AMA HOUSE OF DELEGATESEducation, science and public health (Committee K)Public health and safety A mandated nap time for residents on call could actually worsen patient safety by disrupting the continuity of care, the AMA House of Delegates said in a report it adopted Tuesday, Nov. 10. The house directed the AMA to urge the Accreditation Council for Graduate Medical Education to reject a protected sleep period proposed by an Institute of Medicine panel. That and other changes proposed in the IOM’s December 2008 report come with an estimated $1.5 billion price tag and would be difficult to implement, according to the AMA Council on Science and Public Health report the house adopted. Surgeons have been especially outspoken about the effect of duty-hour rules on training. “There really should not be further tinkering with work-hour restrictions,” AMA Board of Trustee member Peter W. Carmel, MD, a Newark, N.J., pediatric neurosurgeon, said in reference committee testimony. “Our colleagues in Europe are suffering with the fact that they have such restrictions on work hours that they cannot train neurosurgeons the way they should be trained. … They turn out neurosurgeons who cannot pass the board of the American Board of Neurological Surgery.” The AMA will continue to monitor and study the evidence on the effect of work-hour restrictions on physician training and patient care. In other action, the house called for a review of the schedule I status of marijuana to allow for more research on potential medical uses of cannabinoids. The AMA refused to endorse state-based medical marijuana programs. A resolution adopted by the house calls on Congress to repeal the “don’t ask, don’t tell” law that requires gay soldiers to hide their sexual orientation from their physicians and others. Delegates said that the policy threatens the physician-patient relationship and compromises the medical care of gay patients in the military. A separate science council report found that gay families face a host of health disparities, such as unequal access to health insurance benefits. “Exclusion from civil marriage contributes to health care disparities affecting same-sex households,” according to a report recommendation, which the house adopted. Delegates also stepped up their call for restrictions on cell phone use while driving. The AMA previously supported a ban on texting while driving, but the house today voted for a ban on all handheld device use while driving. Delegates cited the growing evidence that the practice seriously distracts drivers and threatens road safety. “We want your hands on the steering wheel,” said AMA Trustee Edward L. Langston, MD. In response to the threat from seasonal flu and influenza A(H1N1), delegates supported the use of more hand sanitizer dispensers in public areas. The AMA will study the ethical and scientific merits of requiring doctors and other health professionals to get immunized against flu strains.Updated November 10, 2009 Service, practice, insurance and related topics (Committee J)Identity protection Delegates adopted policy that seeks ID-theft protections for physicians, following the August theft of a laptop computer from a BlueCross BlueShield Assn. employee. Delegates said the Blues association should pay for five years of credit monitoring and should notify physicians immediately if there are any future breaches of physician information. Several delegates said such steps are necessary to protect physicians from identity theft. In other action, the house encouraged further study into the possible causes of geographic variation in health care delivery and spending. The AMA also endorsed 15 principles for all hospitalist programs. These include: involving patients, medical staff and others in designing and implementing a hospitalist program; promoting a hospitalist model that focuses on team-based inpatient care; and tracking and reporting hospitalist performance measures against goals. Updated November 10, 2009 Legislative advocacy (Committee B)Delegates back leadership’s reform stance The testimony was lengthy, but in the end the House of Delegates backed the AMA leadership’s efforts on health system reform. After about three hours of discussion, delegates on Nov. 9 adopted a health system reform resolution that combined several measures discussed the previous day. The wide-ranging resolution affirmed support for the AMA to continue to work with Congress and Capitol Hill on health reform and to communicate that progress to members. The house also voted that reform legislation should include the repeal of Medicare’s sustainable growth rate formula. AMA leaders said the process showed that the AMA Board of Trustees made the right decisions during this historic year of national debate on health system reform legislation. “It’s an affirmation of the AMA’s position in the health system reform debate,” said AMA President-elect Cecil B. Wilson, MD, after the house voted. Several state and specialty medical societies — lead by the Medical Assn. of Georgia — offered amendments that would have, for example, specified that the AMA does not support a new public health insurance option sponsored by the federal government. Legislation recently adopted by the U.S. House of Representatives includes such a provision. “I believe that the public option will become the only option for our patients,” said M. Todd Williamson, MD, president of the Georgia association. However, the House rejected the amendments by a nearly two-thirds vote. During testimony, some delegates said members should trust the AMA’s leaders on health reform. Nancy H. Nielsen, MD, PhD, AMA immediate past president, said some doctors see the world in black-and-white terms with no in-between. “The legislative process is different than that.” Updated November 9, 2009 Amendments to Constitution and BylawsEthical guidance Good bedside manner is a hallmark of physician professionalism. Now the AMA is set to advise doctors and medical students on how to behave online. The House of Delegates directed the AMA to work with partner organizations to set standards for physician professionalism online, especially when posting at popular social networking sites such as Facebook. The AMA Council on Ethical and Judicial Affairs, meanwhile, will address the issue as part of its ongoing project to modernize the AMA Code of Medical Ethics. Sixty percent of medical schools have reported incidents of medical students posting unprofessional content online, according to a study in the Sept. 23/30 Journal of the American Medical Association. In other action, delegates directed CEJA and the AMA Council on Science and Public Health to examine the science and ethics of kidney transplant chains and other unconventional organ donation processes that have become more prevalent in recent years. One such donation chain took place over eight months, involved six transplant centers in five states and resulted in 10 kidney transplants. The house also asked the Association to work with other Federation of Medicine organizations to help physicians with disclosing sensitive health conditions, such as HIV/AIDS status, to minors. But a controversial CEJA report offering ethical guidance on how to manage potential conflicts of interest associated with industry funding of continuing medical education was referred back to the council for further revisions. The report, which says doctors should avoid industry-supported CME when possible, had been referred back twice previously for changes. The house reaffirmed existing policies on a range of end-of-life care matters and rejected a proposed resolution that called on the AMA to seek legal immunity for physicians who withdraw end-of-life care they believe to be futile. Updated November 9, 2009 AMA governance and finance (Committee F)Interim Meeting gets a reprieve The AMA Interim Meeting will live on. Delegates considered a task force report that recommended replacing the Interim with an AMA Open Forum, starting in 2011. But in the end, they decided to refer the matter, not taking immediate action. Some delegates questioned the cost of changing the meetings and said the house wasn’t ready to vote on the issue. The next Interim is scheduled for San Diego in November 2010. Delegates approved a resolution encouraging AMPAC, the AMA’s bipartisan political action committee, to explore creating an AMPAC council to meet with the AMPAC board of directors at the AMA Annual and Interim meetings. That council would consist of one AMA delegate or alternate delegate from each state delegation not represented on the AMPAC board, plus any other representatives to the House of Delegates as desired by the board.Updated November 9, 2009 This content was posted online only. Copyright 2009 American Medical Association. All rights reserved.
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