AMA House of Delegates

AMA meeting: Delegates see boosting quality of care as duty

A new AMA ethics policy lays out steps physicians should take to make sure patients get the correct treatments.

By Kevin B. O’Reilly — Posted June 29, 2009

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The commitment to provide quality care to patients has long stood as a core tenet of the medical profession, but physicians increasingly have come under scrutiny on this front. Research shows that patients receive only about half of clinically recommended care and finds wide regional variations in medical utilization with little effect on health outcomes.

Government and private payers are stepping up pressure on doctors to improve care. Now the AMA says improving quality is not just a matter of technical competence but also an ethical duty, according to new policy adopted at the Association's Annual Meeting.

Delegates approved a Council on Ethical and Judicial Affairs report saying doctors should work to ensure that patients get care that is safe, effective, timely, efficient and equitable.

"This report addresses physicians' ethical obligation to provide quality care," said CEJA member Hilary Fairbrother, MD, MPH, an emergency medicine resident. "This means getting the right care to the right patient at the right time."

According to the new ethics policy, doctors should:

  • Keep current with best practices and take part in education, certification and quality improvement activities.
  • Communicate effectively with patients, families and other professionals, and coordinate care appropriately.
  • Monitor the quality of care they deliver through case review, peer review and other improvement tools.
  • Implement quality and performance improvement measures in their daily practices.

In reference committee testimony, Georgia pediatrician Joy A. Maxey, MD, said her state delegation supported the proposal. She argued that the AMA needed to take a strong stance on doctors' unique role in medical quality.

"Physicians are the definers of what constitutes quality when it comes to providing medical care to patients -- not industry, not insurance companies, not government, but physicians and their associated professional organizations," Dr. Maxey said.

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Meeting notes: Medical ethics

Issue: Breaches of electronic medical records security can compromise privacy and harm patients physically and emotionally. When such breaches occur, what responsibilities do physicians have toward their patients?
Proposed action: An ethical policy recommending that physicians promptly inform patients of any breach and the potential for harm, describe how the breach happened and what steps patients can take to minimize any adverse results. [Adopted]

Issue: Physician assistants and nurse practitioners are increasingly taking on ownership roles in practices such as retail health clinics. This gives rise to the ethically problematic situation where a doctor is hired to supervise the work of a midlevel practitioner who also owns the practice and is the physician's employer.
Proposed action: An ethical policy that acknowledges the conflicts inherent in such an arrangement. The opinion says physicians have a duty to always exercise their independent professional judgment in patients' best interest, even if it puts them at odds with their employers. [Adopted]

Issue: Some hospital patients with racial or other prejudices are hostile to the physicians assigned to care for them or refuse their treatment, but hospitals do not have uniform guidelines to address these situations.
Proposed action: Direct the AMA to work with other organizations to encourage hospitals and health systems to adopt policies allowing patients to change doctors and have mechanisms to address abusive patient behavior and ensure continuity of care for a patient who declines care from the attending physician. [Adopted]

Issue: So-called chimeric embryos -- created when human genetic material is introduced into a nonhuman embryo or transferred into an enucleated nonhuman egg, creating a hybrid -- are being explored as an alternative to stem cell research techniques that destroy human embryos.
Proposed action: The Council on Ethical and Judicial Affairs said there is a lack of policy or scientific and ethical consensus on chimeras, and the issue affects few physicians. The council proposed examining the issue as part of its review of opinions relating to medical genetics in the AMA Code of Medical Ethics. [Adopted]

Issue: Working with patients to plan in advance for end-of-life care situations is a legally complicated and ethically fraught area for doctors.
Proposed action: Direct the AMA to develop an educational session on advance care planning at an upcoming Annual or Interim Meeting and ask CEJA to update its ethical guidance on end-of-life issues. [Adopted]

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