Aileen brings up some good points.  I'm anxious to see what develops
with this line as I'm sure many of us have thoughts on the subject.

First of all, I wonder if it varies from state to state and country to
country.  I would suggest going to your nearest library reference
section and look up relevant topics in the state (or whatever political
division) statutes.  The first time I did this (I think it was looking
up what constituted "indecent exposure" in relation to breastfeeding in
public-20-30 years ago) I found it wasn't the formidable task I thought
it would be.  I would start with topics like "medical
pa\ractice-limitations" or "medical practice-scope".

In a practical sense, I sometimes think it depends on the attitude of
the person bringing it up.  I get the feeling from some docs that
"practicing medicine without a liscense" means "you're disagreeing with
what I have said".  Currently, prescribing medicines (those that require
a doc's script) is definitely out of our scope of practice.  On the
other hand, I have heard of some LCs who have a great relationship with
some docs who will write up scripts for things like Reglan, Domperidone,
and even Diflucan and trust the LC to give them out appropriately.  I
personally am not comfortable with this.  Perhaps if I didn't also have
an RN liscence that I don't want to jeopardize, I might feel
differently.  Incidentally, several weeks ago, one doc asked me if we
couldn't do that with Reglan so we didn't have to have the moms bother
their office staff for them!  What made it so ironic is that she was
less than supportive of what we told moms when we first started.
Perhaps the further she gets from her own less than happy breastfeeding
experience, the mellower she gets!  One area with a lot of controversy,
especially from some docs and from hospital "higher-ups" is the question
of whether suggesting OTC meds, herbs etc. crosses the line to
"prescribing".

Do LC's "diagnose"?  The same question was hotly debated a number of
years ago when the concept of "Nursing Diagnoses" was popular.  I don't
see that term being used as much anymore and don't know if it's a
general decrease in the use or just where I practice.  When it comes to
something like thrush, for example, I make it a point to tell a mom
something like, "What I'm seeing and what you're describing is
consistent with thrush.  (I'll probably go over the specific things that
suggest thrush as well as any sx she doesn't have.)  Only your doctor
can officially pronounce whether it is thrush or not.  He/she would need
to give you a prescription for some of the treatments.  There are alos
some treatments that don't require a prescription if you want to proceed
on the assumption that it is thrush........"  Or I might say something
like, "It sounds like..............  Only your doctor can diagnose it
for sure.  If it is........................., here are some of the
things you would want to do to deal with it."

If we are careful to describe what we see and not be too quick to use
specific "labels" I think we are outside the action of "diagnosing".
Hopefully, as we become more accepted as health care professionals, we
will be able to consistently state what we see without worrying about
stepping on any toes, but for now, there are times when we are better
off using a conservative approach in terms of using labels that could be
considered medical diagnoses.  This doesn't change how we work with
whatever condition we see, just how we describe it.

My .02 worth, what do others of you feel about the subject?

Winnie Mading RNC, IBCLC

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html