Dear all:

It seems to me that as a user of health care, having one practitioner tell
me I cannot see another practitioner would be denying my rights to a second
opinion.  From a client perspective, I would consider that unethical.

I recently had my second success on my list of three pediatricians for whom
I have made a concerted effort to win over.  The first of the three was a
breeze - a few phone calls with difficult clients and he was won over.  The
second said she's NEVER refer to a lactation consultant.  I must have seen
about 10 clients, sent reports, sent invitations to breastfeeding
conferences, & always praised her degree of interest in breastfeeding.  We
were all falling on the floor in amazement when we got a call referring a
client to us. She even admitted to the client that she never refers to LCs,
but was stumped by this particular latch on difficulty.

I was thinking that some pediatricians are just plain old lost causes and
tettering on the fence about screening and referring the clients from one
particular "TRENDY" pediatrician who puts more effort into the decor of his
office that staying up with the literature on breastfeeding.  I was feeling
discouraged after spending time over the phone with a breast reduction
case, getting the health history completed & the schedule all set only to
have her cancel at the last minute after having seen Dr. Trendy (with
screaming baby in the background & only 1 meconium stool by day 6).
My thought process was that it would probably be better to just
automatically refer these clients to another LC. In addition, I've had at
least 3 women in support group or former clients sobbing over Dr. Trendy's
admonishments over sleep or other breastfeeding related advice, where he
todl them they were spoiling or going to damage their babies. The idea of
screening out clients of Dr. Trendy popped into my head because one of the
pediatricians in Manhattan will not see clients if they plan on giving
formula to their babies.

BUT then I forgot that I had just seen another client of Dr. Trendy who
probably will wean at 2 weeks of age due to a medical issue who I was able
to help go from weight loss, nipple pain & delayed lactogenesis II to full
supply, happy gaining baby, & comfortable nursing for 2 weeks. She was
thrilled.  I was able to give her all the Hale information on the
medications so she and her own Dr (not Dr. Trendy) could decide what to do.
And I was able to put her in touch with another mom with the same medical
condition so she could talk over her situation.  Left to Dr. Trendy alone,
my suspicion is that she would have been told "Why bother, its only 2
weeks".

So, should I keep up the good fight keep right on helping clients of Dr.
Trendy even though I lose a few?  This is not the first breast reduction
client whose baby was exhibiting signs of not taking in enough and having
trouble accepting it.


Susan E. Burger, MHS, PhD, IBCLC

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