A Face-Lift for the Old Club

The A.M.A. adopts sweeping changes in its ethics code

For a long time the American Medical Association often seemed like a stuffy gentlemen's club: jealous of member privileges, adamantly opposed to change. It resisted Medicare, the federal medical program for the elderly, and still balks at government-run national health insurance. But lately the old club is becoming more relaxed. The latest sign of change came at the organization's annual meeting in Chicago last week. By an overwhelming margin, the A.M.A.'s 279-member legislative body, the house of delegates, approved sweeping revisions in the code of ethics that tells doctors how to conduct their practices.

The changes are the first in 23 years and only the fifth in the A.M.A.'s 133-year history. The key revisions:

> Strengthening the confidentiality of the physician-patient relationship, and calling for stronger self-policing in weeding out unethical and incompetent colleagues. Says Dr. James Todd, a Ridgewood, N.J., surgeon who headed the code-revision committee: "A lot of physicians don't like to concede that there are incompetent doctors. But we all know that there are incompetent people in any profession."

> Tacitly acknowledging the substantial role of so-called third parties--Blue Cross and Blue Shield, government agencies --in setting health policy. This was done by dropping the clause barring a physician from working "under terms or conditions which tend to interfere with or impair the free and complete exercise of his medical judgment or skill." Says Todd: "Interference? Medicare, Medicaid, insurance companies--all in some way tell a physician what he can do."

> Dropping the longstanding ban on physician advertising, a move ordered by the Federal Trade Commission. The old phrase directing doctors "not [to] solicit patients" was eliminated. So was the injunction against associating professionally with anyone who does not practice a "method of healing founded on a scientific basis." That leaves physicians free to refer patients to, as well as receive patients from, chiropractors, acupuncturists, herbalists, even faith healers. Says Todd: "Chiropractors are licensed in 50 states. We may not like them, but they are there."

While the A.M.A. stresses that the revisions were prompted by new knowledge and social awareness, it also admits that they are politically astute as well. As Todd explains, "There is great danger in no change because that will leave the profession out of step." Which is what seemed to be happening to the A.M.A. Twenty-five years ago, it spoke for nearly three-quarters of the country's doctors; today its 192,000 members account for less than half. The growth of consumerism, increased governmental scrutiny and new aggressiveness by other health-care groups have shaken the A.M.A.'s dominance. In addition to fighting the FTC order, the A.M.A. has been embroiled in litigation with chiropractors in Illinois, Iowa and New Jersey, and with the New York State attorney general, who charges that the A.M.A. has interfered with the freedom of medical practice. Defending itself now costs the association three-quarters of a million dollars a year in legal fees. Were the A.M.A. to lose the lawsuits, the association could go bankrupt. A bleak prognosis indeed.

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