Dr. Subhashini Ladella

Like many doctors, Dr. Subhashini Ladella works long hours and sees many patients, but she aims to prioritize the patient-doctor relationship to make patients feel seen.

“There are many areas where we see some gaps in the care,” Ladella said. 

Ladella is a clinical professor at UCSF, doctor of maternal fetal medicine and clinical research advisor for obstetrics and gynecology at UCSF Fresno. She has been practicing obstetrics and gynecology for more than 30 years. During the past three decades, she has noticed that Black pregnant moms have higher-risk pregnancies compared to their white counterparts. In the Central Valley, about 10% of babies are born preterm – higher than the national average of about 8% – but of that 10%, about 40% are from Black individuals.

Ladella is spending more time with patients to try to change this. 

“Most of my colleagues, they’re done by 4:30 or 5. I’m here very late,” she said.

She spends many hours charting and catching up on paperwork. She maximizes time with her patients and spends time doing office work after her patients leave for the day.

“I feel like a lot of the providers, they think that they’re doing a good job – which, I do agree, I do think they try to do their best – but there could be a lack of awareness in a lot of them about some of the things that are unique to a certain population group,” she said. 

Preterm births affect the health care system long after birth, including the cost to care for these young patients and even performance in school later in life. Ladella said it’s in the billions of dollars of health care costs from prematurity. 

It’s common for physicians to look at a patient’s medical chart to see what their medical needs are, but talking with patients to get the whole scope of their health is the key factor, Ladella said. 

“The way I practice is very different than a lot of the other providers because I do spend a lot of time with my patients, and that’s very valuable for me,” Ladella said. “I feel like the patient is the best historian than any information you could find in the chart.” 

In order to really understand a patient’s medical history, it requires looking at past documentation in addition to an already user-unfriendly interface of the electronic health record. It’s time consuming, she said, and the health care system is set up in such a way that providers don’t always have enough time between patients to investigate medical charts. 

“The system rushes them through the whole process, and so then they are only there for the five, 10, 15 minutes for each patient,” she said. 

Because of this, Ladella has seen patients hold back questions or feel unheard when voicing medical concerns.

“I can understand from a patient perspective how they feel like they’re not being heard,” she said. 

Among the developed countries, the United States has one of the highest  mortality rates in pregnant mothers — and many are preventable, she said. 

“For Black pregnant moms, we have to have a very heightened sense of alertness when they come through the door,” she said. “The data clearly shows that there’s much higher morbidity and mortality in the Black pregnant moms. So this knowledge and awareness, I think, needs to spread more.”

The lack of time spent with the patient can partly be attributed to the lack of physicians in the Central Valley, but other causes are the barriers a high-risk pregnant woman faces, like insurance coverage, transportation or previous medical conditions.

She offered a solution for the medical community to do more than the standard number of prenatal doctor visits to patients, specific to a patient’s needs. 

“For me it’s a passion,” Ladella said.

She believes that if an adverse birth outcome is preventable, she wants to do her part in spending more time with the patients to fix the system.

“I feel like it’s actually a privilege and a blessing to be able to take care of moms during their pregnancy, especially high-risk conditions. They come very worried,” she said. “They come trusting us and our system and trusting the provider. And I feel like it’s very important for me to build that relationship with my patients, to make them feel comfortable and at ease when they come to me.”