<<     When a lay person comes to an officially recognized professional, and
 that professional recommends an herb, that is prescribing, is it not? >>

When a lay person (i think we mean patient here) comes to an officially
recognized professional and that professional recommends applying purified
lanolin, that is prescribing, is it not?

When a patient comes to an officially recognized professional and that
professional makes recommendations about certain positioning techniques, that
is physical therapy, is it not?

When a patient comes to an officially recognized professional and that
professional makes recommendations about dietary change, suggesting eating
certain foods and not eating others, that is then prescribing, is it not?

When a patient comes to an officially recognized professional and that
professional makes recommendations about using durable medical equipment (a
pump, a tube device, a shield), what is that? prescribing?

it's not a question of whether we prescribe or not, it is merely a question
of degree. that is, what is the difference between lanolin and herbs?

" I have to be careful because I can loose my
license. I am not legally permitted to prescribe for that reason,"

I understand that to mean that, as a nurse, you cannot prescribe. i am not a
"licensed" lactation consultant and perhaps this is indicative of a
difficulty with nurses being lcs as well.

"If the LC recommends a bath or a warm compress or an ice pack....no great
harm can be done."

i think any suggestion can cause harm if misunderstood. what if you didn't
"diagnose" an abcess and the hot pack coincided with the spontaneous
bursting/drainage of the abcess? frostbite? think someone might want to sue
over that?

" None of us
get training in recommending drugs or herbs"

i didn't "get training" in most everything i do in my practice. i could
probably list a hundred things. i learned about almost everything on my own.
i better not ever stop learning, either. i think then i will really be in
trouble.

" (replace the word "nurse" with LC)"

sorry, i do not think this is an equivalent, and this business about
"prescribing" is part of why i don't think the professions are the same.

"Unsupervised sanction of recommending herbs is not a professional act."

everything i do is unsupervised. i don't operate on the basis of fear. i make
treatment plans, the family knows they make the choices, and i tell the
doctor (or hcp, midwife, etc.) what i recommended. i don't just say "go ask
the doctor," why would they pay me for that? especially when the doctor
usually has said, use formula. oh, maybe go call the LC. to me, that's what
being a specialist is about. i try to operate on the basis of equality with
the doctor. i want to tell the doctor what i know and what i suggest, and i
sure hope the doctor will also share with me any suggestions or comments
about why what i recommended might not be good for a particular mother and
baby. teamwork.

i also have plenty of patients who have gotten bad herbal advice from many
places, included "certified herbalists" (what the heck does that mean,
anyway) and "naturopathic practitioners" and all manner of other
practitioners.

"Peer counselors, LLL, CLC, CLE, IBCLC,  and whoever else is out there can
be medically trained people, hair dressers, computer programers, and stay at
home mothers"

people are allowed to wear many hats. i like to wear hats, and trim them
myself. does this render me less qualified to be an LC? i do think, though,
like becky, that IBCLC should be the standard. yes, as a volunteer you have
strict guidelines about what you can and cannot recommend, and it is safe to
always say "many mothers find." however, i am a professional. i tend to say
"i recommend." if i just share information in an anecdotal way, i shouldn't
be charging money for it.

 "My understanding of the IBCLE requirements to sit the exam leads me to
believe that a person could have 2500 hours or 4000 hours of telephone
counselling, and have taken 30 hours of continuing education and sit the
exam, without ever having worked clinically"

this begins to sound like an insult to "accredited" volunteers (notice the
adjective), but i am hoping it is just a misunderstanding. in at least one
volunteer group i am knowledgeable about (and yes, this is where i came from
to become IBCLC), you cannot do ANY telephone counseling without having
experience and having studied extensively, and having been tested and
evaluated by several people, some of whom have worked with you during the
process. did you know that  **** ("accredited volunteers") on average score
higher on the IBCLE than other candidates?

 anyone who has done five years of telephone counseling is also
simultaneously working with groups of live mothers and babies (of all ages)
and sees many, many latches. i am more worried about hospital-based nurses
who never see a baby nurse who is more three days old and think they nursed
their own children "for a long time" because they nursed for three months.

"But there is still that fine line of
"practicing medicine"

this phrase is basically nonsensical except that it seems to mean being a
doctor as opposed to being another type of health care provider.

" we are supposed to know what to do without having the
physician tell us!"

yeah, because doing only what the physicians tell us would usually involve
only putting nipples on bottles of formula and handing them over.

"I would personally not consider 4000 hours of phone counseling, never having
touched a mother, a baby, or a breast as "extensive practical experience."

see above. given the types of calls this involves, you would either quit or
have a nervous breakdown immediately if you didn't have the training needed
to do this type of work. i notice that those who have this background and
wish to become IBCLC seek out opportunities to do more "live and in person"
work.

i am not too happy about nurses giving out information as well as hands on
help, either, based on what the results seem to be. you can see something
once and learn from it, and you can see something a thousand times and not
learn a thing.

i diganose, treat and prescribe all the time. i don't honestly see how i can
do much to help anyone otherwise.

"First of all, I call the moms my "clients", not my patients. Secondly, I
make "assessments", not diagnoses (this gets really fun when I must
determine a differential.........uh, assessment?). And then I make
"suggestions" for a care plan, which may be practical or of a pharmaceutical
nature."

someone that i discussed this with said "what, you aren't a lawyer, why would
you call them clients?" the word clients makes me think of accountants and
realtors. a midwife i knowcalls them "clients" because "they aren't sick."
most everybody i see, however, has a "medical" (lactational) problem. i am
not sure that using different words (hey, i have a degree in rhetoric and
writing, i can split semantic hairs and make up euphemisms with the best of
'em) to describe "diagnosing and prescribing" makes it any different.

i just found out that some of "my peer group" in my area is telling all the
doctors that domperidone doesn't work, that domperidone doesn't work after
three months postpartum (?!?!?! perhaps we would call that "speaking out of
both breasts" instead of speaking out of both sides of one's mouth), that it
is dangerous, etc. i sure hope that i don't have to be in the situation of
being judged by my immediate peers. what "everyone else does" in a strictly
local sense is not necessarily my criteria for excellence. that's the beauty
of lactnet, the international experience, some input that is not strictly
local. this is a great discussion but it seems to come up over and over,
never to be resolved. i agree with whoever mentioned the need for our
professional group (ilca) to come up with some guidelines for this.

carol brussel IBCLC, prescribing all the time in denver, CO
breastfeedinghelp.com (for info on my dangerous herbals)

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