Spotlight on Ethics
Over the last few years, the Academy’s Ethics Committee has observed an upward trend in complaints about unethical expert witness testimony. So far, this year appears to be no exception, as the committee has received more formal complaints (known as submissions) about expert witnesses than at this time last year.
The Ethics Committee has two major roles: adjudicating complaints of unethical behavior and educating members about the importance of ethics in practice.
Adjudicating complaints. One of the most important roles of the Ethics Committee is to review submissions and determine whether and how to act on them. When someone has a complaint about an ophthalmologist’s ethical conduct, that person can send the Ethics Committee a formal letter with specifics about the complaint and supporting documentation. Formal submissions come from all sources: ophthalmologists, patients, patients’ families, an MD’s staff, attorneys, and state and federal agencies. Many are anonymous. The subjects of submissions vary widely but can be narrowed down into the following general categories:
- Communications to public
- Pretreatment assessment
- Informed consent
- Postoperative care
- Patient care/relations
- Unnecessary surgery/procedures
- Comanagement arrangements
- Alternative therapies
- Expert witness testimony
Educating members. The committee long ago determined that “policing” members’ activities was not an effective long-term method of meeting its goals; thus its focus shifted toward education. To address ethical issues facing residents and practicing ophthalmologists, the committee implemented the Bettman Ethics Education Lecture Series in 1993 and in 2005 coauthored the BCSC companion volume, “The Profession of Ophthalmology.” The committee also has set expanded goals for the teaching of medical ethics in the national and international arenas and has worked on mediation as a potential dispute resolution tool.
Questions regarding the Academy’s Ethics Program may be answered at www.aao.org/about/ethics. You may also contact the ethics staff with questions at email@example.com.
TRENDS IN ETHICS. The numbers of submissions to the Ethics Committee about false, deceptive or misleading communications to the public have been in a primarily downward trend since 1986. Patient care continues to be a major concern with many more submissions coming from patients themselves. Expert witness testimony concerns are on the rise. (Select years are shown to illustrate trends.)
SOURCE: Tabulation of submissions per the Ethics Committee database
Dues Payment Reminder
Don’t miss out on your Academy benefits. Members who have not already paid their 2007 membership dues are being suspended this month and will no longer be eligible to receive Academy benefits. Payment of dues is required before members can register for the upcoming Annual Meeting in New Orleans. Suspended members also will no longer receive Ophthalmology, EyeNet Magazine and many other valuable benefits.
To pay your dues, contact Member Services at 866-561-8558 (toll-free in the United States) or 415-561-8581, or go to www.aao.org.
Current Insight Update
Current Insight is the Academy’s online, quarterly publication that provides clinically based assessments of recent developments in ophthalmology.
Free to Academy members, each quarterly edition features nine articles that collectively cover all ophthalmic subspecialties.
This quarter’s edition features expert opinions on a variety of topics, including:
- Tacrolimus in high-risk penetrating keratoplasty
- Recent findings from the monocular trials conducted in the Ocular Hypertension Treatment Study (OHTS)
- The current role of intraocular lenses in infants
- Management strategies for Intraoperative Floppy Iris Syndrome
To read the current edition or previously published editions of Current Insight, visit www.aao.org/current_insight.
Free Report on Acupuncture and AMD
The Academy’s latest Complementary Therapy Assessment (CTA), Acupuncture for Age-Related Macular Degeneration, is now available online, free of charge. CTAs evaluate treatments in eye care and develop an opinion on their safety and effectiveness based on available scientific evidence in order to inform ophthalmologists and their patients.
To read this CTA, go to www.aao.org/education and click “Clinical Statements” and “Complementary Therapy Assessments.”
The Academy will exhibit at two international meetings this month:
- June 9 to 12—European Society of Ophthalmology (SOE) Joint Congress with the Academy in Vienna, Austria. Booth #E27. Visit www.congrex.com/soe2007 for more information.
- June 20 to 25—XIV Afro-Asian Congress of Ophthalmology (AACO) in Marrakesh, Morocco. Visit www.aaco2007.org for more information.
What’s New With BCSC 2007–2008
The new edition of the Basic and Clinical Science Course is now available for ordering. Ten volumes have had minor updates and three have undergone major revisions:
- Section 4: Ophthalmic Pathology and Intraocular Tumors (Product #0280047) discusses advances in the diagnosis and classification of tumors and guides the reader through a tissue-specific sequence that ranges from topography through disease process to general and differential diagnosis. Many new pathologic and clinical photographs and diagrams highlight this latest revision. It covers wound repair, specimen handling—including processing and staining—and diagnostic techniques. It also features a checklist for requesting ophthalmic pathologic consultation.
- Section 7: Orbit, Eyelids, and Lacrimal System (#0280077) emphasizes a practical approach to diagnosis and treatment. This volume summarizes current information on congenital, infectious, inflammatory, neoplastic and traumatic conditions of the orbit and adnexa. Highlights include extensive discussion of thyroid-associated orbitopathy, lymphoproliferative disorders and eyelid neoplasms.
- Section 9: Intraocular Inflammation and Uveitis (#0280097) discusses the clinical approach to uveitis and includes rewritten chapters on noninfectious (autoimmune) and infectious forms of uveitis. It also covers endophthalmitis, masquerade syndromes and complications of uveitis. A discussion on ocular involvement in AIDS has been updated.
Order the complete set. An order for all 13 volumes includes a free copy of the Master Index (#0280957).
CD-ROM: Version 2. You can order the 2007–2008 BCSC CD-ROM beginning June 15 (#0282007). It will ship July 18 and offers all 13 sections, including more than 5,000 pages and 3,000 images on one disk.
BCSC Online. This product will be available for purchase in August. It allows for access to all 13 sections from any computer with an Internet connection.
CME. Each of the 13 BCSC volumes provides up to either 30 or 40 AMA PRA Category 1 credits .
To place an order or find out about pricing information, visit www.aao.org/bcsc or phone the Academy Service Center at 866-561-8558 (toll-free in the United States) or 415-561-8540.
Newest OTA: Laser Scanning Imaging for Macular Disease
The Ophthalmic Technology Assessment of Laser Scanning Imaging for Macular Disease (Product # 112058), published in Ophthalmology this month, evaluates the published literature to answer the question of whether laser scanning imaging is a sensitive and specific tool for detecting macular disease when compared with the current standard techniques of slit-lamp biomicroscopy or stereoscopic fundus photography. This product costs $11 for Academy members ($16 for nonmembers).
To place an order, visit www.aao.org/store or phone the Academy Service Center at 866-561-8558 (toll-free in the United States) or 415-561-8540. OTAs can also be downloaded for free online. Visit www.aao.org/education and click “Ophthalmic Technology Assessments.”
Members At Large
Summer Leadership Program for Women Eye M.D.s
“This important conference will focus on teaching leadership skills designed to en-hance the professional and personal lives of women physicians,” said Mildred M. G. Olivier, MD, the Women in Ophthalmology (WIO) participant in the Academy’s 2006–2007 Leadership Development Program (LDP). Dr. Olivier is referring to the 10th Annual WIO Symposium/ Inaugural Leadership Summit, which she is organizing to fulfill the project leadership component of the Academy’s LDP requirements.
The WIO conference will take place Aug. 2 to 4 in Sedona, Ariz. American Medical Association president-elect Nancy Nielsen, MD, will serve as the conference’s keynote speaker. Other women leaders in the medical field on the WIO agenda include Eve J. Higginbotham, MD, dean at Morehouse School of Medicine, and Vivien Pinn, MD, director of research on women’s health for the National Institutes of Health. Seminar topics include the art of negotiation, effective communication, volunteerism, political advocacy and organizational commitment.
Academy leaders are also slated to be a part of the program, including Cynthia A. Bradford, MD, secretary for state affairs, and Stephanie J. Marioneaux, MD, trustee-at-large, who has been involved for many years in the Academy’s LDP as a media spokeswoman.
The Academy’s medical director for health policy, William L. Rich III, MD, will also lend his expertise on the political landscape in Washington, D.C. Women leaders from industry, including Jacqueline Fause, Adrienne Graves, PhD, and Charlotte McKines are slated to be part of panels discussing effective negotiation skills. Jennifer Staples, who founded Unite for Sight when she was a sophomore at Yale University in 2000, will engage the audience to become more active in volunteerism efforts.
For more information about the conference, visit www.wioonline.org.
Who’s in the News
The San Francisco Chronicle interviewed Michael F. Marmor, MD, for an April 16 story on his use of historical documentation, medical knowledge and computer software to create blurred images of famous works by Claude Monet and Edgar Degas—both of whom suffered from debilitating retinal disease. Dr. Marmor is attempting to accurately depict the way the artists would have seen the works. “I thought it was important to actually see what they saw,” he said.
Winona, Minnesota’s Winona Daily News featured Terrence D. McCanna, MD, in an April 21 story about a bus driver with cataracts who died in a 2005 crash that also killed four others. Dr. McCanna testified in court that the driver had adequate vision for his profession despite cataracts.
How well does Avastin work for the eye problems of animals? J. Gregory Rosenthal, MD, was quoted in the March 11 issue of Toledo, Ohio’s The Blade for a story about Lulu, a local white rhinoceros, and the treatment of her conjunctival growth. Worried about the risks of anesthesia on such a large animal, Lulu’s zoo handlers called upon Dr. Rosenthal to administer Avastin. After two doses and a little time, the mass was reduced to a barely noticeable white dot.
East Brunwick, New Jersey’s Home News Tribune interviewed Jaime Santamaria II, MD, for a March 27 story on the successes of topical clear cornea surgery. “The idea is to give people the best vision they have had their whole lives,” Dr. Santamaria said. “This is incredible technology that is changing the way people live.”
Howard S. Weiss, MD, was interviewed by The Washington Post for a March 20 story on the practice among airline passengers of pouring sterile contact lens solution into smaller bottles to comply with federal regulations. “Don’t do it,” said Dr. Weiss, who noted that it compromises the sterility of the product.
Trenton, New Jersey’s The Times quoted Michael Y. Wong, MD, for an April 11 article about his surgery on a 6-year-old Palestinian girl who lost partial vision during a bombing raid in the Gaza Strip. “Humanity has no border,” said Dr.Wong. “In a doctor’s eyes there are no borders.”
Medicine Offers Solutions to SGR Problem
Earlier this year in its annual report to lawmakers, MedPAC laid out two different solutions to the problematic sustainable growth rate (SGR) payment formula. However, it stopped short of a formal recommendation.
Alternatives to the SGR. The first approach, which is supported by the Academy, the American Medical Association (AMA) and others, is repealing the SGR completely and abandoning the unworkable expenditure target approach. Instead, Medicare should pursue positive incentives for physicians to increase quality and cost-effective care under Medicare.
The second approach expands the expenditure target to cover all providers. To make the target expenditure more relevant to practitioners, target and updates could be set by geographic region. MedPAC proposes that this expenditure target option would require a complete overhaul of the Medicare payment system and a lengthy phase-in. Other challenges for a regional target approach include specialties such as ophthalmology that do not have significant relationships with other major providers such as hospitals who would now share the financial impact of their respective actions. In addition, varying payment levels by region is a political minefield.
The Academy, along with the AMA and others, sent a letter to Congress with recommendations for modifying physician payment formula while encouraging care that is both cost-effective and of high quality. The letter stated that Congress “should support initiatives by organizations representing physicians and others to bridge gaps in care and assure the appropriateness of services provided to beneficiaries.”
Alternatives for improving Medicare. To improve the value of the system, MedPAC suggested incentives for providers who give the best quality of care and use resources judiciously. A key step would include linking pay to quality, and payment for better care coordination for beneficiaries with chronic illness. MedPAC further suggests that certain physician practice groups could act as care coordinators for specific patients. As in previous reports, MedPAC suggests that Centers for Medicare & Medicaid Services (CMS) improve accuracy of pricing or determine the value of physician services by establishing an expert panel to review AMA/ Specialty Society Relative Value Scale Update Committee recommendations to CMS.
Congressional leaders expressed dismay with the lack of definitive recommendations and specifics. The Academy is working with the AMA and others to put forward a unified proposal that includes a long-term solution.
The Academy is working with others to put forward a unified long-term solution for improving Medicare.