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Q&A: Patrice Harris, MD

As the first African-American woman to lead the American Medical Association (AMA), Patrice Harris, MD, is fiercely committed to promoting health equity and diversity in medicine. And as a child psychiatrist, Harris is also a strong advocate for addressing childhood trauma and integrating mental health into traditional healthcare.

During the AMA’s National Advocacy Conference last week, she sat down again with MedPage Today (we also interviewed her last summer after her inauguration) about these priorities as well as responding to the opioid crisis and preventing surprise medical bills. A press representative was present during this interview, which has been edited for brevity and clarity.

What are your core priorities as AMA president?

Three things I want to highlight while I have this platform are: Number one, the importance of the integration of mental health into overall healthcare. Number two, increasing the diversity of the physician workforce in the service and in our goal for health equity. And number three, the importance of adverse childhood experiences (ACEs) and trauma.

AMA has a strong policy around ACE and trauma-informed care, but it’s up to all of the stakeholders in the community, the school system, and pediatricians and others who see these young children, to deliver on them.

Once we screen, the physician community needs to make sure that the broader community has services available for the children.

As you mentioned, increasing diversity in the workforce is a priority for you. In panel discussions, you’ve shared how medical school was initially a bit more challenging than you expected.

Harris: When you start at a medical school, it’s very helpful when you have someone who can show you the ropes. But, as a first-year medical student, I didn’t have anyone — no relatives or even close friends — who had been to medical school.

And my classmates, they had relatives, cousins, friends, who had been to medical school recently.

In my first year, we had weekly quizzes, and I was not doing well on those quizzes and my reflexive response was “I must not be as smart as my classmates. I must not belong here.”

But then, I don’t remember how I found this out, there were old tests and old quizzes that were available and the other students had them. This wasn’t breaking any rules, and it wasn’t a secret. I just didn’t have the information.

At any rate, once I found out, I said, “Can I have copies of those?” and my colleagues said, “Absolutely.” Once I had copies of the the test I started to do well. So I did belong.

Is it true that your guidance counselor recommended you go to nursing school, even after you said you wanted to be a doctor?

Harris: I knew I wanted to be a physician since the eighth grade but didn’t know how to get there.

I went to the advising center and said, “Hey, what should I major in if I want to be a physician?” and I was told, “Go to nursing school.”

And I did apply to nursing school and I got in, and I was sitting at orientation at the end of freshman year saying, “This is not my dream.”

So, I said, “Let me take a breath.” I knew I loved my Psychology 101 class. So, I said I’ll just major in psychology and figure it all out.

Ultimately you chose a career in psychiatry, where you’re exposed to all aspects of mental and behavioral health problems. As head of the AMA’s Opioid Task Force, how do you balance the tensions between the pain community and the addiction community? Do you think the CDC’s opioid guidelines exacerbated those tensions?

Harris: We were worried back then at the beginning that the CDC guidelines would be misinterpreted and misapplied and that legislators, regulators, and pharmacies would then use those guidelines to defend limits — pill count limits, and dosage limits. It gives us no pleasure to know that we were right.

From our standpoint there’s been no push and pull. We want the balance. We were very supportive of the HHS Pain Task Force. When folks said, “Doctors, reduce the number of opioids,” we said, “Absolutely.” We want to be judicious about prescriptions. However, patients will have pain.

As we said at the beginning, we need to make sure that alternatives to pain management such as physical therapy are equitable alternatives to pain and not just alternatives on paper.

What policies do you believe would increase access to opioid use disorder treatment? Does the AMA support getting rid of x-waivers for buprenorphine? Do you support safe injection facilities?

Harris: We are on record as recommending elimination of the need for the waiver. Currently, you can prescribe buprenorphine for other indications, but not for substance use disorder.

Regarding safe injection facilities, we encourage pilot sites and learning from those pilot sites.

What is the AMA doing to address gun violence?

Harris: Physicians see the immediate aftereffects of gun violence, from the trauma surgeons and the anesthesiologists. And people like me, as a psychiatrist, we see the long-term effects and the post-traumatic stress disorder. We don’t get enough media coverage about that.

We were in Orlando soon after the Pulse nightclub shooting in June 2016.

So at that time, we reaffirmed that gun violence is a public health issue. People say, “That’s jargon,” but what that means is that we need research. We need to look at primary prevention.

As physicians, if I want to recommend something to my patients about gun safety, I want those recommendations to be based on the science. Where do we get the science? From the research.

We also support background checks and we support extreme risk protection orders.

Congress is currently debating different versions of legislation aimed at stopping surprise medical bills. What is the AMA’s position on how to resolve this problem?

Harris: From our perspective, our number one priority is to keep the patient out of the middle. Number two, we want to make sure that physicians have a level playing field as they negotiate with insurers, and that’s why we believe that the arbitration and mediation piece is critical.

We also don’t believe that insurers should do the benchmarking. We think that that is not a level playing field.

Finally, there are issues around network adequacy. In many ways, not in all cases, but often that’s at the core of why these unanticipated bills come up in the first place. Whether or not that’s in the legislation, that has been a concern for us and we believe that should be a part of the conversation.

Harris has been on the AMA’s Board of Trustees since 2011 and was inaugurated as president last June. She earned her bachelor’s, master’s, and medical degrees at West Virginia University, and she completed her residency and fellowships in child and adolescent psychiatry and forensic psychiatry at Emory University School of Medicine in Atlanta, where she is now based. Harris has held leadership positions at the American Psychiatric Association, Georgia’s Psychiatric Physicians Association, and the Medical Association of Georgia’s Council on Legislation.

MedPage Today News Editor Joyce Frieden contributed to this article.

2020-02-17T12:00:00-0500

Source: MedicalNewsToday.com