Becky noted,

<< Jan, the part of Pris's talk that set me to brooding was the part about
 "avoiding the temptation to diagnose or prescribe" because by her definitions
 I regularly do both.  I like to think of myself as highly ethical so this set
 me to thinking, and I did come away resolved to be a little more careful how
 I say things, but I suspect I'm back to my old ways. >>

This is good stuff, Becky.  Do you remember what Pris' definitions of
"diagnosing" and "prescribing" were/are?

Again, we are getting into interesting waters, and this is a topic that
should be really explored by a task force which would include IBLCE, ILCA,
physicians, nurses, non-health professional IBCLCs, and an attorney.  I'd
love to see them wrestle with these things.  I suspect much of our tentative
walking around the issues of diagnosing and prescribing is that in most
states, the Nurse Practice Act says the RN doesn't diagnose or prescribe.
But I think we need to look at the definitions thereof....

You are absolutely right, Becky.  It's a bit dippy for us who are educated
and experienced in the field of lactation to say, "Oh my, there is a lump in
your breast consistent with what might possibly be -- dare I say it?  A
Plugged Duct."  Now, is a plugged duct a MEDICAL diagnosis?  Is it a
lactational diagnosis?  Are we allowed to note that the mother has a breast
inflammation coupled with flu like symptoms and a fever of 101, but not
allowed to say "mastitis?"  Which is the medical diagnosis, and which is the
lactational?  If we are professionals with a specific body of knowledge, then
why are we concerned about what the nurse practice act says?  When I am
working with mothers, I am working as a lactation consultant, an IBCLC, with
15+ years of experience; not as an RN with 30+ years of experience.

I think Diane's posting was incredible.  We, as IBCLCs have a specific body
of knowledge, and I think that within that body of knowledge, we can/should
diagnose things related to lactation.  I'm not here to diagnose a specific
cardiac problem with an infant, or determine whether or not a baby has
Hirschsprung's Disease, or if a mother has pneumonia.  But if the baby is as
yellow as a pumpkin, do I say he's yellow, or he is jaundiced, or he has
hyperbilirubinemia?  Which is diagnosing?

People come to us, docs send moms to us, because we have a level of expertise
that most of them don't have, and don't have time in their regular work to
cultivate.

Nurses can make "nursing diagnosis," IBCLCs should be making "lactational
diagnoses," or some such like that.  And I agree with whomever posted that
said if this is all that important, that we don't recommend/advise OTC
remedies (even food supplements -- because that's what herbs are), and we
don't make lactational diagnoses, then the SOP of ILCA need to be revised to
state such -- and then we need to have some specific written guidelines
thereof.

But meanwhile, I'll continue to practice as ethically as I know how; continue
to recommend/advise OTC/herbal preparations -- the ones I know a lot about
and am familiar with -- and will probably continue to diagnose thrush in
babies and yeast in mothers, and plugged ducts, and mastitis, and even
perhaps an abcess should I be so unfortunate as to come across one.

Interesting that while we aren't supposed to diagnose, when we are tested on
the IBLCE exam, we are supposed to know what to do without having the
physician tell us!

Jan B -- over and out for the moment

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