Physicians had the chance to share their opinions on continuity of care in complex health care systems and the ethical obligation to provide competent care during an open forum of the AMA Council on Ethical and Judicial Affairs (CEJA), held Monday at the 2014 AMA Interim Meeting.
Attendees also received an update on the project to critically review and update the AMA Code of Medical Ethics. Physician can continue to review and comment on changes to the Code through Dec. 31 via the online CEJA Forum or by sending an email with comments.
CEJA’s updates to the Code have been conservative, and attendees were reminded of this in discussion about continuity of care.
“The comments [in the Code] about continuity of care are unchanged since 1992,” said CEJA member James E. Sabin, MD. “Since 1992, there have been major changes in the health system, and there’s no suggestion any of this is stopping soon …. There’s reason to think the changing system creates new challenges to continuity of care and new opportunities.”
Physicians touched on a variety of obstacles to care continuity, including patients not having continuous health care coverage, difficulty in patients making appointments and problems with electronic health records that prevent communication between physicians.
Joseph Selby, MD, a professor of family medicine at West Virginia University School of Medicine, said providing interpersonal continuity of care in today’s environment is “virtually impossible as medicine interfaces with business models.” He said it’s difficult for physicians in hospital systems to comply with hospital mandates and patient volumes.
Discussion also covered the issue of competence, specifically how to self-assess competence in a variety of situations. CEJA Vice-Chair Stephen L. Brotherton, MD (pictured left), highlighted the many ways in which a physician’s competence may be deteriorating.
“Your skills may fade, and you’re not really aware that’s happening,” he said, pointing to age, number of hours worked, lack of sleep and other factors that could have an effect on competence.
Other physicians made comments on the necessity of defining competence exactly, which CEJA admitted was a challenge.
CEJA will evaluate all comments from the open forum as it moves forward in its work.
What do you think? Share your opinions on continuity of care and competence with a comment below at AMA Wire® or on the AMA’s Facebook page.
