Dear Patricia and Everybody: I like Patricia's approach which is to empower the mother to take care of the situation herself. Waiting for someone else to take care of you when you know what needs to be done is a waste of time and energy. So the mother can make the appointment herself with an ENT. Then the results can be shared, along with copies of articles to the PED. Sometimes I feel like a priestess of the sacred writings. I think that most LCs I know are far more knowledgeable about the current published research on lactation and related topics than most MDs. We spend the time because we know it is important. And this runs right smack up against that fashionable idea called "Standards of Practice" which means that whatever is done in the community by the most practitioners is the legal standard, regardless of what the research says. A challenge for us is to reconcile those two threads. Best answer is to educate the consumer. It was consumer demand that got childbirth education going! Warmly, Nikki