Hi All,

Barbara and Alison both make good points. Letters/reports sent to primary
care providers are a fabulous way of educating the medical community.

I moved to Dayton in 1989, and began seeing moms shortly thereafter. My
reports to their doctors were (and are) usually 2 pages with detailed
explanations/descriptions (like Barbara's), AND with suggested remedies
(like Alison's). I often include relevant citations from the literature
and/or pages copied from Dr. Lawrence's book or a research article, for
example, on jaundice. I usually send to both docs (ped and OB) with a formal
copy to the parents. This also summarizes for my records what I said to
everybody at the time. I do not pull any punches in these reports. This
strategy also forces me to explain how I arrived at my lactation diagnosis,
and what (if any) literature is available to support it. I call them
"teaching reports."

Over the years, the general level of BF knowledge is much improved in my
local medical community. More LCs have been hired by the hospitals, public
health service, and WIC. Some of them are vulnerable to pressure to
softpedal their assessment of the problem (play politics), but since I'm in
private practice, I can still write and say whatever I want within my
Standards of Practice. The sum of all the community LCs, in all settings,
carrying forth the same messages is clearly working. The calls for the
stupid and easy stuff have greatly diminished. Now I mostly see moms with
ongoing problems, moms finding their way to me from rural hospitals where
there is no LC, or really complicated situations referred to me by the
first-line providers. And I'm quite happy about this situation.

Yes, it takes a long time to write two-page reports with footnotes and
references. Yes, the reports might not be read. And yes, I believe this time
is well-spent because I've seen the positive results.

Linda J. Smith, BSE, FACCE, IBCLC
Bright Future Lactation Resource Centre
Dayton, OH USA
http://www.bflrc.com