I just want to be sure Sam doesn't get slack for something Pam said, It was
me, Pam who said I will and do answer questions on the phone. I am not going
to charge a mom to tell her a simple thing like how to store breastmilk, how
long to let the baby nurse, when it is okay to pick up her crying baby, how
many stools her baby should be having, etc. etc. And, a mom calling and
asking how many times her baby should be stooling and what it looks like has
never made me think a doctor had suggested weaning for it. I did not know she
was told to wean until after I answered her question. If she chooses to wean
to formula or not is her decision. I did not tell her not to wean to formula,
I answered her question. I suggested she call her doctor back and be sure
she had the information correct and I gave her a couple of phone numbers for
doctors who can give her a second opinion about weaning. Like I said, I will
mail her doctor an information sheet about stools. I did not comment to the
mom about the inaccuracy of the information or disparage the doctor for not
knowing, I questioned it here, where I knew that others would understand the
frustration you feel when breastfeeding is about to be ended unnecessarily. I
would think of all people to be frustrated, other doctors would really be
frustrated! I did not think they would feel attacked, I thought if anything they
would shake their heads and wonder why they know this and another doctor
doesn't. I did not diagnose, I do not do such a thing as that is for a physician
to do. I do not give medical advice. Breastfeeding is not a medical event.
Stooling is not a medical event unless it is abnormal. I just do not ever
see myself charging for a consult for answering a question or providing
information. I also do not think I will start sending reports unless I see the
client and have her permission to do so. But, if I am not seeing her, she does
not have an issue that needs a visit and so it doesn't warrant a report to a
doctor. See, this is really an issue that I disagree with. Until the S.o.P.
is finalized, I am following the Standards according to ILCA, and I do not
read "must report every single contact with any person who contacts you to her
health care provider" written anywhere. I see 'when appropriate' and simple
questions do not require a report of any kind to anyone. Just a note in my
paperwork of the phone call and the information I provided. If LCs are not
allowed to answer questions on the phone, and we are only allowed to give
information in person and we must even have a consent form to tell a mom how often
to pump or send her a link to a website to read more for herself, I will
need to see that in writing as a condition of my credential. I can do more than
that as a doula and still make a nice living. And, there are plenty of LCs
with websites that provide information --- do they need to stop doing that
because something on their website may be read by a mom who was told something
different?
This is my third post, so I want to be sure to cover one more thing. I
think it is unfair to call it 'doctor bashing' when we share what happened to a
mom or baby and a doctor is involved. We do not use names, but since we are
talking of a specific situation, it is a specific health care provider we are
talking about. We all know that there are great doctors and bad doctors,
great nurses and bad nurses, and great LCs and bad LCs. I do not take it as an
attack against all doctors when statements are made about a particular
situation or problem. I do not take it as LC bashing when one LC is doing
something we don't like and we discuss it. No one thinks we are talking about all
nurses when the comments are made about some behaviors of nurses. For the most
part, if a situation is being discussed the hope is that there will be input
and guidance from those who know more, who know different, or who have some
expertise in the particular situation. I agree that calling names is not
professional or appropriate. Of course doctors are not stupid. I have a good
friend in med school and I know the rigors of her studies and no way can
'stupid' people make it there. Even if they did graduate at the bottom half, they
are still smarter than those who could not even make it into the class! I
have too much up close and personal time with doctors to think they are anything
but very smart. Which is why I said it was not that they cannot know, but
that they were not taught, and if their education included it, they would know
it. Which brings us all the way back to the original question.....how would
doctors want to be given the information? What is the least threatening way
to share information that contradicts a doctor's current practices?
I work so well with the doctors who I know I will always agree with. It is
so much easier that way....they give my number, I know they already gave
great information. Yep, that is my comfort zone for sure. But, I have stepped
out of it and I do think I have good communication skills. I listen, I agree
as much as possible, I offer the research where I get my information from,
and sometimes we agree to disagree and the mother needs to make her own
decisions and it is her decisions I work within even when it is to follow the
doctor's recommendation to use formula because in the end, she is the one charge.
I give her the information available, she has a right to information and I am
not going to withhold it. It is her decision what to do with the
information. Also, lets remember that not all mothers share the information their
doctors provided. I see plenty of mothers who tell me they have not even told
their doctors of their situation so they have not had a doctor tell them what
to do and I do not have to worry about any of this. LCs are not a referral
only allied health care provider so moms can call without notifying their
doctors. My report may be the first time the doctor is even aware there is a
problem with breastfeeding. I do not get the doctor's name and number, call
before I see the mom and be sure we are on the same page, so it is very likely I
will say something contrary to what her doctor has told her and not even know
it. That is why my consent form covers that very possibility.
I think private practice LCs are in a very different situation than are
hospital based LCs and how we practice is not going to be the same. It may also
change how we communicate with the doctors Hospital based LCs will be seeing
the doctor, will be able to quickly contact the doctor if there is an issue
with an order given. It will be easy for them to be sure the mother has it
right, that the doctor really did order 2 ounces of formula after every
feeding at the breast for the 2 day old baby because she read it in the chart.
And, because it is in the chart, it is what the doctor ordered. Is it still
'doctor's orders' if the doctor just told the mom something on the phone or at a
well visit that is just not what mom wants to do? Who decides if a mom has
the right to find other information and make her own choices? If a doctor has
told a mother something a private practice LC may& or may not know about it.
She also will have to call the doctor's office and wait for a return call.
It will not be so easy for the private practice LC as it is for a hospital
based LC to find out what a doctor really said. How appropriate is it also to
question the mother's right to share what she wants us to know and nothing
more? And, there is no chart at the bedside for us to read, so we have to rely
on what the mom tells us, and she may or may not tell us everything.
Private practice is very different from hospital practice. Is breastfeeding ALWAYS
a medical event that needs to be reported to the doctor? I just get so
frustrated by the constant medicalization of normal human behavior. I do
understand sometimes the two overlap, but breastfeeding itself is not a medical
event.
Thank you to the doctors who have already provided some guidance for this
issue.
Best
Pam MazzellaDiBosco, IBCLC, RLC
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html
|
