A Physician’s Experiences of an Integrative Medical Model in Obstetrics

Interview with Mark Taslimi, OB/GYN

Mark Taslimi became a physician over 40 years ago and has dedicated his career to working with the healthcare needs of women and babies during pregnancy. He has also been credited with implementing successful, evidence- based models of pregnancy healthcare systems in several rural communities around Iran and Tennessee. Currently, Dr. Taslimi is a clinical professor at Stanford University, Department of OB/GYN Division of Maternal Fetal Medicine. He is also the clinical director of the Stanford/Lucile Packard Children's Hospital Perinatal Diagnostic Center in Santa Cruz, CA. If one watches Mark Taslimi speak with his patients in the Stanford Santa Cruz office, there is no doubt that he loves his life's work. "In the beginning, I worked for the Health Ministry in the Kurdish Mountains in Iran providing care to children and families [before specializing in obstetrics]," says Taslimi. "After that, I worked for over 5 years with a small number of midwives and OB/GYNs in Iran." During his time in the Middle East, Taslimi spearheaded a local healthcare reform to better serve the needs of the local population. This reform was based on an integrated model of both the midwifery and obstetrical fields. "I suggested that we pull together and work as a group," he said. "I was a newcomer in town, and was faced with the prospect of practicing as a solo obstetrician. Instead of going this route, I pulled our resources together which made me a part of a collaborative team. It was an excellent way to best serve our patients. Since most deliveries occurred at home, the model worked beautifully. The midwives did a majority of the deliveries at home, but some were assigned to the hospital as well. It was usually two midwives and one doctor available around the clock. The midwives provided a majority of the care since most pregnancies were low-risk." According to Taslimi, the results of this integrative model were seen in the team's low C-section rate (5.5%) and satisfied consumer outcomes. After his work in Iran, Taslimi was on staff at the University of Tennessee. During his time there, he created an "out of box model" that again included the integration of local, rural healthcare services (for the low-risk population) and high-tech specialists at the University teaching hospital (for the high-risk population). According to Taslimi, this model was exceptionally successful as it provided patients and physicians the ability to access appropriate, cost-effective care. The program was so successful that Taslimi's efforts were expanded through grants provided by the March of Dimes and the State of Tennessee. "About 70% of pregnant women hardly even need a hospital [when giving birth]," says Taslimi. "The trouble is how to separate the 70% from the 30%. In my opinion, every pregnant women needs to go through a screening process, but it does not necessarily need to be done by a physician." In order to explain how this idea works, Taslimi describes this model as being like a pyramid: the base of the pyramid is comprised of midwives, physician assistants, and nurse practitioners—healthcare providers sufficiently trained to provide routine care in pregnancy. "The benefit of this model," Taslimi points out, "is that providers at the broadest, lower base of the pyramid are available in most small communities and can do the primary screening. It does not need to be done by a physician." As one moves up the pyramid, the next levels include family practitioners and local obstetricians. "At the top of the pyramid are hospital-based specialists, such as those at Stanford, who are able to treat cases with severe problems such as congenital cardiac defects," says Taslimi. "A key aspect to this pyramid model is ongoing communication between the providers on the various levels. "This communication should go up and down the ladder. It's a team approach. It's a wider base, with a smaller tip. The best care can be provided at both ends of the pyramid... provided everybody works together as a team." When asked what his opinions are on the nation's current healthcare system, Dr. Taslimi states, "We have extremely high quality medical care in the USA, and we have a significantly poor management of the business and structure of providing care to our patients. It has fallen into the hands of people who are not qualified to manage the delivery of care, namely the insurance companies. I believe the management of delivery of healthcare needs to change dramatically."