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