> When she did, the doctor had a
>fit that I had "prescribed" medications, and blew up all over the
>place.  He, the manager of the OB unit, and the hospital lawyer have
>agreed that it is not my place to discuss medications with patients,
>that this is prescribing.
> Is this truly so?  They have also decided that it is not my place to
>give out any handouts that mention meds; any recommending of
>medications can only be done by the physician.  I find this insane.
>Am I out of line?

I suspect I walk a fine line on this one. As an LC (aside from RN-LC
factors), we are "allied" health professionals, which removes us from the
realm of prescribing.  And yet, chiropractors, PTs, RNs, etc. don't often
hesitate to recommend common OTC remedies such as aspirin, acetaminophen
or ibuprofen; cough medicines, decongestants, etc. for common problems.
Sometimes they are more in tune with what will work for a given situation
than the GP, and we do rely on their specialized expertise for pinpoint
help.  We LCs work hard to find solutions for our clients, and sometimes
we know better than anyone else what may be appropriate.  Just this week
I had to refer a client back to her MD for ductal yeast, and I thought
long and hard over how to word my MD report. I decided to make a plain
statement that  the mother was *referred* back to her MD for "treatment
of ductal yeast symptoms" (notice I am trying to avoid a definitive dx),
and then I stated that diflucan, in extended dose, appears in our
experience to be the most effective therapy for ductal yeast, and that
references were available. Those who have respect for our profession are
not usually offended by this approach, but those who do not know us or
respect us may well be offended regardless of how we approach the
problem. Herein lies your problem!

I recently received an irritated call from an MD's office after having
sent out a report. They were not upset about the report, in fact they
hardly read it; rather, they were upset that the patient, who called for
an appointment, was "self-diagnosing".  I had to explain to them that she
was not, in fact, "self-diagnosing", but that she was being referred back
to them by me because of my initial assessment. I had to stress the fact
that I was SENDING THE MOM BACK TO THEM, not trying to take their place
in practicing medicine.  I sent the mom in with a tentative description
of what I perceived to be the problem-- she needed to tell them
*something* to justify the appointment!  Sometimes it is frustrating when
it seems like the medical profession wants its cake and wants to eat it,
too.

Are we wrong to suggest potential remedies? I don't think so, though how
we handle this really makes a big difference in how our suggestions are
perceived.  I love the LLL approach that teaches leaders to say, "many
mothers have found this _________ helpful", or "research suggests that
______ may help this problem. We can share with mothers what we know to
be common solutions to their apparent situations; they should not be
denied this info, most especially when their HCP may or may not even be
aware of it or care about breastfeeding issues. Mothers deserve helpful
information, but semantics are everything, too.  And then, despite our
best precautions, this sometimes blows up in our face anyway.

On technical grounds, your opposition may be "right". But in terms of how
the real world generally works for moms, I disagree that we should keep
silent.  Again, this whole controversy points to the need for our
profession to be established by something that carries the weight of a
license so that we *can* make professional recommendations without this
type of criticism.

Climbing down off the soap box,
Lisa Marasco, BA, IBCLC-- who is willing to get whatever additional
training is necessary to meet everyone's demands for qualifications, but
who has no desire to be a doctor or nurse per se.