Dr Sue Ieraci: New midwife laws draw vitriol

I have never seen myself as the stereotypical arrogant and paternalistic doctor. I do, however, believe that professionalism comes with both rights and responsibilities.

So I was surprised at the response I received when I decided to post a comment on the ABC’s website on the topic of midwives’ access to Medicare.

I’d been listening to a fairly typical pre-election interview on ABC Radio National’s Life Matters with AMA President Dr Andrew Pesce (an obstetrician).

Dr Pesce was asked about the AMA’s stance on the pre-election health strategies of the two major political parties.

At the very end of the interview he was asked about recent federal legislative changes that will give private midwives access to Medicare.

Under the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, which will be effective from November 1 this year, private midwives must enter into a written agreement with a specific obstetrician.

A midwife’s patient management plan must be approved by the obstetrician before he or she is allowed access to Medicare payments.

Although Dr Pesce spent most of the interview discussing issues such as e-health and rural health, all ten responses posted on the program’s feedback page after the interview related to his comments on the amended law.

Midwifery Anger, a previous discussion on the topic broadcast on Life Matters on August 12, likewise drew 56 responses.

Most were strongly worded complaints about the imposed control of obstetricians over private midwives’ access to Medicare and the alleged loss of a birthing mother’s right to choose.

“Human rights” and “unconstitutional” were among the strong phrases being used.

In my view, the issue comes down to this: any independent practitioner who has access to the public purse must practise according to principles approved by the expert community.

So my own comment was this: if the obstetrician is expected to provide support for complexities and complications, shouldn’t they be involved in the care plan?

I was met with vitriol.

Some might say I am blinded by the medical model which places me in a position of clinical authority.

But perhaps proponents of the other view are also equally blinded by their own ideology.

I guess we’ll have to see which ideology prevails.

Dr Ieraci is a specialist Emergency Physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. In addition to her emergency department work, Sue runs the health system consultancy SI-napse.

Posted 6 September 2010