The AMA: A 160-year commitment to quality care

AMA Leader Commentary. By William G. Plested III, MD, May 21, 2007.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President William G. Plested III, MD.

The ongoing obsession with the cost of medical care has spawned some interesting proposals about controlling physician behavior about which I have been outspoken. The most common excuse for these schemes is that the quality of medical care is so poor that they are necessary. It is now openly stated that physicians and the AMA really don't care about quality.

It therefore is time for some straight talk about the ongoing commitment to quality of physicians in general and the AMA in particular.

When a youngster makes a decision to pursue a career as a physician, he or she quickly learns that this decision means a lifelong commitment to the pursuit of quality in everything that they do. That continues and intensifies through medical school, years of residency, and a life of practice and continuing education.

I have never met a physician who does not try to give each and every one of his or her patients the very best that he or she has to offer. Do physicians care about quality? Every waking moment, thank you very much.

So what about the AMA's commitment to quality?

The AMA was founded in Philadelphia in 1847. The agenda that first year included the appointment of a committee on medical education. It set the first-ever educational standards for the teaching of medicine in the United States.

The other initial undertaking of the new association was the establishment and publication of a code of medical ethics. That code has undergone constant updating and revision and today stands as the most respected in the world.

Over the next several years, the AMA focused upon efforts to study and educate the public about the dangers of quack remedies and nostrums, regulations regarding quarantine of patients with infectious diseases and general public sanitation.

In 1883, the Journal of the American Medical Association was founded to publish and widely disseminate peer-reviewed scientific articles.

Medical education throughout the country was still a major concern of the AMA, and the Council on Medical Education was established in 1904. Between 1906 and 1907, the council inspected and rated 160 American medical schools. Its unwavering commitment to the improvement of medical education led directly to the Flexner report, which was published in 1910 and which revolutionized medical education in this country.

In 1905, the AMA established the Council on Pharmacy and Chemistry to set standards for the manufacture and marketing of drugs. The federal government created the U.S. Food and Drug Administration the following year.

The AMA developed standards for hospital internships in 1914, standards for specialty training in 1923 and a list of approved residency programs in 1927.

1938 saw the publication by the AMA of the first authoritative dietary recommendations for Americans.

In 1951, the AMA joined other groups concerned about quality and founded the Joint Commission on Accreditation of Hospitals. The AMA maintains a strong position on the board of directors of this organization to this day.

The Council on Medical Education published the first list of continuing medical education courses for physicians in 1954. This was followed in 1968 by the establishment of the AMA physician's recognition award to certify those physicians who complete approved CME programs.

Today the quality of the environment is in vogue. Few realize that the AMA adopted a statement recognizing the dangers of air pollution and thus provided a medical basis for government action in 1965, fully five years before the Environmental Protection Agency was established.

1997 saw two historic actions by the AMA regarding its long-held commitment to quality care.

The first was the development of the American Medical Accreditation Program. The second was the establishment of the National Patient Safety Foundation. This foundation's mission is to fund research aimed at reducing medical errors and to make health care delivery safer. In parallel, AMA advocacy efforts resulted in patient safety legislation enacted by Congress and signed into law by President Bush in 2006.

AMAP proved to be a bit ahead of its time and did not survive. But a direct outgrowth of this was the AMA-convened Consortium for Performance Improvement. The consortium presents a forum for all physicians concerned about the care of a specific disease to establish measures that can be used as a guide (importantly not a mandate) for treatment.

The consortium pioneered this voluntary peer mechanism of quality improvement long before anyone had the idea that government or insurers should try to tell physicians how to practice medicine.

This is a very brief review of a tiny sampling of the actions and initiatives that have been undertaken by practicing physicians through the AMA since its founding in 1847.

Keep it handy so that you can refute the outrageous claims that the AMA isn't interested in quality. There are 160 years of constant, consistent, well-documented commitment to the quality of care our patients receive.

Quality was job one when the AMA was founded, and it remains so today.

Sooner or later, it will become apparent to even the casual observer that the quality issue has been raised spuriously by those whose true agenda is not quality at all but is purely cost.

It has been easy for some to demagogue the issue and cloak their costs agenda in a righteous veil of concern for quality. This ploy is rather pathetic. But I am unprepared to keep quiet when they get "the bit in their teeth" and get carried away to the point that they pompously assert that any physician who does not ascribe to their ham-handed attempts to mandate his or her treatment of patients does not care about quality.

To paraphrase an old country song:

"When you're runnin' down my profession, hoss, you're walkin' on the fightin' side of me."

Dr. Plested, a thoracic and cardiovascular surgeon from Brentwood, Calif., was chair of the AMA Board of Trustees during 2003-04 and served as AMA president during 2006-07.

The doctors are in the house
The AMA's House of Delegates is holding its Interim Meeting Nov. 7-10 in Houston, addressing issues such as health system reform and physician payment.
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