Nikki raises a good question. This whole thing about diagnosing bothers me a lot, because truth be told, there are a lot of things that we are better at diagnosing in the lactation world than many HCPs are. In the nursing world you have "nursing diagnosis" and in the lactation world I believe in "lactation diagnosis."  But this has not been formalized, leaving us in fair chaos when it comes to how to practice. I recently was at a conference in which an ENT presented on tongue-tie. She mentioned (in a positive way) about LCs diagnosing tongue-tie...  say what?  During the Q&A I asked about this, did she really think that was kosher?  And she replied to the audience that in her experience, the LCs who refer to her give her a detailed description of what the tongue is/isn't doing, the anatomical issue, the suck.... while the peds she interacts with "sit across the room, look at the baby and say there is no tongue-tie." She stated that she believed that LCs were in a much better place to make that call!  That was the most empowering thing I'd heard in a long time. 



We are still a developing profession, still defining our job in many ways. One of our major drawbacks is a lack of formalized training. If our training included these things, it would provide legitimacy to our right to "diagnose" lactation conditions, even if we are not in a position to provide medical treatment that might be needed. 



I would love to see a dialogue started about the very things Nikki is talking about, where we are supposed to recognize what we are seeing but are not supposed to "diagnose" it. What can we be formally trained to "own?"   The very real truth is that breastfeeding conditions are rarely taught in medical school, and in many cases we are providing guidance to HCPs on what may be going on and sometimes even in potential appropriate treatments.  Unless the profession of Breastfeeding Medicine Physician expands greatly, this gap continues and the unmet needs are great.  Where *should* we fit into this big picture? 



I hope that we will not settle for the status quo. Rather, in the face of the reality of what we deal with, I hope that we will fight to properly equip ourselves and then establish our right to make lactation diagnoses where we are the in best position to do so.  The fact that we are starting to gain licensure should support this right. We still have a lot of work to do.



~Lisa Marasco





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