It’s a simple question, but for Obstetric Physicians, one that often leads to confusion and frustration on both sides and tends to end with a list of examples of the types of patients we care for, rather than any clear definition. I therefore read with interest a recent blog post by a geriatrician on their efforts to explain their speciality both to colleagues and the general public.1 To help with this, they have developed the 5 M’s of geriatrics – Mind, Mobility, Medications, Multi-complexity and Matters Most.2
I could certainly relate to their frustration with trying to explain who you are and what you do. As a new and still relatively unknown specialty, Obstetric Medicine could benefit from a similar easy to describe list of core competencies and values. A simple sales pitch, a definition. A united answer to the dreaded question: ‘What do obstetric physicians actually do?’
I regularly come across colleagues, both junior and senior, who are unaware that we even have an obstetric medicine department, even though, by international standards, we have a large and active unit. Still others conclude that I must have trained as an obstetrician as well as a physician, or confuse my role with that of my Maternal Fetal Medicine specialist colleagues. Then there are those who don’t see the need for Obstetric Physicians at all. If it’s difficult to get our own medical colleagues to understand our role, it is almost impossible for the general population.
Although it may seem strange, we actually have a lot in common with our colleagues in geriatrics. We are dealing with medical disorders in a population with altered physiology and pharmacokinetics, multi-complexity and psycho-social vulnerabilities. On top of this, we share with our Obstetric colleagues the unique situation of caring for two patients: mother and baby.
In discussion with colleagues, we came to the consensus that our greatest contribution is woman-centred care. By this we mean the coordination of care for a woman with multiple medical conditions, so that the expertise of a number of sub-specialists can be brought together, in one place, filtered through the knowledge and experience of medical disorders in pregnancy we possess, in partnership with her obstetrician, to provide the best possible care. At times this may not seem like much, but the value of coordinated care has been well documented outside of pregnancy: most clearly with the rise in morbidity and mortality when hospitals lose general medicine services in favour of multiple subspecialists, and in the rise of the ‘hospitalist’ in the US and similar systems in recent years.3
Rather than 5 M’s, I put it to you that we define our core business by the acronym OBMED (for what is a good idea without a great acronym). O for Overarching, woman-centred care; B for Baby, to acknowledge our second patient; M for Medications, for careful but effective prescribing, expertise and research on drugs in pregnancy and lactation and consideration of altered pharmacology in pregnancy; E for Emergencies and critical care, as well as Education; and D for Disease prevention and public health.
In this issue, we demonstrate the spectrum of Obstetric Medicine with a comprehensive review of substance abuse in pregnancy4 and our Journal Watch which features the recent literature on the role of aspirin in women at high risk for preterm preeclampsia.5 Research articles address the role of peripheral deiodinase activity in increasing the risk of gestational diabetes in overweight women, and the potential role of hypomagnesemia in causing adverse pregnancy outcomes. One way of addressing the complexity and variation in managing diseases in pregnancy is collaboration between colleagues – we present a paper demonstrating the use of an instant messaging app in acquiring real-time input from geographically remote colleagues.6
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
References
- 1.Molnar F. The Geriatric 5Ms – the 5 simple words every geriatrician needs to know. British Geriatric Society Blog 13/10/2017, https://britishgeriatricssociety.wordpress.com/2017/10/13/the-geriatric-5ms-the-5-simple-words-every-geriatrician-needs-to-know-the-new-mantra/ (accessed 8 May 2018).
- 2.Tinetti M, Huang A, Molnar F. The geriatrics 5M's: a new way of communicating what we do. J Am Geriatr Soc 2017; 65: 2115. [DOI] [PubMed] [Google Scholar]
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