do I DO that ?”. And then I received an email from Louise Andrew , MD , JD , an AMA Ambassador and SPS Delegate . Dr . Andrew is an emergency physician , internist and attorney currently living in Victoria BC . She arranged a call to discuss my concept of polypharmacy and how the AMA might be able to impact this issue of special relevance to senior patients . We had a series of calls over several months as Dr . Andrew helped me shape a rather nebulous concept into a series of actionable steps that the AMA might take . Recognizing that I am a novice at writing AMA Resolutions , Dr . Andrew with both clear focus and gentle humor helped me shape up my concept from a block of marble into a recognizable statue . She guided me through the necessary steps .
1 st — Search the AMA Policy Finder ( https :// www . ama-assn . org / form / policy-finder ). If this idea is already an AMA policy then there would be no reason to duplicate it . I learned there were no AMA policies on polypharmacy .
2 nd — Research the topic in the medical literature and with concerned colleagues who might support the concept .
3 rd — Compose and rank order the Rationales for a resolution . ( These are the “ Whereas ” clauses ). We arrived at a series of Whereas clauses related to the medical problems stemming from too many medications in the patient ’ s possession , quality of care issues , and who else other than physicians are attempting to take action to reduce the impact of polypharmacy .
4 th — Write the Resolved Clauses . These are the “ asks ” or actions being proposed to the AMA House of Delegates . The action steps should flow logically from the various Whereas Clauses .
5 th — Create a title for the resolution — Dr . Andrew suggested that it be descriptive , succinct and catchy , but not kitschy . For me this was more difficult than some of the other parts . Ultimately we arrived at : Reducing Polypharmacy as a Significant Contributor to Senior Morbidity .
After a few more tweaks , Dr . Andrew felt my suggested resolution was ready to go before the SPS . The discussion that ensued was lively , with senior physicians acknowledging the problem while debating what AMA could or could not do . Would electronic data systems through artificial intelligence eventually make this problem go away ? Are physicians too over-extended to really look at the medications , or should this be a pharmacist or other team member ’ s role ? How do we reconcile differences in physician resources around the country ? Some states like Maryland have already legislated a medication review process .
After a few meetings there was consensus on the modifications of Resolved Clauses , and the SPS Governing Council and members voted to transmit the resolution to the HOD , which assigned it to a Reference Committee .
After consideration and debate / discussion by all attendees , the Reference Committee can make one of several recommendations :
• Adopt : Resolved Clause ( s ) become ( s ) Official AMA Policy as written
A SECOND OPINION
http :// www . uccomama . com / wp-content / uploads / 2018 / 09 / How-to-Write-a-Quality-Resolution . pdf
• Not Adopt : Resolved Clauses do not become policy
• Adopt as Amended : Resolved Clauses become Official AMA Policy with addition , deletion , or alteration of one or more RESOLVED clauses
• Reaffirmed in Lieu of : Existing policy is supported instead of adopting new policy
• Refer for Study : More evidence needed before creating policy . ( 1 )
Resolutions that pass the Reference Committee review are then brought before the HOD with one of these recommendations . After further debate by the full House , they either do , or do not become AMA policy and AMA leadership takes actions appropriate to that policy .
The Kentucky Medical Association uses a similar process . I had previously taken policies on motorcycle helmet laws through the Reference Committees of KMA . I have been on KMA reference committees in the past and recognize the value in honing resolutions brought before them .
As a Walter Mitty type within organized medicine , I have found both KMA and now , the AMA itself , to be very open to hearing any member comments and concerns . Both associations encourage physicians to craft thoughtful resolutions supported by facts and leading to action steps . At least personally I was gratified to have my concern over the dangers of polypharmacy heard . With support from Dr . Louise Andrew and from the entire SPS , my concern was brought to the AMA House of Delegates , and finally on June 15 it was debated , and adopted with useful modifications . How gratifying that my thoughts were not only welcomed , but supported by colleagues from all over the country and then by the AMA itself , AND that I may have helped improve the safety and health of our patients . I no longer feel like Willie or Walter . I now know I have supportive colleagues in our Senior Physician Section , and ultimately , a most powerful ally in our AMA .
References :
1 .) Plagge T , Wang S : How to write a resolution . AMA publication http :// www . uccomama . com / wp-content / uploads / 2018 / 09 / How-to-Write-a-Quality-Resolution . pdf accessed June 12 , 2022
2 .) Submitting a resolution & how policy is developed , residents and fellow section , AMA publication https :// www . ama-assn . org / member-groups-sections / residents-fellows / submitting-resolution-how-policy-developed
Dr . James is the Chief Medical Officer , Passport Health Plan by Molina Healthcare .