During my recent holiday in Australia, I had an interesting discussion with
some colleagues about the application of the Code of Ethics regarding
reporting to the primary health care provider. While our Code doesn't actually
require us to report to the primary health care provider, a point upon which
their entire argument rests, I was taught, in fact, enthusiastically required, by
my mentors, that one always, without fail, reported to the mother's and
infant's primary hcp after a consultation. My Australian colleagues rarely, if
ever, report to the primary hcp, arguing that their care stands alone.
My colleagues maintain that this is appropriate for several reasons. Other
allied hcp's, speech therapists and occupational therapists, for example, do
not report. They, like IBCLCs, are credentialed to practice, and respected
as the experts in the field. They may consult with physicians, but are not
junior to them. Furthermore, their health care system operates differently.
Well babies and mothers are generally seen in by a clinic-system which
substitutes for the pediatrician-centered care of the US. There, pediatricians are
specialists who care for sick children (what a concept) instead of spending
the majority of their days looking into sore throats and getting gobbed on by
runny nosed toddlers. Well-child clinics, staffed primarily by nurses, and
occasionally GPs (and these are primarily expats who take this route) provide
care, immunizations, and monitor developmental milestones, etc. Therefore,
my friends argue, there is no one to whom to report.
My opinion differed, however, in that in the three years I was in private
practice in Canberra (where I was the only person in private practice, a new
concept for that city), I saw primarily train wrecks. I felt it my
responsibility under those circumstances, where the infants were at risk to report to
pediatricians or GPs. I would have done it anyway, of course. In addition, as
I maintain with my colleagues today, I think reporting helped get our
profession 'on the map' if you will, with the OBs, GPs and peds in town. Some of
them were a bit taken aback, but they got used to it. It was also an
opportunity to educate them (especially the OBs were still recommending nipple prep
with toothbrushes!).
So, where we are is their saying "we don't do that here", partially because
it doesn't fit their system, but also, I think, because they remain fiercely
independent and determined not to be dominated by the "American" model. But,
to be fair, they say no, that's not it. I can only speak from experience.
When I lived there, I took more than an occasional bashing about our/my (read
American) "interventionist" style of consulting (which I prefer to term
'activist'). Yes, I think we are more likely to intervene with a pump, suck
training, an SNS or other 'gadget,' whether it's because we think it's the best
option or the mother 'demands' it. Whereas, and this is a huge and probably
unfair generalization, one is more likely to see a much more "hands off"
approach to almost every challenging situation as the first course of action there.
So, this is an interesting application of one's personal code of ethics vs.
the IBLCE defined Code of Ethics, vs what we/I have been taught is the
best/only way to implement the intent of the Code of Ethics. The founding mothers
of the profession themselves beat it into me that one wouldn't dream of
conducting a consultation without reporting, yet it isn't strictly written that we
must do so in the Code. Our colleagues elsewhere would just as soon fall on
their periodontal syringes (if they used them) as write a report to the
primary hcp, if they could define one. What to do, what to do?
Barbara Ash
Falls Church, VA
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