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ISMS Guards Against Legislative Micromanagement of Medicine
William A. McDade, MD
ISMS President
William A. McDade, MD, PhD

Micromanagement is regarded as one of the cardinal sins of leadership, and for good reason. The micromanager inevitably wastes time making decisions about issues with which he has little experience, and the whole team suffers as a result.

When legislators try to micromanage, the consequences can be devastating - especially when it comes to medicine.

Of course, I'm not saying the legislature should wash its hands of anything related to health care. The members of the Illinois General Assembly have a strong interest in addressing significant public health threats, and they have the authority to regulate health professionals who care for the people of Illinois. Every day, ISMS works cooperatively with legislators to develop sound policy that protects patients and allows physicians to exercise their medical judgment.

Unfortunately, legislators sometimes try to use their regulatory authority in ways that would ultimately do more harm than good.

Three public health issues stand out as recent examples of how legislators sometimes try too hard to make a difference, and end up legislating the practice of medicine instead:

Child abuse is a major problem nationwide, and health care professionals are on the front lines of detecting and reporting abuse. SB 3421 would have required that anyone licensed by IDFPR who is also a mandated reporter, including every physician, must receive regular training on recognizing child abuse. This may seem reasonable at first, but a large portion of physicians never encounter children in their practices, and many do not see patients at all.

Opioid addiction, which includes addiction to prescription medications as well as our state's heroin epidemic, is another example of this phenomenon. The Illinois House of Representatives Heroin Crisis Task Force is currently considering a wide range of options, including mandatory CME, mandatory use of the Prescription Monitoring Program prior to prescribing, separate licensure of so-called "pill mills," codification of particular evidence-based guidelines, requiring toxicology screening of patients who are prescribed opioids, and much more. Final legislation has not yet been introduced, but many of these mandates would place undue burdens on physicians and patients.

Hepatitis C is a significant public health threat that affects over 3 million Americans, and in 2013 the State of Illinois set up a Hepatitis C Task Force to research the issue and recommend action. This task force has asked why physicians do not always follow CDC guidelines for Hepatitis C screening, which recommend that all adults born 1945-1965 should receive testing for Hepatitis C. SB 2670 would have mandated this screening in Illinois.

The CDC guidelines are meant to assist in the clinical practice of medicine, not to overrule a physician's medical judgment. While increasing screening and reducing deaths from Hepatitis C are important goals, mandated screening is the wrong approach. Many insurance carriers do not fully cover the cost of screening or treatment. There undoubtedly would be many screened individuals who do not have Hepatitis C, and the resources expended on such a mandated screening effort would have a significant adverse impact on the use of health care dollars.

Similar stories can be told about testing of newborns for the CMV virus, identifying elder abuse, and a host of other issues. The temptation is strong for well-meaning legislators to turn clinical guidelines into state law, mandate particular topics for CME, and otherwise micromanage medicine.

Fortunately, the Illinois State Medical Society is here to help make sure good intentions do not give way to bad policy.

Physicians take seriously our responsibility to keep our skills sharp and to treat each patient according to our medical judgment. There are only so many hours in a day, and the more time a physician must spend on mandated screenings and required CME topics that aren't relevant to his or her patients, the less time he or she has for what really counts.

ISMS works hard every day to make sure our senators and representatives understand this. We work with them individually to craft responsible legislation, and we testify before legislative committees and task forces on behalf of Illinois' physician community.

We also bend over backwards to provide an abundance of rich and relevant CME materials. It's no coincidence that we offer access to resources on recognizing and reporting child abuse, responsible prescribing of opioid pain medications, and countless other topics.

Physicians have the training and experience to know what topics are relevant to their practices. We have the professional responsibility to stay current on those topics and on the appropriate guidelines to help us treat our patients. And thanks in part to ISMS, we have ample opportunity to do so.

All we need now is for the state legislature to let us do what we’re trained to do.

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