To: Darlene Breed (and anyone else who has ever had problems stepping on an MD's toes), Reading your account of recommending medication changes to your client's cardiologist made me think, "No surprise there!" Pride is not a rare trait among physicians, and as a group, we don't like being second-guessed (then again, who does.) In the community where I practice Pediatrics I try to make it a point to be the common link between other docs in the community and lactating mom-infant pairs (even those who might not be my regular patients) to help with such problems. A typical scenario might be that I get a call from one of our LC's about a med problem. I can then cal the doc and say something like: "Ms. Smith says you're treating her for such-and-such with drug X. I take care of her daughter Janey who is breastfeeding, and that's something we really need to continue. Is there something like drug Y or drug Z that you can use instead?" More commonly the doc just tells mom to stop breastfeeding, but the drug they are already prescribing is OK, in Hale's book for example. Then I might call them and tell them it is OK to continue to nurse and that I would take the resposibility for making that decision as far as the infant is concerned after talking it over with mom. The bottom line is that most docs will take such requests from other MD's better than from individuals they don't know or whose credentials they don't understand. Pride is often the problem and I won't try to defend that. However, an MD would be unwise to take advice about a serious problem from someone whom they did not know or whom they are not sure was truly trained to deal with the problem. Ultimately, the point of all my talking is this: if you can, get permission from mom and enlist the help of the baby's MD (if there is one) to act as the messenger. It's more likely not to lead to a confrontation, and it keeps the baby's doc informed of what medication mom is on should the baby have a reaction to the drug in question. John DiMichele, MD, FAAP St. Johnsbury, VT