I'm really enjoying this discussion.  I've received lots of offline requests about 
how to talk to HCP's.  I obviously can't speak for all of us, but I can tell you 
what's worked for me.  Easy things:  most people love to hear good things 
about themselves, and most docs like to think that they can help.

First off, I love Mimi's posts, she's so much more gentle than I am.  I think 
what we're saying is that the passion that this community has for 
breastfeeding precedes your discussions with HCP's.  And sometimes that 
passion gets in the way.  One of things that I grew up with in medicine is that 
LC's can be a bit crazy, and your whole message can get dismissed simply by 
the HCP falling back that excuse.  The doc to whom you may be speaking may 
expect something from you, some "crazy" aggressive talk that you yourself 
didn't earn.  (Take a look at the posts from the last few weeks and check out 
how many times docs have been called stupid.  And it comes through in 
lectures I've heard.  I shared a story already where a colleague left a 
conference because the speakers basically said LC's are all right and all docs 
are dumb.)  If they are expecting you to be one of "those lactation people" 
then your message is already lost.  Just something to keep in mind.

The LC that got my attention (before I saw the light) said something 
like "You're just the person I wanted to see.  I know you'll know what to do."  
Of course, I didn't but how could I admit that?  The question that needed 
my "expertise" was that one of my patients wasn't latching and the mother's 
nipples were really beat up.  My hospital LC said "this mother really trusts you 
and she's sure that you can get the surgeon to fix the baby's tongue -tie."  
Mind you, I hadn't even looked to see if the baby was tongue-tied, and had I 
seen it, I wouldn't have thought it was a problem.  In the discussion that 
ensued, I learned about normal tongue movements and nursing and all sorts of 
stuff that I was fascinated by, I called the ENT, he fixed it, and the mother 
was profuse in thanking me (which I think my LC had something to do with) 
and I was sold. I wanted to learn more about how I could help.

With Sam's infant under bili lights at 24 hours of age, maybe we can assume a 
few things.  First, it's unusual for a child to be under lights at 24 hours of age 
unless there's a hemolytic process going on.  And then, the doc does need to 
keep that baby under lights (and the AAP policy statement on hyperbili is more 
for non-hemolytic processes, so it may not be the best reference here.) So, I 
guess I would approach the HCP with the idea that you could learn 
something.  I have found that saying "I'm hoping you could help me" or "I need 
your guidance on this case" is a great way to start, since, most docs can't 
resist helping (or being a hero) and it's acknowledging this power dynamic that 
exists with docs and everybody else.  I use it all the time with my higher-ups 
and it works.

Maybe you can find out why all this is transpiring-- you said that you were 
shocked and this was atypical for your hospital.  Maybe there's a reason.  You 
could say that you are trying to help this motivated mom and you really want 
to learn about what's going on so that you are better able to help.  And 
maybe you can slip in a suggestion that protein hydralysate formulas are 
better for jaundiced babies if they need to be supplemented and if you could 
use those formulas, it would help mom because those formulas taste bad, are 
expensive, and seem more like medicine and then your job helping this mom 
would be easier.

Maybe, with the poop scenarios, that doc was worried about a malabsorption 
process.  A conversation could go something like "Mrs. X just called me and I 
wanted to find out if you were suspecting any abnormalites with the baby.  I'm 
hoping I can give her advice about normal breastfed stools but I was 
wondering if there was some other issue you were worried about with the baby 
first."  It's hard to lose here-- the info out there supports your position and 
could be sent to the doc if they were interested.

Another suggestion is to get a breastfeeding-friendly doc in your area to be 
your advocate.  Most docs listen better to other docs.  Since I have become 
an IBCLC, I handle these discussions with other HCP's.  We created a 
breastfeeding task force at my hospital, I named myself chair, and with 
that "authority" I have been able to troubleshoot when the situations arise. My 
hospital IBCLC's don't have to fight these battles since I do it for them.  You 
could make that doc "director of lactation services" or ask for one to be 
appointed your "hospital liason."  

As far as receptionists go, ask to speak to the doctor's nurse.  That's the way 
most people (that don't know my email address) get to me.

And if you believe that docs will never learn and continue to take a pessimistic 
attitude towards our learning ability then it'll never happen.  The AAP has tons 
of stuff on breastfeeding on it's website and lots of docs in the Section on 
Breastfeeding.  We're out there, in growing numbers, and we can help you if 
you ask.

Jenny Thomas
www.drjen4kids.com

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