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Council On Ethical And Judicial Affairs Open Forum

In conformity with Resolution 14 (I-94), which requires the Council on Ethical and Judicial Affairs (CEJA) to "conduct an Open Forum at all future meetings for the purpose of discussing pending ethical opinion issues," the 2014 Interim Meeting Open Forum will be held:

Monday, November 10, 2014
9:30 a.m. to 11 a.m.
Hilton Anatole, Grand D/E
Dallas, TX

The Open Forum is open to all AMA members, interested non-members, other guests, and the press.

New Proposed Issues

Open Forum attendees are invited to introduce emerging ethical issues that may warrant attention from CEJA and inclusion in the AMA "Code of Medical Ethics."

Continuity of Care in Complex Health Care Systems

Continuity of care is a fundamental element of a successful patient-physician relationship. As more Americans receive medical care from complex health systems, physicians face new challenges in providing continuity of care. To save money, employers may switch health plans suddenly, potentially disrupting their employee’s relationships with their physicians (Emanuel & Dubler 1995). The increasing bureaucratization of health care does not diminish the importance of continuity of care. In fact, complex health care systems make it increasingly important. Patients may feel intimidated by the complexity of the health care system or may be confused as to how to access medical care. Without continuity of care, complex health care systems may inadvertently burden or discourage patients or neglect aspects of care and follow-up that are essential to patient well-being. 

Relevant Principles of Medical Ethics:
Principles: IV, VI, VIII, IX.

Relevant Literature:
Emanuel EJ and Dubler NN. “Preserving the Physician-Patient Relationship in the Era of Managed Care.” JAMA. 273(4):1995.

Hussey PS, Schneider E C, Rudin RS, Fox S, Lai J, Pollack CE. “Continuity and the Costs of Chronic Disease”. JAMA Internal Medicine. 174(5):2014.

The Ethical Obligation to Provide Competent Care

CEJA Report A-I-91 defines physician incompetency as “the inability to provide sound medical care because of deficient knowledge, poor judgment, or substandard clinical skills.” Incompetent physicians may make medical errors, harm patients, and undermine the public’s trust in the medical profession. Much of the current dialogue surrounding physician competency centers on the definition of competency. As one study notes, current standards for competent practice focus on technical, cognitive, and emotional aspects of practice, only some of which are measureable. The most common assessment techniques include multiple choice exams, assessments by attending physicians, and mock patient exams to review technical and communication skills. There has been much debate among physicians including members of the HOD about the burdens of maintenance of certification and licensure. The goal of this discussion is to discuss the ethical elements of the obligation to provide competent care, how these differ from the elements necessary for maintenance of certification and licensure and what assessment tools are appropriate for measuring quality of one’s practice. 

Relevant Principles of Medical Ethics:
Principles: I, II, V, VIII.

Relevant Literature:
Gallagher TH, Prouty CD, Brock DM, Liao JM, Weissman A, Holmboe ES. “Internists’ Attitudes About Assessing and Maintaining Clinical Competence.” J Gen Intern Med. 29(4):608-14. 2013.

Lipsett PA, Harris I, Downing S. “Resident Self-Other Assessor Agreement: Influence of Assessor, Competency, and Performance Level.” Arch Surg. 146(8):901. 2011.


Procedural Guidelines

A member of the Council on Ethical and Judicial Affairs will briefly present each topic on the agenda. After an issue has been introduced, the audience will be invited to discuss, with the Council, the ethical and professional considerations most relevant to the development of ethical guidelines on the topic at hand. In addition, the Council will collect written testimony for consideration at the time of the Open Forum or prior to it. Advance written testimony can be submitted to the Council staff, by e-mail at danielle.hahn@ama-assn.org or by fax at (312) 464-4799. Written testimony submitted to the Council will be given the same consideration as if it had been delivered orally.

Any member of the Association is privileged to speak on agenda items. Members should be mindful to disclose any conflict of interest that may influence their testimony. All other individuals should request from the Chair the privilege to provide oral testimony, indicating their identity and affiliation. Such a request will be honored upon approval of the Chair. Due to time constraints or other considerations, however, the Chair may not approve such requests.

All commentary should directly relate to the AMA Principles of Medical Ethics:

I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements, which are contrary to the best interests of the patient.

IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX. A physician shall support access to medical care for all people.

The Chair may establish rules on the presentation of testimony with respect to time constraints, repetitive statements, etc. The Chair also has the authority to prohibit photography, filming, and audio or video recording if the Chair feels that such factors would be undesirable for the orderly conduct of the meeting. Adherence to these guidelines will ensure that the forum runs smoothly and that the results are satisfactory to all.

Disclosure. The content of this activity does not relate to any product of a commercial interest as defined by the ACCME; therefore, there are no relevant financial relationships to disclose.

Learning Objectives

  • Describe why continuity of care is essential to patient well-being and satisfaction in complex health care systems.
  • Recognize the core values of continuity of care and how those values should be maintained in any system of health care.
  • Consider the ethical reasons why assessment of clinical competence is an essential element of patient care.
  • Recognize that the ethics of providing quality care in one’s medical practice is a topic separate and distinct from the ongoing debate about maintenance of certification.
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.