collaboration

Yesterday the Health Ministers announced the extension of the 'exemption', enabling midwives  (1) to continue our work of attending births without indemnity insurance, until 2015, and (2) to make collaborative arrangements with hospitals and health services.

Go to the APMA blog for the wording of the announcement.

Immediate response from the Australian Medical Association (AMA) called on the Health Ministers to reverse their decision about collaboration, stating that “This decision is transferring sensitive patient care and management from a doctor to a bureaucrat. It must not proceed.”


In response, I have left the following message at the AMA media site:

Dr Hambleton, and AMA
I think it would be good to talk to real midwives who have incorporated Medicare into what we offer women.  We are not dangerous.  We are very conscious of the limitations of natural physiological processes in pregnancy, childbirth, and thereafter - and our own limitations when illness or complications present.
I have been practising independently as a midwife for many years, and I attend women who plan homebirth, as well as women who intend to give birth in hospital. 
The collaborative arrangements that have supported the care I provide for my clients, enabling Medicare rebates on antenatal and postnatal consultations, have been mainly with GPs who have never met me.  This is the sort of letter the doctor receives:
Dear Dr D
W has asked me to provide midwifery services for her, with a plan to give birth at home, and a back-up booking at H Hospital.  W’s calculated due date is XX/XX/XX.  With your referral and collaboration I am able to provide Medicare rebates for W for antenatal and postnatal midwifery services.  I am required to demonstrate a collaborative arrangement with a named medical practitioner, to whom she will be referred if the need arises. 
Under this collaborative arrangement, I am required to send you a Maternity Care Plan (draft attached), results of any tests and investigations, and referrals (obstetric or paediatric).  Also I am required to send a discharge summary to you as the patient’s GP.
In preparing a maternity care plan, I have discussed this with W.  The plan is basically to proceed under normal physiological conditions, working in harmony with the natural processes, unless complications arise.  We plan to go to the H hospital without delay for urgent obstetric concerns, or W would be referred to you for non-urgent medical indications.
Thankyou for your assistance in this matter.

I ask that you use the resources of the AMA to enhance collaboration between two distinct professions - not to remove the competition.

Joy Johnston

Your comments are welcome.