HONOLULU – The American Medical Association (AMA) gathered physician and medical student leaders from all corners of medicine at its Interim Meeting to shape guiding policies on emerging health care topics.

The AMA’s House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, residents, and medical students representing every state and medical specialty. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.

The policies adopted by the House of Delegates include:

Ensuring accuracy of pulse oximeter readings in patients with pigmented skin

Pulse oximeters are an essential tool used to estimate a patient’s oxygen level and help guide medical decision-making. Given numerous studies showing that skin pigmentation can affect the accuracy of pulse oximetry readings—negatively impacting patient care—the AMA adopted policy today calling for the U.S. Food and Drug Administration (FDA) to ensure pulse oximeters provide accurate and reliable readings for patients with diverse degrees of skin pigmentation. The policy also calls on FDA to ensure health care professionals and the public are educated on the limitations of pulse oximeter technology. Accounting for errors in measurement is important for clinicians when developing diagnosis and treatment plans.

“Concerns about the accuracy of pulse oximeters in pigmented skin have been noted for more than 30 years, yet Black and Brown communities are still facing adverse health impacts from these devices—particularly during the COVID-19 pandemic when use of and reliance on pulse oximeters increased,” said AMA President-elect Jesse M. Ehrenfeld, M.D., M.P.H. “We urge the FDA to take swift action to address the growing uncertainty around these devices, including making sure health care professionals are aware of their limitations and increase testing of devices that were already cleared by the agency, to ensure the health and safety of the public.”

Earlier this month, Dr. Ehrenfeld joined other physicians in providing testimony to an FDA panel aimed at offering solutions to address long-time concerns with inaccurate and inequitable pulse oximeter readings.

Advocating for a minimum age for juvenile justice system jurisdiction

According to research from the Office of Juvenile Justice and Delinquency Prevention, in the United States, proportionally more children younger than 18 years of age interface with the juvenile justice system than any other country. In addition to placing children at a higher risk of poor health outcomes, the juvenile justice system oftentimes does not address the root causes of children’s disruptive behavior according to a recent JAMA study. Given these statistics and in alignment with the United Nations’ recommendation to change the minimum age for juvenile justice jurisdiction from 12 to 14 years, the AMA adopted policy today in support of establishing a minimal age of 14 years for juvenile justice jurisdiction in the U.S. Under the new policy, the AMA will also develop model legislation for setting a minimum age at which youth and young adults can be processed through juvenile courts.

“Research shows that people who experience their first incarceration as a young child have worse health outcomes as adults compared with those first incarcerated as adolescents. We believe setting a minimum age for when a young person enters the juvenile justice system will lessen the harmful effects that early justice involvement can have on children and their families over the course of their lives recognizing that children and adolescents need developmentally appropriate, trauma-informed care and services,” said AMA Trustee Drayton Charles Harvey.

Advocating for paid and expanded parental, family and medical necessity leave for physicians-in-training

The AMA adopted policy today in support of paid and expanded parental, family and medical necessity leave for medical students and other physicians-in-training. Specifically, the AMA recommends that medical practices, departments and training programs strive to provide 12 weeks of paid parental, family and medical necessity leave in a 12-month period for their attending physicians and physicians-in-training, as needed.

Under the new policy, the AMA also calls on medical schools to develop parental, family, medical leave policies specific for medical students—in alignment with the leave policies and benefits already guaranteed to their trainee counterparts in residency training. The new policy also encourages the development of compassionate leave policies as part of the physician's standard benefit agreement and outlines the components that should be included.

Additionally, the AMA is urging support for parental and medical leave policies for medical students, residents and physicians to include leave for abortion and stillbirth to promote physical and psychological healing.

“It is important that medical students and all physicians-in-training have access to equitable, adequate and paid parental, family and medical necessity leave to support their health and well-being,” said AMA Immediate Past Chair Bobby Mukkamala, M.D.