Diagnosing (dx)  is the privilige of MDs. RNs may make nursing dx.  I think
that LCs make lactation dx, and that over time, custom will establish this
as our province of expertise -- esp. if we keep moving forward with
education requirements and adhere to certification that documents
competency.

  I work with MDs who expect me to look closely at the baby, and who trust
me to tell them what is wrong with the way the baby is feeding and to alert
them to maternal conditions they may be unaware of.  (For instance, many
pediatricians do not know the mother has a history of breast surgery, or of
a specific illness or condition that may affect bfg).  I work with some MDs
who do NOT like me to draw conclusions.  In other words, even if I think it
is a reflux problem, they reserve the right to make that dx.  What I do is
try to develop a sense of how to work most respectfully with the specific
doc and give them what they want.  It's all the same to me so long as we
communicate in the way best suited to get the bfg dyad the help they need.
If it is a doc who is concerned about protocols of dx, then I carefully
DESCRIBE what I see, but allow the doc to draw the conclusions.  If it's a
doc I have a long, friendly relationship with, I might be more casual and
offer a conclusion, "Well, looks like reflux; prob. a swallowing study would
help."

My response to getting called on the carpet if the way I've phrased a report
offends a doc is to say:  I am sorry.  How can I more effectively work with
you in the future?

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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