Heidi wrote:
        I am thinking that if I can feel intimidated and guilty for
questioning
        my favorite doctor, then brand new, unsure mothers surely can, too.
        Especially if their doctor came "highly recommended,"  I can totally
        understand how a new mother who may be facing a crisis can be
        intimidated by a doctor.  There is no excuse for poor or
misinformation.
        I am just saying that some mothers have a hard time finding their
        voices.  Let's figure out how to help these moms . . .

Very good points, I think.  And keep in mind that it's not just about their
being *intimidated* by their doctors (at least I sure hope it's not) it's
also about trust and about their relationship.  If a patient really likes
and respects her doctor, she may feel she's being put in a position where
she has to 'take sides' and if her relationship with her doctor is closer or
more longstanding than her relationship with you (the LC), then she might
feel like she has to discount you.  Similar to the mom's who have a hard
time following your advice when it conflicts with a loved one's advice or a
cultural practic.

How about treating the situation just as you would when any other respected
or significant person in a mom's life gives bad information?  We've all had
to find sensitive and respectful ways to tell women that the advice their
mothers or sisters or friends have given (or even the way they've been doing
things in the past themselves) is incorrect.  And in the process you've also
got an opportunity to empower a mom to think for herself and maybe even to
turn around and reeducate those very people.

Begin by acknowledging your respect for the erroneous advice-giver.
Acknowledge that there's a place for his/her opinion, or at least a reason
why they might hold their particular view and you're not accusing them of
being stupid or uncaring.  Then gently introduce the correct information and
give support for your view.  Something like the following:

"You know, your doctor is concerned and I'm sure he wants the very best for
your baby.  I think I know where he's coming from.  There are often trends
in medicine where for awhile a practice will be popular and widely used,
sometimes even too widely used.  Then sometimes we discover that it wasn't
such a good idea after all.  In the case of clipping frenulums, there used
to be a lot of that done but not always for good reason.  So then doctors
relooked at the practice and decided it wasn't helping the way they thought
it did and so it fell out of favor.  Your doctor probably sees it as an
unnecessary procedure b/c that's what he was taught in med school.  But
sometimes practices that fall out of favor may fall too far out of favor, so
that even when they could be helpful, they don't always get done.  It's that
way for clipping frenulums.  But it turns out that, even though it's still
not a procedure which needs to be done for most babies, there truly are some
babies who benefit.  So the procedure is making a comeback in some cases,
such as for breastfeeding babies.  I agree with your doctor that it's not
something every baby needs done.  But I think your baby is one of those
special cases where I think this would really help.  And here's why..."
(give examples, give literature, etc).  Then, depending on the patient and
her relationship with her doctor, you might even be able to help her to win
over her doctor's support.

An approach like this avoids accusations and allows the mom to feel good
about both you and her doctor.  She doesn't have to feel like she's going
behind her doctor's back.  She'll also be more confident in going back and
talking to her doctor now b/c she can talk to him from this same perspective
(as in "I know you have my best interests at heart and I know why you feel
this way about this procedure and I'm sure it's not for every baby, but that
breastfeeding specialist gave me this information which really convinced me
that this is something I want to try...)  Assuming the patient is on good
terms with this doctor, she may be more effective than you in convincing
him.  And just think how much more convincing it will be if the patient goes
ahead with the procedure and it's a success...

Just my .02.  The basic message here is one that applies well to
communicating directly with physicians also.

-Catharine Decker, MD
(I go blabbering about how not to work with us doctor folks, so now I
suppose I ought to give a suggestion or two on what I believe might work
better...)

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