Many have said that our doctors are very clinical and detached. Some say that they interfere out of convenience to get to that golf game. Maybe that’s true for some, but not for most.
The number one reason that they are clinical, sometimes detached and interfere way too much is because of litigation … the fear of being sued. Who can blame them? The majority of their patients walk into their office completely uneducated, ill-informed and quite frankly, irresponsible for choices that are available to them. They leave the entire decision-making up to their doctor or midwife. Oh …and by the way … if anything goes wrong … these patients can and will sue you!
Can you imagine what it would be like at work if you could be sued for even the slightest error? How would that affect your job performance?
Now I’m not saying that our providers are the victims of their patients. It really is just a vicious circle for us all and both providers and patients are equally to blame.
Let’s start with providers.
I met with Dr. Alan Schapker, MD, Medical Director of Bethany Womens Healthcare in Phoenix. I wanted to ask him questions from an OBGYN’s perspective. He graciously agreed to talk with me during his 5-minute break from patients.
I wanted to know why he decided to include Certified Nurse Midwives (CNM’s) in his practice. He told me that initially he just wanted a female OBGYN choice for his patients who felt more comfortable with a female provider. However, most of the female OB’s were joining practices together, so finding one to fit his practice was proving to be very difficult. During that time he was also becoming aware of the changes in OB care. He noticed how women in labor were being managed more out of routine than out of medical necessity. With more interventions, there were more risks. More risks led to more complications. He felt that the routine interventions were not evidenced based and therefore did not prove to bring better outcomes. Including fetal monitoring, epidurals and ultrasounds. More physicians were implementing routine intervention out of fear of litigation.
Dr. Schapker believed that when women are supported, educated and encouraged to let nature take its course, the outcomes are better and safer. So in 1993 he opened a freestanding Birth Center called Bethany Birth Center. He hired CNM’s to work collaboratively within the practice. Unfortunately, after over 2,000 births, they were forced to close their doors in June of 2007 due to insurance issues.
It was so interesting to hear his take on its closing. Not too long ago the first Out-Patient Surgery Center opened in Arizona. At first, there was lack of support from the medical community and of course insurance companies. However, when it was proven to be as safe, if not safer, Out-Patient Surgery Centers popped up all over the country providing surgery procedures from hip replacements to plastic surgery.
Evidence based data indicated that Out-Patient Centers were cost effective (no overnight stays), the staff and nurses were experts on specific procedures and, let’s not forget the biggest advantage … less risk of infection because you are not doing surgery in the same facility that you are treating major illness, disease and bacteria. Seems like great common sense. So why would a Free Standing (Out-Patient) Birth Center be closed? There is no surgery going on at all, no sick people being treated, the staff are experts at taking care of low-risk women and most of all…it saves money!
Yet even with evidence based statistics, Bethany Birth Center had to close its doors and direct their patients to Phoenix Baptist. The staff at Phoenix Baptist assures their patients that they do their best to respect the patients’ choices. From what I saw first hand, that is exactly what they do. Both OB’s and CNM’s are on staff at Phoenix Bapitist.
After our “5-minute” interview ended 45 minutes later, I wondered, what do Arizona patients, Phoenix Baptist, Bethany Women’s and Dr. Alan Schapker know that Orange County and countless other cities across the country don’t?
Over 95% of women who are pregnant or will become pregnant have absolutely no idea of the choices available to them. They simply listen to their friends, who listened to their friends and so on and so on… They all say the same thing. “GET THE EPIDURAL!!!!” or “ Just have a C-Section, it’s so much easier and you can get a tummy tuck right after!” or “ When are they going to induce you ?” All of it is based on lack of informed consent. Do you know the pros and cons? Do you understand the risks?
We are all responsible for our healthcare options, choices and education. Evidence based practice produces better outcomes with fewer risks to mother and baby. Medical and alternative models of care can and should work collaboratively together in the best interest of the patient.
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