From the perspective of a healthcare consumer who has lived in several different states in the US, I 
would suggest that the reasonableness of reporting to a primary healthcare provider differs from 
state to state.

In Minnesota, which more closely resembles a European welfare state than most other states in the 
US, most primary healthcare is provided by family physicians.  When we lived there, we went to the 
family doc for everything -- pediatrics, well-woman exams, you name it.  So if that doc had said, 
"Why don't you see our lactation consultant?"  Or, "Let me refer you to a local private practice LC," 
then I can see how it would be standard practice for the LC to report back after our appointment.

But then we moved to Columbia, Maryland, where there were very few family docs at all.  Long 
story short, I did not have a primary healthcare provider.  Most doctors' practices were so 
specialized that I tended to go straight to specialists, depending on my health concern.  When I 
had a dermatological problem, I called a dermatologist directly and got an appointment.  When I 
had a gynecological question, I went to the midwives at the Baltimore Birth Center.  As an LLL 
leader, I knew who the local IBCLCs were, and if I had needed one, I would have called one of them 
for an appointment.  

Most other women I knew were in the same boat as I.  They went to various specialists, sometimes 
"mainstream" and sometimes "alternative," depending on their neeeds, but few had any one 
primary care provider.  I don't think this is particularly uncommon in metropolitan areas, and is 
certainly not a situation limited to poor women who use the ER for primary care. 

So what do IBCLCs do in these situations?  When a woman calls directly, has not been referred by a 
HCP, and does not, in any meaningful sense, have a PCP, how does an IBCLC fulfill this obligation 
to report?    

Kerry Ose

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