While OpenAI capabilities have made its way into every domain possible, there’s one field where LLMs, if utilised correctly, can have the highest impact by directly affecting lives — the medical field. Earlier this year, ChatGPT had even cleared all three parts of the United States Medical Licensing Examination (USMLE) and we even saw how ChatGPT helped save a dog’s life through accurate medical diagnosis. However, we have not seen much practical applications in the medical field. Does GPT-4 capabilities make it a suitable player in the medical field?   

Massive Potential

A paper released by OpenAI and Microsoft on the Capabilities of GPT-4 on Medical Challenge Problems was released in March, this year. In this research, GPT-4 have shown impressive language understanding and generation abilities in medicine. The study evaluates GPT-4’s performance on medical competency exams and benchmark datasets, even though the model wasn’t specialised for medicine. 

The researchers assess GPT-4’s performance on official USMLE practice materials and MultiMedQA datasets. GPT-4 surpasses the USMLE passing score by over 20 points, outperforming previous models (including GPT-3.5) and even models fine-tuned for medical knowledge. Additionally, GPT-4 demonstrates improved probability calibration, implying that it’s better at predicting correct answers. The study also explores how GPT-4 can explain medical reasoning, customise explanations, and create hypothetical scenarios, showcasing its potential for medical education and practice. The findings highlight GPT-4’s capabilities while acknowledging challenges related to accuracy and safety in real-world applications. 

In comparison to its older models, GPT-4 has gotten much better when tested on official medical exams such as USMLE. GPT-4 improved by more than 30 percentage points when compared to GPT-3.5. While GPT-3.5 was getting close to this passing score (60% of multiple-choice questions to be correct), GPT-4 passed the score by a huge number. 

Alignment and Safety In Place 

When an earlier version of GPT-4, referred to as the base model, was compared with GPT-4, the former had slightly better performance by about 3-5% on some of the tests. This suggests that when the model was made safer and better at following instructions, it might have lost a bit of its raw performance. The researchers suggested that future work could focus on finding ways to balance accuracy and safety more effectively by refining the training process or by using specialised medical data. 

Where does Med-PaLM fit in? 

The above research did not compare GPT-4 with models such as Med-PaLM and Flan-PaLM 540B, as the models were not available for everyone to try at the time of study. 

Google recently launched their multimodal healthcare LLM with Med-PaLMM – a large multimodal generative model that encodes and interprets biomedical data. Its capabilities are far more advanced than GPT-4 considering how it can handle various types of medical data such as clinical language, medical images, genomics and even performs a wide range of tasks. The model can generalise to new medical tasks and perform multimodal reasoning without specific training. It is able to precisely recognize and explain medical conditions in images using just instructions and prompts given in language. 

Never Fool-Proof

However, GPT-4 applications are not as diverse as the ones Med-PaLM offers. Though GPT-4 was announced with multimodal features, it is not yet available for users. Furthermore, there have been negative observations on GPT-4’s capabilities in medical diagnosis. Problematic and biased results were part of the outcome, and concerns on how GPT-4’s inclination to embed societal biases may hamper its suitability for aiding clinical decisions. 

The prevalent problem of hallucinations still persists with GPT-4 spewing incorrect information. The model has been generating incorrect answers for medical citations. GPT-4 produced over 20% errors for medical citations.  

While GPT-4 might not be completely reliable as a medical assist for diagnosis with the current performance , there are other functions that the model can assist in. Hospitals are looking at AI to help relieve doctor burnout. With applications that can write notes for electronic health records and drafting empathetic notes to patients, AI can help smoothen the process. Transcribing doctor and patient comments, then creating physician’s summary format for electronic health records is one of the best use cases in the medical field. With the current limitations, GPT-4 still has a long way to go before it can be entirely adopted in the medical field. 

Ukrainian military leadership has approached President Volodymyr Zelenskyy with a request to expand the ongoing general mobilization, Zelenskyy said on Aug. 23.

During a press conference at the Crimean Platform Summit, a journalist asked Zelenskyy whether there would be an acceleration of mobilization considering the ongoing counter-offensive, and whether “everyone will serve,” as some military observers tend to say.

Read also: Pulling forces from eastern Ukraine would put Slovyansk, Kramatorsk at risk — Zelenskyy

The president did not offer a direct answer, but suggested that the Ukrainian military does indeed have a need for greater manpower.

“To be honest, the military approached me with this, to allow to mobilize more [people]...; that's all I can tell you for now,” said Zelenskyy.

Read also: Ukrainian military advancing in several areas, despite dense minefields, says Zelenskyy

Additionally, the head of state mentioned that currently, issues with the medical military examinations and recruitment centers are actively being resolved.

“The issue of recruitment centers is a very important issue, [along with] medical commissions at the centers,” he added.

Read also: Ukrainian parliament set to extend martial law, mobilization for another three months

“It is necessary as soon as possible to accelerate processes, establish order, and then begin discussions about the need to increase [ranks of the military] — how and with whom.”

On Aug. 17, martial law and general mobilization in Ukraine were extended by another 90 days.

During general mobilization, all military-eligible men aged 18 to 60 can be called up for military service, unless they have legal grounds for deferment or exemption.

We’re bringing the voice of Ukraine to the world. Support us with a one-time donation, or become a Patron!

Read the original article on The New Voice of Ukraine

This story below and the report in the video player above discuss instances of sexual violence and may be upsetting for some readers or viewers.

COLUMBUS, Ohio (WCMH) – A woman is suing a Columbus medical practice, accusing an employee of sexual misconduct.

Unyime Williams originally came to the United States from Nigeria on a student visa, before taking a job at Walmart. Williams said things were going well; she received multiple promotions and eventually became a manager.

Williams applied for her green card. U.S. Citizenship and Immigration Services (USCIS) requires all green card applicants to undergo a medical examination. The examination must be performed by a doctor designated by USCIS as what’s called a civil surgeon.

The government website lists civil surgeons by location, which is how Williams found Trust Medical Services on South Hamilton Road in 2021.

The evaluation includes a mental health screening, screenings for various communicable diseases, and vaccinations. Unsure of what to expect at the doctor’s office, Williams chose to trust the professionals.

“It was just like a series of, you know, meeting different people in different rooms,” Williams said. “And I went in [a room], and I saw a guy with a coat or white coat and actually thought it was a doctor.”

Williams said the conversation with the man in the white coat began normally, until he said, “take off your shirt for me.”

Williams obliged and unbuttoned her shirt.

“At first I did not know what he was talking about, because I did not expect him to admire my breasts, you know?” Williams said. “He said, ‘This is nice. I like this. This is beautiful.’ And I got a little bit uncomfortable. But then, like I said, to me, this is a doctor. So I did not want to accuse anyone of what they were not really doing.”

The man in the white coat is named in the lawsuit and accused of battery, as well as infliction of emotional distress. He is not charged with a crime.

Williams said the man pulled one side of her bra down and touched her breast.

He then collected a blood sample from her arm, which Willliams said was exposed before she unbuttoned her shirt.

“I started kind of like trying to close my shirt a little bit,” Williams said. “And then he said, ‘No, no, no. Leave that open for me.'”

Williams said the phlebotomist asked for her phone number and offered to help her “pass” her medical exam. She wrote down her number, and he left.

“It was at the end of this that I realized what happened,” Williams said. “As I was walking out, I was so scared. I sat in the car, I couldn’t drive for maybe at least 10 minutes.”

This happened in 2021, and Williams said she has not heard from the man since. Her attorney does not know if he is still employed at Trust Medical, which did not respond to emails from NBC4. Two phone calls to the medical practice were placed on hold for extended periods of time.

Williams returned to Trust Medical days later for another round of vaccinations. She decided to report the incident and record her conversation with a receptionist on her cell phone.

“He reached into my bra– this side of my bra — and lifted it with his hands like that, and looked inside to see my nipples,” Williams can be heard telling the female receptionist.

“I’ll let you stop right there,” the receptionist replies. “‘Cause you are not the first person.”

“I’m not the first person?” Williams asked.

“No,” the receptionist said.

The receptionist appears to sympathize with Williams, telling her she was aware of at least two other complaints against the same phlebotomist.

“The only thing I will tell you, it’s going to be hard to win since you really don’t have a video or something,” the receptionist tells Williams after calling a manager to report the incident. “But I want to remove him from here. That’s my own– my goal, because I don’t want him to do it to another person ever again.”

The receptionist, who is not named in the lawsuit, explained to Williams that she did not want to directly involve herself with the issue because she and the phlebotomist immigrated from the same country, and she was worried he would spread rumors about her. (The receptionist does not name the country in the recording.)

“Just imagine the women that have suffered because of this,” Williams said. “It made me so scared.”

David DeVillers, the attorney representing the phlebotomist, said he could not comment on the lawsuit, but said his client no longer works at Trust Medical.

Williams said her life has not been the same over the past two years.

“For very long time I stopped working. Because I was so scared to be around men,” Williams said. “I’m constantly having panic attacks. I’m constantly just looking over my shoulder.”

Williams said her parents nearly convinced her to move back to Nigeria.

“But then I thought about it. Just running away from it is not going to solve it,” Williams said. “Maybe I’m the only voice, because maybe the reason why the other women refuse to… speak up is because they just could not. Because as Africans — especially African women — we’re not allowed to talk about things like this.”

A lawsuit filed in July by attorney Daisy Ayllon on Williams’s behalf seeks to hold the phlebotomist and his employers, Trust Medical Services and Laboratory Corporation of America Holdings (Labcorp) liable. In addition to the claims against the phlebotomist, the lawsuit accuses Trust Medical and Labcorp of negligence.

“This is a clinic that caters to immigrant community and immigrant women,” Ayllon said. “And immigrant women are particularly vulnerable to being subjected to these types of insults by medical professionals.”

According to the National Sexual Violence Resource Center, immigrants are particularly vulnerable to sexual misconduct because of language and cultural barriers, fears that asking for help will lead to deportation, and a lack of information on sexual assault.

“The reason that this individual was able to be there and be so successful at victimizing women is because the companies that employed him didn’t do anything to educate women and empower women to speak out to make sure that they understood the process,” Ayllon said. “It’s never okay for any employee to ask a woman to disrobe in front of them whenever they’re going there for any type of medical examination.”

The phlebotomist, Trust Medical and Labcorp each filed separate answers in response to Williams’s complaint, denying the allegations.

A spokesperson for Labcorp said the company does not comment on pending litigation.

Williams hopes that by sharing her voice in court, it can be heard by others who might be scared to speak up and empower them to come forward.

Help and resources for victims of sexual assault are available at RAINN.org, or through the National Sexual Assault Hotline at 800-656-4673.

Bar exams moved online during the pandemic, fueling attention to issues under discussion, such as widely varying bar pass rates from state to state, and large costs to graduates of prep courses needed even after three years of law school.

Law school administrators and members of the profession wrung their hands: Are we really turning out so many graduates incompetent to practice law?

Some modest reforms are under way. There’s a next generation bar test on the horizon that diverges a bit from the old style. But a lot of state bars are still just thinking about it, and bar test modifications continue to be (rightfully) criticized.

And in the midst of this debate, along came ChatGPT—never a law student—and passed the bar exam. Academia is in turmoil over the significant potential for AI-assisted papers and exams.

Out of the chaos sown by these developments, might we possibly reap a whole new perspective on how to train lawyers? It is, after all, overdue to reform legal education, which has changed only marginally for many decades.

Of course law students still need to learn legal doctrine, and how to find and understand case law, statutes, and regulations. And clinical legal education, which is now often a graduation requirement, has been a valuable addition to legal education.

But should law school consume three mostly-classroom years and then be followed by a bar test that requires lots of memorization and lightning-fast essay and multiple-choice responses that don’t reveal the kind of in-depth thinking attorneys are called on to do? Especially considering the great expense in time and money for law school and then bar prep?

What should we be teaching and then, if not testing, evaluating? A long and well-researched report from 2020, “Building a Better Bar: The Twelve Building Blocks of Minimum Competence,” suggests a helpful framework to answer that question.

Most critically it focuses much attention on what we in the legal academy have mostly failed to teach: the genuine practice of law. It’s about time we do so.

Consider medical education. It begins with two years immersed in the textual, classroom, and lab study of subjects necessary to the practice of medicine. Then students progress to two years learning the clinical—the actual—practice of medicine, even before years of post-graduate residency training. And some medical schools are even introducing clinical practice into those first two years.

What would “medical model” legal education look like?

Lawyers for America, invented at UC Hastings (now UC Law San Francisco), is a model that provides students with a different route to learning to be a lawyer while simultaneously helping to Improve our country’s massive access to justice problem.

Ponder: Two years of classroom learning and a third year devoted entirely to a well-supervised externship with a legal nonprofit or government legal office. Given the current bar exam, summer is then devoted to study and the test, and then after the bar test the fellows return for a full year of fellowship-paid work.

The participating organizations pay LFA enough to support the fellowship stipends—less than their cost of hiring a new lawyer, enabling the stretching of their always tight budgets. Bonus: They’ve already trained their new fellow for all of their 3L year. Supervisors are very committed to their training because fellows will soon be their colleagues for a year.

Our fellows so far have engaged in great public service through the program and have moved very successfully to careers. Many of the fellows have stayed in public interest or public service careers, some clearly achieving positions that just on the basis of grades and pedigree could have been difficult to obtain. Their excellent experience—and thus meaningful recommendations—has propelled them forward.

Can we do more to make law school-affiliated hands-on experiences not only necessary but sufficient for licensure as a lawyer? Or at least sufficient along with passage of a much-simplified written exam, perhaps focusing on a limited number of subjects chosen by each examinee from a larger selection, and with dramatically reduced emphasis on speed and memorization?

Alas, change comes hard both to legal educators and to bar examiners. We started LFA after a dean told us we should ask for forgiveness rather than permission, or the idea might never have moved forward. Other law schools have considered joining us and hit various barriers.

For their part, bar examiners have put together committees to recommend change, but things move slowly—if at all. A California Blue Ribbon Commission spent about two years and still couldn’t reach consensus on a non-bar-exam route to licensure. A subgroup of that commission has just prepared a lengthy draft urging a “portfolio bar examination” in hopes of obtaining full commission approval.

For a good starting point to consider change, law school administrators should look to the medical school model and take to heart the feedback in the “Building a Better Bar” report about the value of experiential learning in the careers of many law graduates.

We need to train lawyers for the needs of today, under the conditions of today’s world. Yesterday’s ways shouldn’t be forever.

This article does not necessarily reflect the opinion of Bloomberg Industry Group, Inc., the publisher of Bloomberg Law and Bloomberg Tax, or its owners.

Marsha Cohen is a professor at UC Law SF. She taught podium classes and for many years supervised an extensive Judicial Externship Program which fueled her interest in “medical-model” legal education, on which Lawyers for America was built.

Write for Us: Author Guidelines