Physicians can guide major changes ahead in health care

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

By William G. Plested III, MDis a thoracic and cardiovascular surgeon from Brentwood, Calif. He served as AMA board chair during 2003-04, and as AMA president during 2006-07. Posted July 17, 2006.

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This is my first AMNews article in the series that I will be privileged to share as president of the AMA. My last series appeared in 2003-04, when I was chair of the Board of Trustees.

My style is to be straightforward, honest and unafraid to advocate vigorously for patients and physicians. I feel that open debate is an imperative and must be welcomed. However, that debate must lead to solutions and not become an end in itself. One of the greatest obstacles that all organizations face today is that our insistence upon endless debate often leaves us exhausted. We tend to finish a prolonged debate and have a feeling that we have "done something" -- and we move on to the next issue. This, of course, is ridiculous, since debate is only noise if the next steps of decision, action and follow-up are not taken.

So, I am open to debate, but we need a measure of discipline.

We are living in a time that promises unique opportunities for physicians. A wide variety of circumstances have coalesced to bring health care to the top of our national agenda. A wide-ranging, national debate will begin following the upcoming election in November. It should form a major, if not the overriding, issue for the next presidential election. The results of that election probably will give overall direction to the changes that will transform health care delivery.

As I said, I view the prospect of major changes in our existing health care delivery system as a precious opportunity for physicians. We will see no end of those who will aggressively claim that they have all the answers. But such advice can be expected to be based on narrow self-interest and emotion with little or no data or experience to back it up. Here is where physicians have an insurmountable advantage that we cannot underestimate or squander. Only physicians have the training and experience necessary to make appropriate decisions about the real needs of patients.

An important aspect of this debate is that the universe of health care delivery considerations will be on the table. We will have the opportunity to craft a rational plan that addresses what we know to be the greatest challenges to our patients.

To begin, we must prevail in our ongoing quest to reform the tort system of medical liability. No meaningful overhaul of our health care delivery system will be able to survive if this is not done.

Real and realistic solutions to the worsening problem of the uninsured will be central. This will necessitate a careful look at the status of both the public and private sectors. We will hear the usual calls to hand over everything to government through a single-payer program.

It is imperative that such demands are accompanied by proof of success of such programs in similar-sized countries with similar populations. In my opinion, the only viable solution for the United States today is a combination of public and private insurance mechanisms that does not exclude any American.

Next we will need to explore the demographics and projected needs of our patient population and match that with our physician and nonphysician work force. A team approach to care seems a much more reasonable and viable solution than an endless procession of scope-of-practice battles.

Throughout all levels of our discussions, we need to focus on modern health information technology. I have publicly called on all physicians to move to an electronic medical record by 2010 -- as a professional imperative to maximize the quality of care we offer our patients.

The most significant part of the HIT debate for us will be the ownership, management and access to the data that will be produced.

Insurers, government, employers and an endless array of others are salivating at the prospect of controlling patient data. Our patients are depending upon us to partner with them to control these sensitive, personal data, and we must not let them down.

The betterment of the health of the public always has been and will continue to be essential to our duty to our patients. We must lead in the quest to promote healthy lifestyles, eradicate health disparities and to be certain that our cities and towns are prepared for a disaster.

Actually, a review of the major issues that will drive legislative decisions in the near future reflects the priorities of the American Medical Association.

We are on the brink of a monumental restructuring of health care in America, and the AMA is prepared. I hope every physician will participate and will make a commitment to be a fully informed resource for their own patients. Patients will want and need the counsel of their physicians.

Again, I appreciate the opportunity to share these issues. Over the next several months, I will look at each of them in more depth and comment on other issues as they arise.

William G. Plested III, MD is a thoracic and cardiovascular surgeon from Brentwood, Calif. He served as AMA board chair during 2003-04, and as AMA president during 2006-07.

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