The ethics discussions are very interesting.

With regard to consents and reports:  My intake form has a place at the
bottom where moms are asked to sign to consent to information sharing.  I
always explain as they examine this field on my intake form that it exists
because it is my normal practice to fax a brief report to the physician who
referred her to me. (75% of my referrals are physician referrals; the
remainder are self-refers and old clients with new babies.) I fax to the
appropriate HCP even if the referral didn't come from the doctor. These
reports are quite useful tools to educate physicians about bfg related
issues.  Most mothers are happy to participate in this effort.  Also, many
of the mothers I see wish to obtain health insurance reimbursement for the
cost of the visit.  Sometimes the health insurance people need info to
process the claim, and the signed consent is essential to my being able to
facilitate this aspect of assisting my client.

Occasionally a mother does not want me to share info, in which case I do not
(unless there happens to be a child welfare issue, in which case I'm
obligated to contact Child Protective Services.  This has happened once in
20 yrs.)  Most mothers sign because they want the pediatrician,
obstetrician, midwife or family practice doc to be in the loop with what I
have assessed.  This tends to be an issue in the cases I see, which often
are complicated and which often require additional medical treatment for
either the mom, the baby, or both.  Occasionally the mother wishes me to
provide her with a copy of the info I've faxed to the primary HCP.  I'm
happy to do this, and I maintain all charts in case there is a future need
to refer to them.  Because I am not a primary care provider nor a licensed
medical professional, I like having to report to an HCP.

I think that part of the problem comes when so many of us are practicing in
very different settings and each settiing requires some diff. type of
charting.  Also, many of you have licenses and are performing some of your
duties with regard to lactation care within the scope of practice of other
disciplines.  If you are a nurse practitioner or a midwife with prescriptive
privileges, you can provide an antibiotic for mastitis.  I must refer these
clients back to a medical professional who can help in these cases.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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