Magda, you expressed concerns about violation of client confidentiality if a
case is discussed with hospital staff, or with the referring doctor after a
hospital visit.  This is definitely a new and awful thought!

Part of my history taking before the actual consultation begins includes
obtaining the names of the client's doctor, obstetrician and baby's
paediatrician, and details of why she wants to see me etc.  At that time I
ask the client if I may report to the referring doctor, and discuss her
situation with the other doctors if necessary (IMHO, that is).  This is
included in our Standards of Practice. I have never had a client refuse -
mostly the response is pleased surprise, and quick consent, as if I should
even need to ask!

At the end of the consult I write in the hospital notes.  These are kept in
the client's room and thus accessible to her at all times, and to the staff,
and to me (so I can see what has happened so far) so there are no secrets. I
record briefly what I saw, what I did and what I recommended.  On the way
out, as a courtesy to the staff, I find the nurse looking after that mom and
baby and verbally report the same things.  I assume that the nurse needs to
know what the problem is before she can help her to breastfeed from now on
and, furthermore, we don't want to give the mom conflicting info.  Sometimes
the staff perception of the problem is different from what I see, sometimes
it's the same.   I *don't* tell the nurse what the mom *said* (only what *I*
said/recommended) unless it's something that seems important regarding the
breasts or the baby,
e g "The mom said the baby has been vomiting." or unless it seems (to me) to
affect her attitude towards breastfeeding her baby, "The mom said that she
would actually prefer to bottle-feed", or unless it's a compliment - which I
*always* report, verbatim, as positive reinforcement!

When I'm verbally reporting to the OB or paed concerned, we sometimes really
discuss the whole thing, yes, and I always assume that we are working out a
strategy that will result in the most benefit to both members of the couple.
Sometimes when I report what I've seen, the OB provides me with the reason
I'm seeing it - because he has had the care of this mom for several months
and knows her history - and suddenly it all fits into place and we can go on
from there.

Is this really a violation of confidentiality?  If so, where does reporting
end and confidentiality begin?

Pamela Morrison IBCLC, Zimbabwe
mailto:[log in to unmask]