This from Barbara Wilson Clay.

Basically, I don't see much new here.  The Code of Ethics has always
required that we report to the supervising medical care provider of the
people we see.  The wording of Tenet 23 states:

     Require and obtain consent to share clinical concerns and information
with the physician or other primary health care provider before initiating
consultation.



Tenet 23 speaks to the issue of scope of practice.  Unless otherwise
qualified and additionally licensed, most LCs are not primary care
providers.  Consequently, they are obligated to consult with and report to
the patient/client's primary care provider.  Patient confidentiality
requires that the patient be informed of the intent to share information.
This intent should be made clear prior to beginning the consultation. Signed
consent must be obtained.





The current wording of Tenet 9 states:
              Recognize and exercise professional judgment within the limits
of her/his qualifications.

Again, this speaks to scope of practice.  Unless we are additionally
licensed with perogative to prescribe or refer, what we are supposed to do
is describe and confer.

When I write my reports, I never say (for example) "this baby is tongue-tied
and needs to see an ENT for frenotomy".  I would say:  "the baby's lingual
frenulum is attached approximately 1 cm from the tongue-tip.  The infant was
observered crying with his mouth wide open and the tongue did not elevate to
the upper alveolar ridge, and began to distort as it approached it's upper
range of mobility (about at the mid-line).  The infant was unable to
maintain a seal at breast, sustaining a good latch only momentarily.  The
baby appears to be compensating for inability to hold onto the breast with
normal application of suction by clenching with the jaws.  The mother's
nipples appear pinched when the baby comes off and there are crusty, yellow
lesions on the tips of both nipples.  These lesions began to appear on Day
1, and have persisted to Day 14 (the day of my assessment).  The mother
denies febrile sx but is taking 600 mg of ibuprofen q4 hrly and may be
masking sx of mastitis.  Test weights determined the baby was only able to
obtain 45ml (total) during a fussy breastfeeding session that lasted
approximately 50 minutes.  The mother describes the feeding I observed as
typical.  The infant is 2 oz below his birthweight of 7lb5oz, and cries
excessively."

This report would alert the pediatrician to more closely assess and deal
with the tongue issue, and would alert the OB that the mother may need
diagnosis and treatment of a staph infection.  This makes the appropriate
people responsible for medical care and gives them information they may not
now have about the condition of their patients, that my more detailed (and
longer) assessment provides them.

 I typically mention to the parents that there are pediatric ENTs or
dentists in our community who perform these evaluations.  Then it's the
parent's job to take all this up with the doc.  He/she has my report in hand
giving a clear idea of what is going on.  If the doc dismisses the problem
and the parents call me back, I say:  "As consumers, you always have the
right to a second medical opinion and you can insist your doc refer you on
or you can seek counsel from another pediatrician.  If they ask me for a
referral, I provide one.

At no point in this process have I exceeded what I am capable or certified
to do, and working as a team member has protected the perogatives of the
doctor's scope of practice.  This means that my courtesy becomes a bridge
between our specialities, and over time has resulted in more (not less)
ability to advise on the subj. of lactation.

Maybe viewing ourselves as important members of a team is really a good
thing.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
Lactnews Press
www.lactnews.com 

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