Our residency program had a lecture this week by a psychiatrist about
psycotropic meds in pregnancy and the diagnosis and treatment of
post-partum psychiatric disorders.  Much of the tone of her talk was
"protect yourself against liability".  She focused on stopping all
psychotropic meds before pregnancy, and not using any in the first
trimester.  I was already biting my lip in the back row!!  Then the PhD
psychologist (knowing I was in the room, and how I feel about
breastfeeding...) asked her about meds in lactating women.  She said she
encourages moms to give the baby colostrum then wean to formula so they
can resume their meds since "the risks of any med to mom are greater than
the risk of formula"  AAAAARRRRRGGGGGHHHH.  I was, by this time, barely
able to control myself, but this was about 3 minutes before the end of her
lecture, and rather than disrupt things, I was going to speak to her
privately at the end of the lecture and offer her some references, etc.
My astute residents, however, turned to me and asked my opinion.  It came
out rather more strongly than would have been diplomatic, but she was very
open to my point of view, and asked for references when I pointed out that
artificial feeding has known, quantifiable risks, that most psychotropic
meds do not get to the baby in significant quantities and do not have
known risks, and that one should know about the pharmacology of meds in
lactating moms and their babies before making such a blanket statement.
The residents and the speaker asked me several appropiriate questions,
which I tried to answer respectfully and factually, although my passion
was probably obvious!

My colleague/partner (the psychologist) turned to me crossly and said "let
her finish her lecture" , then aftewards asked me to apologize to her for
taking over her talk.  I did send her a note apologizing if I came on too
strong, and enclosed some references for her.  (She was really quite
gracious about the whole thing.)  I would not have been upset if she had
merely said *she* was uncomfortable about prescribing for breastfeeding
mothers, but the context included the usual message that breastfeeding is
not important anyway, along with my additional pet peeve of practicing
defensive rather than scientific medicine.

Thanks for the opportunity to vent a bit to a sympathetic audience.  Any
suggestions on how I might have handled this differently or what I should
say to my psychologist colleague, who set up the whole situation with his
question then seemed very upset that I was disagreeing with his speaker?

--
Anne Montgomery, M.D.
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St.Peter Hospital Family Practice Residency
Olympia, WA