>Question to those of you in private practice -- how do you obtain accurate
information re your consultee's history.  Often moms are unsure as to what
actually transpired, what drugs they got, why interventions were made --
>do you get releases in order to read their hospital records?  or do you
have to just go with what the moms and families say happened?
  Chanita
        I do not have charting privileges at our local hospital, but I do
make a point of asking the staff to tell me verbally anything that may be
pertinent.  Usually patients are referred by physicians or the nursing
staff, so even if I make home visits I am briefed.  I ALWAYS make a point of
asking the family about their view of the situation.  Almost inevitably they
have excellent judgement.  And quite frankly it is the situation that is
happening in the present I am concerned most about.  If I need to I can
always call the attending physician/ped or nurse for more detail.  I do
consider myself one of a team, perhaps this is one of the joys of a small
community.  One of the detriments is that we always operate with less
information than you might be comfortable with. Diagnostic testing is not as
available as in a larger centre. I do get all mothers to sign a release
allowing me to speak to their other HCProviders.  It is the hospital which
restricts my access to their charts. I have never tried to get access in all
honesty.  I gain more information verbally, the staff tend to ask questions
and if need be negotiation can take place to reach a situation everyone
involved feels can be achieved. I write a recommendation/report on my own
letterhead which is attached to the patient's chart in hospital and which I
mail to the physician if it is a home visit. It is usually more detailed
than standard hospital charting. This serves many purposes, not only does
everyone get to see what and why I have recommended something but it is a
very effective teaching tool for physicians.  If you say/write the same
thing often enough you start to see/hear your words echoed back to you. If
what I suggest is controversial or I feel the physician is not 100%
receptive I often attach a support reference (usually only one as it is more
likely to be read). I have been continuing this practice for the past 10
years, so it is taken for granted by the staff.  Obviously consideration has
be given for the staff workload -- if they are frantic I learn less than if
things are calm.  At the same time I ease their workload as I take over the
care of one mother/babe for an hour or two.  I'm not sure how applicable
this would be in a larger centre.
--"Without interest and passion nothing great has ever happened in history.
Hegel"
               Rhoda Taylor, B.A., IBCLC   Duncan, B.C., Canada--