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Subject:
From:
"Patricia Gima, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 22 Dec 1996 06:31:44 -0600
Content-Type:
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Ann asks for suggestions for diplomatic response to recommendations from a
doctor in whom the mother has "complete trust."

Complete trust in the infalibility of any HCP is not a good idea. One of our
steps in maturity is to learn that noone knows it all, but that's ok.  We
can completely trust that our HCP will do the best he/she can to be well
informed and to treat with the greatest knowledge available. But when there
is an area that this HCP lacks knowledge we go to another who knows, ideally
by referral.

This doctor's orders are based on a little bit of knowledge
(antibiotics/yeast) and a lot of ignorance.  For starters he believes that
oral yeast is caused by something that happens in the mouth, and that this
something can be washed away by abm.  WOW!

You probably know all the areas of "misunderstanding" in this treatment; but
how do you tell this mother that her doctor is wrong without shaking her
complete trust in his infalibility?  What is our role in perpetuating the
myth of infalibility?  What is our duty to our clients to pass on accurate
information to the best of our knowledge?  Is it to this mother's advantage
to continue to believe her doctor can't be under-informed? If she discovers
that there is something about yeast, immune protection of exclusive
b'feeding, etc that this doctor doesn't know, where does that leave her?  Is
it necessary for her to believe that he knows everything before she can
trust him to be the caregiver for her baby?

We all have similar dilemas with erroneous advice and I believe we must
address it. But how?  That was you question, wasn't it?

Sometimes I do it better than at others, but I usually make it clear that I
understand that busy doctors can't read all that comes their way and I
compliment him/her on something if I can.  And I make it clear that if there
were a room full of highly competent doctors they would disagree on many
treatment recommendations.  In this case I would tell her what I know of the
systemic nature of yeast overgrowth and also about the effect abm would have
on her baby's immune system, and consequent vulnerability to yeast infection
or further colds and sinus congestion. If I were being very gentle I might
tell her that some people recommend rinsing the baby's mouth with water
after feeds.

I would also assure her that just because her doctor doesn't know all there
is to know about yeast doesn't mean that he isn't an outstanding doctor for
her baby.  There are A LOT of doctors who don't know much about yeast.

I would do all of this in a dialog, not a lecture, while getting a feel for
how she is taking it allas we go.  Every mother is different.(Surprize!)

This is a very wordy way of saying that I believe we need to impart the
knowledge that we have and sometimes that may change the way parents view
their child's doctor, and in my opinion, for the better.

Patricia Gima,  IBCLC
Milwaukee

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