Pam,
I know just what you are talking about. One evening I get a phone call from
an ER doctor that I don't know saying that a doctor in another town had
referred this patient to me with xyz problem and what would I like for him
to do with her. I asked the doctor if he knew I wasn't a doctor, but a
nurse and IBCLC and he stated, "Yes, but aren't you the Breast Friend"
(hospital joke), I states "yes" and he stated, "Well then what would you
like for me to do with your patient". I asked him question about the
patient's condition, and together we concurred it was mastitis and a plan of
treatment was decided. Then he asked, "when would you like to see your
patient." Which I did the next day in my out patient clinic. Not only have
I worked 25 years in this hospital and now worked myself up to a level where
a doctor called for my assistance to help a very ill breastfeeding mother to
let all of this be jeopardized by this SOP. I can continue to function as a
RN and as "Your Breast Friend" leaving the IBCLC behind and the possibility
of litigation if need be.
Crystal Stearns RNC MS IBCLC
-----Original Message-----
From: Pam Hirsch, RN, BSN, IBCLC [mailto:[log in to unmask]]
Sent: Tuesday, October 31, 2006 2:30 PM
Subject: Scope of Practice/Diagnosing
Angela, Royce and All: OK, I have to speak up now. I am an RN and an LC
-
neither is separate from the other. Lactation is my CLINICAL SPECIALTY a
nd
I am guilty of clinical malpractice if I have a mom/baby in my office (or
on the phone, for that matter) and I suspect a high bili, a breast
infection, whatever and I do NOT bring this not only to the mother's
attention but her doctor's as well. This is an issue that has cropped up
periodically over the years - I have been criticized by non-licensed LCs
for checking a baby's circ, umbilical cord, asking a mom about her lochia
,
incision, etc. while seeing a mom/baby for a lactation problem, as going
beyond the lactation consult. What do you think would happen if I got a
phone call from a doctor's office and the doctor is asking me why I did n
ot
refer his patient back to him for XYZ problem when he understands I saw h
er
in my office the previous day? At the very least, I hope the only thing
that happens is that I am embarrassed for not picking up a problem. Like
Royce, I have many doctors owing me debts of gratitude for picking up a
high bili, a severe mastits, etc. Because I am hospital-based it is also
very convenient for the mom. I remember once calling a ped's office late
one afternoon to let him know that I had a a pretty significantly jaundic
ed
baby sitting in front of me. Did he want me to send the baby down to the
lab for a bili? He asked if I could do that! My response to him was cal
l
an order over to the lab and I would send the baby down, and by the way,
did he also want to order a chem panel and a CBC while he was at it? He
was not offended, he was grateful. A couple of days later I saw him on
rounds and he thanked me, telling me I had helped this mom avoid a hospit
al
admission by catching the problem early enough. Another time I had a mom
in the office with a chubby, happy beautifully nursing 3 week-old. Mom w
as
miserable with a temp of 105 (I took her temp in the office) and a rock
hard red breast. (She had wondered if her bra was too tight 3 weeks befo
re
when I saw her in the hospital - I had recommended that she get fitted an
d
she admitted that she was continuing to wear the too small bra, leading t
o
a really nice mastitis.) She nursed the baby, we pumped the infected
breast getting several ounces of green pus. She was horrified that the
baby was drinking that! but it obviously wasn't harming the baby. Then I
sent her next door to her doctor's office. I saw her doc as I was
returning from escorting her to the door and told him she was on her way
over to his office and that he would be admitting her for IV antibiotics.
He semi-sarcastically asked me where I got my MD from, but ended up
apologizing to me the next day when he asked me if I could go the medical
unit to see her, as he had indeed admitted her with the worst mastitis he
said he had ever seen. Another OB once told me that he was awed by my
ability to "diagnose" mastitis over the phone. To keep myself out of leg
al
trouble, I will tell a mom to see her doctor as I suspect she might have
XYZ going on and that her doctor needs to see her in order to diagnose an
d
recommend treatment.
I have said this many, many times to many, many docs over the years. My
purpose in life is to help a mother meet her breastfeeding goals, not tak
e
over an MD's practice. I rely on the doctor for the medical diagnosis, an
d
given that diagnosis, I work with the mom to develop a realistic feeding
plan to help her achieve her breastfeeding goals within the constraints o
f
the medical diagnosis.
Enough said!
Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL USA
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