Before I contribute to our SETI topic, I wanted to post about something that I've been deliberating over the past week or so. Recently, my med school email account has been flooded with emails asking me to join the
American Medical Association (AMA), not to be confused with the American Medical
Student Association (AMSA), which I'm a part of. Needless to say, I've done a lot of research about the organization, and the information I found was pretty interesting. I thought I would share some of this info, as well as how they are trying to entice me to join as a med student, since I feel like this is only the tip of the iceberg with regards to organizations/companies trying to get the support of med students and doctors.
The AMA was founded back in the mid 1800s, and it was basically
established to improve medical education, promote public health, advance medical science, and create a standard set of ethics for doctors around the country. Today, they claim to be the largest medical association in America. I was shocked to find out that less than 20% of doctors are actually members of the AMA, and about 30% of the members are actually medical students, residents, or fellows--not practicing, licensed, physicians. I think it would be accurate to say that most Americans believe that the AMA is the spokesperson for the beliefs of all physicians, but this is clearly not the case from these statistics. This is an important point.
The AMA does not speak for the majority of practicing physicians in the U.S. However, they are seen as having tremendous political power, acting as the lobbyist for the entire medical community. The President of the United States makes it a point to speak at AMA meetings every once in a while, and Obama was relieved that the AMA accepted the House Health Reform Bill not too long ago. The AMA also performs charity work on national and international levels, contributing money and physicians for public health improvement.
On to my dilemma.
The emails I have gotten about the AMA have all been incentive-oriented. Here's the basic layout of all these emails:
Hello, and congratulations on being accepted to _______ School of Medicine! I know how hard the first year of medical school can be, which is why I would like to invite you to join the largest support group of medical students in the nation. Because the AMA helps create policy, you can make a difference in the issues that matter most to students like us: expanding coverage for the uninsured, medical school loan debt relief and reasonable resident work hours. You also receive complimentary subscriptions to a number of AMA publications, most notably the Journal of the American Medical Association, to help keep you informed on these and other issues. We are currently offering a 4-year membership, which is $68, and free Netter Flashcards, a $35 value, which are essential for Human Structure. If you happen to already have the flashcards we also will have very nice dissection kits that you can choose instead, also a must have for Anatomy. Join the AMA today and start making a difference.
As much as I like flashcards and dissection kits, I wanted to know what the real benefits were of joining the organization. What better place to look but their
website, where they detail the top 10 reasons for joining. I won't spend too much time on them here, since you can read them for yourselves, but a good number of their reasons for joining are again these small incentives: flashcards, online subscriptions to their journal--which incidentily every medical student should have access to through their school, a residency search tool--which again everyone has access to (if you're a member, you can print mailing labels!), access to certain health policy internships in D.C. (politics isn't really my cup of tea as a med student...I rather spend the extra time doing something to increase my abilities as a physician, and worry about politics later), networking through conferences and meetings (networking as a med student should not be one of your highest priorities, in my opinion), and a web-based forum (now
that's cool!--sarcasm intended), and other misc. leadership opportunities/advocacy benefits. To be honest, I still wasn't persuaded to join or not to join at this point. I had to do more fishing around on their website, to get a clear idea of what they stood for ethics-wise.
Now, before I get into specific ethical stances, I want to discuss how the AMA works. Essentially, the AMA is a union. Doctors get benefits, and they agree to abide by certain rules and regulations of the union--otherwise, bad things happen. The code of ethics is basically the AMA's set of rules, and, as I understand it, members have to agree to the code to become members. What can the AMA do to doctors who don't abide by its rules? Well, the networking structure that the AMA has can be a blessing or a curse, depending what your standing is with them. For example, they could effectively cut off your referrals from other AMA members, making it harder to get patients. Word of mouth is an untamed beast, especially in medicine. Ultimately, they could kick you out of the organization for numerous violations of their code, which would not look good to anyone reviewing your CV. Fortunately (or unfortunately?) they do not have the membership that they once had, so dissenters of the AMA have much less to worry about than they used to.
Conveinently, the AMA has their
code of ethics section right on their website. I found a couple of entries in this code to be contrary to what I deem is ethically correct. The AMA believes that euthanasia and physician-assisted suicide are absolutely wrong in every case, and that performing these acts is "incompatibile with the physician in a role as healer." It's interesting, then, that palliative sedation is deemed ethically permissible by the AMA. If euthanasia and physician-assisted suicide are not allowed, why should palliative sedation be any different? Along these lines, I feel like the role of a physician is not only that of a healer, which seems to run counter to the very ideologies that the AMA holds. In the role of a healer, physicians treat diseases. They fix pathological issues in the body. Of course I do not disagree with this statement...this is what doctors do! But I feel that doctors should be treating
illnesses, which encompass much more than the disease itself. Illnesses affect the patient, their families, and their psychological, social, and physical issues. Doctors have a responsibility to care for the entire patient, something that I feel is lost in our culture of attacking diseases and waging wars against pathogens, etc. End-of-life care is as much in the doctors realm as is giving a vaccination to a child.
I also find objection to the AMA's stance on gift-giving by companies. While they do take a stance that is mainly anti-gifts, they do allow for companies to take physicians on trips and provide meals, etc. that are "for the ultimate benefit of the patient." I believe that under no circumstances should a doctor become entangled with the companies that provide them with medical supplies and equipment. The act in itself is not beneficial for the patient, as it may persuade the doctor to give medication or perform a procedure that is ultimately unnecessary or not in the patient's best interest.
Finally, I am not one to let others make decisions for me, which would essentially be the case both with advocacy in Washington and in providing care for my own patients if I became a member of the AMA. Members are finding this hard to swallow in recents weeks, with the AMA's support of the House Health Reform Bill. The former AMA president as well as various AMA regional groups are in strong opposition of the AMA's support of the bill, since it will decrease physician salaries and allow for less physician control in the care of their patients. They are finding out the hard way that only a select few people have a tremendous amount of power in the organization, determining organization-wide policy endorsements when there is considerable divide in the organization itself. That's a shitstorm that I will happily avoid.
So, in the end, I decided not to join the AMA. I felt that surrendering my ethics to the AMA was too high of a cost, not to be outweighed by the promise of professional networking and a nifty set of flashcards. As much as I appreciate their efforts to get higher salaries for physicians, money won't make me a better doctor. Having a good set of ethics will.
Jim