On Tue, 31 Oct 2006 08:37:33 -0500, Kirkwood, Angela
<[log in to unmask]> wrote:
>In reading the multitude of SOP responses, I am wondering why so many of
>us are feeling outraged. As an RN/BSN, I am aware that I cannot tell a
>mother to take or use a medication, that would be out of my nursing
>scope of practice as well as IBCLC. I can tell her that many mothers
>have found a medication to be helpful and advise her to ask her
>physician if that would be appropriate for her, give detailed
>information to give to the MD, or even speak to the Md myself to give
>evidence based information to them but I cannot tell her to use it
>because that is legally prescribing. Those of us that are doing so,
>should not be. >>
Angela, I don't think any of us that object to this Scope of Practice are
advocating for that. I certainly am not. I have no desire to be a
doctor; I grew up with one! My dad is a doctor. That's not the life for
me, thank you very much. The life of an IBCLC is perilously close as it
is. But this SoP goes a lot farther than merely telling us not to
prescribe.
<< In regards to giving information against doctors
>advise-we can tactfully give evidence based information without stating
>that the physician is a quack and does not know anything about
>breastfeeding regardless of the reality of the situation....We all have
>to work as a team together and when it comes down to the bottom line,
>the physician has the legal responsibility for the medical well being of
>the patient and the parents have the final decisions. >>
We cannot give evidence-based information that contradicts what her doctor
has told her, not unless the meaning of the word "contradict" has changed
in the last couple of weeks. I actually looked it up just now, to be sure
that I'm not imagining things.
So, to clarify: the SoP forbis us from "contradicting or ignoring the
advice of a client's health care provider."
From the dictionary:
con-tra-dict 
–verb (used with object) 1. to assert the contrary or opposite of; deny
directly and categorically.
2. to speak contrary to the assertions of: to contradict oneself.
3. (of an action or event) to imply a denial of: His way of life
contradicts his stated principles.
4. Obsolete. to speak or declare against; oppose.
–verb (used without object)
5. to utter a contrary statement.
What about "advice" - the other significant word in that statement? Per
the dictionary, advice is:
1. an opinion or recommendation offered as a guide to action, conduct,
etc.: I shall act on your advice.
2. a communication, esp. from a distance, containing information: Advice
from abroad informs us that the government has fallen. Recent diplomatic
advices have been ominous.
3. an official notification, esp. one pertaining to a business agreement:
an overdue advice.
So to paraphrase the SoP, we cannot utter statements contrary to, or
assert the opposite of, the opinions or recommendations that our clients'
health care providers have offered them as a guide to their action.
That's pretty broad. One of my first feelings on this topic was that
whoever wrote it simply does not know how to write. Sometimes people trip
themselves up when trying to write - they think they have to say things
other than how they would say them in conversation, other than in plain
simple language.
Often when I'm editing someone, or helping a friend to write, I'll
ask, "What are you trying to say?" And invariably they'll reply with a
perfectly fine statement, "I'm trying to say that blah blah blah blah
blah". I'll immediately jump on that and say, "THEN SAY IT THAT WAY."
If IBLCE wants to tell us not to prescribe, then that's what they should
say. In plain English. If they want to tell us not to call doctors
quacks, if they want us to acknowledge that we must work as a team
together with doctors because they have the legal responsibility for the
medical well being of our clients, then THAT is what they should have
said. I would have had no problem with that, and I doubt many others
would.
But they didn't say that. They said something much broader. It looks like
they're listening to us, however, and so I am cautiously hopeful at this
point.
But I'm not going to exhale about this subject until the scope of practice
says something much closer to your post than to what it currently states.
Maybe they should have asked YOU to write it! Any number of people on
Lactnet would have done a much better job than IBLCE did, in my opinion....
Regina Roig Lane, BS IBCLC (very sorry for the long post!)
Senior Lactation Consultant
Miami-Dade County Health Dept
WIC/Nutrition Breastfeeding Program
7785 NW 48 ST, Suite 300
Miami FL 33166
(786) 336-1333 x162
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