Mary Ellen Schneider

ALEXANDRIA, VA. — Traditional tort reform measures like damage caps won't address some of the fundamental problems with the medical liability system, experts said at a meeting on patient safety and medical liability sponsored by the Joint Commission on Accreditation of Healthcare Organizations.

“The main reason most people sue is because they are angry at the physician,” said Lucian L. Leape, M.D., of the department of health policy and management at the Harvard School of Public Health, Boston. The medical community needs to address the reasons why people sue—injuries, unmet expenses, and anger. But the current system and the most commonly proposed reforms, such as damage caps, don't address the need to increase disclosure of errors to patients or encourage physicians to offer apologies.

In the current tort system, filing a lawsuit is often the only way that patients feel they can get information about what happened to them or impose a penalty on the physician, said Michelle Mello, Ph.D., also of the department of health policy and management at the Harvard School of Public Health. But this process often fails to secure an admission of responsibility or an apology, she said.

Damage caps also fail to address the poor correlation between medical injury and malpractice claims, she said. The malpractice system is “blocking efforts at patient safety,” said Troyen A. Brennan, M.D., professor of medicine at Harvard Medical School, Boston, and professor of law and public health at the Harvard School of Public Health.

A new system should be established to separate compensation for injuries from deterrence, he said. In order to do that, liability for negligence has to be eliminated, and reporting has to be made based on patient injury.

“You have to enable open and honest reporting,” Dr. Brennan said. And physicians have to realize that reporting patient injury is part of their professional responsibility. Currently, some physicians do not disclose errors or injuries. It's a rational economic response to their rising premiums and fear of being sued, he said, but it's not an ethical response.

ALEXANDRIA, VA. — Traditional tort reform measures like damage caps won't address some of the fundamental problems with the medical liability system, experts said at a meeting on patient safety and medical liability sponsored by the Joint Commission on Accreditation of Healthcare Organizations.

“The main reason most people sue is because they are angry at the physician,” said Lucian L. Leape, M.D., of the department of health policy and management at the Harvard School of Public Health, Boston. The medical community needs to address the reasons why people sue—injuries, unmet expenses, and anger. But the current system and the most commonly proposed reforms, such as damage caps, don't address the need to increase disclosure of errors to patients or encourage physicians to offer apologies.

In the current tort system, filing a lawsuit is often the only way that patients feel they can get information about what happened to them or impose a penalty on the physician, said Michelle Mello, Ph.D., also of the department of health policy and management at the Harvard School of Public Health. But this process often fails to secure an admission of responsibility or an apology, she said.

Damage caps also fail to address the poor correlation between medical injury and malpractice claims, she said. The malpractice system is “blocking efforts at patient safety,” said Troyen A. Brennan, M.D., professor of medicine at Harvard Medical School, Boston, and professor of law and public health at the Harvard School of Public Health.

A new system should be established to separate compensation for injuries from deterrence, he said. In order to do that, liability for negligence has to be eliminated, and reporting has to be made based on patient injury.

“You have to enable open and honest reporting,” Dr. Brennan said. And physicians have to realize that reporting patient injury is part of their professional responsibility. Currently, some physicians do not disclose errors or injuries. It's a rational economic response to their rising premiums and fear of being sued, he said, but it's not an ethical response.

ALEXANDRIA, VA. — Traditional tort reform measures like damage caps won't address some of the fundamental problems with the medical liability system, experts said at a meeting on patient safety and medical liability sponsored by the Joint Commission on Accreditation of Healthcare Organizations.

“The main reason most people sue is because they are angry at the physician,” said Lucian L. Leape, M.D., of the department of health policy and management at the Harvard School of Public Health, Boston. The medical community needs to address the reasons why people sue—injuries, unmet expenses, and anger. But the current system and the most commonly proposed reforms, such as damage caps, don't address the need to increase disclosure of errors to patients or encourage physicians to offer apologies.

In the current tort system, filing a lawsuit is often the only way that patients feel they can get information about what happened to them or impose a penalty on the physician, said Michelle Mello, Ph.D., also of the department of health policy and management at the Harvard School of Public Health. But this process often fails to secure an admission of responsibility or an apology, she said.

Damage caps also fail to address the poor correlation between medical injury and malpractice claims, she said. The malpractice system is “blocking efforts at patient safety,” said Troyen A. Brennan, M.D., professor of medicine at Harvard Medical School, Boston, and professor of law and public health at the Harvard School of Public Health.

A new system should be established to separate compensation for injuries from deterrence, he said. In order to do that, liability for negligence has to be eliminated, and reporting has to be made based on patient injury.

“You have to enable open and honest reporting,” Dr. Brennan said. And physicians have to realize that reporting patient injury is part of their professional responsibility. Currently, some physicians do not disclose errors or injuries. It's a rational economic response to their rising premiums and fear of being sued, he said, but it's not an ethical response.

Officials at the National Institutes of Health are tightening restrictions on outside consulting arrangements with industry after more than a year of investigations turned up potential conflicts of interest.

“Nothing is more important to me than preserving the trust of the public in NIH,” Elias A. Zerhouni, M.D., NIH director, said in a statement announcing the new ethics rules. “It is unfortunate that the activities of a few employees have tainted the stellar reputation of the many thousands of NIH scientists who have never compromised their integrity and have selflessly served the nation with great distinction through their discoveries.”

The new policy bars all NIH employees from engaging in compensated or uncompensated employment or consulting relationships with those organizations that are substantially affected by NIH decisions. Such organizations include pharmaceutical manufacturers, biotechnology companies, support research institutions, health care providers and insurers, and related trade and professional associations.

The policy also prohibits NIH employees from participating in compensated teaching, speaking, writing, or editing with these affected organizations.

Further, NIH employees are prohibited from self-employment activities that involve the sale or promotion of services or products from these organizations.

However, employees are allowed to teach courses that require multiple presentations and are part of an established curriculum at a university or college. They can also teach, speak, or write as part of a continuing education program. However, if the funding for the program comes from a substantially affected organization, like a drug company, it must be funded by an unrestricted grant.

NIH employees can also author articles, chapters, and textbooks that are subject to peer review provided that funding from affected organizations is in the form of unrestricted contributions.

Under the new policy, NIH employees are also allowed to continue clinical care to individual patients.

The new regulation also takes aim at stock ownership. NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in affected organizations including biotechnology, pharmaceutical, and medical device companies. All other NIH employees are subject to a $15,000 cap on such holdings.

“This new policy is an extension of a profession-wide examination of physicians' relationships to industry,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock. Medical schools are likely to be the next major institutions to seek out greater transparency in the relationships between their faculty members and industry, Dr. Golden predicted.

The interim final regulation was developed by the Department of Health and Human Services with the Office of Government Ethics and went into effect immediately. Officials at HHS will continue to review the impact of the regulation and work on developing a comprehensive policy regarding outside consulting activities.

The new policy comes after about a year of internal NIH investigations as well as congressional inquiries into consulting arrangements between NIH employees and outside companies. NIH officials had previously proposed a 1-year moratorium on all outside consulting arrangements.

“Though I believe that some outside activities are in the best interest of the public when designed to accelerate the development of new discoveries, we must first have better oversight systems to ensure transparency and sound ethical practices and procedures,” Dr. Zerhouni said.

The new policy was praised by the Association of American Medical Colleges. “The rules are clear and unambiguous and will enhance the public's confidence in the integrity and dedication of NIH employees and scientists,” AAMC President Jordan J. Cohen, M.D., said in statement.

“We also firmly support NIH's plan to assess the impact of these new rules within 1 year. Given the sweeping changes being made and the possibility of unintended consequences, it is prudent for the agency to undertake a thorough review after full implementation so that appropriate modifications can be made, if necessary.”

Officials at NIH also announced a new policy aimed at speeding the public's access to scientific articles that result from NIH-funded research.

Under the policy, the agency is calling on scientists to voluntarily release manuscripts supported by NIH to the public within a year of peer-reviewed publication.

These articles would then be made available online in an archive managed by the National Library of Medicine.

Officials at the National Institutes of Health are tightening restrictions on outside consulting arrangements with industry after more than a year of investigations turned up potential conflicts of interest.

“Nothing is more important to me than preserving the trust of the public in NIH,” Elias A. Zerhouni, M.D., NIH director, said in a statement announcing the new ethics rules. “It is unfortunate that the activities of a few employees have tainted the stellar reputation of the many thousands of NIH scientists who have never compromised their integrity and have selflessly served the nation with great distinction through their discoveries.”

The new policy bars all NIH employees from engaging in compensated or uncompensated employment or consulting relationships with those organizations that are substantially affected by NIH decisions. Such organizations include pharmaceutical manufacturers, biotechnology companies, support research institutions, health care providers and insurers, and related trade and professional associations.

The policy also prohibits NIH employees from participating in compensated teaching, speaking, writing, or editing with these affected organizations.

Further, NIH employees are prohibited from self-employment activities that involve the sale or promotion of services or products from these organizations.

However, employees are allowed to teach courses that require multiple presentations and are part of an established curriculum at a university or college. They can also teach, speak, or write as part of a continuing education program. However, if the funding for the program comes from a substantially affected organization, like a drug company, it must be funded by an unrestricted grant.

NIH employees can also author articles, chapters, and textbooks that are subject to peer review provided that funding from affected organizations is in the form of unrestricted contributions.

Under the new policy, NIH employees are also allowed to continue clinical care to individual patients.

The new regulation also takes aim at stock ownership. NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in affected organizations including biotechnology, pharmaceutical, and medical device companies. All other NIH employees are subject to a $15,000 cap on such holdings.

“This new policy is an extension of a profession-wide examination of physicians' relationships to industry,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock. Medical schools are likely to be the next major institutions to seek out greater transparency in the relationships between their faculty members and industry, Dr. Golden predicted.

The interim final regulation was developed by the Department of Health and Human Services with the Office of Government Ethics and went into effect immediately. Officials at HHS will continue to review the impact of the regulation and work on developing a comprehensive policy regarding outside consulting activities.

The new policy comes after about a year of internal NIH investigations as well as congressional inquiries into consulting arrangements between NIH employees and outside companies. NIH officials had previously proposed a 1-year moratorium on all outside consulting arrangements.

“Though I believe that some outside activities are in the best interest of the public when designed to accelerate the development of new discoveries, we must first have better oversight systems to ensure transparency and sound ethical practices and procedures,” Dr. Zerhouni said.

The new policy was praised by the Association of American Medical Colleges. “The rules are clear and unambiguous and will enhance the public's confidence in the integrity and dedication of NIH employees and scientists,” AAMC President Jordan J. Cohen, M.D., said in statement.

“We also firmly support NIH's plan to assess the impact of these new rules within 1 year. Given the sweeping changes being made and the possibility of unintended consequences, it is prudent for the agency to undertake a thorough review after full implementation so that appropriate modifications can be made, if necessary.”

Officials at NIH also announced a new policy aimed at speeding the public's access to scientific articles that result from NIH-funded research.

Under the policy, the agency is calling on scientists to voluntarily release manuscripts supported by NIH to the public within a year of peer-reviewed publication.

These articles would then be made available online in an archive managed by the National Library of Medicine.

Officials at the National Institutes of Health are tightening restrictions on outside consulting arrangements with industry after more than a year of investigations turned up potential conflicts of interest.

“Nothing is more important to me than preserving the trust of the public in NIH,” Elias A. Zerhouni, M.D., NIH director, said in a statement announcing the new ethics rules. “It is unfortunate that the activities of a few employees have tainted the stellar reputation of the many thousands of NIH scientists who have never compromised their integrity and have selflessly served the nation with great distinction through their discoveries.”

The new policy bars all NIH employees from engaging in compensated or uncompensated employment or consulting relationships with those organizations that are substantially affected by NIH decisions. Such organizations include pharmaceutical manufacturers, biotechnology companies, support research institutions, health care providers and insurers, and related trade and professional associations.

The policy also prohibits NIH employees from participating in compensated teaching, speaking, writing, or editing with these affected organizations.

Further, NIH employees are prohibited from self-employment activities that involve the sale or promotion of services or products from these organizations.

However, employees are allowed to teach courses that require multiple presentations and are part of an established curriculum at a university or college. They can also teach, speak, or write as part of a continuing education program. However, if the funding for the program comes from a substantially affected organization, like a drug company, it must be funded by an unrestricted grant.

NIH employees can also author articles, chapters, and textbooks that are subject to peer review provided that funding from affected organizations is in the form of unrestricted contributions.

Under the new policy, NIH employees are also allowed to continue clinical care to individual patients.

The new regulation also takes aim at stock ownership. NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in affected organizations including biotechnology, pharmaceutical, and medical device companies. All other NIH employees are subject to a $15,000 cap on such holdings.

“This new policy is an extension of a profession-wide examination of physicians' relationships to industry,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock. Medical schools are likely to be the next major institutions to seek out greater transparency in the relationships between their faculty members and industry, Dr. Golden predicted.

The interim final regulation was developed by the Department of Health and Human Services with the Office of Government Ethics and went into effect immediately. Officials at HHS will continue to review the impact of the regulation and work on developing a comprehensive policy regarding outside consulting activities.

The new policy comes after about a year of internal NIH investigations as well as congressional inquiries into consulting arrangements between NIH employees and outside companies. NIH officials had previously proposed a 1-year moratorium on all outside consulting arrangements.

“Though I believe that some outside activities are in the best interest of the public when designed to accelerate the development of new discoveries, we must first have better oversight systems to ensure transparency and sound ethical practices and procedures,” Dr. Zerhouni said.

The new policy was praised by the Association of American Medical Colleges. “The rules are clear and unambiguous and will enhance the public's confidence in the integrity and dedication of NIH employees and scientists,” AAMC President Jordan J. Cohen, M.D., said in statement.

“We also firmly support NIH's plan to assess the impact of these new rules within 1 year. Given the sweeping changes being made and the possibility of unintended consequences, it is prudent for the agency to undertake a thorough review after full implementation so that appropriate modifications can be made, if necessary.”

Officials at NIH also announced a new policy aimed at speeding the public's access to scientific articles that result from NIH-funded research.

Under the policy, the agency is calling on scientists to voluntarily release manuscripts supported by NIH to the public within a year of peer-reviewed publication.

These articles would then be made available online in an archive managed by the National Library of Medicine.

Currently available lines of human embryonic stem cells are contaminated with a nonhuman molecule that compromises their potential use in humans, according to a study from researchers at the University of California, San Diego, and the Salk Institute in La Jolla, Calif. The study was published in the online Jan. 23 issue of the journal Nature Medicine.

Supporters of expanding the federal policy on stem cell research touted the research as evidence that the current policy isn't working. In August 2001, President Bush announced a policy allowing federal funding for human embryonic stem cell research but only on a limited number of stem cell lines that were derived before Aug. 9, 2001. “Stem cell policy in 2005 should not be based on 2001 policy,” Rep. Mike Castle (R-Del.), said in a statement. “An expansion of this policy is critical to our scientists and researchers who need access to the best stem cell lines available and who want the important ethical guidance of the National Institutes of Health.”

Rep. Castle and Rep. Diana DeGette (D-Colo.) have been pushing for an easing of the 2001 federal policy.

Meanwhile, at the state level, some states want to follow in California's footsteps by attracting scientists to their states to conduct research on human embryonic stem cells. The governors of New Jersey and Connecticut have announced proposals to spend millions to entice stem cell researchers to their states, and a New York state senator wants to ask the state's voters for approval of a $1 billion stem cell research initiative.

Currently available lines of human embryonic stem cells are contaminated with a nonhuman molecule that compromises their potential use in humans, according to a study from researchers at the University of California, San Diego, and the Salk Institute in La Jolla, Calif. The study was published in the online Jan. 23 issue of the journal Nature Medicine.

Supporters of expanding the federal policy on stem cell research touted the research as evidence that the current policy isn't working. In August 2001, President Bush announced a policy allowing federal funding for human embryonic stem cell research but only on a limited number of stem cell lines that were derived before Aug. 9, 2001. “Stem cell policy in 2005 should not be based on 2001 policy,” Rep. Mike Castle (R-Del.), said in a statement. “An expansion of this policy is critical to our scientists and researchers who need access to the best stem cell lines available and who want the important ethical guidance of the National Institutes of Health.”

Rep. Castle and Rep. Diana DeGette (D-Colo.) have been pushing for an easing of the 2001 federal policy.

Meanwhile, at the state level, some states want to follow in California's footsteps by attracting scientists to their states to conduct research on human embryonic stem cells. The governors of New Jersey and Connecticut have announced proposals to spend millions to entice stem cell researchers to their states, and a New York state senator wants to ask the state's voters for approval of a $1 billion stem cell research initiative.

Currently available lines of human embryonic stem cells are contaminated with a nonhuman molecule that compromises their potential use in humans, according to a study from researchers at the University of California, San Diego, and the Salk Institute in La Jolla, Calif. The study was published in the online Jan. 23 issue of the journal Nature Medicine.

Supporters of expanding the federal policy on stem cell research touted the research as evidence that the current policy isn't working. In August 2001, President Bush announced a policy allowing federal funding for human embryonic stem cell research but only on a limited number of stem cell lines that were derived before Aug. 9, 2001. “Stem cell policy in 2005 should not be based on 2001 policy,” Rep. Mike Castle (R-Del.), said in a statement. “An expansion of this policy is critical to our scientists and researchers who need access to the best stem cell lines available and who want the important ethical guidance of the National Institutes of Health.”

Rep. Castle and Rep. Diana DeGette (D-Colo.) have been pushing for an easing of the 2001 federal policy.

Meanwhile, at the state level, some states want to follow in California's footsteps by attracting scientists to their states to conduct research on human embryonic stem cells. The governors of New Jersey and Connecticut have announced proposals to spend millions to entice stem cell researchers to their states, and a New York state senator wants to ask the state's voters for approval of a $1 billion stem cell research initiative.

This year, the American Board of Family Medicine is changing the way physicians perform chart review as part of their maintenance of certification.

Starting in January, the board replaced part 4 of the process—the traditional Computerized Office Record Review—with the new Performance in Practice Module. The PPM is a prospective system of evaluating and improving patient care.

“We'd really like to be able to assure our patients that family physicians are dedicated to performing quality medicine,” said Thomas Norris, M.D., president of the American Board of Family Medicine (ABFM) and vice dean for academic affairs at the University of Washington School of Medicine.

The new process will be similar to the old chart review system. Physicians will still be asked to submit information from selected patient records. However, whereas the old system was primarily aimed at maintaining high quality medical records, the new system will focus on evaluating systems of care and improving patient care, Dr. Norris said.

The information will be provided over the Internet and will be measured against evidence-based quality indicators. Physicians will receive feedback on their performance, and that information will be used to develop an individual quality improvement plan.

Later, physicians will be required to complete a follow-up record review to determine if their patient care has improved.

But the new process is likely to be less work for physicians than the old system, said ABFM executive director James C. Puffer, M.D. The system's prospective nature means that physicians won't spend as much time going back into records to extract information and that the board is requiring much less information from each of the patent charts, he said.

At press time, ABFM was finalizing its online instrument for completing the requirement. ABFM will offer physicians a choice of modules for either diabetes or hypertension this year. ABFM also plans to offer continuing medical education credit for the time spent completing the module.

In addition, the American Academy of Family Physicians has developed a program to aid physicians in completing the part 4 requirements of maintenance of certification. The program, called Measuring, Evaluating and Translating Research Into Care (METRIC), is awaiting approval from the American Board of Family Medicine.

METRIC is currently available for evaluation of diabetes care. AAFP plans to launch a coronary artery disease module in July and to continue to launch two new disease modules each year, according to Christine Pullman, METRIC program manager.

AAFP will also offer CME credit for physicians who complete the module.

The part 4 requirement was praised by Richard Feldman, M.D., chair of the board of the Indiana Academy of Family Medicine, who has been critical of other parts of the maintenance of certification process.

“It's probably the most important and positive addition that they've done to the whole program,” he said.

The new requirement gives physicians an opportunity to evaluate their performance and make positive changes in their practice routines, Dr. Feldman said, ultimately improving patient care.

This year, the American Board of Family Medicine is changing the way physicians perform chart review as part of their maintenance of certification.

Starting in January, the board replaced part 4 of the process—the traditional Computerized Office Record Review—with the new Performance in Practice Module. The PPM is a prospective system of evaluating and improving patient care.

“We'd really like to be able to assure our patients that family physicians are dedicated to performing quality medicine,” said Thomas Norris, M.D., president of the American Board of Family Medicine (ABFM) and vice dean for academic affairs at the University of Washington School of Medicine.

The new process will be similar to the old chart review system. Physicians will still be asked to submit information from selected patient records. However, whereas the old system was primarily aimed at maintaining high quality medical records, the new system will focus on evaluating systems of care and improving patient care, Dr. Norris said.

The information will be provided over the Internet and will be measured against evidence-based quality indicators. Physicians will receive feedback on their performance, and that information will be used to develop an individual quality improvement plan.

Later, physicians will be required to complete a follow-up record review to determine if their patient care has improved.

But the new process is likely to be less work for physicians than the old system, said ABFM executive director James C. Puffer, M.D. The system's prospective nature means that physicians won't spend as much time going back into records to extract information and that the board is requiring much less information from each of the patent charts, he said.

At press time, ABFM was finalizing its online instrument for completing the requirement. ABFM will offer physicians a choice of modules for either diabetes or hypertension this year. ABFM also plans to offer continuing medical education credit for the time spent completing the module.

In addition, the American Academy of Family Physicians has developed a program to aid physicians in completing the part 4 requirements of maintenance of certification. The program, called Measuring, Evaluating and Translating Research Into Care (METRIC), is awaiting approval from the American Board of Family Medicine.

METRIC is currently available for evaluation of diabetes care. AAFP plans to launch a coronary artery disease module in July and to continue to launch two new disease modules each year, according to Christine Pullman, METRIC program manager.

AAFP will also offer CME credit for physicians who complete the module.

The part 4 requirement was praised by Richard Feldman, M.D., chair of the board of the Indiana Academy of Family Medicine, who has been critical of other parts of the maintenance of certification process.

“It's probably the most important and positive addition that they've done to the whole program,” he said.

The new requirement gives physicians an opportunity to evaluate their performance and make positive changes in their practice routines, Dr. Feldman said, ultimately improving patient care.

This year, the American Board of Family Medicine is changing the way physicians perform chart review as part of their maintenance of certification.

Starting in January, the board replaced part 4 of the process—the traditional Computerized Office Record Review—with the new Performance in Practice Module. The PPM is a prospective system of evaluating and improving patient care.

“We'd really like to be able to assure our patients that family physicians are dedicated to performing quality medicine,” said Thomas Norris, M.D., president of the American Board of Family Medicine (ABFM) and vice dean for academic affairs at the University of Washington School of Medicine.

The new process will be similar to the old chart review system. Physicians will still be asked to submit information from selected patient records. However, whereas the old system was primarily aimed at maintaining high quality medical records, the new system will focus on evaluating systems of care and improving patient care, Dr. Norris said.

The information will be provided over the Internet and will be measured against evidence-based quality indicators. Physicians will receive feedback on their performance, and that information will be used to develop an individual quality improvement plan.

Later, physicians will be required to complete a follow-up record review to determine if their patient care has improved.

But the new process is likely to be less work for physicians than the old system, said ABFM executive director James C. Puffer, M.D. The system's prospective nature means that physicians won't spend as much time going back into records to extract information and that the board is requiring much less information from each of the patent charts, he said.

At press time, ABFM was finalizing its online instrument for completing the requirement. ABFM will offer physicians a choice of modules for either diabetes or hypertension this year. ABFM also plans to offer continuing medical education credit for the time spent completing the module.

In addition, the American Academy of Family Physicians has developed a program to aid physicians in completing the part 4 requirements of maintenance of certification. The program, called Measuring, Evaluating and Translating Research Into Care (METRIC), is awaiting approval from the American Board of Family Medicine.

METRIC is currently available for evaluation of diabetes care. AAFP plans to launch a coronary artery disease module in July and to continue to launch two new disease modules each year, according to Christine Pullman, METRIC program manager.

AAFP will also offer CME credit for physicians who complete the module.

The part 4 requirement was praised by Richard Feldman, M.D., chair of the board of the Indiana Academy of Family Medicine, who has been critical of other parts of the maintenance of certification process.

“It's probably the most important and positive addition that they've done to the whole program,” he said.

The new requirement gives physicians an opportunity to evaluate their performance and make positive changes in their practice routines, Dr. Feldman said, ultimately improving patient care.

Laws that require parental notification for teens to receive prescription contraception at family planning clinics could increase the risk of teen pregnancy, according to a study by Rachel Jones, Ph.D., and her colleagues.

“Family planning clinics need to be supported in the work that they are doing with teens,” said Dr. Jones, senior research associate at the Alan Guttmacher Institute (JAMA 2005;293:340-8).

The study found that if a law required clinics to inform parents in writing when their teenagers got prescription birth control, 18% of teens would have sex using no contraceptive method or would rely on rhythm or withdrawal. About 1% of teens surveyed said their only reaction to such a law would be to stop having sex.

Most teens said they would continue to use the services at the clinic even if parental notification was required or would use over-the-counter contraceptives, such as condoms.

The implications are that mandated parental notification laws would discourage few teens from having sex and would likely increase rates of adolescent pregnancy and sexually transmitted diseases, the study authors concluded.

The study was based on a nationwide survey of 1,526 adolescent females under age 18 years who were seeking sexual health services, excluding abortion and prenatal and postnatal care, at publicly funded family planning clinics in 33 states.

About 60% of respondents said their parents were aware that they were using a clinic for sexual health services. In most cases, the teens had either voluntarily told their parents or they had come to the clinic at a parent's suggestion.

About one-third of teens surveyed said that their parent or guardian was unaware that they were obtaining sexual health services at the clinic. About 4% said they were unsure if their parents knew.

Reasons respondents gave for not informing their parents included:

▸Not wanting parents to know of the teen's sexual activity.

▸Not wanting parents to be disappointed by the teen's sexual activity.

▸Not feeling comfortable with discussing sex with their parents.

▸Not wanting parents to know the reason for the teen's clinic visit.

▸Wanting to take responsibility for their own health.

Concerned Women for America (CWA), a group that supports abstinence-only education, discounted the study. CWA said the study is biased because its authors are researchers associated with the Alan Guttmacher Institute, which is affiliated with Planned Parenthood.

“Policymakers need to stop treating parents as a suspect class, presumed not to have their own kids' best interests at heart,” Wendy Wright, CWA's senior policy director, said in a statement. “Adolescents benefit when their parents are involved in their lives, and policymakers shouldn't forbid their involvement in their daughters' and sons' most important decisions.”

Texas and Utah currently require parental consent for teenage use of state-funded family planning services, and a similar restriction exists in one county in Illinois. Last year, lawmakers in Kentucky, Minnesota, and Virginia introduced bills to impose parental consent requirements on teens seeking contraception.

On the federal level, lawmakers have introduced proposals in recent years to require parental involvement in teenagers seeking contraceptives at federally funded clinics; none has become law.

“All this history does not bode well for the future,” Cynthia Dailard said in a teleconference sponsored by the Alan Guttmacher Institute. Ms. Dailard, a public policy associate at the institute, predicted that parental notification for sexual health services will be high on the federal agenda in the wake of the 2004 elections. Also, several newly elected senators have aggressively advocated against the use of federal dollars for family planning, she said.

Laws that require parental notification for teens to receive prescription contraception at family planning clinics could increase the risk of teen pregnancy, according to a study by Rachel Jones, Ph.D., and her colleagues.

“Family planning clinics need to be supported in the work that they are doing with teens,” said Dr. Jones, senior research associate at the Alan Guttmacher Institute (JAMA 2005;293:340-8).

The study found that if a law required clinics to inform parents in writing when their teenagers got prescription birth control, 18% of teens would have sex using no contraceptive method or would rely on rhythm or withdrawal. About 1% of teens surveyed said their only reaction to such a law would be to stop having sex.

Most teens said they would continue to use the services at the clinic even if parental notification was required or would use over-the-counter contraceptives, such as condoms.

The implications are that mandated parental notification laws would discourage few teens from having sex and would likely increase rates of adolescent pregnancy and sexually transmitted diseases, the study authors concluded.

The study was based on a nationwide survey of 1,526 adolescent females under age 18 years who were seeking sexual health services, excluding abortion and prenatal and postnatal care, at publicly funded family planning clinics in 33 states.

About 60% of respondents said their parents were aware that they were using a clinic for sexual health services. In most cases, the teens had either voluntarily told their parents or they had come to the clinic at a parent's suggestion.

About one-third of teens surveyed said that their parent or guardian was unaware that they were obtaining sexual health services at the clinic. About 4% said they were unsure if their parents knew.

Reasons respondents gave for not informing their parents included:

▸Not wanting parents to know of the teen's sexual activity.

▸Not wanting parents to be disappointed by the teen's sexual activity.

▸Not feeling comfortable with discussing sex with their parents.

▸Not wanting parents to know the reason for the teen's clinic visit.

▸Wanting to take responsibility for their own health.

Concerned Women for America (CWA), a group that supports abstinence-only education, discounted the study. CWA said the study is biased because its authors are researchers associated with the Alan Guttmacher Institute, which is affiliated with Planned Parenthood.

“Policymakers need to stop treating parents as a suspect class, presumed not to have their own kids' best interests at heart,” Wendy Wright, CWA's senior policy director, said in a statement. “Adolescents benefit when their parents are involved in their lives, and policymakers shouldn't forbid their involvement in their daughters' and sons' most important decisions.”

Texas and Utah currently require parental consent for teenage use of state-funded family planning services, and a similar restriction exists in one county in Illinois. Last year, lawmakers in Kentucky, Minnesota, and Virginia introduced bills to impose parental consent requirements on teens seeking contraception.

On the federal level, lawmakers have introduced proposals in recent years to require parental involvement in teenagers seeking contraceptives at federally funded clinics; none has become law.

“All this history does not bode well for the future,” Cynthia Dailard said in a teleconference sponsored by the Alan Guttmacher Institute. Ms. Dailard, a public policy associate at the institute, predicted that parental notification for sexual health services will be high on the federal agenda in the wake of the 2004 elections. Also, several newly elected senators have aggressively advocated against the use of federal dollars for family planning, she said.

Laws that require parental notification for teens to receive prescription contraception at family planning clinics could increase the risk of teen pregnancy, according to a study by Rachel Jones, Ph.D., and her colleagues.

“Family planning clinics need to be supported in the work that they are doing with teens,” said Dr. Jones, senior research associate at the Alan Guttmacher Institute (JAMA 2005;293:340-8).

The study found that if a law required clinics to inform parents in writing when their teenagers got prescription birth control, 18% of teens would have sex using no contraceptive method or would rely on rhythm or withdrawal. About 1% of teens surveyed said their only reaction to such a law would be to stop having sex.

Most teens said they would continue to use the services at the clinic even if parental notification was required or would use over-the-counter contraceptives, such as condoms.

The implications are that mandated parental notification laws would discourage few teens from having sex and would likely increase rates of adolescent pregnancy and sexually transmitted diseases, the study authors concluded.

The study was based on a nationwide survey of 1,526 adolescent females under age 18 years who were seeking sexual health services, excluding abortion and prenatal and postnatal care, at publicly funded family planning clinics in 33 states.

About 60% of respondents said their parents were aware that they were using a clinic for sexual health services. In most cases, the teens had either voluntarily told their parents or they had come to the clinic at a parent's suggestion.

About one-third of teens surveyed said that their parent or guardian was unaware that they were obtaining sexual health services at the clinic. About 4% said they were unsure if their parents knew.

Reasons respondents gave for not informing their parents included:

▸Not wanting parents to know of the teen's sexual activity.

▸Not wanting parents to be disappointed by the teen's sexual activity.

▸Not feeling comfortable with discussing sex with their parents.

▸Not wanting parents to know the reason for the teen's clinic visit.

▸Wanting to take responsibility for their own health.

Concerned Women for America (CWA), a group that supports abstinence-only education, discounted the study. CWA said the study is biased because its authors are researchers associated with the Alan Guttmacher Institute, which is affiliated with Planned Parenthood.

“Policymakers need to stop treating parents as a suspect class, presumed not to have their own kids' best interests at heart,” Wendy Wright, CWA's senior policy director, said in a statement. “Adolescents benefit when their parents are involved in their lives, and policymakers shouldn't forbid their involvement in their daughters' and sons' most important decisions.”

Texas and Utah currently require parental consent for teenage use of state-funded family planning services, and a similar restriction exists in one county in Illinois. Last year, lawmakers in Kentucky, Minnesota, and Virginia introduced bills to impose parental consent requirements on teens seeking contraception.

On the federal level, lawmakers have introduced proposals in recent years to require parental involvement in teenagers seeking contraceptives at federally funded clinics; none has become law.

“All this history does not bode well for the future,” Cynthia Dailard said in a teleconference sponsored by the Alan Guttmacher Institute. Ms. Dailard, a public policy associate at the institute, predicted that parental notification for sexual health services will be high on the federal agenda in the wake of the 2004 elections. Also, several newly elected senators have aggressively advocated against the use of federal dollars for family planning, she said.

WASHINGTON – Complementary and alternative therapies should be held to the same standards as conventional treatments, according to a new report from the Institute of Medicine.

“Complementary and alternative medicine [CAM] use is widespread and here to stay,” Stuart Bondurant, M.D., said at a press briefing sponsored by the institute. “The same rules should apply for testing of effectiveness and safety regardless of the origin, whether CAM or conventional medicine.”

Already, the use of CAM therapies in the United States is widespread and amounts to $27 billion a year in out-of-pocket costs by consumers, a figure that is comparable with the projected out-of-pocket expenditures for all U.S. physician services, the report said. In 1997, the total number of visits to CAM providers (629 million) outpaced the total number of visits to all primary care physicians (386 million), according to a survey from that year.

But despite the increases in the use of CAM services, few patients are disclosing their use of CAM therapies to their physicians. Less than 40% of CAM users told their physicians about their use of alternative therapies, according to surveys conducted in 1990 and 1997.

The IOM committee defined CAM broadly as encompassing “health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period.” The committee's definition also states that CAM includes resources that patients perceive as being associated with positive health outcomes.

While the same principles should be used in evaluating both conventional and alternative treatments, some new testing methods may have to be devised for CAM therapies, said Dr. Bondurant, interim executive vice president and executive dean of Georgetown University Medical Center in Washington.

For example, randomized controlled trials might not be appropriate for all CAM treatments. However, other innovative designs include preference trials that include randomized and nonrandomized arms, observational and cohort studies, case-control studies, studies of bundles of therapies, studies that specifically account for placebo or expectation effects, and attribute-treatment interaction analyses.

The committee also recommended that physicians and other health care providers should be educated about CAM therapies. Medical schools should incorporate information about CAM treatment in their curricula and it should continue to be addressed in CME courses.

Training programs can incorporate CAM information in a way similar to how they have addressed areas such as geriatrics and HIV/AIDS over the last decade, said committee member Florence Comite, M.D., of Yale University, New Haven.

Licensing boards and accrediting and certifying organizations should set competency standards for the appropriate use of both conventional medicine and CAM, the committee said.

CAM practitioners also have a role to play by being trained as researchers. This approach would help to ensure that the research reflects the actual ways in which CAM therapies are used, the report said. CAM practitioners should also work to develop practice guidelines for CAM therapies, the committee recommended.

“The intent of the report is not to medicalize or co-opt CAM but to sustain the existing forms of validated CAM therapies whether integrated into conventional practices or continuing as freestanding approaches,” Dr. Bondurant said. “The committee urged that great care be taken to test CAM therapies in the ways that they are actually used.”

The report also addresses the area of dietary supplements by calling on Congress and other federal agencies to amend the Dietary Supplement Health and Education Act of 1994. The law should be changed to strengthen quality control, accuracy and comprehensiveness in labeling, enforcement actions for misleading claims, and consumer protection, the committee said.

The National Institutes of Health and the Agency for Healthcare Research and Quality requested the report.

The IOM report is available online at http://national-academies.org

WASHINGTON – Complementary and alternative therapies should be held to the same standards as conventional treatments, according to a new report from the Institute of Medicine.

“Complementary and alternative medicine [CAM] use is widespread and here to stay,” Stuart Bondurant, M.D., said at a press briefing sponsored by the institute. “The same rules should apply for testing of effectiveness and safety regardless of the origin, whether CAM or conventional medicine.”

Already, the use of CAM therapies in the United States is widespread and amounts to $27 billion a year in out-of-pocket costs by consumers, a figure that is comparable with the projected out-of-pocket expenditures for all U.S. physician services, the report said. In 1997, the total number of visits to CAM providers (629 million) outpaced the total number of visits to all primary care physicians (386 million), according to a survey from that year.

But despite the increases in the use of CAM services, few patients are disclosing their use of CAM therapies to their physicians. Less than 40% of CAM users told their physicians about their use of alternative therapies, according to surveys conducted in 1990 and 1997.

The IOM committee defined CAM broadly as encompassing “health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period.” The committee's definition also states that CAM includes resources that patients perceive as being associated with positive health outcomes.

While the same principles should be used in evaluating both conventional and alternative treatments, some new testing methods may have to be devised for CAM therapies, said Dr. Bondurant, interim executive vice president and executive dean of Georgetown University Medical Center in Washington.

For example, randomized controlled trials might not be appropriate for all CAM treatments. However, other innovative designs include preference trials that include randomized and nonrandomized arms, observational and cohort studies, case-control studies, studies of bundles of therapies, studies that specifically account for placebo or expectation effects, and attribute-treatment interaction analyses.

The committee also recommended that physicians and other health care providers should be educated about CAM therapies. Medical schools should incorporate information about CAM treatment in their curricula and it should continue to be addressed in CME courses.

Training programs can incorporate CAM information in a way similar to how they have addressed areas such as geriatrics and HIV/AIDS over the last decade, said committee member Florence Comite, M.D., of Yale University, New Haven.

Licensing boards and accrediting and certifying organizations should set competency standards for the appropriate use of both conventional medicine and CAM, the committee said.

CAM practitioners also have a role to play by being trained as researchers. This approach would help to ensure that the research reflects the actual ways in which CAM therapies are used, the report said. CAM practitioners should also work to develop practice guidelines for CAM therapies, the committee recommended.

“The intent of the report is not to medicalize or co-opt CAM but to sustain the existing forms of validated CAM therapies whether integrated into conventional practices or continuing as freestanding approaches,” Dr. Bondurant said. “The committee urged that great care be taken to test CAM therapies in the ways that they are actually used.”

The report also addresses the area of dietary supplements by calling on Congress and other federal agencies to amend the Dietary Supplement Health and Education Act of 1994. The law should be changed to strengthen quality control, accuracy and comprehensiveness in labeling, enforcement actions for misleading claims, and consumer protection, the committee said.

The National Institutes of Health and the Agency for Healthcare Research and Quality requested the report.

The IOM report is available online at http://national-academies.org

WASHINGTON – Complementary and alternative therapies should be held to the same standards as conventional treatments, according to a new report from the Institute of Medicine.

“Complementary and alternative medicine [CAM] use is widespread and here to stay,” Stuart Bondurant, M.D., said at a press briefing sponsored by the institute. “The same rules should apply for testing of effectiveness and safety regardless of the origin, whether CAM or conventional medicine.”

Already, the use of CAM therapies in the United States is widespread and amounts to $27 billion a year in out-of-pocket costs by consumers, a figure that is comparable with the projected out-of-pocket expenditures for all U.S. physician services, the report said. In 1997, the total number of visits to CAM providers (629 million) outpaced the total number of visits to all primary care physicians (386 million), according to a survey from that year.

But despite the increases in the use of CAM services, few patients are disclosing their use of CAM therapies to their physicians. Less than 40% of CAM users told their physicians about their use of alternative therapies, according to surveys conducted in 1990 and 1997.

The IOM committee defined CAM broadly as encompassing “health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period.” The committee's definition also states that CAM includes resources that patients perceive as being associated with positive health outcomes.

While the same principles should be used in evaluating both conventional and alternative treatments, some new testing methods may have to be devised for CAM therapies, said Dr. Bondurant, interim executive vice president and executive dean of Georgetown University Medical Center in Washington.

For example, randomized controlled trials might not be appropriate for all CAM treatments. However, other innovative designs include preference trials that include randomized and nonrandomized arms, observational and cohort studies, case-control studies, studies of bundles of therapies, studies that specifically account for placebo or expectation effects, and attribute-treatment interaction analyses.

The committee also recommended that physicians and other health care providers should be educated about CAM therapies. Medical schools should incorporate information about CAM treatment in their curricula and it should continue to be addressed in CME courses.

Training programs can incorporate CAM information in a way similar to how they have addressed areas such as geriatrics and HIV/AIDS over the last decade, said committee member Florence Comite, M.D., of Yale University, New Haven.

Licensing boards and accrediting and certifying organizations should set competency standards for the appropriate use of both conventional medicine and CAM, the committee said.

CAM practitioners also have a role to play by being trained as researchers. This approach would help to ensure that the research reflects the actual ways in which CAM therapies are used, the report said. CAM practitioners should also work to develop practice guidelines for CAM therapies, the committee recommended.

“The intent of the report is not to medicalize or co-opt CAM but to sustain the existing forms of validated CAM therapies whether integrated into conventional practices or continuing as freestanding approaches,” Dr. Bondurant said. “The committee urged that great care be taken to test CAM therapies in the ways that they are actually used.”

The report also addresses the area of dietary supplements by calling on Congress and other federal agencies to amend the Dietary Supplement Health and Education Act of 1994. The law should be changed to strengthen quality control, accuracy and comprehensiveness in labeling, enforcement actions for misleading claims, and consumer protection, the committee said.

The National Institutes of Health and the Agency for Healthcare Research and Quality requested the report.

The IOM report is available online at http://national-academies.org

A new organization is moving forward with plans to provide accreditation and certification services for neurology subspecialties.

The United Council for Neurologic Subspecialties (UCNS) is currently working on accreditation and certification standards in the area of behavioral neurology and neuropsychiatry. Accreditation standards for behavioral neurology and neuropsychiatry are expected to be available early this year and certification standards are expected to be available in 2006.

In addition, the group is reviewing applications from five other neurology subspecialties that are seeking to pursue accreditation and certification through UCNS. Officials at UCNS are keeping the names of the subspecialties that have applied for membership confidential until the process is complete.

UCNS was launched in 2003 to provide accreditation and certification of neurology subspecialties that are at an early stage in their development process. The group was established by the American Academy of Neurology, the American Neurological Association, the Association of University Professors of Neurology, the Child Neurology Society, and the Professors of Child Neurology.

The new body provides an alternative pathway for subspecialties that are established enough for accreditation and certification but are not large enough to go through the traditional routes–accreditation through the Accreditation Council for Graduate Medical Education (ACGME) and certification through the American Board of Medical Specialties (ABMS).

For example, the vascular neurology subspecialty recently succeeded in getting a certification exam for its subspecialists through ABMS; however, the subspecialty of behavioral neurology and neuropsychiatry is much smaller and requires more developmental support to navigate the process.

The ACGME and ABMS criteria have been used as models for the UCNS requirements.

“We felt we needed to offer this,” said Stephen Sergay, M.D., chair of UCNS and a clinical neurologist in Tampa, Fla.

For more than a decade, subspecialties have been a major part of neurology, Dr. Sergay said, but there has not been a recognition of the extra time and training that neurologists have invested in their subspecialty area.

Accreditation and certification for these subspecialties will help to ensure high-quality patient care, he said.

The activities of UCNS will also have a positive impact on the cohesiveness of the approach to training for various subspecialties, Dr. Sergay said. Currently, there may be five training programs in a given subspecialty, and they will all be slightly different. Now, the sponsoring organizations for a new subspecialty will have to come to a consensus on a core curriculum and training requirements before they apply for membership in UCNS.

That made the subspecialty of behavioral neurology and neuropsychiatry a good fit for UCNS since so much work had already been done on establishing a core curriculum in the field, said David L. Bachman, M.D., president of the Society for Behavioral and Cognitive Neurology, one of the groups that sponsored the subspecialty for membership with UCNS. Dr. Bachman chairs the behavioral neurology section for the American Academy of Neurology and is director of the division of adult neurology at the Medical University of South Carolina in Charleston.

UCNS recently finished a draft of the application form that will be used to accredit training programs in behavioral neurology and neuropsychiatry. The application form was developed according to the training requirements provided by the subspecialty.

Currently, nine training programs have agreed to pilot the form. These programs will review the form and provide comments to UCNS.

“We want the programs to feel comfortable that these are reasonable criteria that people can live with,” said Dr. Bachman, who now sits on the UCNS board of directors as a representative of his specialty.

It's likely that the training programs will be able to begin applying early this year and UCNS plans to begin accrediting programs in the fall, said Mari Mellick, UCNS manager, in St. Paul.

Certification for physicians will run on a parallel track to accreditation, Dr. Bachman said. There are a number of people who have already been trained in behavioral neurology and neuropsychiatry. As a result, leaders from the subspecialty and officials at UCNS are also working to develop grandfathering criteria for those physicians who have already been training in this field.

A new organization is moving forward with plans to provide accreditation and certification services for neurology subspecialties.

The United Council for Neurologic Subspecialties (UCNS) is currently working on accreditation and certification standards in the area of behavioral neurology and neuropsychiatry. Accreditation standards for behavioral neurology and neuropsychiatry are expected to be available early this year and certification standards are expected to be available in 2006.

In addition, the group is reviewing applications from five other neurology subspecialties that are seeking to pursue accreditation and certification through UCNS. Officials at UCNS are keeping the names of the subspecialties that have applied for membership confidential until the process is complete.

UCNS was launched in 2003 to provide accreditation and certification of neurology subspecialties that are at an early stage in their development process. The group was established by the American Academy of Neurology, the American Neurological Association, the Association of University Professors of Neurology, the Child Neurology Society, and the Professors of Child Neurology.

The new body provides an alternative pathway for subspecialties that are established enough for accreditation and certification but are not large enough to go through the traditional routes–accreditation through the Accreditation Council for Graduate Medical Education (ACGME) and certification through the American Board of Medical Specialties (ABMS).

For example, the vascular neurology subspecialty recently succeeded in getting a certification exam for its subspecialists through ABMS; however, the subspecialty of behavioral neurology and neuropsychiatry is much smaller and requires more developmental support to navigate the process.

The ACGME and ABMS criteria have been used as models for the UCNS requirements.

“We felt we needed to offer this,” said Stephen Sergay, M.D., chair of UCNS and a clinical neurologist in Tampa, Fla.

For more than a decade, subspecialties have been a major part of neurology, Dr. Sergay said, but there has not been a recognition of the extra time and training that neurologists have invested in their subspecialty area.

Accreditation and certification for these subspecialties will help to ensure high-quality patient care, he said.

The activities of UCNS will also have a positive impact on the cohesiveness of the approach to training for various subspecialties, Dr. Sergay said. Currently, there may be five training programs in a given subspecialty, and they will all be slightly different. Now, the sponsoring organizations for a new subspecialty will have to come to a consensus on a core curriculum and training requirements before they apply for membership in UCNS.

That made the subspecialty of behavioral neurology and neuropsychiatry a good fit for UCNS since so much work had already been done on establishing a core curriculum in the field, said David L. Bachman, M.D., president of the Society for Behavioral and Cognitive Neurology, one of the groups that sponsored the subspecialty for membership with UCNS. Dr. Bachman chairs the behavioral neurology section for the American Academy of Neurology and is director of the division of adult neurology at the Medical University of South Carolina in Charleston.

UCNS recently finished a draft of the application form that will be used to accredit training programs in behavioral neurology and neuropsychiatry. The application form was developed according to the training requirements provided by the subspecialty.

Currently, nine training programs have agreed to pilot the form. These programs will review the form and provide comments to UCNS.

“We want the programs to feel comfortable that these are reasonable criteria that people can live with,” said Dr. Bachman, who now sits on the UCNS board of directors as a representative of his specialty.

It's likely that the training programs will be able to begin applying early this year and UCNS plans to begin accrediting programs in the fall, said Mari Mellick, UCNS manager, in St. Paul.

Certification for physicians will run on a parallel track to accreditation, Dr. Bachman said. There are a number of people who have already been trained in behavioral neurology and neuropsychiatry. As a result, leaders from the subspecialty and officials at UCNS are also working to develop grandfathering criteria for those physicians who have already been training in this field.

A new organization is moving forward with plans to provide accreditation and certification services for neurology subspecialties.

The United Council for Neurologic Subspecialties (UCNS) is currently working on accreditation and certification standards in the area of behavioral neurology and neuropsychiatry. Accreditation standards for behavioral neurology and neuropsychiatry are expected to be available early this year and certification standards are expected to be available in 2006.

In addition, the group is reviewing applications from five other neurology subspecialties that are seeking to pursue accreditation and certification through UCNS. Officials at UCNS are keeping the names of the subspecialties that have applied for membership confidential until the process is complete.

UCNS was launched in 2003 to provide accreditation and certification of neurology subspecialties that are at an early stage in their development process. The group was established by the American Academy of Neurology, the American Neurological Association, the Association of University Professors of Neurology, the Child Neurology Society, and the Professors of Child Neurology.

The new body provides an alternative pathway for subspecialties that are established enough for accreditation and certification but are not large enough to go through the traditional routes–accreditation through the Accreditation Council for Graduate Medical Education (ACGME) and certification through the American Board of Medical Specialties (ABMS).

For example, the vascular neurology subspecialty recently succeeded in getting a certification exam for its subspecialists through ABMS; however, the subspecialty of behavioral neurology and neuropsychiatry is much smaller and requires more developmental support to navigate the process.

The ACGME and ABMS criteria have been used as models for the UCNS requirements.

“We felt we needed to offer this,” said Stephen Sergay, M.D., chair of UCNS and a clinical neurologist in Tampa, Fla.

For more than a decade, subspecialties have been a major part of neurology, Dr. Sergay said, but there has not been a recognition of the extra time and training that neurologists have invested in their subspecialty area.

Accreditation and certification for these subspecialties will help to ensure high-quality patient care, he said.

The activities of UCNS will also have a positive impact on the cohesiveness of the approach to training for various subspecialties, Dr. Sergay said. Currently, there may be five training programs in a given subspecialty, and they will all be slightly different. Now, the sponsoring organizations for a new subspecialty will have to come to a consensus on a core curriculum and training requirements before they apply for membership in UCNS.

That made the subspecialty of behavioral neurology and neuropsychiatry a good fit for UCNS since so much work had already been done on establishing a core curriculum in the field, said David L. Bachman, M.D., president of the Society for Behavioral and Cognitive Neurology, one of the groups that sponsored the subspecialty for membership with UCNS. Dr. Bachman chairs the behavioral neurology section for the American Academy of Neurology and is director of the division of adult neurology at the Medical University of South Carolina in Charleston.

UCNS recently finished a draft of the application form that will be used to accredit training programs in behavioral neurology and neuropsychiatry. The application form was developed according to the training requirements provided by the subspecialty.

Currently, nine training programs have agreed to pilot the form. These programs will review the form and provide comments to UCNS.

“We want the programs to feel comfortable that these are reasonable criteria that people can live with,” said Dr. Bachman, who now sits on the UCNS board of directors as a representative of his specialty.

It's likely that the training programs will be able to begin applying early this year and UCNS plans to begin accrediting programs in the fall, said Mari Mellick, UCNS manager, in St. Paul.

Certification for physicians will run on a parallel track to accreditation, Dr. Bachman said. There are a number of people who have already been trained in behavioral neurology and neuropsychiatry. As a result, leaders from the subspecialty and officials at UCNS are also working to develop grandfathering criteria for those physicians who have already been training in this field.

WASHINGTON – New tools to help preteens avoid underage drinking are available from the Substance Abuse and Mental Health Services Administration.

The “Too Smart to Start” initiative is aimed at adolescents aged 9–13 years.

The tool kit offers classroom presentations, posters, public service announcements, and information about structuring parent/child conversations on alcohol. It can be obtained by calling SAMHSA at 800–729–6686.

“Unlike illicit drugs, where we have seen an 11% decline in use over the past 2 years among youth, and unlike tobacco use where we have seen major declines in use since the mid-1990s, the rates of underage drinking really have not changed much over the years,” SAMHSA Administrator Charles G. Curie said at a press conference sponsored by SAMHSA.

About 11.6% of 12-year-olds report using alcohol at least once in their lifetime. That percentage more than doubles by age 13, and by age 15 more than half of teens report alcohol use, according to SAMHSA's National Survey on Drug Use and Health.

The approaches in the program were field tested in nine cities and counties over the last 2 years.

The program is being rolled out nationally through partner groups such as the American Medical Association. The AMA and SAMHSA has sent out joint letters to county and state medical societies encouraging them to disseminate the information about the program.

WASHINGTON – New tools to help preteens avoid underage drinking are available from the Substance Abuse and Mental Health Services Administration.

The “Too Smart to Start” initiative is aimed at adolescents aged 9–13 years.

The tool kit offers classroom presentations, posters, public service announcements, and information about structuring parent/child conversations on alcohol. It can be obtained by calling SAMHSA at 800–729–6686.

“Unlike illicit drugs, where we have seen an 11% decline in use over the past 2 years among youth, and unlike tobacco use where we have seen major declines in use since the mid-1990s, the rates of underage drinking really have not changed much over the years,” SAMHSA Administrator Charles G. Curie said at a press conference sponsored by SAMHSA.

About 11.6% of 12-year-olds report using alcohol at least once in their lifetime. That percentage more than doubles by age 13, and by age 15 more than half of teens report alcohol use, according to SAMHSA's National Survey on Drug Use and Health.

The approaches in the program were field tested in nine cities and counties over the last 2 years.

The program is being rolled out nationally through partner groups such as the American Medical Association. The AMA and SAMHSA has sent out joint letters to county and state medical societies encouraging them to disseminate the information about the program.

WASHINGTON – New tools to help preteens avoid underage drinking are available from the Substance Abuse and Mental Health Services Administration.

The “Too Smart to Start” initiative is aimed at adolescents aged 9–13 years.

The tool kit offers classroom presentations, posters, public service announcements, and information about structuring parent/child conversations on alcohol. It can be obtained by calling SAMHSA at 800–729–6686.

“Unlike illicit drugs, where we have seen an 11% decline in use over the past 2 years among youth, and unlike tobacco use where we have seen major declines in use since the mid-1990s, the rates of underage drinking really have not changed much over the years,” SAMHSA Administrator Charles G. Curie said at a press conference sponsored by SAMHSA.

About 11.6% of 12-year-olds report using alcohol at least once in their lifetime. That percentage more than doubles by age 13, and by age 15 more than half of teens report alcohol use, according to SAMHSA's National Survey on Drug Use and Health.

The approaches in the program were field tested in nine cities and counties over the last 2 years.

The program is being rolled out nationally through partner groups such as the American Medical Association. The AMA and SAMHSA has sent out joint letters to county and state medical societies encouraging them to disseminate the information about the program.

Most group practices are still using paper medical records and charts, according to preliminary results from a survey by the Medical Group Management Association.

“Paper is still the dominant mode of data collection,” William F. Jessee, M.D., president and CEO of the Medical Group Management Association (MGMA) said in a webcast sponsored by the group.

But the scale is tipping, he said. About 20% of group practices report that they have an electronic health record of some kind. In addition, 8% have a dictation and transcription system for physician notes, combined with a document imaging management system for information received on paper. “We're seeing a steady movement toward a paperless office,” Dr. Jessee said.

The preliminary findings are based on responses from about 1,000 group practices that responded to an electronic questionnaire. The second stage of the survey will include mailing more than 16,000 printed questionnaires to a sample of group practices across the country. Complete results from the survey are expected this spring.

The survey is part of a contract from the Agency for Healthcare Research and Quality to MGMA's Center for Research and the University of Minnesota. The purpose of the contract is to provide a baseline that describes the use of new information technologies in medical groups.

Some of the challenges physicians face in making the transition to an electronic health record include knowing which product to buy, how to go about buying it, and how to implement the system, said David Brailer, M.D., national health information technology coordinator for the Department of Health and Human Services.

“Many groups stumble at every point along the way,” Dr. Brailer said.

The private industry is working to create a voluntary certification process for electronic health record products.

The American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology have formed a nonprofit group—the Certification Commission for Healthcare Information Technology—that is planning to pilot a first-step certification process this summer.

Dr. Brailer also plans to explore interoperability issues. It's not enough to have every practice using an electronic health record, he said, they also have to be able to share data with other providers and institutions.

Most group practices are still using paper medical records and charts, according to preliminary results from a survey by the Medical Group Management Association.

“Paper is still the dominant mode of data collection,” William F. Jessee, M.D., president and CEO of the Medical Group Management Association (MGMA) said in a webcast sponsored by the group.

But the scale is tipping, he said. About 20% of group practices report that they have an electronic health record of some kind. In addition, 8% have a dictation and transcription system for physician notes, combined with a document imaging management system for information received on paper. “We're seeing a steady movement toward a paperless office,” Dr. Jessee said.

The preliminary findings are based on responses from about 1,000 group practices that responded to an electronic questionnaire. The second stage of the survey will include mailing more than 16,000 printed questionnaires to a sample of group practices across the country. Complete results from the survey are expected this spring.

The survey is part of a contract from the Agency for Healthcare Research and Quality to MGMA's Center for Research and the University of Minnesota. The purpose of the contract is to provide a baseline that describes the use of new information technologies in medical groups.

Some of the challenges physicians face in making the transition to an electronic health record include knowing which product to buy, how to go about buying it, and how to implement the system, said David Brailer, M.D., national health information technology coordinator for the Department of Health and Human Services.

“Many groups stumble at every point along the way,” Dr. Brailer said.

The private industry is working to create a voluntary certification process for electronic health record products.

The American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology have formed a nonprofit group—the Certification Commission for Healthcare Information Technology—that is planning to pilot a first-step certification process this summer.

Dr. Brailer also plans to explore interoperability issues. It's not enough to have every practice using an electronic health record, he said, they also have to be able to share data with other providers and institutions.

Most group practices are still using paper medical records and charts, according to preliminary results from a survey by the Medical Group Management Association.

“Paper is still the dominant mode of data collection,” William F. Jessee, M.D., president and CEO of the Medical Group Management Association (MGMA) said in a webcast sponsored by the group.

But the scale is tipping, he said. About 20% of group practices report that they have an electronic health record of some kind. In addition, 8% have a dictation and transcription system for physician notes, combined with a document imaging management system for information received on paper. “We're seeing a steady movement toward a paperless office,” Dr. Jessee said.

The preliminary findings are based on responses from about 1,000 group practices that responded to an electronic questionnaire. The second stage of the survey will include mailing more than 16,000 printed questionnaires to a sample of group practices across the country. Complete results from the survey are expected this spring.

The survey is part of a contract from the Agency for Healthcare Research and Quality to MGMA's Center for Research and the University of Minnesota. The purpose of the contract is to provide a baseline that describes the use of new information technologies in medical groups.

Some of the challenges physicians face in making the transition to an electronic health record include knowing which product to buy, how to go about buying it, and how to implement the system, said David Brailer, M.D., national health information technology coordinator for the Department of Health and Human Services.

“Many groups stumble at every point along the way,” Dr. Brailer said.

The private industry is working to create a voluntary certification process for electronic health record products.

The American Health Information Management Association, the Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology have formed a nonprofit group—the Certification Commission for Healthcare Information Technology—that is planning to pilot a first-step certification process this summer.

Dr. Brailer also plans to explore interoperability issues. It's not enough to have every practice using an electronic health record, he said, they also have to be able to share data with other providers and institutions.

More than 4 years ago, Raymond M. Pomm, M.D., started to see a pattern of disruptive behavior occurring in physicians across Florida, where he is the medical director for the state's Impaired Professionals Program.

Hospitals were reporting a range of inappropriate and disruptive behaviors, from yelling to berating nurses in front of other staffers to physical violence. But the behavior didn't fit any patterns typically associated with psychiatric disorders such as bipolar disorder or substance abuse, he said, so he searched the country for a person or program that could help to change the behavior.

“It became a real dilemma,” Dr. Pomm said.

Then in 2002, Eva Ritvo, M.D., a psychiatrist, and Larry Harmon, Ph.D., a psychologist, stepped forward with a unique approach.

They started the Physicians Development Program, which provides a complete psychiatric, psychological, and workplace evaluation of potentially disruptive physicians, offers referrals to local treatment, and monitors behavior to chart improvement.

“We really try to tailor the program to the individual doctor,” said Dr. Ritvo of the department of psychiatry and behavioral sciences at the University of Miami and chair of the department of psychiatry at Mount Sinai Medical Center in Miami Beach.

They also use the Physicians' Universal Leadership Skills Survey Enhancement (PULSE) tool to evaluate and monitor physician behavior. The survey was developed by asking a variety of health care professionals what their colleagues do at work that motivates them to perform at their best, and what disrupts or discourages them.

When a physician agrees to go through the program, Dr. Harmon sends the survey to nurses, physician colleagues, and hospital leadership to find out how the individual physician behaves.

This feedback gives the physician some insight into how he or she is viewed by colleagues. This is a “magic moment” in the program, said Dr. Harmon, who is chair of the ethics advisory board of the Florida Psychological Association.

The physicians, along with hospital administrators, choose the people who will complete the survey. “This is not mental health treatment, this is physician development,” Dr. Harmon said.

Seeing this report usually turns around the behavior, Dr. Harmon said. Once the behavior is pointed out in a structured, objective way by a neutral third party, the findings are seen as credible and have an impact on the doctor.

The feedback report allows Dr. Harmon to constructively confront the doctor's lack of insight, he said. Physicians do not notice their disruptive impact on others until they see the collective voice of their team members reflected in the report. It's also the best way to find out if a physician isn't being disruptive, but may be a political target at the hospital.

After the survey is shown to the physician, Dr. Harmon conducts a follow-up survey to chart the physician's progress.

So far, all of the physicians who have been through the program have improved their behavior, he said.

About 42 physicians have completed the program since its inception in 2002. They come from around the country and from various specialties, Dr. Ritvo said.

“Typically, our physicians are not what you'd expect,” she said.

These physicians usually don't see their behavior as inappropriate and will say that they are just trying to get the best care for their patients. And they are usually excellent doctors but they are operating under a lot of stress and generally have some type of personality disorder involving obsessive behavior and control issues. “We see a lot of perfectionism,” Dr. Ritvo said.

In the future, Dr. Ritvo said she hopes to focus more on prevention and to be able to offer physicians a chance to assess their behavior before they are reported for inappropriate behavior.

The Physicians Development Program isn't just for disruptive physicians, Dr. Harmon said. It can also be used by groups of physicians who want to provide confidential feedback about how they are impacting their staff and colleagues. “It gives physicians a chance to see themselves as others see them, and maybe for the first time.”

Prevention is key, Dr. Pomm said. Hospitals should conduct ongoing assessments of personnel and work environments and offer help to employees, he said.

State medical boards are also in a position to help physicians get help before a disciplinary action is necessary, said James N. Thompson, M.D., president and CEO of the Federation of State Medical Boards.

Developing a nonpunitive way to identify physicians who are heading toward trouble would serve the public, reduce disciplinary actions, and keep physicians in practice longer, Dr. Thompson said.

Checklist Can Help Ensure Appropriate Behavior

So how do you avoid becoming a disruptive physician? Dr. Ritvo and Dr. Harmon have put together some tips to ensure that your behavior is appropriate:

▸ Periodically ask staff, supervisors, and colleagues how you are doing with “teamwork.”

▸ Let your staff know when they are doing a good job.

▸ Praise in public; reprimand in private.

▸ Reprimand the mistake, not the person.

▸ Foster positive and open communication with staff.

▸ Beware of sarcasm, tone of voice, as well as body language.

▸ Set clear and realistic goals for yourself and your staff and make sure that the goals are communicated effectively.

▸ Develop stress reducing techniques.

▸ Humor can be an effective way to cope, but remember what is funny to one person may be offensive to another.

▸ Avoid all sexual comments at the office.

▸ Avoid excessive work hours.

▸ Add balance to your life.

▸ Seek help when needed.

More than 4 years ago, Raymond M. Pomm, M.D., started to see a pattern of disruptive behavior occurring in physicians across Florida, where he is the medical director for the state's Impaired Professionals Program.

Hospitals were reporting a range of inappropriate and disruptive behaviors, from yelling to berating nurses in front of other staffers to physical violence. But the behavior didn't fit any patterns typically associated with psychiatric disorders such as bipolar disorder or substance abuse, he said, so he searched the country for a person or program that could help to change the behavior.

“It became a real dilemma,” Dr. Pomm said.

Then in 2002, Eva Ritvo, M.D., a psychiatrist, and Larry Harmon, Ph.D., a psychologist, stepped forward with a unique approach.

They started the Physicians Development Program, which provides a complete psychiatric, psychological, and workplace evaluation of potentially disruptive physicians, offers referrals to local treatment, and monitors behavior to chart improvement.

“We really try to tailor the program to the individual doctor,” said Dr. Ritvo of the department of psychiatry and behavioral sciences at the University of Miami and chair of the department of psychiatry at Mount Sinai Medical Center in Miami Beach.

They also use the Physicians' Universal Leadership Skills Survey Enhancement (PULSE) tool to evaluate and monitor physician behavior. The survey was developed by asking a variety of health care professionals what their colleagues do at work that motivates them to perform at their best, and what disrupts or discourages them.

When a physician agrees to go through the program, Dr. Harmon sends the survey to nurses, physician colleagues, and hospital leadership to find out how the individual physician behaves.

This feedback gives the physician some insight into how he or she is viewed by colleagues. This is a “magic moment” in the program, said Dr. Harmon, who is chair of the ethics advisory board of the Florida Psychological Association.

The physicians, along with hospital administrators, choose the people who will complete the survey. “This is not mental health treatment, this is physician development,” Dr. Harmon said.

Seeing this report usually turns around the behavior, Dr. Harmon said. Once the behavior is pointed out in a structured, objective way by a neutral third party, the findings are seen as credible and have an impact on the doctor.

The feedback report allows Dr. Harmon to constructively confront the doctor's lack of insight, he said. Physicians do not notice their disruptive impact on others until they see the collective voice of their team members reflected in the report. It's also the best way to find out if a physician isn't being disruptive, but may be a political target at the hospital.

After the survey is shown to the physician, Dr. Harmon conducts a follow-up survey to chart the physician's progress.

So far, all of the physicians who have been through the program have improved their behavior, he said.

About 42 physicians have completed the program since its inception in 2002. They come from around the country and from various specialties, Dr. Ritvo said.

“Typically, our physicians are not what you'd expect,” she said.

These physicians usually don't see their behavior as inappropriate and will say that they are just trying to get the best care for their patients. And they are usually excellent doctors but they are operating under a lot of stress and generally have some type of personality disorder involving obsessive behavior and control issues. “We see a lot of perfectionism,” Dr. Ritvo said.

In the future, Dr. Ritvo said she hopes to focus more on prevention and to be able to offer physicians a chance to assess their behavior before they are reported for inappropriate behavior.

The Physicians Development Program isn't just for disruptive physicians, Dr. Harmon said. It can also be used by groups of physicians who want to provide confidential feedback about how they are impacting their staff and colleagues. “It gives physicians a chance to see themselves as others see them, and maybe for the first time.”

Prevention is key, Dr. Pomm said. Hospitals should conduct ongoing assessments of personnel and work environments and offer help to employees, he said.

State medical boards are also in a position to help physicians get help before a disciplinary action is necessary, said James N. Thompson, M.D., president and CEO of the Federation of State Medical Boards.

Developing a nonpunitive way to identify physicians who are heading toward trouble would serve the public, reduce disciplinary actions, and keep physicians in practice longer, Dr. Thompson said.

Checklist Can Help Ensure Appropriate Behavior

So how do you avoid becoming a disruptive physician? Dr. Ritvo and Dr. Harmon have put together some tips to ensure that your behavior is appropriate:

▸ Periodically ask staff, supervisors, and colleagues how you are doing with “teamwork.”

▸ Let your staff know when they are doing a good job.

▸ Praise in public; reprimand in private.

▸ Reprimand the mistake, not the person.

▸ Foster positive and open communication with staff.

▸ Beware of sarcasm, tone of voice, as well as body language.

▸ Set clear and realistic goals for yourself and your staff and make sure that the goals are communicated effectively.

▸ Develop stress reducing techniques.

▸ Humor can be an effective way to cope, but remember what is funny to one person may be offensive to another.

▸ Avoid all sexual comments at the office.

▸ Avoid excessive work hours.

▸ Add balance to your life.

▸ Seek help when needed.

More than 4 years ago, Raymond M. Pomm, M.D., started to see a pattern of disruptive behavior occurring in physicians across Florida, where he is the medical director for the state's Impaired Professionals Program.

Hospitals were reporting a range of inappropriate and disruptive behaviors, from yelling to berating nurses in front of other staffers to physical violence. But the behavior didn't fit any patterns typically associated with psychiatric disorders such as bipolar disorder or substance abuse, he said, so he searched the country for a person or program that could help to change the behavior.

“It became a real dilemma,” Dr. Pomm said.

Then in 2002, Eva Ritvo, M.D., a psychiatrist, and Larry Harmon, Ph.D., a psychologist, stepped forward with a unique approach.

They started the Physicians Development Program, which provides a complete psychiatric, psychological, and workplace evaluation of potentially disruptive physicians, offers referrals to local treatment, and monitors behavior to chart improvement.

“We really try to tailor the program to the individual doctor,” said Dr. Ritvo of the department of psychiatry and behavioral sciences at the University of Miami and chair of the department of psychiatry at Mount Sinai Medical Center in Miami Beach.

They also use the Physicians' Universal Leadership Skills Survey Enhancement (PULSE) tool to evaluate and monitor physician behavior. The survey was developed by asking a variety of health care professionals what their colleagues do at work that motivates them to perform at their best, and what disrupts or discourages them.

When a physician agrees to go through the program, Dr. Harmon sends the survey to nurses, physician colleagues, and hospital leadership to find out how the individual physician behaves.

This feedback gives the physician some insight into how he or she is viewed by colleagues. This is a “magic moment” in the program, said Dr. Harmon, who is chair of the ethics advisory board of the Florida Psychological Association.

The physicians, along with hospital administrators, choose the people who will complete the survey. “This is not mental health treatment, this is physician development,” Dr. Harmon said.

Seeing this report usually turns around the behavior, Dr. Harmon said. Once the behavior is pointed out in a structured, objective way by a neutral third party, the findings are seen as credible and have an impact on the doctor.

The feedback report allows Dr. Harmon to constructively confront the doctor's lack of insight, he said. Physicians do not notice their disruptive impact on others until they see the collective voice of their team members reflected in the report. It's also the best way to find out if a physician isn't being disruptive, but may be a political target at the hospital.

After the survey is shown to the physician, Dr. Harmon conducts a follow-up survey to chart the physician's progress.

So far, all of the physicians who have been through the program have improved their behavior, he said.

About 42 physicians have completed the program since its inception in 2002. They come from around the country and from various specialties, Dr. Ritvo said.

“Typically, our physicians are not what you'd expect,” she said.

These physicians usually don't see their behavior as inappropriate and will say that they are just trying to get the best care for their patients. And they are usually excellent doctors but they are operating under a lot of stress and generally have some type of personality disorder involving obsessive behavior and control issues. “We see a lot of perfectionism,” Dr. Ritvo said.

In the future, Dr. Ritvo said she hopes to focus more on prevention and to be able to offer physicians a chance to assess their behavior before they are reported for inappropriate behavior.

The Physicians Development Program isn't just for disruptive physicians, Dr. Harmon said. It can also be used by groups of physicians who want to provide confidential feedback about how they are impacting their staff and colleagues. “It gives physicians a chance to see themselves as others see them, and maybe for the first time.”

Prevention is key, Dr. Pomm said. Hospitals should conduct ongoing assessments of personnel and work environments and offer help to employees, he said.

State medical boards are also in a position to help physicians get help before a disciplinary action is necessary, said James N. Thompson, M.D., president and CEO of the Federation of State Medical Boards.

Developing a nonpunitive way to identify physicians who are heading toward trouble would serve the public, reduce disciplinary actions, and keep physicians in practice longer, Dr. Thompson said.

Checklist Can Help Ensure Appropriate Behavior

So how do you avoid becoming a disruptive physician? Dr. Ritvo and Dr. Harmon have put together some tips to ensure that your behavior is appropriate:

▸ Periodically ask staff, supervisors, and colleagues how you are doing with “teamwork.”

▸ Let your staff know when they are doing a good job.

▸ Praise in public; reprimand in private.

▸ Reprimand the mistake, not the person.

▸ Foster positive and open communication with staff.

▸ Beware of sarcasm, tone of voice, as well as body language.

▸ Set clear and realistic goals for yourself and your staff and make sure that the goals are communicated effectively.

▸ Develop stress reducing techniques.

▸ Humor can be an effective way to cope, but remember what is funny to one person may be offensive to another.

▸ Avoid all sexual comments at the office.

▸ Avoid excessive work hours.

▸ Add balance to your life.

▸ Seek help when needed.