In fact, our usual instructions to a patient with an STI is to have their
partner come for treatment or go to their own provider immediately. It is a
strongly worded suggestion. I don't write a prescription for someone I
haven't seen as a patient. There are lots of good reasons for this rule of
thumb, obviously.

In the case of thrush, etc., in a breastfeeding dyad, of course I would
write prescriptions for both patients because I happen to be trained for
that. But most practitioners are not. That's just the way it is, and
grumbling about individuals who stick to their scope of practice guidelines
just isn't fair to the individual practitioner. The people to grumble at are
the educators in med school and NP programs who still give you blank stares
when you talk about lactation and maternal/child healthcare.

I'm a little prickly about this subject because I had dinner with my old
nemesis (head of women's health department at my graduate school) last week
and she doesn't even give me the blank stare. She rolls her eyes and says,
"There she goes again" to get a laugh from everybody at the table. And my
fellow classmates smile uncomfortably because they run into the holes in
their training every day now, just as I warned them they would.

So if we could sell a comprehensive lactation module to med schools and NP
programs, we might see some improvement in continuity of care. Otherwise,
we're just wasting our time grumbling at the poor providers out in practice.

Bonny Cannell Nothern, RN, MSN, RNC, IBCLC

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