> I think we have a duty to
> educate the mother about the importance of both being treated as well as
> other general ideas for management, but are we strolling out of the
> realm of our "non-medical" service?
>
I think one of the ways I clarify the scope of my volunteer help is
this: I am here to provide support and information to the mother. I can
give the mother information that she can share with her health care
provider, and I can give her information about how to communicate her
needs to her health care provider. I also have a real interest in
gaining / retaining the respect of health care providers in my area, so
I model that -- occasionally clamping down with my teeth, but generally
in a sincere belief that we're all working on the same team.
Here are some phrases I use quite often, "Have you asked your doctor why
he recommended ...?" "You might want to mention to your doctor that ...
suggests both mother and baby should be treated for thrush" (providing
the reference) and adding, "S/he might have a good reason for suggesting
another treatment, and you can call me again if s/he recommends
something different from what I'm suggesting." "How do you feel you /
the baby are responding to ...?"  "Would you like some other suggestions
about dealing with thrush?" The last time I felt I was getting too close
to "diagnosing" over the phone, I finally said, "If you want to go to
the After-Hours clinic, you can tell the doctor that ... said this
sounds like it's consistent with thrush, but she couldn't tell over the
phone." (Probably wouldn't have even been that bold before a) passing
"the" exam and b) getting to know some of the hcps in the area better.)
I know that the on-call doctors don't necessarily recognize thrush -- I
told the mother that sometimes there weren't clearly visible symptoms in
the mother or the baby -- but I have learned the limits of my knowledge,
too.
I also remind myself that I'm here to give suggestions, not advice
(medical or not) and don't make recommendations -- as a volunteer. Each
setting and each position has a different scope of practice, though.
Jo-Anne Elder, PhD, IBCLC and experiencing vicarious stress to empathize
with those writing this year...

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