The American Medical Associations annual House of Delegates meeting opened this weekend in Chicago, and the organizations present and past leaders made strong statements and offered bold visions, but whether many members were listening is an open question.
Saturday turned out to be something like a Presidents Day at the meeting, and sometimes it seemed like you couldnt turn around without seeing a past association president.
There was 2002-03 president Yank Coble Jr. checking in. John Nelson, 2004-05, was to be seen seated near the front of the House of Delegates with the Utah delegation. The president in between, New Orleans surgeon, attorney and patient safety consultant Donald Palmisano (2003-04) could be seen chatting with his son Donald Jr., the attorney for the Medical Association of Georgia.
(Its easy to spot a Georgia delegate. They all wear replicas of the green jacket awarded winners of golfs Masters Tournament held each year in Augusta, Ga. The Florida delegates all wear jackets of a different shade of green. The Nebraska delegates all wear Cornhusker red, reflecting the University of Nebraskas school color.)
I caught the tail end of 2005-06 President J. Edward Hills speech to the AMAs medical student section. The family physician from Tupelo, Miss., warned the students to beware of the parasites dwelling within the healthcare industrial complex, and ended with some quotes from Milton Friedman and Calvin Coolidge. Quoting Friedman, Hill told of how crisisor perceived crisishelps to push change by making what was seen as politically impossible become politically inevitable.
Hill then quoted Coolidge who explained the power of persistence. He received a polite standing ovation and it was announced that Hill had time to answer some questions, but no one asked any. So, after a few moments of awkward silence, Hill stepped down from the podium.
Perhaps not hearing about the students indifference to Hills offer to share his knowledge, three more former presidents offered their time and insights as mentors and they urged their peers to do the same during a panel discussion sponsored by the AMAs senior physician group.
While noting that they were not calling for a return to the good old days and acknowledging that those days were not all that good for certain segments of society, Daniel Stormy Johnson (1996-97), Robert McAfee (1994-95), and Lonnie Bristow (1995-96) said they felt that the heart of their careers came during the golden age of medicine.
It was the golden age, McAfee explained, because physicians were autonomous, there were unprecedented breakthroughs being made in science and technology, and physicians had the opportunity to be powerful advocates for their patients. Since then, third partiesspecifically payers and governmenthave been allowed in the exam room, and the physicians role as patient advocate has been diminished.
As a result, McAfee said public-opinion polls reflect shrinking respect for physicians.
To reverse the trend, McAfee expressed support for a report that was being presented by the AMAs Council on Ethical and Judicial Affairs, which called for an end to doctors accepting payments from healthcare vendors, save for help in training physicians on how to use new diagnostic or therapeutic devices or techniques.
Im sure the issue is not ready for acceptance at this meeting, McAfee acknowledged, but he added that physicians need to quickly return to strict ethical practices in their daily life. It behooves us to go back to our roots.
Bristow agreed, and added that there were some doctors who suggest that the best response to the negative findings from some AMA-sponsored surveys was for the AMA to stop taking surveys.
I want to underline everything Bob just said as strongly as I can, Bristow said.
He added that neighbors berate him constantly about why isnt the AMA speaking (out) about this, that and the other thing. The fact is, the AMA may be taking stands on the very issues his neighbors are suggesting, he said, but the public doesnt know about these and that position papers are produced, filed away and forgotten.
I suggest we have to become more vocal patient advocates, Bristow said.
On a lighter note, Johnson said that, in addition to public perception, physicians should also pay attention to their own public appearance. One of his older colleagues had promoted the WALT principle, which stands for Walk like a doctor, Act like a doctor, Look like a doctor and Talk like a doctor.
I see a lot of residents who look like bums, Johnson said, adding that their appearance does more to build respect than the Mercedes they have in the parking lot.
When the House of Delegates convened later that afternoon, AMA Chief Executive Officer and Executive Vice President Michael Maves also offered some candid analysis. After presenting some rosy financial announcements and touting political and professional victories and struggles, he said the AMA has to get ready for some changes.
Physicians are not buying our value proposition, Maves declared. The AMA is seen as irrelevant to their daily lives. For many physicians, were simply just not worth the price.
To address this, he said there is no big bang, but that the AMA will work toward providing physicians tools they need in daily practice, engage in the right professional advocacy efforts at the right time, andas personal and professional concerns are relieved somewhatfocus on making the word a healthier place: The ideal that compelled most of us to become physicians
This message was echoed by Ronald Davis, a Michigan epidemiologist wrapping up his term as AMA president. As a video from the stage play The Lion King that featured a performance of the song Circle of Life was projected on either side of him, it was noticeable that Davis appearance had been significantly altered.
As the video ended, Davis made some quick jokes about his newly bald head and the hair he lost during chemotherapy treatments he has received for pancreatic cancer. He said his wifes favorite joke on the subject is that men have three basic hairstyles: Parted, unparted and departed.
His talk stayed with themes of circles and wheels and leaving a legacy. Early on, he mentioned the current hamster wheel dance on Medicare pay adjustments that occurs every year, and he noted how the potential of a 21% payment cut in 2010 may be the meltdown scenario that prompts lawmakers to act.
He also called on physicians to promote their patients health by promoting a healthier environment.
Why shouldnt physicians be the loudest advocates for a safe and healthy world for our children to grow up on? Davis asked. We in this room should try to use our clout to get products to be less toxic, to achieve more sustainable agriculture, and to show some real leadership in developing energy efficiency.
Although he praised the medical team that is treating him, Davis also noted that he has seen several times how breakdowns in communication almost caused medical errors, and he called on physicians to intensify efforts to improve communication and patient safety.
A benefit of being a physician is that I understand whats happening to me, he said. But a disadvantage of being a physician is that I understand whats happening to me.
Davis praised the therapeutic and communication values of patient Web sites and encouraged physicians to tell their patients about them.
He also told doctors not to give up on patients.
As a physician, I know the survival statistics for someone with stage IV pancreatic cancer, but, if the five-year survival is 5%, thats not zero, Davis said. So never take away someones hope.
On Sunday, more than 250 resolutions and reports were debated by eight committees with four meeting in the morning and four in the afternoon. Some topics were dealt with in a matter of seconds, while others were subjected to long back and forth debate. For one particular issue, the discussion took so long because about 30 people lined up to voice their opposition. It could have lasted longer, but only three people spoke in support.
The issue on the floor was the Council on Ethical and Judicial Affairs report recommending an end to industry financial support of medical education.
New this year at the delegates meeting was the placing of three microphonesone labeled pro, another labeled con and a third, which became known as the ambivalent mikein the center of the room. The councils chairman, Mark Levine, an internist from Denver, originally stood as the lone speaker at the pro microphone, while the line behind the con mike extended out the door in what Baltimore neurologist Mike Williams described as a conga line behind me that stretches back to Gary, Ind.
Before speaking, Levine turned around and someone remarked with a jokeapparently meant to be taken literally and figurativelythat, Theres nobody behind you, Mark.
After he spoke, some 30 speakers noted particular programs that would cease to exist without industry funding or how they personally were insulted that the council didnt think they were smart enough to tell the difference between legitimate clinical information and promotional advertising.
Bristow, the former AMA president who spoke in support of the report the day before, was in the audience, but he left shortly after the discussion began.
While noting that the report lacked focus and perhaps should have concentrated on medical students and younger physicians, he said in an interview later that the reports opponents missed the point.
Its not important whether they think they know the difference between education and advertising, whats important is whether the public believes physicians are acting in the best interest of patients, he explained.
Bristow said that, if he would have spoken, he would have told the story of how when confronted with a message that his doctor was employed by his enemy and out to kill him, Alexander the Great told his doctor, You are my physician with whom I have complete trust.
The point of the story is that everything is based on patient trust, he said. The danger is, if we lose that trust we have nothing. Were dead meat.
Chicago-based reporter Andis Robeznieks covers organized medicine, among other issues.