>the part of Pris's talk that set me to brooding was the part about
>"avoiding the temptation to diagnose or prescribe" because by her definitions
>I regularly do both.

Since I rarely see classic plaques, I'm generally so uncertain about what
I'm seeing that *the mother and I* form a temporary conclusion after
considerable time spent looking, pondering, comparing (including comparing
our own tongues sometimes), discussing.  I don't think at the end of it that
she has any sense that I "diagnosed" it, because I didn't.  We came to a
mutual certainty:uncertainty ratio on which she'll act, in a way that we
mutually pieced together, until something changes our level of certainty
enough to push us in another direction.  That's an entirely different
process from "Your baby has thrush, Mrs. Jones."

Often we end up with a few days' stalling time built in to our mutual game
plan, since the idea of thrush is new to her and she may not "own" it yet;
I may sell a bottle of gentian violet for her to return unopened for a
refund if her soreness clears fully with improved positioning.  One of my
thrush sheets lists all the primary and supportive treatments I know about,
from plain water to Diflucan.  I always give her that one.  I may give her
assorted other sheets as well (thank you, Jack Newman, Kay Hoover, and Pat
Gima), depending on our course of action and her interest.

In my note to her doctor I enclose or summarize the same sheets, tell
him/her that it looked suspicious to us and that the mom may be calling with
questions or to get a diagnosis or see about treatment.  Diagnosing?  It's
more like two of us groping in the dark to find the light switch.  No
telling which of us will find it first...

Diane Wiessinger, MS, IBCLC  Ithaca, NY, wondering now if it's "diagnosing"
to say, "Your baby has your eyes..."

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