Well, I am the least medical among us, but I notice that we're really talking
about two different situations.

If I am an consultant of some kind not tied to a particular hospital -- a
freelance LC, or an LLLL, or a WIC person, or just my friendy neighborhood
bf-advocate self -- then the mother has come to me for advice just the same
way she has gone to her doc for advice.   The MD or DO has knowledge and
training about many more areas than I do, but there might still be one or two
areas in life where I know more.   Neither of us has intrinsically more
authority over the mom than the other, as long as each of us is sticking to
our areas of expertise.   So if I know the doc is wrong, you bet I'm gonna
say so.

But an in-hospital situation, it seems to me, is different.  If I am
understanding hospital life correctly, most hospitals' system is that the
attending is directly responsible for each patient that he or she has
admitted, and that therefore the rest of the hospital personnel -- all
immeasurably valuable for their specialized knowledge, that's why they are
there after all -- are meant to funnel their relations with the patients
through the attending.  Not so?   I know that when I have gone for a consult
with a specialist doc their reports always go to my referring, eg attending,
doc before they will give them to me.  That's what it means to "get an order"
for something, as I understand it -- the mom can do whatever she pleases, as
long as she has custody of her baby, but staff employed by the hospital are
obligated by their rules of employment to pass their advice, decisions, etc
through the hospital's system.

I'm certainly not saying that this is the perfect arrangement -- Susan
Wirtjes story about the doc who forbids kangaroo care was particularly
depressing, wasn't it?  And it's part of what makes hospitals dangerous
places to stick around in -- you are subject to the errors and ignorance and
general iatrogenic risks of the same folks that are supposed to take care of
you.  But at the same time, parents are entitled to have the person they've
chosen as their info-funnel be their info-funnel, even if he is a dope (or
just made a mistake).    Think about the cases we've all heard about where
the ultra-sound tech tells the pregnant mom, "Gee, looks like the baby's dead
to me."    It's out of line -- even when it's true.

All of which suggests that in the hospital it might be more politic to say,
"You know, I'm seeing something here that is interesting but I think I will
be able to talk about it more intelligently after I have talked to your doc
about how it compares with what he saw in his exam."   Then **page the
doctor** to say that there's a dang cleft in the soft palate and he missed
it, and does he want me to tell the parents on the spot or is he going to
drag his butt out of bed to do it himself?

I don't mean to be unsupportive to the Lactnetter who had this depressing
situation in her own hospital practice -- it's a huge drag have to work with
people who are hung up on authority, anyway, and worse still when the
authoritarians are making mistakes...   But organizations are allowed to have
rules to keep them running smoothly, and the level of independence that is
possible within them isn't -- and probably should not be -- the same as it
would be for an LC in private practice.

Folks who have actually worked in hospitals, am I wrong on this?  Naive?

Elisheva Urbas
freelance editor & cultural critic on bf and other issues in NYC

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