Kathy Eng quotes the ILCA standards of practice. Our interpretations are
different. This is not to argue that we should or should not send a report to
HCPs, it is to say it is not mandatory as currently written. Legal documents
should not make assumptions. On the other hand, trusting us as
professionals to know when it is appropriate makes perfect sense. I do not interpret it
to mean must. I read "as appropriate" to mean just that. As appropriate.
Who determines when it is appropriate? As has been pointed out by several, it
is not always appropriate depending on the area you live as others have
pointed out. Having permission to share information with a health care provider
is important for USA LC's who cannot discuss medical information without
consent. However, I still feel uncomfortable with the idea that I would have to
refuse care to a mom who doesn't choose to allow me to share her information
with others---her right to privacy comes first in my mind and would make the
"when appropriate" mean for her, it would not be appropriate. Also, I do not
consider the word "communicate" to mean "report to".. The words "report to"
also have a variety of meanings. It can mean simply to provide the
information, or it can mean 'answer to' . I consider the ethics of my work to mean I
'answer to' the clients I serve. I consider it appropriate to share
information when breastfeeding assistance is part of a medical situation that has the
potential to change the advice of the hcp or if the hcp has asked the mother
to see me. I do not interpret appropriate to mean provide a report for every
phone call, email, question I answer, or even visit that is not about a
medical issue. Of course, I personally do not believe breastfeeding is a medical
issue in every circumstance and only on the occasion that there is a medical
issue and breastfeeding is involved do I consider it 'appropriate' to 'share
the information' or 'provide a report of the information shared' or
otherwise communicate my findings and what I shared with the mother(pick the
semantics that works). Otherwise, I have a consent that allows to share the
information, I have a consent form that states anything that I offer that is
different from her health care providers information is for her and her hcp to
discuss and her decision to make. I am not working in a health care institution.
I think that the scope, the standards and the ethics will all be governed by
the place of employment also. I do not understand the need to take one
method of care's rules and apply them globally and across all practices. This
assumes the standard of care of the institution within the USA is the standard
we should hold everyone too. Why do we not look to other countries and model
their standard? Prefer we look to a country with the highest rates of
breastfeeding initiation and duration and model our care for breastfeeding mothers
and babies after that if we insist on not respecting the differences we bring
to the profession.
#3.3.7 "Document and communicate to health care providers as
appropriate: assessment information, suggested interventions,
instructions provided, evaluations of outcomes, modifications of plan of
care, follow up strategies."
Take care,
Pam MazzellaDiBosco, IBCLC, RLC
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