Kathy,
       You asked if it is ethical to charge someone when you can't give her a
diagnosis or suggestions to affect change.  I worried about that when I first
went into private practice.  I decided that if I had absolutely nothing new
to offer a mother, I would not charge her.  And there were a few times when
that happened, especially before I knew about pediatric chiropractic and
CranioSacral Therapy.  For instance, if the mother was already using the correct pump
and pumping routine for her situation, and I had absolutely no idea how to
help her and no new information to offer, I would not charge, even if I spent an
hour trying to determine that nothing I knew was going to help.
       On the other hand, if I have been able to recognize, point out, and
explain symptoms that show the need for further help from another type of
therapist, or can explain why she needs to ask her doctor for further tests that
might yield answers, and I also help her develop a pumping routine that will help
maintain/build supply until baby can breastfeed more effectively and help her
find a way to feed the baby that will not be detrimental to future
breastfeeding, then I feel I have been useful to this mother and I do charge her, even
if I was not able to immediately make breastfeeding better.  I figure my doctor
charges, even if he wasn't able to help, so to some extent I take my cue from
that.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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