In trying to walk a fine line between being too shrill or too wimpy, dozens of delegates Tuesday delved into the mind-numbing sport of resolution editing, on-the-fly wordsmithing and entry into the Satanic depths of parliamentary procedure with flurries of first- and second-order amendments amid points of order, points of clarification and points of privilege.

For example, doctors debated, removed, added and eventually retained the word "active," which trustees interpreted to mean a proactive approach to solving inequitable projects.

The result of the all-day debate: "The message we got is that the House wants us to be more aggressive in making sure that pay-for-performance trials don't come at the expense of physicians or force physicians to compromise their basic principles," J. James Rohack, a cardiologist from Temple, Texas, and a member of the AMA Board of Trustees, told United Press International at the AMA's annual meeting in Chicago.

The delegates railed against all forms of pay-for-performance, whether worked out with government or suggested by insurance companies. William Hazel, an orthopedic surgeon from Herndon, Va., and also on the AMA board, said that treating two different patients -- an athlete and an elderly woman -- for knee surgery may look the same in hospital coding but may have very different resource usage.

"Yet the pay-for-performance trial may not be able to tell the difference," he told UPI.

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Ed Susman, UPI Medical Correspondent