Jan I tried not to post again until we heard some 'official' clarification
... but it got the better of me ;-)
I, too, agree with the posters that the interpretation is that you should
obtain consent, not that you must therefore follow through.  And I also
take your point that the primary HCP doesn't have to be the
doctor.  (Aside:  am I right in my thinking that here in Aus a physician is
the term used to describe a doctor who specialises in medical problems, as
opposed to a surgeon or an obstetrician - if so, there's some cultural
trivia for you).
Joy explained the Aussie system well, but I will also add that many mothers
in my area don't go to the child health nurse for their free well-baby
check-ups, and would only go a doctor when someone was ill.  If they want
their baby weighed they are as likely to go to the chemist where there is a
baby weigh scale that they can use for free with no assistance, or maybe
the totally clueless (about baby care) chemist assistant might help
her.  To have a primary health care provider is not compulsory, and I don't
deem it my right nor my responsibility to tell them they must have one or I
will refuse to see them. And besides this information doesn't usually come
out until after the consultation has commenced anyway.  Please don't anyone
extrapolate my opinions to the US system... I'm not passing comment at all
on what should or should not be done in the USA.
In my role as a responsible IBCLC if I feel the mother's concern is
entirely within my scope of practice then I don't have any worries about
this.  If I feel the baby should be referred to another practitioner
(doctor in particular) then I do push them to choose someone and will write
a letter to the doctor.  So far I've never had the occasion where a mother
still doesn't go to the doctor if I've strongly recommended that she does.
As Joy noted - in Aus paediatricians are specialists who only see sick
children (other than the after birth check that baby is normal), and the
only person allowed to refer a child to a paediatrician is a
doctor.  (That's irrelevant to our discussion, just letting you know the
situation here.)
I don't have any problems with the wording of the Code of Ethics statement
as it stands.  And I don't see that writing "no HCP" on my maternal notes
therefore precludes me from assisting a mother and baby.  And I totally
agree with whoever said that sending letters is great for all kinds of
reasons (education, future referrals, awareness, etc).

Denise
PS:  Oh dear Rachel - those surges are getting to you ;-)
PPS:  See you next month Iona.

Denise Fisher
mailto:[log in to unmask]
http://www.health-e-learning.com

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