Jennifer Tieman writes:
"Sending a report in a concise format raises the IBCLC's professional
appearance and might help the HCP view them more as a fellow professional."

We have a fairly large private practice and send a report to the mother's &
every baby's HCP for every visit that we do.  We try to be very factual and
give an analysis of what we observe, any fixes that we make, the plan that
parents are following and any follow up needed by the HCP.  We almost always
have excellent relationships with the HCPs that we report to and get many
referrals as the results of the reports and success we have with the
clients.  Since we are in a big city (5th largest in the USA) there are lots
of moms to see.

Recently my partners & I have found that a few Dr's are so dogmatic about
what they want moms to do that we get our hands slapped for offering certain
ideas.  If we put some things in the reports it results in a response of "I
will not send anyone to you if you tell them 'that'".  Unfortunately the
"that" changes from HCP to HCP depending on their particular quirk.  That
leaves us frustrated and looking for ways to send the report that is
accurate and complete but not get the HCP angry.  When they are mad at us,
the mom gets caught in the middle.  If we do not include all of our
suggestions, it is an incomplete report in my opinion.

Here are a few of examples of the things that we have seen as problems.  To
protect privacy, there is a blend of a few different moms in each:

Example #1.  Mother is shown how her baby cannot lift her tongue about
midline, cannot lateralize at all and this is the likely reason that baby is
"always" feeding but not growing appropriately and she has sore nipples.
Mom is told to talk to the Dr about this and it is likely that the Dr. will
recommend clipping the tongue.  The Dr. tells the mother "Why would you want
to mangle your child's mouth like that?  It is painful, unnecessary and the
LCs always say the baby is tongue-tied."  This is followed by an angry phone
call to us by the mom asking why we would want to hurt her baby and a call
from the HCP saying don't tell moms the baby might be tongue tied.  Now, we
did not diagnose, we described the problem and the likely solution.

Example #2.  Mom has a baby who is not growing well due to scheduled timed
feedings on the advice of the ped (pediatrician).  Baby is 4-oz over BW at a
month and fussy all of the time.  We suggest mom cue feed and baby gains
5-oz in 2 days and is happy.  Ped is angry that we will not back him up on
scheduled feedings and babies do not need to eat more than every 2 or every
3 hours (depending on the Dr.)

Example #3.  Mom has a baby who is having a lot of difficulty with turning
her head to one side.  Ped has said there is nothing wrong with the baby.
Baby will be fine.  LC suggests a second opinion from a chiropractor known
to have helped several other babies in the same circumstance.  Puts it in
report.  Results:  an angry phone call form the ped stating we will not send
any patients to you if you ever suggest this again.

Example #4.  Mom has chronic plugged duct problems in one breast.  Patient
is treated and re-treated over several months with several medications and
therapies.  Ultrasound is done and there is nothing seen other than the
plugged duct.  LC finally suggests to mom who is overwhelmed by now and
ready to quit BF entirely, that she wean form the problem side.  Dr.
response is "you cannot wean from just one breast, don't listen to them"
and, again an angry phone call with threats not to see "their" patients
again.

Years ago at the ILCA conference Barbara Wilson-Clay taught a session on
writing reports and that is the guidelines that we started with so I feel
that reports are pretty good for the most part.  Any tips for dealing with
telling the Drs something that they may not want to hear are welcome.  I do
not want to alienate the Drs but really feed that it is important for our
practice to continue to send complete, accurate reports.

Linda L Pohl, IBCLC
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www.eBESTFed.com

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