Jane writes:
So what do you do if a client (whom you ask for a referral from her
primary care before you see) tells you that her pediatrician told her "it's ok to
see the lc, but if you do anything different from what I've told you to do
on her advice, you will need to find another pediatrician." And the
pediatrician refuses to hire IBCLC's in his office, only personnel that will
continue whatever he thinks is right? This is where independent IBCLC's may
encounter conflict. Do you refuse to see clients of that particular
pediatrician?
~~~ Ah what a fun scenario. Since many local MDs will not refer to me, it's
become less of an issue. They do not "believe in" or assess or refer a
baby for evaluation for posterior tongue ties, nor for issues that could
benefit from gentle bodywork. The IBCLC they refer to does not assess or refer
for these issues either. Still occasionally a mother gets my # from another
source ( local LLLL, friend, former client, other IBCLC who knows my skill
set and practice style) and then I have to make a decision. Once in a fit
of pique ( the first time it happened after I learned about this refusal to
refer) I suggested that the mom might want to contact the IBCLC the MD
recommends, since hearing different information from different professionals
can make things harder instead of easier. Usually now, though, I explain that
there are different views on some issues, that I will give the most
thorough and updated assessment and suggestions I can, then they can decide what
they want to do. Often they are open to this since I am often the IBCLC
called after the initially referred to IBCLC, the MD, or any other host of
information sources has not "solved" their problems. Sometimes this is
because they are not solvable in the way mom wants, sometimes they are but mom
decides not to move forward with the new assessment and suggestions, but
feels heard and is now more informed, and sometimes mothers move forward
without their pediatrician's "blessing" because they are frustrated, and when
they do things might actually change for the better. Sometimes it's so far
along in the process, that things don't really get better but they make peace
with whatever portion of breastfeeding and relationship with their baby
they do have. I take that journey with them, which most moms appreciate. The
notes I write focus on the function or lack of function, rather than using
terms like posterior tongue tie. I try to describe what I see at a consult,
what I do not see that I should, etc. I am also transparent with the other
IBCLC (and I ask the mother to be as well,) we agree to disagree, but
remain in professional and personal relationship with each other. Hope that
helps.
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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