i am a bit lost.
sorry coz i was just browsing thru all the replies.
just yday after dinner with hubby, he told me cases whereby those categorized as high risk cases, anything with complications, if they were to seek medical attention in private hospital, they will reject you and ask to go to govt hospital, but i just dont understand. why the rules? isnt doctors, regardless private or govt should offer medical attention to those in needs and not turn them away?
for example, i am now with DSH and so far my gynea said my pregnancy is normal, lets say, few weeks down the road, i have some complications, touch wood, will they reject me and ask me to go govt hospital?
then if thats the case, why bother goin to some hospital where i have to pay so much and in return get kick out just because i am term as high risk?
can they do that?
sorry ladies, am not sure whether we are all talking about the same thing, i am just being panicky and wants to get some answers.
Let me tell you why?
High risk cases like severe preeclampsia or hypertension in pregnancy, uncontrolled diabetes, placenta praevia, multiple cesarean section scars (like more than 3 or 4), severe intrauterine growth restriction etc are high risk cases. These cases required intense monitoring, neonatal ICU care and sometime ICU backup or other medical discipline back up like surgeon or urologist.
Almost all obstetricians in Malaysia are solo practitioners. This mean they manage the pregnancy ALONE usually without the help from others like physicians, surgeon, anesthetists etc unless absolutely necessary. ALL private obstetricians wants their patients with good outcome because any bad outcome mean potential bad reputation. Also most of the pediatricians in private also works solo.
So when we have a high risk cases e.g. severe preeclampsia, this case mean potential use of ICU for 24 hours continuous monitoring and good neonatal care and neonatal ICU. So often the cost involved will be tremendous which the final bill can easily 10x the bill for normal delivery. Second, most hospitals are not equipped well with neonatal care facilities like ventilators etc especially those shoplot delivery centre. There is no way such hospitals can managed premature babies and babies with complications.
So being a responsible doctors, naturally these patients will be referred to gov hospital which has the most complete set of equipment (this is the biggest reason). E.g Sg Buloh Hospital has 20 ventilators for babies and trained neonatologists and 20 HDU bed of high risk mothers. HKL has 50 beds of ICU etc. This kind of facilities cannot be matched by any private hospitals. Even in those small number of hospitals with these facilities, you can imagine the final bill if you use them. The public doctors there work as team 24 hours to monitor the high risk mothers which the private doctors often cannot do because they have to attend clinics, deliver other mothers etc. Hospital like HKL and Klang hospitals have a dedicated specialist IN the labour room and stay in hospitals 24 hours (there is a 24 hour oncall anesthetist as well) to attend the complicated obstetric cases. Klang hospital even have doctors works in shift to prevent overworked doctors. There is no such service in private as your private obstetrician can at the same time running around different hospitals to attend their patients and if you are not lucky, your doctor may not be attending to you in labour as he is delivering another patient in another hospitals 20km away. If you need C section at the middle of the night imagine that the time needed to wait for the anesthetist to come from his home to give you gas.
What about blood bank? Only gov hospitals will have extensive network to get blood in the shortest possible time. I had experience of doing a C section for a placenta pravia which need 40 pints of blood and the blood was obtained as far down from Seremban hospital. I have seen private patient with placenta praevia having C section done in a reputable private hospital but have severe bleeding and got packed to gov hospital because they can't get enough blood. The patient when arrived in gov hospital was having only haemoglobin 2g% (normal 11%) and almost died. All of us are trained and worked in gov hospitals before and we knew all sorts of these complications and horror stories can happen in a pregnant ladies.
So in the end a private obstetrician will not want to make their life difficult by having all these complications in their practice. Naturally they will select their patients that they manage. They will select the low risk normal patients with normal pregnancy (or at most moderate risk) because this is the group with least risk of obstetric complications to deal with and with best outcome. They don't want surprise and managing difficult complications in their practice. Private doctors cannot afford to have any medicolegal problem which may take a lot of their time, money and reputation.
So in the end you will get these impression that gov hospital is 'bad' and private hospital seem 'excellent'. This is partly because ALL high risk cases are actively send by almost ALL private obstetricians to gov hospitals and they keep all the able paying 'normal low risk' patients for themselves.Just let me tell you the last secret of the private doctors and this is also the beauty of Malaysian health system:
Malaysian public health care / hospital is like another insurance for ALL the private doctors, they are the guardian angels for private doctors. ANY HIGH RISK PATIENTS OR PATIENTS with complications which they cannot or don't want to manage can be sent to public hospitals so that they can sleep well at night and this is the reality of truth.
But this way of practice may not be bad. All doctor should know their limitation of themselves and their facilities. Refer when he think he cannot cope with the possible complications and this is for the interest of the patients.
One good example is oure forumer fluene who got twin pregnancy and having premature deliveries. No sane private doctors will take this cases, the risk is just too high and even if any private hospital willing to take her, imagine the bill of neonatal ICU care for a few weeks for premature twins. The bill will be at least 6 figures. First of all, thanks for sharing so much useful infos with us here.
I just started to TTC 6 months ago (married for 2yrs) due to my health problems. I'm both diabetic and hypertensive.
So in terms of risk, I'm sure mine would be super duper high. After months of trying and failing (am sure mainly because of my health issues though it's under control), I want to consult a gynae asap. Just want to know for my case, should I go straight to GH to do all the necessary tests or can I do it at private hospital then take the results (to avoid long q) and consult gynae at GH since I'm going to deliver there next time? And I read that no medication is allowed during pregnancy for diabetics? Does it mean that I'll be on insulin all the way thru my pregnancy?
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