A physician writes orders for the diagnostic studies, care and treatments
his/her patients receive. A patient can request a particular treatment, but the
physician does not have to order it if he/she feels it is not medically
appropriate or in the patient' s best interest.
Any person can request a service as an outpatient, and, if they are willing
to pay, and find someone willing to do it, can have it done. For example, most
ethical fertility specialists will insert a maximum of 2-3 fertilized ova in
the IVF procedure. The risk of higher order mutiples being premature and ill
is just too great. Can you find someone who is willing to put in 4, 5 or 6
ova? Sure - if you pay for it. Is it ethical - I think not. Is it best for
the patient - I believe not.
Hospitals lose a great deal of money if unecessary studies and procedures are
done on patients, not to mention the health risk to the patient herself. A
physician doesn't "bar" a woman from having a mammogram, but if she is 25, in
good health, with no family history of breast cancer or other risk factors, the
physician may refuse to order one. The woman, if she feels strongly enough
about it, can still get it, but it is unlikely her insurance will pay for a
procedure considered "medically unnecessary".
Breastfeeding knowledgeable physicians recognize the value of a lactation
consultant's services and use them freely, if available. Are there some LCs
advice I trust more than others? Sure. Do I refer to one rather than another LC
in certain circumstances? Sure. Do physicians refer to other physicians and
ancillary services selectively? Sure.
I believe we are all doing what we feel is in the best interest of our
patients. Sometimes we disagree as to what the best is.
Nancy
Nancy E. Wight MD, IBCLC, FAAP, FABM
Neonatologist
Children's Hospital and Sharp Mary Birch Hospital for Women
Medical Director, Sharp HealthCare Lactation Services
San Diego, CA
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