Response from Barbara Wilson Clay-

Hi,
Not being on LN in a while, I guess I have not had a sense of how
impassioned the dialog about the SOP is.  My point really was that similar
statements have been in the existing Code of Ethics for years.  I feel sad
that anyone would mistake my responses for a sign that I have "joined the
Dark Side" against my colleagues in a profession I've worked faithfully to
promote for 25 yrs. I had no input whatsoever into the writing of the new
SOP, and I'm glad they are going to be looked over again.  But I do
respectfully assert my right to an opinion.

The way I figure it, you can't have it both ways.  Either we are an
accepted, integrated health care profession  (seeking to become consistently
educated) and held to certain standards of accountability (i.e. reporting,
communicating with other care providers, maintaining records, staying
evidence-based) or we are people who operate totally outside the established
health care system, reporting to no one, saying whatever we wish without
being held to any requirements to justify (or even reveal!) our rationales.
I quite agree that sometimes it is appropriate to disagree with the
supervising doctor; but unlike nurses we are not dispensing meds (which has
always been outside the SOP of LCs).  Midwives and nurses are  licensed to
perform procedures.  Both nurses and midwives have disciplinary boards that
supervise their conduct and act to protect consumers in the event of bad
outcomes.  Controls on  behavior that monitor practice are not really about
us; they seek to protect consumers.  LCs are ancillary, not primary care
providers. This is a key point, and does not, in my opinion anyway,
denigrate what LCs do.

RE: reporting.  I have a template in my Word program.  When a mom calls me,
I tell her about my services.  I say:  My fee includes a report to your
primary care providers (midwife, OB, Fam Practioner, Ped) so that they will
have the information from my assessment. This way the mom knows when setting
the appt. that I report to the doc.  I can only recall one case in 25 yrs
when a mom objected.  She had a social relationship with her pediatrician
and didn't want him to know she'd had implants with a periareolar incision.
He was encouraging no supplements and nurse more, but the baby was FTT owing
to drastically reduced milk production capacity.  Can you see the bind here?
The ped couldn't really NOT have that info and safely advise this mother
regarding her baby's growth.

My consent form has a place where the mom reads and signs that info about
the visit will be shared. So we go over this issue again during the actual
consult.  My report is typically a paragraph long (the doc doesn't need a
term paper), so if there is info the mom doesn't want shared, we can dialog
about whether that's info the doc needs in order to provide standard care.
I don't have to share non-essential info.

My computer has a fax program and I also have a fax machine.  I have an
Address Book in the fax program where I enter in the fax numbers of the docs
I do the most business with.  With a click, I fax the 1 pg report to them
from my computer at the same time I print a copy for my chart.  The mom
often requests a copy and I'm happy to provide it.  If I don't have the
doc's fax #, I typically ask the mom to call the doc's office and get the
fax #.   I enter it into my fax address book so I don't have to mess with
looking it up next time.

I maintain records (charts) stored in plastic bins labeled with the
appropriate year of service and keep them in the attic of an outbuilding in
my back yard.  I am unclear how long I am supposed to keep them, and at some
point I will begin shredding them.  I don't share all the records (case
notes) with other hcps, just the pertinant reports. But I always remember
these are records that belong to the patient, so I chart with care.    Twice
I've had records suphoenaed by lawyers:  once in a divorce/custody case and
once in a malpractice case.  Occasionally insurance companies want to see
certain elements of the charts when considering reimbursements.  My consent
form mentions consent to share with insur. cos.  People can refuse to sign,
in which case I can decide whether to provide care on some sort of emergency
or compassionate basis or refer on as seems most appropriate based on their
reasons for refusal.

Linda Smith's book on the ABCs of Priv. Practice has excellent info and
advice about how to maintain records and shares the way several successful
priv. prac. LCs organize this aspect of practice/business.

I think I've said all I have to say about the subject for now.

Lactnews Press
www.lactnews.com

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