Hi, Connie:  I had no sooner read (and deleted) all my e-mail from the
weekend, including your post on diagnosing tight frenulums when I was
approached by your director of neo at Copley - he also provides coverage
here at Good Shepherd Hospital - and asked about my particular handling of
tight frenulum issues.  He told me he is not upset (he used stronger
language that is not really printable here) with an LC "diagnosing" tight
frenulum, but what the docs really get upset about is when other HCPs do
not include the MD in the "loop".  He said that the parents of the baby in
question were told by the hospital LC that their baby had a tight frenulum
and that the LC gave the parents the name of an ENT.  The parents then
brought the baby in for an evaluation - neo then got a call from this ENT
who was puzzled as to why a doc to doc consult wasn't done.  In other
words, the LC did not work within the system.  What the docs like to see is
that the LC (or any other HCP) assess and refer back to the doc for further
evaluation.  In this particular case, the LC should have given her
explanation of the tight frenulum and referred the parents back to the doc
(and it's OK to say that the doc may want to refer to an ENT).
This neo told me that the way this particular situation was handled made us
all look like we don't approach health care management as a team.  I was
actually impressed that he does view health care as a team approach.
Anyone who is a licensed health care provider gets "indoctrinated" very
early on in the learning progress as a student as to how to work the system.
Maybe we can network a little.  Our hospitals are the same distance west of
Chicago, just on opposite ends of the metro area.

Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL  USA

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