It’s hard to believe that this year’s APA annual meeting is right around the corner. I’m sure that our meeting, to be held this year in Chicago May 13 to 18, will be a terrific opportunity for all of us to meet with and learn from psychiatrist colleagues from around the country and the world.

As you know, I have selected "The Doctor-Patient Relationship" as the theme of this year’s annual meeting. This was a very personal choice for me, but it’s one that I know resonates with all of our members. The doctor-patient relationship is at the heart of all the work that we do and provides the context within which all of our therapeutic interventions are made.

Unfortunately, the sanctity of the doctor-patient relationship has been under assault from many fronts over the past decade. Third-party reimbursement policies have always impinged on the doctor-patient relationship, but the rise of managed care approaches to reimbursement in the 1990s greatly accelerated the level of intrusiveness. Further, with a "second guessing" approach to utilization management, many managed care models have raised doubts in many patients, and in many of us, about whether we treating psychiatrists are able to use all of our knowledge and skills for the patient’s benefit.

Government policies and changes in information technologies have also played a role in weakening the boundaries of our relationships with our patients. The Clinton administration’s recommended guidelines for medical-record privacy were an important first step, but they left many of us with concerns that, should those regulations be enacted as written, further erosions into the privacy of the doctor-patient relationship would occur. The absence of patients’ rights legislation also makes it more difficult for individuals to preserve the privacy of their relationships with their physicians.

The widespread transmission of medical-record data across large computer systems, often operating in different countries around the world, has also raised significant concerns. Every new "hacking" episode that makes the news leaves me more concerned that it’s only a matter of time before someone manages to get into large medical-record databases.

So it’s essential that we rededicate ourselves to doing all that we can to protect the boundaries of our relationships with our patients. Our annual meeting in Chicago will provide us a terrific opportunity to do just that. Of course, the majority of our members are not able to attend each year’s annual meeting, so it’s essential that our activities permeate all of our Association’s endeavors, not just during one week in May, but throughout this year and every year.

This year is a particularly good year to talk about ongoing APA advocacy efforts in this regard. As you know, the membership approved the bylaws changes necessary to continue with our corporate reorganization (Psychiatric News, April 7). We are moving full-steam ahead and are on track for the changeover to occur on January 1, 2001. Once our corporate reorganization is in place, APA will be in a position to devote significantly more resources to public information and public advocacy than we can at present.

In fact, in anticipation of these new resources being made available, the Board of Trustees, at its meeting last month, approved the creation of the Commission on Litigation, Advocacy, and Public Policy. This commission will have the responsibility for making recommendations to the Board of Trustees about how to allocate our new advocacy resources. This commission also will incorporate the functions of APA’s Committee on Uses of the Litigation Fund, which has provided valuable support for a number of lawsuits around the country over the last several years. That fund was established, however, with a one-time-only allocation of $1 million, and about half of it has been spent. The Board’s decision will ensure that the pool of funding available will be not only replenished annually but also expanded so that more resources will be available to support all our advocacy activities. In addition, we will be able to make these decisions in better coordination with our public education and advocacy missions.

As I’ve discussed in previous columns, the Board of Trustees reallocated APA’s budget in anticipation of our corporate reorganization. This reallocation will free up nearly $25 million over the next 10 years, the vast majority of which will be used to enhance our public education, advocacy, and government relations activities at both the national and state levels. An important part of this funding stream includes direct support for district branch activities that will be possible once our corporate reorganization is completed.

So, I’m very happy to be able to say that during the coming years APA is going to be able to do a lot more than ever to protect the doctor-patient relationship. We continue to be assaulted on a daily basis by new threats to this centrally important relationship. I am certain that APA will continue to move more and more aggressively to enhance the sanctity of the doctor-patient relationship.

I hope to see you all in Chicago, where we’ll have many sessions devoted to discussing these issues in more depth.