Andrew,
 thanks for your comments about some of the realities of medical
training and gaining expertise. I imagine that lack of training
in "obscure areas" like lactation applies to other areas as well.
I also understand that physicians can't be experts in everything and,
like all of us, must pick and choose based on our interests, experience
etc.
  I guess my concern is that patients as well as physicians understand
that
doctors can't know everything and that referring to people who do know
about
things be a more integral part of how doctors work. I feel very lucky
to have a pedicatrician for my kids who is very good at saying when he
does
not know something and gathering the info. himself and/or referring us to
specialists of various types as necessary. I also understand that
the current climate in medical management does not lend itself to such
referrals, but it can be done.
  Patients need to ask for and insist  upon referrals to lcs and others
depending on the issue and doctors need to know when they do not know
enough
and either get the info. or refer patients to someone who can help.
 This is a broader issue than just lactation and it would behoove us to
work with others who face similar issues.
  Does anyone have experiences in which
such relationships have been developed can shed some light on how best to
create the environment in which professionals of all expertises can work
together for the better health of our patients and clients?
  Naomi Bar-Yam

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New England Complex Systems Institute
http://necsi.org
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