Jan, the part of Pris's talk that set me to brooding was the part about
"avoiding the temptation to diagnose or prescribe" because by her definitions
I regularly do both.  I like to think of myself as highly ethical so this set
me to thinking, and I did come away resolved to be a little more careful how
I say things, but I suspect I'm back to my old ways.  When I see a baby at a
consult with white stuff growing in his mouth I think what I'm supposed to
say is something like, "that white growth in your baby's mouth has an
appearance consistent with thrush."  What I say is more like "your baby has
thrush."  And I call the baby's doctor and he usually prescribes something
over the phone, and then mom & I talk about her nipples and I tell her she
can call her doctor for something or here are the OTC choices.  So I guess
I'm prescribing for her.

I'm a little more careful if it's something not quite so clear-cut--there
have been quite a few babies with horrible rashes that the doctor has said
"it's just baby acne," and I might say "you know, to me those dry scaly
patches look more like they might be eczema, do you eat a lot of dairy
products?"  So I guess I'm diagnosing eczema.  What are my choices--go argue
with her doctor, ignore the rash?  If that were my baby I'd hope somebody
would tell me, because most of the time I'm right.

And how about things like plugged ducts or mastitis?  How many of us don't
"diagnose" these and tell moms what to do for them.  I guess I'm clueless as
to what the big deal is with diagnosing or prescribing (nonprescription
items--is that an oxymoron?) something we are knowledgeable about.  The
doctors I work with would think I'd lost my mind if I started referring
everything to them.

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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