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AMA Resolution Would Seek to Label “Ungrateful†Patients

 

Redondo Beach, CA, June 11, 2009 - At the

American Medical Association’s (AMA) Annual Meeting next week,

delegates will vote on a resolution which proposes to develop CPT

(billing) codes to identify and label “non-compliant†patients (1) The resolution complains:

 

“The stress of dealing with ungrateful patients

is adding to the stress of physicians leading to decreased physician

satisfaction.†“This resolution is alarming in its

arrogance and its failure to recognize, or even pay lip service to,

patient autonomy,†said Desirre Andrews, the newly elected president of

the International Cesarean Awareness Network (ICAN). If

approved, the resolution could hold implications for women receiving

maternity care. For pregnant women seeking quality care and good

outcomes, “non-compliance†is often their only alternative to accepting

sub-standard care. Physicians routinely order interventions like

induction, episiotomy, or cesarean section unnecessarily.

Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies

by cesarean and was told by her obstetrician that she needed another

surgical delivery. “My doctor told me that I needed to have a cesarean

delivery at 39 weeks, or my uterus would rupture and my baby would

die.†She sought out another care provider and had a healthy and safe

intervention-free {home} birth at 41 weeks and 3 days gestation.

A recent report by Childbirth Connection and The Milbank Memorial Fund,

called “Evidence-Based Maternity Care: What It Is and What It Can

Achieve ,†(2)

shows that the state of maternity care in the U.S. is worrisome, driven

largely by a failure of care providers to heed evidence-based care

practices. For most women in the U.S., care practices that have been

proven to make childbirth easier and safer are underused, and

interventions that may increase risks to mothers and babies are

routinely overused. The authors of the report point to the “perinatal

paradox†of doing more, but accomplishing less. The

resolution proposed by the Michigan delegation of the AMA could

threaten patient care and patient autonomy for several reasons:

• Billing codes that would categorize any disagreement and exercise of

autonomy on the part of the patient as “non-compliance†“abuse†or

“hostility†could create a pathway for insurance companies to deny

coverage to patients • Use of these labels fails to recognize patients as competent partners with physicians in their own care

• Tagging patients as “non-compliant†fails to recognize that there is

not a “one size fits all†approach to care, that different opinions

among physicians abound, and that patients are entitled to these very

same differences of opinion • Labeling patients as

“non-compliant†may, in fact, be punitive, jeopardizing a patient’s

ability to seek out other care providers The resolution also

fails to address how it would implicate patients navigating

controversial issues in medical care, like vaginal birth after cesarean

(VBAC). While a substantive body of medical research demonstrates that

VBAC is reasonably safe, if not safer, than repeat cesareans, most

physicians and hospitals refuse to support VBAC. (3)

The language in the resolution suggests that patients who assert

their right to opt for VBAC could be tagged as non-compliant, even

though their choice would be consistent with the medical research.

“The reality is that the balance of power in the physician-patient

relationship is decidedly tipped towards physicians. The least

patients should have is the right to disagree with their doctors and

not be labeled a ‘naughty’ patient,†said Andrews. About Cesareans:

When a cesarean is medically necessary, it can be a lifesaving

technique for both mother and baby, and worth the risks involved.

Potential risks to babies from cesareans include: low birth weight,

prematurity, respiratory problems, and lacerations. Potential risks to women include:

hemorrhage, infection, hysterectomy, surgical mistakes,

re-hospitalization, dangerous placental abnormalities in future

pregnancies, unexplained stillbirth in future pregnancies and increased

percentage of maternal death. Mission statement: ICAN

is a nonprofit organization whose mission is to improve maternal-child

health by preventing unnecessary cesareans through education, providing

support for cesarean recovery and promoting vaginal birth after

cesarean. ICAN has 110 chapters in North America and Europe, which

hold educational and support meetings for people interested in cesarean

prevention and recovery.

 

(1) Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patientsâ€

(2) Evidence-Based Maternity Care: What It Is and What It Can Achieve

(3) http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans