Re: doctors' report -- working draft

[Guest guest]

Dear Margaret,

I have struggled with the way to send reports to the docs for a long time. From feedback I get from them, they want the weights listed sequentially, the reason for vist/impressions and feeding plan. Your template is very similar.

I did send narratives with bold-faced comments (ex: tight lingual frenulum, hypoplastic tissue, mother elects to pump and bottle etc) But have recently started a templated page with a grid that lists date, weight, urine, stools, transfer and amount pumped. It is easy reading. The next box is titled "reason for visit" and the last is "summary" There are grids for "next appt" etc. It takes just minutes after I fill in the fields for dates and weights etc.

I still take my medical/birth hx, bfing hx, mther assesment, baby assessment on another page and quickly type up the doc sheet as I go along. This is at the hospital where I may see 30 pts a week for 90 mins appts. For homevisits I use my hand-written form and quickly type a summary with weights to fax to do when I get back to office. Sometimes a ped office may get 3-4 reports from me a day. It is an excellent marketing tool.

Short and sweet is the deal. While not compromising our notes, the HCPs can get the essence of the visit and what the projected outcome/plan my be. Anything too long is overkill for these busy docs. You can include medcial hx they may not be aware of ("d/t reduction surgery...") I get hand-written reports from a ped office and it is time-consuming to wade thru the data....I can feel their pain!

My receptionist will read aloud from this sheet when I call in for a refresher before returning a call. It is succinct and I can usually recall all I need to know.

In regards to a suspected retained placenta (and mom started clotting the next night) I had written "......referred mother to Dr. Z to r/o placental or endocrine isssues" Thus, putting th ball in their court without diagnosing.

Jan Ellen Brown RDH IBCLC

Charlotte, NC

doctors' report -- working draft

There's very little standardization on the

post-consult reports that LCs send to doctors - some

LCs send a copy of their working notes and checklists,

while others compose a multi-page narrative trying to

present a full picture (probably with some cutting and

pasting of boilerplate for common problems).

I'm finding that, even with cutting and pasting, my

narratives take way too long to compose (at least so

they do credit to the profession). Even then, I

wonder how useful this effort is -- is a probably

overworked, maybe not breastfeeding-oriented doctor

going to take the time to read a narrative, and, more

important, realize what's significant, and where the

proposed recommendations are going? Are the problem's

likely root(s) not standing forth clearly among all

the observations (and in a reasonable history-taking,

one accumulates a lot of data, some significant, some

less-so, at least in connection with the current

working hypothesis.)

Since eveveryone'saperwork is a work-in-progress, I'm

sharing a still-forming idea: having a one-page

template for short, typed answers to very briefly

answer what seems like the bottom-line questions:

How's the baby doing? What's the problem? What's

causing it? What's being done to solve it? In the "additional notes," I'd probably also give huge

positive strokes to the dyad. Since the report is

problem-oriented, the things going right should be

noted, too-- at minimum, the mother's motivation and

care.

A cover letter would offer an opportunity for further

dialogue and interest in the doctor's feedback.

I'd love to get your comments or thoughts on

refining/expanding this idea, or some sharing on how

*you* do doctors' reports, and what you find most

effective, and if you get much response from other

HCPs

I know checks in on this list sometimes,

and it would be great to hear if the new edition of

The LC in Private Practice book will have any new

thoughts on the reporting side of things.

Anyway, the proposed form follows my signature.

Margaret Sabo Wills, LLLL, IBCLC

Here's the form:

Letterhead

Report on Lactation Consult

Date of consult:

Mother?s name:

Baby?s name:

Baby?s Date of Birth: Gestational age: Birth weight: Lowest recorded

weight Breastfeeding difficulties or concerns:

Baby?s age and pre-feed weight, at time of consult (if

applicable) Factors reported from pregnancy/birth history possibly

significant to breastfeeding difficulty

Observation of baby?s physical and behavioral

characteristics

gain/loss from previous weight checks: during

days Same scale? Observations: Mother and baby anatomy/actions possibly

significant to difficulty

Feeding Observation: milk transfer/approximate

length of feeding

Other probable factors contributing to breastfeeding

difficulty: Actions/discussions/learning activities during

consult:

Further recommendations:

Health issues and other concerns to discuss with other

health care providers:

Additional notes:

Breastfeeding is a dynamic system involving two

individuals, both growing and learning on many levels.

The lactation consultant has encouraged the mother to

follow-up by phone and, if necessary, in-person with

the consultant and other health-care providers while

working on breastfeeding difficulties. _____________________________________________

name, title

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