Introducing A/Prof Alexis Shub

A/Prof Alexis Shub is a Maternal Fetal Medicine subspecialist and the Lead of the Diabetes and Endocrine Clinic at Mercy Hospital in Melbourne. She is also the Lead of PIPER (Paediatric Infant Perinatal Emergency Retrieval) Perinatal, a board member of ADIPS, and an examiner for the RANZCOG CMFM program. She sits on several committees, including CCOPMM (Consultative Council on Obstetric and Paediatric Mortality and Morbidity), Safer Care Victoria, LEAPP, and the National Maternity Data Development Project Advisory Group. 

A/Prof Shub has a special research interest in diabetes and completed her PhD investigating the relationship between periodontal health and preterm birth.   

First things first – to what degree was medicine and O&G a choice, and how much was luck and circumstance?

I am of the era when it only took a VCE mark to get into medicine – so I did, no thought or planning or idea of what I was doing. Once I started, I knew that obstetrics was for me, and that hasn’t changed in all those years. It is still the best job in the world. 

When did you realise how much we didn’t know? Why did you decide to do a PhD? 

As a junior doctor, I didn’t ask “why do we do it that way? Is there a better way?” I’m forever grateful to those wise and experienced clinicians who told me what to do, and I still hear their voices in my head and appreciate what they taught me about how we work as a team and how we treat our patients. It took me a while to realise how much we don’t know, or that so often, we do things because that’s the way we have always done them. 

I also didn’t really decide to do a PhD. I was working at the fantastic unit at KEMH as the MFM fellow, and in that role, research and investigation were part of the way things were done. The set up was so supportive, with all the infrastructure needed. My PhD was supported by enough time and salary, but also by generous experts in animal work, lab work, statistics, and research methodology, who shared, taught, and encouraged. I had my first child partway through the PhD and handed it in at 36 weeks pregnant with the next, and I completely recognise that completing would not have been possible without that level of support. 

Why diabetes? Why SOMANZ? What role do you think societies such as these play in the broader guideline world?

I also fell into the world of diabetes. I started at the Mercy as an MFM consultant and was allocated to the diabetes clinic and have loved it ever since.  

As obstetricians we need to be involved in both GDM and pre-pregnancy diabetes, along with our colleagues in endocrinology, diabetes educators, dietitians, midwives, and paediatricians – it is the ultimate multidisciplinary pregnancy, and we all have something to offer.  

If we leave policy and planning in diabetes to our endocrine colleagues, we risk missing some of the facets of patient-centred care. Societies like SOMANZ and ADIPS are really important in the guideline world – they provide the opportunity for our committed, passionate, knowledgeable, experienced clinicians to get together and help the rest of us with the tricky bits. They have the strength of a strong multidisciplinary base, so that women get the best care and outcomes. 

What’s the best way to encourage people to follow guidelines and practice evidence-based medicine? How can we close the Green Gap?¹ 

It is easy to see why people sometimes don’t follow guidelines. We all have the best intentions and want to provide safe, effective, evidence-based care for our patients, but there can be so many steps on the way – knowing the guideline exists, getting access to it, finding the section that is relevant to your question, working out if it applies to your patient, and sometimes dealing with different guidelines across different places that we work. It is the responsibility of guideline writers and disseminators, including RANZCOG, to make all those steps easy. 

Did you ever set out to lead, per se? Or just to get work done? What’s your greatest achievement in your career to date?

I like things to work well. I want to make it easy for staff to do the right thing, and harder to do the wrong thing, so that we provide really good care, use our limited health dollar wisely, and make healthcare a place that we want to work. We are all good at standing in the corridor and complaining, and while it is very therapeutic to do so, it doesn’t actually lead to change. 

What would you have done differently?

I’m not sure that I would have done anything differently. I think that all the diversions and places I ended up, from working in Darwin and East Timor, to roles with medical students, to in utero surgery on sheep, were really valuable – they weren’t part of a clear career progression or plan, but I have learnt so much from all  these roles and the people I met along the way.