Letters to the Editor - March 13, 2006

AMA-OMSS: Tell the Joint Commission not to weaken medical staff bylaws - It's psychiatrist -- not "shrink"

AMA-OMSS: Tell the Joint Commission not to weaken medical staff bylaws

The American Medical Association Organized Medical Staff Section wants to call attention to the importance and need for all physicians who practice in the hospital setting to participate in the Joint Commission on Accreditation of Healthcare Organizations' Field Review of Medical Staff Standard (MS) 1.20. The newly proposed MS. 1.20 minimizes the importance of the medical staff bylaws.

Opponents of OMS self-governance have repeatedly attempted to employ MS.1.20 as a vehicle for trivializing many of the functions of the OMS. The proposed standard suggests that, while medical staff "administrative procedures" be set forth in the OMS bylaws, that "associated administrative procedures" may be moved to supplemental documents. These supplemental documents often can be modified more easily than medical staff bylaws. The AMA-OMSS Governing Council believes that changes in medical staff bylaws should be accomplished with studied determination and deliberate consideration. This is why the AMA strongly advocates that all medical staff administrative procedures regarding medical staff organization, credentialing, peer review and fair hearings be in the bylaws. If any administrative policies or procedures associated with these core concepts are moved to supplemental documents, the documents must be approved by a significant majority of voting members of the OMS.

The OMSS is aware of other attempts to undercut the medical staff, including: 1. Boards of directors change their own bylaws to intentionally create a "de facto" conflict with the medical staff bylaws, to force the OMS to change its bylaws to remove the conflict. 2. Boards place too much authority in the hands of the medical executive committee, thus allowing this smaller group of physicians to act for the entire OMS. This problem is compounded when the MEC is made up physicians employed by the hospital. 3. Boards move key processes and procedures from the medical staff bylaws to supplemental, easily-amended documents.

The deadline for field review is March 10, 2006. Please submit your comments online to JCAHO as soon as possible (www.jcaho.org/accredited+organizations/field_reviews.htm) and send the OMSS a copy of your comments (omss@ama-assn.org).

--Bill Monnig, MD, chair, American Medical Association Organized Medical Staff Section

It's psychiatrist -- not "shrink"

At the risk of being accused of over-sensitivity, I would like to ask my fellow physicians to refrain from using the term "shrink" as a synonym for psychiatrist. The stigma of mental illness is well known and centuries old. Because of fear of "losing one's mind" the mentally ill have been subject to myriad slanderous terms: nuts, loco, bonkers, ad nauseam.

Similarly, those who try to ameliorate their suffering are denigrated by the appellation of "shrink." Along the same vein: "Psychiatrists are as nuts as their patients" or the ultimate backhanded compliment: "You're the sanest psychiatrist I know."

Care of the mentally ill is never easy: Stigma, discriminatory insurance coverage, etc., but it is worsened by fellow physicians' calumny. We may never convince Hollywood to stop using the term, but let's start with us.

--Mark Dillen Stitham, MD, Kailua, Hawaii