A new uninsured patient attended for her first antenatal visit with me last week. She was 23 weeks pregnant in her third pregnancy. I asked her where she had been attending for her antenatal care to date this pregnancy. She said nowhere.
She was seeing her endocrinologist for her diabetes management, but had not had any pregnancy care. The public hospital was delaying in giving her an appointment for her first antenatal visit.
She had explained to the hospital staff about her health situation. As well she had been confined at that hospital in her previous pregnancy, so they had her previous pregnancy notes.
The hospital staff also advised her they expected her to change her endocrinologist to one that they used. She had diabetes and was under the care of this excellent, well-respected endocrinologist for diabetes management. She found their comment upsetting.
This new patient had attended public hospitals for pregnancy care in her previous two pregnancies. With the first she was induced at 37 weeks because of hypertension concerns. In the second she was induced at 38 weeks because of hypertension and diabetes.
Both hypertension and diabetes persisted after her last pregnancy. As well, she has anxiety, asthma and a BMI of 42.24 (healthy weight range18.50 – 24.99). She is a high-risk patient.
When I met her at 23 weeks gestation in her third pregnancy she advised me she was taking methyldopa 500mg twice per day (hypertension management), Metformin 1000mg twice per day (diabetes management), Lexapro 20mg per day (anxiety management) insulin 34U per day (diabetes management), Symbicort (asthma management), folic acid, aspirin 150mg (to minimises the risk of preeclampsia and growth retardation of her baby), Ferrograd C, and Vitamin D.
I am very upset that despite all these risk factors (hypertension, insulin dependent diabetes, anxiety, asthma, and a high BMI) the public hospital had not been willing to give her an antenatal clinic appointment. Plus, it is concerning the hospital staff wanted her to change from an excellent, highly qualified, well-respected endocrinologist with whom she had an excellent relationship for diabetes management to an endocrinologist who she did not know and who most likely was more junior.
This history reinforces but my opinions about the poor quality of care many public patients can receive. I ceased being a VMO obstetrician at a public hospital years ago because of my concerns about the poor quality of care and avoidable complications and adverse outcomes of some patients who were admitted under me but who I never met, was never contacted about or was contacted too late. I know of other obstetricians who have quit the public system for similar reasons. I am sure the situation has become worse, with increasing antenatal bookings but not the necessary increase in staff resources.
