AMA keeps its focus on the doctor-patient relationship

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

By Robert M. Wah, MDis a reproductive endocrinologist and ob-gyn in McLean, Va. He was chair of the AMA Board of Trustees during 2011-12 and is currently AMA president-elect. Posted Nov. 14, 2011.

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If you talk to anyone ? physicians or patients ? about health system reform, it becomes apparent that the real core issue is the physician-patient relationship.

On the one hand, patient concerns come down to: "Will I be able to keep my own doctors? Will I have access to the physicians I need?"

On the other, physicians worry about: "Will I be able to spend the time with my patients that they need? Will I be able to get them the additional care and support required?"

The AMA mission statement is "to promote the art and science of medicine and the betterment of public health."

Our relationship with our patients is at the heart of this statement. For the vast majority of us, the most rewarding part of our careers is the unique role that we are privileged to play in our patients' lives. The doctor-patient relationship is one of the many things I am thankful for during this Thanksgiving season.

Like most physicians, I can recall many rewarding and heartwarming occasions that stand out for me.

Once, my wife and I were at a restaurant out of town, and she mentioned to me that a woman at another table was looking our way like she knew me. A few minutes later, the woman came over to our table, introduced herself and said I had been her surgeon a number of years before. She said I had saved her life ? and gave me a big hug.

There have been other instances as well, many related to my obstetrics practice. "You delivered our son/daughter," is not uncommon, but it is a sign of time passing that I now also hear, "You delivered me" !

Of course, I am not unique. Nearly all physicians have similar experiences, which they, like me, cherish. These manifestations of the doctor-patient relationship show in real human terms what being a physician is all about. It is this relationship that is at the heart of everything that the AMA has stood for and worked for over the past 160 years, and is the core focus of our work in Washington.

You may have seen the superb new AMA ad campaign that speaks to the physician-patient relationship. It was launched in late October as a reminder of what the enormous effort to reform American health care really should be all about.

More information about the campaign and a video of the ad is available online (link).

The ad campaign supports a number of ongoing AMA initiatives directly related to the doctor-patient relationship, among them our work on behalf of health literacy, private sector advocacy, the campaign to end Medicare's sustainable growth rate and improve Medicare, and our support for the Medicare Patient Empowerment Act.

Health literacy is critically important to patient health. This AMA initiative has two parts: the need to be sure that patients understand what physicians, pharmacists, hospitals and insurance companies are telling them and a related effort to be sure that information is being given to patients in a way that is easy to comprehend and carry out. A recent government survey estimated that more than 89 million Americans have limited health literacy skills.

The AMA was the first national medical organization to adopt a policy recognizing that low health literacy can affect medical diagnosis and treatment. That was back in 1998. Today it offers various health literacy resources, including tool kits, patient safety monographs and tip cards, and reports that can help physicians create safer, shame-free health care environments for patients with limited health literacy and, by extension, for all patients (link).

The AMA has a long history of intervening on behalf of our patients and doctors when insurance companies insert themselves between physicians and patients. More information about our private sector advocacy is available online (link).

The campaign to end SGR and other Medicare-related efforts also speaks to the doctor-patient relationship. Physicians are becoming increasingly frustrated with Medicare, given the uncertainty associated with repeated payment patches, costly mandates and paperwork. Increasing numbers of physicians are opting either not to participate in Medicare at all or to limit their participation severely.

This includes not accepting new Medicare patients or military patients under Tricare, which is mandated to use Medicare payment rates. The AMA even has created a Medicare Physician Payment Action Kit, which includes information, along with a number of resources on the subject for physicians (link).

In addition, the AMA is hard at work to see that new Medicare programs live up to their promise. For example, the AMA made many suggestions to improve the complicated and nearly 700 pages of proposed rules from the Centers for Medicare & Medicaid Services on accountable care organizations (link).

And while not perfect, the final rule included many of the AMA's suggestions. Our goal was to make sure there is a level playing field that allows physicians of all practice types to form, run or participate in innovative care delivery such as ACOs, if they choose to. We also were instrumental in getting the Federal Trade Commission and Justice Dept. to change rules so that doctors can come together in innovative care delivery organizations.

Likewise, the AMA supports the Medicare Patient Empowerment Act (H.R. 1700/S. 1042). These two bills, introduced by Rep. Tom Price, MD (R, Ga.), and Sen. Lisa Murkowski (R, Alaska) seek to allow private contracting between Medicare beneficiaries and their physicians without penalty to either party. Currently, there are 22 co-sponsors of H.R. 1700. The AMA continues to encourage members of Congress to co-sponsor the bills.

And we continue to work toward repeal of the flawed and highly controversial Medicare Independent Payment Advisory Board.

All of these illustrate what threatens the doctor-patient relationship, and these threats come from both inside and outside the health care community. That's why it is so crucial that physicians join together to combat these challenges.

The AMA is the one place where physicians come together across geographies, specialties, modes of practice or career stages to make their voices heard in public, regulatory and legislative venues.

To all of you who are members of the AMA, I thank you for your membership and support. To other physicians, I encourage you to join your physician colleagues, because together we are stronger ? and more effective. Together we can protect our profession. And our cherished doctor-patient relationship.

Robert M. Wah, MD is a reproductive endocrinologist and ob-gyn in McLean, Va. He was chair of the AMA Board of Trustees during 2011-12 and is currently AMA president-elect.

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