>Example:  Mom is seen by LC for symptoms of bilateral mastitis.  Instead of
>collaborating with Mom's CNM or MD (if there is one), she gives the Mom advice
>to treat symptoms.  Mom develops full-blown bilateral mastitis, cultures out
>Group B Strep, baby comes down with late-onset sepsis because maternal
>treatment was delayed, develops meningitis and has a poor outcome.   Who is
>responsible?

In this case the word bilateral should be a red flag, of course, and she
needs to look into medical care.  But anything can turn nasty.

And whether it does or doesn't, who's ultimately responsible?  *The mother*.
I might give mastitis suggestions over the phone, but repeated several times
through them is something like, "But you're the best judge of what's
happening.  If at any time you're uneasy with how things are going..." with
an appropriate action outlined (like calling her doctor).  Or in a consult,
"Do you like the sound of this?  Does it feel good to you?  Or do we need to
change it in some way?  It needs to work for you, not me."

I see it as my job to *give her ideas to work with*, not to take care of
her.  She needs to take care of herself.  I'm just her *consultant*, not her
savior.  Saviors get sued because the client (or patient) handed over
control.  Part of my job is to make sure she sees me - and herself - for who
we really are.  She's in control.  I'm just in the seat beside her.

Wish I knew for sure where I heard this definition of a consultant (in any
field):

A consultant is hired not for his education or for his initials but for his
life experience.  He is expected to provide ideas from outside the
mainstream; that's why he was consulted.  He offers these ideas with the
understanding that many of them will not be implemented, or will not be
implemented in the way that would make them most effective.  The client
understands this as well."
--
Diane Wiessinger, MS, IBCLC  Ithaca, NY
www.wiessinger.baka.com

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