32 LOUISVILLE MEDICINE
A SECOND OPINION
This space is for our physician members to speak their minds freely on both medical or non-medical issues of the day and respond to the opinions of others . The GLMS Editorial Board reserves the right to choose what will be published . Please note that the views expressed in Doctors ’ Lounge or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine .
FROM HEAR TO RESOLUTION : GETTING A RESOLUTION HEARD
I am just one doctor . I can have big dreams about what I would do if I were in charge , but of course , I am not . Sometimes I feel like the Willie Loman or Walter Mitty of clinical practice . Nonetheless , I do have ideas and thoughts on how incremental changes could help make a difference for our patients . I am one of roughly a quarter million physicians holding membership in the American Medical Association ( AMA ). It is the largest professional association in the country . I figured that as just one member , my thoughts didn ’ t much matter . But one recurring concern particularly worried me , and that issue has taken root through an AMA resolution , not only making it to the floor of the House of Delegates , but indeed being adopted . I was amazed that an organization the size of AMA would take one of my concepts through an intricate vetting process that could actually promote needed change .
Let me back up . My lack of experience drafting a resolution for the AMA House of Delegates is not unique , but it ’ s more than a bit daunting . Even though I ’ m a “ doctor of a certain age ”, I figured I could learn from physicians with more policy experience . I aligned my AMA membership with the Senior Physician Section ( SPS ). ( There are at least a dozen different Sections which a member could join .) Every couple of months the SPS would host educational or policy development meetings , often engaging interesting speakers . I suspect that all of the sections do this , to some extent . For the SPS , the focus is on issues of relevance to seniors and senior physicians . Often during discussions at SPS and especially SPS Policy Development meetings ( composed of leaders and liaisons from state societies , of which I am one ), someone with a specific interest might propose a resolution idea . [ After I started attending the SPS , the first resolution I recall was one calling for more education about
by TOM JAMES , MD
the connection between unaddressed hearing loss and cognitive decline . Hearing loss is the major remediable cause of dementia . So , there was discussion , policy and literature search , and ultimately strong , concerted advocacy all leading to a Resolution that has just been adopted by the House of Delegates ( HOD ).]
Others at the SPS brought forward their ideas ; a few were felt to be ripe for action . Others , maybe not so much . So , like Arthur Miller ’ s Willie Loman , I decided that I would try to sell this group on a longstanding clinical concern of mine , polypharmacy . In my clinical practice over the years I have been amazed by the number of medications ( and OTC meds and herbs ) that some of my patients have in their possession . In training I learned how to ADD medicines , but I was never taught how SUBTRACT them . And I suspect that is true for the majority of practicing physicians . In my career I have admitted more patients than I would like who ’ d had adverse drug events , frequently due to their confusion over all their medicines , resulting in polypharmacy . At one of the SPS sessions , the leader asked for other topics for discussion . Like the new kid in school , I quietly raised my Zoom hand for recognition . I had not been part of the Section very long , and it seemed that many of these senior physicians from around the country all knew each other . So somewhat awkwardly , I ventured my thoughts on polypharmacy and my concerns with too many medications leading to inappropriate dosing and / or drug interactions . I fully expected silence followed by the Delegate ’ s quickly asking for other suggestions . But to my surprise there were supportive comments from other SPS members . It seemed almost everyone has met our unfortunate patient , Polly Pharmacy .
It was suggested that I consider writing this topic up as a potential resolution for the next meeting . This “ suggestion ” held the ring of a classroom teacher , meaning “ You had better do that if you are to remain in my class .” The next day I emailed Alice Reed , the AMA Group Manager for the SPS . “ HELP !”, I called to her , “ How