Joy brings up the points that got a lot of us going when IBLCE tried
to launch their not-so-great scope of practice document a few years
ago - if I recall correctly, this clause was in the scope of practice,
even though it has little to do with scope and everything to do with
code of ethics, which IBLCE seemed to think were the same thing.

I agree with everything Joy writes, and I want to comment.  Since
moving out of the US to a completely different health service system,
I see that the adversarial attitude that so often characterized
dealings with health care providers in the US is not such a prominent
feature in systems where the practitioners have more of an interest in
doing 'nothing' than in doing 'something'.   Rather than being
concerned that a provider is going to tell me I need surgery or
medication or treatment of some kind when I don't really need it, I am
now more concerned that they will say I do not need something when in
fact I do.  It can get confrontational that way too, but it seems to
be less of a problem.

I completely agree that the person consulting me holds the right to
decide who should be informed of what transpires between us, unless I
learn something during our dealings which compels me to break
confidentiality.  Child protection laws require me to report if a baby
is being criminally neglected or abused.  Other than that, whether
it's in the woman's and/or child's interest for her GP or the child's
well-child center to have information about the consultation is up to
the woman, and this is backed up in Norwegian laws for health
practitioners, which bar me from communicating information about a
consultation without the express permission of the client.  Obviously,
given the choice between respecting a fiat from IBLCE or the laws of
the country in which I hold a license to practice, I will go for the
laws.   If the GP or the well-child center have referred her to us
because of a breastfeeding problem, it's more likely that I would urge
her to let us send a report back - and I would draft an outline of it
while she is there, so we agree on what is to be covered, and what, if
anything, should be omitted.

I don't think I have ever written notes more than one page long for a
chart, and even that is pushing the limit for what any other
practitioner has time or inclination to read - not to mention what I
have time to write!   This goes for chart notes of all kinds, not just
BF consults.  I need there to be enough info so I can remember the
full details of our contact when I read it later, but it must be
concise enough to be useful as a vehicle of communication to the
others.  I prioritize: info about the problem, what my impression is,
how I think it could be dealt with, and what signs I will use to
determine whether the plan is working as intended.   The woman can
fill in details ad lib when she sees her other provider again.

Another way to do it is to provide the woman with this written
information so she can share it with whoever she likes.

Rachel Myr
Kristiansand, Norway

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