Does anyone use an algorithm when trying to decided why a mother has low milk supply?

When i see a patient i try to determine the reason for lactation failure of course most of the time it is simple supply and demand but occassionaly this isn't the reason. I was just accused of going out of my scope of practice because I saw a patient and after a history report told her that she may have a hormonal imbalance and suggested that she gets some labs checked. Her doctor emailed my supervisor and told her that i was out of my scope of practice by doing this. It almost seemed like she expected me to be saying "You have lactation failure so you need to go see your primary doctor to have this diagnosed". Unfortunately what would happen is the doctor would say - "Some women just can breastfeed, here is some formula'" By the way this doctor and a few others have denied the recommend lab testing that i suggested. One time i had a doctor who refused to do a prolactin level but ordered the mother reglan (1 tablet a day for 5 days). 

I tried looking through the scope of practice for IBCLC and compentecy list but it wasn't specific enough. They say that i should know the causes but it doesn't necessarily say that it is my job to provide the client with this information. 

I am going to work up an alogorhytm to provide this doctor with so she knows what i look at when a mother has lactation failure but was checking to see anyone else had one already? And how does everyone else handle these situations. 

Jessica Callahan RN, IBCLC
NC, USA

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