Speaking as a physician, if I ordered a "lactation
consult" I would be expecting a consultation from an
IBCLC.  I think the supervisor who says physicians
don't know and don't care is wrong.  Some may not, but
many do.  And if you want to encourage physicians to
order consultations, I believe they should be treated
professionally as any other medical consultation would
be (ie: surgery consult, GI consult, etc).  Complete
notes should be dictated in the chart just as they
would be if a different medical specialist were
consulted.  I don't know what the standard is in other
hospitals, but I've worked at places where the LC
notes just got jotted by hand among the other various
nursing notes and were usually very brief.  If you
want to educate physicians and catch their attention
and command their respect, a full evaluation with
assessment and recommendations is far more effective.
The doctors will rarely even look among the nursing
notes, particularly if they are handwritten and/or
located in a different part of the chart from MD
notes.  But, if the consultation is dictated on the
chart in full, as any other medical consultation would
be, then the MDs will read it and hopefully learn from
it and appreciate the importance of it as well.  If it
were up to me, this would be the distinction I would
desire when *ordering* a "lactation consult" vs
routine breastfeeding support and education.  I would
want it conducted by an IBCLC and treated in the same
manner as the other medical consultations I ordered
(ie: surgery consult or GI consult), to appear as a
full evaluation with assessment and recommendations on
the chart.

Catharine Decker, MD
Family Practice/Urgent Care




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