The headline over a recent editorial in American Medical News -- a publication of the American Medical Association -- read "Put Patients First."

That was the message from the AMA House of Delegates that passed two important statements on patients' rights at its semi-annual meeting in June..

The AMA has not always been the patient's friend. True, it has done much over many decades to set lofty goals for American medical practice. But its leaders often have paid far more attention to protecting doctors' incomes and powers, whether or not limits were needed to benefit society. COMMENTARY

In recent years, the AMA has been changing under more enlightened leadership. It may now be changing further.

It is pushing a program for nationwide health coverage that falls short of universal, tax-paid coverage but is as comprehensive as many current proposals. The group's new executive vice president, surgeon James Todd, says that "confrontation" between doctors and the rest of the world is obsolete and that today's needs cry for "cooperation," since "the legislators have a terrible problem, the physicians have a terrible problem, and we must work together or the patients will suffer."


The AMA House of Delegates -- a democratic body representing members all over the country -- got off to a good start at the June meeting by approving both a patients' bill of rights and a clear statement that physicians with financial conflicts of interest "have an ethical obligation to place the health and well-being of their patients before all other concerns."

The document on patients' rights plainly said, "The patient" -- meaning every patient in the land -- "has a basic right to to have available adequate health care."

Millions of Americans do not have it available.

At an earlier meeting in December, the AMA delegates hesitated to take this position and referred the document's first version back to its drafters. The sticking point was the matter of every patient's right to care.

Again in June, some doctors thought that by endorsing such a basic right, they might be endorsing a government-paid national health plan. One objector -- Louisiana physician and lawyer Donald Palmisano -- tried in June to substitute the words "a right of access" to care, instead of a "a basic right."

Washington's Charles Epps Jr., dean of Howard University Medical School and delegate representing the American Academy of Orthopedic Surgeons, replied: "The word 'access' suggests that a person has the right to enter a line, but," in fact in this nation, "there's no guarantee of care at the end of the line."

Palmisano's proposal to once again reject the document as written was defeated by a 246-to-147 vote.

There was another interesting point in the statement as passed. It reminded physicians that in some way they should assume "a part of the responsibility" for the care of those who can't pay.

The second document addressed the fact that doctors affiliated with many health plans are paid by how economically they practice -- that is, by how few costly tests, hospitalizations or referrals to specialists they approve. If they cost the plan too much, they may be paid less or even forced to pay a penalty.

Some health plan patients have complained bitterly that under this system they have been denied needed care.

The AMA said:

"Physicians must not deny their patients access to appropriate medical services based {on} personal financial reward" or penalty.

Physicians must inform patients about all appropriate treatment alternatives, "regardless of cost" and regardless of whether or not the health plan provides them.

Physicians must make sure patients are told about any restrictions on treatment, and any obligations their physicans may have to restrict patients' options.

Physicians should promote active programs to monitor the quality of care wherever they practice.

Once more, amen.

Just under half of American doctors are AMA members today, but the AMA, more than any other medical organization, still sets the tone for American medicine.

It's easier for us to pay attention to what doctors are saying when they tell us -- as the AMA has just done -- that they are as seriously concerned with the rights of patients as with their own hassles.

Victor Cohn has begun a leave of absence and will be a visiting scholar at Johns Hopkins University. "The Patient's Advocate" will resume next summer.