In part of Lisa's most excellent post, she said:
 
 
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." >>

I will yet again get on my hobby horse and say that we do not diagnose  
tongue tie.  We observe a tongue tie and call it what it is.  No one  would 
accuse us of "diagnosing" a cleft lip/palate, a hypospadius, a baby with  
hyperbilirubinemia, a kid with circumoral cyanosis and so on.  If you see a  
person with a bone sticking out of his leg, you aren't diagnosing a broken leg,  
you are observing a broken leg.   We don't hesitate to look at a  baby's 
mouth and call it thrush, or a mom's red burning nipples and call it  yeast.  
Now, perhaps some only describe, but my experience as a nurse says  that we 
call it what it is, and with the exception of tongue tie, it's expected  
that we do so.  Not sure we are even using the really really cumbersome  
nursing diagnosis language any more.  
 
Mom comes into your office with a fever of 102, redness & pain on  the 
right breast and feels as though she has been hit by a truck.  Do you  discuss 
mastitis with her -- and refer her back to her OB for treatment?   Of 
course.....  Is this diagnosing?  And what would be the answer on  the IBLCE exam 
-- to go back to Nikki's good question.
 
We only tiptoe around tongue tie as a diagnosis because some HCPs have  
gotten angry that we call it and they can't see it and we refer back to them 
for  treatment.  "Don't need to treat -- she can always give a bottle -- wait  
and see if there are speech issues -- everyone has sore nipples, you just 
have  to tough it out.....and on and on and on....."  
 
Finally, is "IBCLCs cannot diagnose" a dictum or something that has been  
passed down from person to person?  Where is it in writing?
 
Jan Barger, RN, MA, IBCLC, FILCA
Annoyed in Wheaton IL


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