Heeding the privileges of the profession

A message to all physicians from the chair of the AMA Board of Trustees, Duane M. Cady, MD.

By Duane M. Cady, MDis a general surgeon who was in private practice for 35 years in Syracuse, N.Y. He served as chair of the AMA Board of Trustees during 2005-06. Posted July 4, 2005.

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While preparing to become the 59th chair of the Board of Trustees of the Americzan Medical Association, I have been reminded at every turn of the complexity of our profession and the size of the challenges it faces.

I remember a goal my wife, Joyce, set for herself several years ago. She vowed she would scale and descend all 46 Adirondack high peaks in New York State. Today, Joyce is among the select members of the "46ers," having earned her membership one step at a time, one mountain at a time.

That's the kind of approach you and I need to take in dealing with the challenges ahead.

Like you, I have heard all kinds of ideas from outside the ranks of organized medicine about how to fix this or fix that. Some are simple. Many are easily understood. Many miss the mark.

What becomes clear when you dig deep is that the problems and issues that beset us have two things in common. First, they all derive from our unshakable dedication to our patients. And, second, they all deal with access to quality care.

The medical liability crisis that is eroding our ranks and assaulting our livelihood is a legal snarl that if you cut through the rhetoric and examine the fundamental issue is an issue of access to care.

Our concern for the 45 million uninsured Americans is a payment issue that prevents access to timely care. Everyone gets care. That's a certainty. But postponing or avoiding preventive care because of payment concerns means that too many Americans live sicker and die younger than those with coverage, all for want of insurance coverage.

Medicare reform and the sustainable growth rate formulation are concerns because, if left uncorrected, they will mean that fewer physicians will be able to afford any additional Medicare caseload. Medicare patients won't have access to care when or where they need it.

Clinical quality improvement and patient safety, likewise, address issues of access to the highest-quality, safest care we can provide. Better care and safer care actually could cost more initially but eventually will equate to less costly and more available care.

When we promote healthy lifestyles, we're promoting access to sound treatment, effective preventive care and life-changing behavioral regimens for those not seeking them now.

And the entire range of issues surrounding disparities in health care due to race or ethnicity boil down to equal access, unbiased access and the impartial treatment of individual patients.

Concern for our patients and dedication to increased access are the common denominators. Beyond them lie literally thousands of questions, concerns, ideas and special interests. Each is important, and each is knitted into a fabric of such complexity and extent that no one of us can easily grasp it all.

That is why the current AMA theme, "Together we are stronger," is such a powerful idea. The AMA, in advocating positive change in Washington, in the states, in clinics and hospitals, and across the nation, is fulfilling its traditional role as leader and advocate for the profession.

As I write this, the AMA Annual Meeting in Chicago is only a few days away, and I am looking forward to another inspiring display of both the diversity and the integrity of the House of Delegates.

Literally hundreds of viewpoints will receive a full and fair hearing. Scores of resolutions and reports, hundreds of pages of analysis, thousands of conversations and discussions will be aimed not at uniformity and unanimity but at improving the profession and enhancing the art and science of medicine.

This is the united effort, the pooled intellect, the strength of us all working together for our patients and our profession.

Medical liability reform and fixing the "unsustainable" sustainable growth rate formula remain top priorities, for if physicians do not have the income to keep their practices open, access to care becomes moot.

The 45 million uninsured demand an equally high priority for our AMA, and we have been working on it in earnest for several months. I will have more on this issue in the coming columns.

Ours is a large task. The challenges are unprecedented. But I am convinced that we have the wisdom and the willpower to resolve many, if not all, of these issues for the good of our patients.

They deserve nothing less. We are committed to nothing more. You can have no greater reward than knowing you have served not only the health of your patients but their total well-being as well.

Duane M. Cady, MD is a general surgeon who was in private practice for 35 years in Syracuse, N.Y. He served as chair of the AMA Board of Trustees during 2005-06.

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