During my recent holiday in Australia, I had an interesting discussion  with 
some colleagues about the application of the Code of Ethics regarding  
reporting to the primary health care provider.  While our Code doesn't  actually 
require us to report to the primary health care provider, a point upon  which 
their entire argument rests, I was taught, in fact, enthusiastically  required, by 
my mentors, that one always, without fail,  reported to the mother's and 
infant's primary hcp after a consultation.  My  Australian colleagues rarely, if 
ever, report to the primary hcp, arguing that  their care stands alone.
 
My colleagues maintain that this is appropriate for several reasons.   Other 
allied hcp's, speech therapists and occupational therapists, for example,  do 
not report.  They, like IBCLCs, are credentialed to practice, and  respected 
as the experts in the field.  They may consult with physicians,  but are not 
junior to them.  Furthermore, their health care system operates  differently.  
Well babies and mothers are generally seen in by a  clinic-system which 
substitutes for the pediatrician-centered care of the  US.  There, pediatricians are 
specialists who care for sick children (what  a concept) instead of spending 
the majority of their days looking into sore  throats and getting gobbed on by 
runny nosed toddlers.  Well-child clinics,  staffed primarily by nurses, and 
occasionally GPs (and these are primarily  expats who take this route) provide 
care, immunizations, and monitor  developmental milestones, etc.  Therefore, 
my friends argue, there is no  one to whom to report. 
 
My opinion differed, however, in that in the three years I was in private  
practice in Canberra (where I was the only person in private practice, a new  
concept for that city), I saw primarily train wrecks.  I felt it my  
responsibility under those circumstances, where the infants were at risk to  report to 
pediatricians or GPs.  I would have done it anyway, of  course.  In addition, as 
I maintain with my colleagues today, I think  reporting helped get our 
profession 'on the map' if you will, with the OBs, GPs  and peds in town.  Some of 
them were a bit taken aback, but they got used  to it.  It was also an 
opportunity to educate them (especially the OBs were  still recommending nipple prep 
with toothbrushes!).  
 
So, where we are is their saying "we don't do that here", partially because  
it doesn't fit their system, but also, I think, because they remain  fiercely 
independent and determined not to be dominated by the "American"  model. But, 
to be fair, they say no, that's not it.  I can only speak  from experience.  
When I lived there, I took more than an occasional  bashing about our/my (read 
American) "interventionist" style of consulting  (which I prefer to term 
'activist').  Yes, I think we are more likely to  intervene with a pump, suck 
training, an SNS or other 'gadget,' whether it's  because we think it's the best 
option or the mother 'demands' it.  Whereas,  and this is a huge and probably 
unfair generalization, one is more likely to see  a much more "hands off" 
approach to almost every challenging situation as the  first course of action there. 
 
So, this is an interesting application of one's personal code of ethics vs.  
the IBLCE defined Code of Ethics, vs what we/I have been taught is the 
best/only  way to implement the intent of the Code of Ethics.  The founding mothers 
of  the profession themselves beat it into me that one wouldn't dream of 
conducting  a consultation without reporting, yet it isn't strictly written that we 
must do  so in the Code.  Our colleagues elsewhere would just as soon fall on 
their  periodontal syringes (if they used them) as write a report to the 
primary hcp,  if they could define one.  What to do, what to do?
 
Barbara Ash
Falls Church, VA

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html