Monday, February 4, 2008

The Pressure on Doctors

It's easy to get down on all physicians providing obstetrical care in a hospital setting. Knowing doctors personally and professionally I realize there are many out there that are struggling against the hostile rise in cesarean sections and practice approaches. The book Pushed offers an honest look at the pressure and conflict that many obstetricians face.

In my state there are not many choices for malpractice insurance. In fact, as of this writing, there are two companies that offer such coverage. Both insurance companies offer a premium discount for practices with higher cesarean rates. Why? In court a cesarean is always going to be viewed as the safest route of delivery (for the infant, which is where most malpractice claims arise). Hence, if you do more cesarean births the insurance company is less likely to pay out millions of dollars in litigation. This pressure has led many providers to stop doing births in my community. In essence, the docs that honor evidence-based approaches to care are getting tired of the fight and leaving birthwork altogether.

Here is a recent article published about a doctor that is in the same predicament in North that forced her to leave a booming obstetrical practice altogether. Her stance and the truth she speaks about is important - not only for consumers but also for other providers. If a stance is taken against this sort of climate could we see change occur?

From the article:

"I don't see any end in sight right now," said Dr. Bruce Flamm, regional chairman of The American College of Obstetricians and Gynecologists, saying there's little concrete data on how many c-sections are unnecessary. "All of the current pressures seem to be going in the direction of more c-sections, not less."

He and other national medical experts are concerned with the trend; a trend they believe is pushed by medical liability issues, convenience for both doctors and patients, and perhaps hospitals' financial and staffing pressures.

"There are some doctors who say the only cesarean section I have ever been sued for is the one I didn't do," Dr. Flamm said. "It's a sad but true situation." Not only is there a decreased chance of getting sued if a c-section is performed, but it's less time consuming to perform c-sections instead of waiting out long and sometimes difficult labor.

Leading medical groups such as the Centers for Disease Control and Prevention, National Institutes of Health and the World Health Organization have all spoken out against the increase, demanding the medical community investigate ways to lower the rate to 15 percent or below. ...Dr. Sandland thought she was doing just that.

In the decade she has delivered babies and cared for their mothers in New Hanover County, she has always had a rate below 10 percent.

"I've always maintained I'm a midwife with a MD behind my name," she said from her two-story Pine Valley home last week while preparing to move. "It's better for Mother Nature to decide when it's time, not the doctor. My philosophy is you don't interfere unless you really have to."

Fellow Wilmington obstetrician Dr. Joshua Vogel said though she was considered too set in her ways or a renegade by some doctors, he admired her talents to deliver naturally in situations when other doctors would have automatically pushed for a c-section. "She was a valuable asset for patients," he said.

Dr. Sandland said she became the target of the hospital's professional review and credentials committees. Because it is confidential by law, she could not legally discuss the peer review process.