From the president

This column was originally published in AMA eVoice on July 19, 2007. Dr. Davis is president of the American Medical Association.

Patient safety advocates earned a well-deserved victory last week when Hawaii Gov. Linda Lingle vetoed a bill that would have given psychologists limited prescribing rights. This legislation, actively opposed by a broad coalition that included the AMA, would have allowed health care professionals who have not undergone the extensive and necessary education and training to prescribe powerful and potentially dangerous medications to patients. I'm glad the governor recognized the potential danger in this legislation and exercised her veto power to defeat it.

Prescribing rights for psychologists is an ongoing issue in Hawaii—similar legislation creeps into the Legislature every year—and this bill is just the latest in a long line of proposed or actual scope-of-practice expansions nationwide that threaten patient safety. Many of you may be familiar with the matter of optometrists in Oklahoma obtaining privileges a few years ago to do non-laser (scalpel) surgery, arguably the most egregious example of scope-of-practice expansion.

We can defeat efforts such as these by working together, and the Scope of Practice Partnership (SOPP)—a watchdog of legislative, regulatory, and legal endeavors that seek to expand the scope of practice of non-physician providers into the practice of medicine—provides a valuable vehicle for that. Through the SOPP, the AMA is leading the effort to contest these scope-of-practice expansions.

Officially rolled out in early 2006, the SOPP has grown to include the AMA, the American Osteopathic Association, 12 national medical specialty societies, 47 state medical associations and the Medical Society of the District of Columbia, and 16 state osteopathic societies. SOPP task forces address such issues as licensure of naturopaths, doctor of nursing practice programs and truth-in-advertising state pilots in an effort to counteract the more than 200 scope-of-practice bills and regulations tracked by the AMA's Advocacy Resource Center.

The SOPP also is overseeing the completion of the AMA Scope of Practice Data Series, a compendium of information and resources for medical associations on 10 non-physician providers, and the creation of a geographic mapping tool that will allow Federation partners the ability to map, on a state-by-state basis and by specialty, the practice location of not only allopathic and osteopathic physicians but also various non-physician providers.

Issues facing a single specialty or specific state eventually could affect others, so it's important that other physician groups get involved. If your state of specialty society isn't part of the SOPP, please advocate for it to join.

Nurses, optometrists, psychologists, pharmacists, and many other non-physician practitioners play a critically important role in the delivery of care to patients. Our challenge is to ensure that the care they deliver is within the scope of their training and education. An appropriate and well-defined supervisory relationship—such as that between physicians and physician assistants—is an important ingredient for good collaborative care for the benefit of patients.

Many examples exist where physicians and other health care practitioners are working together in relative harmony, respectful of different roles and responsibilities. For example, at the Henry Ford Health System in Detroit, a large integrated delivery system where I work, both ophthalmology and optometry services are provided throughout the organization, in many cases co-located within a particular facility. Ophthalmologists and optometrists at Henry Ford work together to develop and maintain a trusting relationship while delivering complete and coordinated eye care to patients.

With better consensus on the appropriate roles of various professionals, physicians and other health care practitioners can develop better-defined working relationships, which is important as the concept of team care becomes more prevalent. And we can ensure that the high standards of the practice of medicine are being upheld in all instances of patient care.

The lighter side

There is one type of health care provider whose enlarging scope of practice I'd celebrate-clown therapists.

The Big Apple Circus has a clown care program, established in 1986, that "brings laughter and joy to the bedsides of acutely and chronically ill children year round," as stated on the program's Web site. More than 90 "clown doctors" (specially selected professional performers who are trained to work in the sensitive hospital environment) make 250,000 one-on-one bedside visits annually in hospital clowning programs operating in Atlanta; Baltimore; Boston; Chicago; Miami; New Haven, Conn.; New York; Providence, R.I.; Seattle; and Washington, D.C.

One of these hospital clowning programs operates at the University of Chicago, where I attended medical school. It is one of many "expressive therapies" used at the university's Comer Children's Hospital that help young patients cope with their hospital stay; others are art therapy, music therapy, pet therapy, and cooking.

These humanistic therapies are long-overdue efforts to bring warmth, compassion, and humor into a health care system that is all-too-often cold, fragmented, and technology-driven. Of course, physicians themselves can get into the act, as demonstrated powerfully by Dr. Patch Adams.