ACP 2015: "Still, Do No Harm"

I’ll admit I was a little nervous to attend the annual American College of Physicians (ACP) meeting this year. In February, the American Board of Internal Medicine (ABIM) was forced to issue an apology to its members for the poorly handled roll out of its “Maintenance of Certification” (MOC) program, after two embarrassing Newsweek articles raised questions about the ABIM’s financial motivations. While the ACP and ABIM are separate organizations, their goals are closely aligned and I wondered whether the MOC debacle would cast a pall over the conference.

My concerns were initially dispelled when a visiting colleague from Singapore shared how much she was looking forward to attending the meeting. “I’ve been told by physicians around the world that the ACP meeting is the best meeting for internal medicine.” She was unaware of the MOC controversy, and her enthusiasm was catching.

The next day at the Boston Convention Center, I was struck by the empty halls-unlike other conferences I had attended, at ACP conventioneers were actually attending the talks and seminars! Aside from a tense Q&A by the ABIM’s CEO on the first day of the conference, the ABIM was largely absent from the remainder of the sessions. Instead the tone was mostly upbeat, with former South Dakota Senator Tom Daschle giving an uplifting keynote. Daschle’s address lauded the Affordable Care Act and the value-oriented shift occurring in health care policy. He praised internists for research that has improved the quality of patients’ lives, and encouraged physicians not to accept the “status quo.”

“High value care,” “costs of care,” and “quality of care” emerged over and over as upcoming priorities for researchers, educators, and clinicians. But the phrase I heard most often as I attended talks on patient perspective, nutrition, diabetes, and ethics was “transparency.” Almost every speaker stressed transparency as a goal-when discussing the use of feeding tubes for patients with dementia, exploring goals of care, or talking about genetic testing. Transparency seemed to be the key to partnering with patients, by providing honest counsel instead of old-fashioned guarded bromides.

For me, the tone of the conference was captured by the ethics seminar on Friday. When I told a colleague that I was attending “Updates in Ethics,” she joked, “what will they say: “Still, do no harm”?” Notwithstanding the awkward title, the talk was riveting. Three speakers moved through topics as varied and urgent as caring for patients with Ebola, the Sunshine Act, research ethics and genome sequencing, and philosophical exemption policies for vaccination. The message was clear: it’s an exciting time to be an internist.

As I rounded out my time at the conference by making one last sashay through the exhibition hall, passing the pharma reps and their scaled-back swag, I ended up in a deserted corner. On one side was a series of posters explaining the much-maligned MOC process, while the other wall displayed a blown up comic strip from the Annals of Internal Medicine’s (ACP’s main academic journal) new trailblazing “graphic medicine” section which features patient-doctor stories rendered in graphic novel form. It was as if the two walls told the same story-medicine is moving forward, and it’s our job to try to keep up.