Physicians see positive role for spirituality in medicine

At its 2016 Interim Meeting, in Orlando, Fla., the AMA House of Delegates adopted policies aimed at expanding access to spiritual care, mental health services, protecting newborns from harm, improving access to care for prisoners and ex-convicts, and supporting physicians’ efforts to highlight shortfalls in care.

With research suggesting that patient satisfaction is lower and cost of care is higher in the absence of spiritual support from care teams, the AMA adopted policy recognizing the importance of individual patient spirituality and its effect on health. Delegates also encouraged giving patients access to spiritual care services.

In addition, the AMA adopted policy “supporting mental health and faith community partnerships that foster improved education and understanding regarding culturally competent, medically accepted and scientifically proven methods of care for psychiatric and substance use disorders.” The policy says mental health professionals should better understand the role faith can play in mental health and addiction recovery for some patients. The AMA will support the efforts of mental health professionals to “create respectful, collaborative relationships with local religious leaders to improve access to scientifically sound mental health services.”

A rising number of college students are experiencing disorders such as depression, anxiety, suicidal ideation, alcohol misuse, eating disorders and self-injury. According to a 2014 National Survey of College Counseling Centers, 94 percent of surveyed college counseling directors reported that the number of students with significant mental health problems is a growing concern.

The AMA adopted policy supporting strategies to destigmatize mental illness and enable timely and affordable access to mental health services for undergraduate and graduate students. The Association will support college and university efforts to stress to undergraduate and graduate students and their parents the importance, availability and efficacy of mental health resources. Lastly, the policy supports collaborations among university mental health specialists and local public or private practices to provide a larger pool of resources, “such that any student is able to access care in a timely and affordable manner.”

“Many physicians-in-training do not seek out treatment for physical, mental health or addiction issues because they are concerned about confidentiality, the possible negative impact that receiving treatment could have on their future career in medicine, or burdening colleagues with extra work,” AMA Board Member and medical student Omar Z. Maniya said in a statement. “With a high number of medical students and residents experiencing depression, burnout and suicide, and too many physicians overlooking their own health needs, we must do everything we can to reduce the barriers and stigmas that keep them from receiving care.”

About 2.3 million Americans are incarcerated, including nearly 40,000 juveniles. According to research cited by the AMA Council on Medical Service, the incarcerated population has a higher rate of chronic diseases, mental health conditions, substance use disorders and contagious diseases than the general population. Incarcerated juveniles tend to have additional health challenges, such as recent histories of physical abuse or assault, sexual abuse or assault, victimization by sex trafficking, emotional abuse, neglect, traumatic loss and violence at home, in the community and in school.

The AMA adopted policy to address the health and health care access issues of people who are incarcerated. It directs the AMA to:

• Advocate adequate payment to physicians and other health professionals to encourage improved access to health care services for prisoners
• Support partnerships and information sharing among correctional systems, community health systems and state insurance programs to help prisoners access a continuum of health care
• Advocate the provision of gynecologic and obstetric care for incarcerated women and adolescent females
• Encourage state Medicaid agencies to maintain a prisoner’s Medicaid enrollment status throughout the incarceration process
• Encourage state Medicaid agencies to accept and process applications from prisoners and to work with the correctional system to help prisoners apply for  Medicaid
• Encourage state Medicaid agencies to cover health care services, such as care coordination, to help prisoners in transitioning into the community

The AMA adopted policy supporting implementation of newborn fall-prevention plans and post-fall procedures through clinically proven, high-quality and cost-effective approaches. These accidents most commonly occur when newborns fall out of the arms of sleeping parents. Such preventable falls, which happen as often as 1,600 times a year, can injure or even kill newborns and lead to severe emotional distress among parents and caregivers. Fall-prevention measures include improved awareness and education for parents and medical staff, better observation of mothers and newborns, patient-safety contracts, equipment safety protocols and post-fall procedures.

This policy builds on existing policies aimed at preventing accidental harm to children, including those encouraging CPR training for parents and caregivers, promoting the proper use of infant car seats and eliminating risk factors for sudden infant death syndrome.

The applications of genetic testing are expanding into whole-genome sequencing, carrier screening, prenatal testing, preimplantation genetic diagnosis, newborn screening and predictive testing. However, some physicians are not prepared to counsel patients on genetic testing results due to a lack of experience, perceived ethical, legal, and social implications, and difficulty in understanding the clinical impact of genetic test results. And more than half of primary care physicians say they lack access to genetics expertise that could help them navigate this new terrain.

The AMA adopted policy supporting:

• Appropriate use of pre- and post-test counseling for patients undergoing genetic testing
• Physician preparedness in counseling patients or referring them to qualified genetics specialists
• The development and dissemination of guidelines for best-practice standards concerning pre- and post-test genetic counseling
• Research and open discourse concerning issues in medical genetics, including genetic specialist workforce levels, physician preparedness in the provision of genetic testing and counseling services, and the impact of genetic testing and counseling on patient care and outcomes

In July, the AMA launched an online program aimed at educating physicians and other health professionals on the benefits and limitations of genetic testing and when it is appropriate to incorporate it into their practices. Modules from the series, called “Precision Medicine for Your Practice,” will be released individually over the next year and will be available online at the AMA Education Center. The modules focus on applications of genetic testing, which include expanded carrier screening, prenatal testing, targeted therapy in oncology, genomic sequencing, cardiogenomics, neurogenomics, pharmacogenomics and ethics in precision medicine.

Employed physicians are sometimes held accountable for problems that they lack the resources or authority to fix. The moral dilemmas created by accountability without authority can create stress, cause depression and contribute to physician burnout. In addition, fear of retaliation or can make many employed physicians unwilling to report problems when they encounter them, jeopardizing quality of care and putting patients at risk.

The AMA adopted policy supporting whistleblower protections for physicians and other health care providers who raise questions of quality, safety and efficacy of health care and are adversely treated by their employers. The new policy also calls for the AMA to advocate for language in medical staff bylaws to minimize negative repercussions for physicians who report problems in the workplace.

Chronic traumatic encephalopathy (CTE), a condition linked to cognitive impairment and mood disturbance that has been diagnosed postmortem in a growing number of football players, is thought to develop after repetitive brain injuries such as concussions. According to the Centers for Disease Control and Prevention, an estimated 250,000 children per year are treated in U.S. emergency departments for sports and recreation-related injuries causing concussions. And a 2011 study found that between 5 percent and 35 percent of the more than 1.5 million Americans in the military deployed to war zones since 2001 had sustained a concussion during their deployment. These numbers make it extremely important to better characterize the types of brain injuries that lead to CTE.

AMA delegates voted to support research into the detection, causes and prevention of injuries “along the continuum from subconcussive head impacts to conditions such as chronic traumatic encephalopathy.”

“With hundreds of thousands of Americans sustaining concussions each year, it is vital that we research the full continuum of head impacts,” AMA Board member Willarda V. Edwards, MD, said in a statement. “Whether the concussion occurs during youth sports like football, soccer, and basketball or during a military deployment, the insidious symptoms of CTE are occurring eight or 10 years after the inciting event. Further research into the causes, prevention, and detection of CTE are critical, but we must begin this effort by understanding how to prevent it.”

Earlier in the 2016 Interim Meeting, the AMA Board of Trustees honored Bennet I. Omalu, MD, MBA, MPH—the physician who first diagnosed CTE in an NFL player—with the Distinguished Service Award, the AMA’s highest honor.