Well, the answer is that there is not to my knowledge standardization of 
education re: breastfeeding to MDs at all.  It is happening at the local 
level...if there is someone near a medical school/residency program who 
cares to go to the work of developing a curriculum (AND the powers that be 
will encorporate one!), it happens.  If not, it does not.

We have a Family Practice residency program in my town, and I went to the 
director and asked if I could please speak yearly to the residents.  That 
only happens if I call and nag them to let me speak.  (It has been twice in 
5 years)   But they DID make it part of their pediatric rotation for 2 weeks 
to come shadow me, so with their clinic time and lectures and my schedule 
they end up with 15-20 hours of observation of me and the LCs doing consults 
and making phone calls.  I try and meet a minimum amount of objectives (set 
by me...the objectives set by the program are extremely vague).  These are 
all volunteer hours on  my part, of course.

As for mastitis treatment, I "know" Keflex is not supposed to be the 
greatest drug against staph, but it is Jack Newman's first-line choice for 
mastitis, and usually mine as well.  It is anectdotal, but it seems to do 
the job most of the time.  And if it does not within 24-36 hours I switch. 
Maybe this is because many cases of mastitis are not truly infectious, and 
they would get better if we gave them candy.  But if I get a case that comes 
from another hcp who has already been on Amoxicillin (a really poor choice) 
and not getting better, then I go straight to Clindamycin or Dicloxicillin.

As long as I am on this rant, I will go on to agree that there is a lot of 
misunderstanding/ignorance out there. I got a call from a large metropolitan 
area 8 hours from here from a crying mom who was admitted to the hospital 
for the second time in two weeks for mastitis...getting big gun IV 
antibiotics...very frustrated with her care.  In talking with her for 10 
minutes on the phone, it sounded to me like recurring plugged ducts (was 
happening in opposite breasts in different areas) possibly due to 
ill-fitting pump flanges and sub-optimal milk removal.  The infectious 
disease specialist was treating her as if she had some terrible resistant 
bacteria.

It IS extremely frustrating to see the rampant lack of knowledge out there. 
When I started this 5 years ago I naively thought everyone (MDs) would WANT 
to learn about the physiology of the breast and the breastfeeding 
relationship.  I have not found this to be the case.  I have reluctantly 
come to the conclusion that you cannot teach someone who does not want to 
learn, and I cannot make them want to.  BUT I am hopeful that it will be the 
moms who keep pushing and insisting and expressing their disappointment that 
will eventually push even the reluctant ones to learn.  I know it will not 
be the AAP.

Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE

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