The situation may be very different for LCs practicing within a
hospital setting than for those in other situations including
private practice.  Originally we only reported when we felt there
was something the doc needed to address or when we got a referral
directly from the doc.  Now all our outpatients are seen under an
order from baby's doctor.  (We have had no problem getting the
orders from any of the docs-Peds or Family Practice).  We document
using the TLC program (in which we made many changes and
modifications of the various lists).  We print up a report which
includes the feeding plan and give it to mom.  If there are comments
we want to make that might not be appropriate ito hand to mom, we
then add these to the comments.  This goes to Medical Records and a
copy is always fax'd to baby's HCP.  I don't know if all the docs
read these or only if they are reviewing baby's office chart.  I
have had several thank me for a report-usually they don't go out of
their way, but if the run into me on the unit.  Before we started
using this program, I wrote up a fictitious report on "Susie Sample"
and her son "Junior Sample" in which I described a typical consult,
suggestions, etc.  We presented this at a Ped staff meeting and it
was very well received.  They indicated it was the type of
information they would find helpful.
There are times we contact a doc directly while talking with the
mom.  Typical ones are:
1-Baby is noticably jaundiced and/or mom has asked about baby's
yellow skin.  If I feel it is more than typical, I will call the doc
and ask if he/she wants a bili drawn.  They usually call lab right
away and order one.  This saves mom a separate trip to the hospital
if the doc decides later it is needed and usually saves the doc a
call from mom which she would probably do later that day or the next
to ask about the jaundice.  In most cases, it isn't a level that
needs Rx, but we have "caught" a few that were serious enough levels
to warrant treatment. (usually done at home unless level is over 20
or rising rapidly-even if the doc feels home therapy is sufficient,
many insurance companies won't cover outside of hospital if it's
over 20)
2-Doc has told mom to supplement and I don't feel it is needed at
this point.  Typical case is where mom took baby to the doc a couple
days after going home.  Baby is still losing weight and doc is
understandably concerned so supplement is ordered and mom is sent to
us to evaluate feeding.  We probably see her the next day and in the
meantime milk volume has "kicked in".  Or we adjust her latch and
baby now takes a very good amount (as shown by pre and post feed
weights).  I will call the doc while mom is in the office with me,
describe my findings and ask if he/she agrees that mom can hold off
on supplementing.  We usually arrange for another weight check in
24-48 hours either with us or with the doc to be sure things have
really turned around.  I rarely find a doc who doesn't agree with
this.  If continued supplement is warranted, I will describe to him
the plan for giving in a way to reduce confusion potential and will
also clarify the amount he is recommending.  "Supplement with an
ounce after every nursing" can mean "get an ounce in baby any way
you can" or "give UP TO an ounce depending on what baby will take".
Most parents seem to think it is the first meaning, while I find
most docs mean the second.

I see LCs as collaborators in the baby's care.  Neither LC or doctor
is subservient to the other.  We each have our areas of expertise.
Since the doc oversees the general care, he/she needs to know what
other collaborators are doing and suggesting.  I don't necessarily
need to hear from the doc about every aspect of his examinations of
baby, but hopefully, when we are working with a baby the doc will
keep us posted on what he sees/does that impacts feeding.  For
instance, if a baby is having a weight checked with the doc after we
have worked with her, they are usually very happy to report back to
us with the current weight.  (Although, we usually have the mom call
us with it as we also want to assess her progress with whatever
changes we recommended when she saw us.)

Winnie

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