Re: Consents for Breastfeeding Support Group?

November 20, 2011

yes, that's how I see it. I work UNDER someone who is their PRIMARY care provider as I see them for such a short period of time Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and

baby To: Sent: Saturday, November 19, 2011 9:36 PM Subject: Re: Consents for Breastfeeding Support Group?

So let me see if I understand this correctly.

In private practice I forward copies of my evaluation and assessments to physicians when I see their patients but I'm confident that were they to be asked they most certainly see me as a colleague because I have very collaborative, functional relationships with the Dr.'s I refer to but I do not believe I would consider the fact that I provide them a copy of my evaluation and care plans as constituting working 'under' them in my private practice.

When I work in hospital yes, I could see this. But in a private practice you would consider yourself as working under any MD you forward an evaluation, assessment and care plan to?

Do you think those Dr.'s and their according organizations/business and insurance providers would consider you as a private practice IBCLC RN who is sharing an assessment as working under them? That is not how it works in my area.

In , Dana Schmidt wrote:

>

> I work off a physician.Ã‚ I take physician referrals. If the patient self-refers, I always report back to the physician.Ã‚ That's my training as a nurse. If you are not a nurse, it may be different. I don't know. I was a nurse first.

>

> Ã‚

>

> Dana Schmidt, BS, RN, IBCLC

> Cradlehold, Director

> Breastfeeding Education & Support

>

> www.cradlehold.net

> http://breastfeedinghomevisitservices.weebly.com/shop.html

>

> Providing the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby

>

November 20, 2011

in an ideal world.... most drs never read my reports! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months.--- Subject: Re: Consents for Breastfeeding Support Group?To:

Date: Saturday, November 19, 2011, 6:44 PM

I agree , sharing the evaluation and assessment is a courtesy, and marketing opportunity.

However it should be the standard of care for all IBCLC services because we are part of the healthcare team and we should be collaborating with the patient's physician to facilitate communication, and continuity of care.

I also work in a hospital and when we call in specialists (physical therapy, ultrasound, anesthesia) for a consult, they always report back to the patient's provider. Because we are part of the same team.

I report back to both the mother and the baby's provider.

>

> I do the same thing. Ã‚ it's a courtesy issue for me... as well as an opportunity to market myself and an opp. to teach physicians (or usually nurses). Ã‚ never been a nurse, never will be one... Ã‚ but always report.

>

> Beebe, M.Ed., IBCLC

> Lactation Consultant/Postpartum Doula

>

> www.second9months.comwww.facebook.com/thesecond9months.

>

November 20, 2011

Okay, wow! I've been following this conversation and I think I am a bit

confused.

I understand where you are coming from Dana. With the RN this chain of command

has been drilled into you. But I don't see an IBCLC in PP as " under " anyone.

Yes we should report to the primary physician. I see that as a good practice to

do because that way the physician is aware of any issues and he/she can follow

up with the patient next visit. However if I am " under " the doctor and he

disagreed with my care it would be his prerogative to tell me what I should do

and I have to follow that. I think that's where I'm having an issue.

I know it is customary to send a write up when you receive a referral, but I

know that my allergist never ever sends any information to my primary physician.

He sees me as a self referral as the original doctor referring me moved to

another state and I haven't seen him since the day he referred me 15 years ago.

And honestly I think he would never send a write up unless asked anyway. He's a

very old school military doc.

It reminds me of when I was seeing a sub specialty physical therapist. I was

referred by a specialist that I was referred to by my primary care physician (so

two referrals deep). The PT did send reports to the referring physician and as

a courtesy sent those reports to my primary physician (not that he ever looked

at them). When I asked a few questions during an appointment with the

specialist about my physical therapy he said I should ask my physical therapist

because this was her specialty and he didn't know as much on the subject as she

did.

So my physical therapist was not " under " any of my physicians. She was a

partner with them in my care. My primary physician disagreed with her a few

times, but he simply said " go ask her such and such and see what she says. " He

never said she was flat out wrong. Really it boils down to a difference in

opinion and it might be 20 years (if ever) that we'll figure out which one was

right.

So if I spend two hours with a mom and come up with a care plan that includes

something like frequent STS and nursing as often as baby desires and the doctor

feels baby should be on a strict 3 or 4 hour feeding schedule so baby isn't

" spoiled " he/she can disagree all he/she wants, but he/she can't make me tell

her to do it his/her way. I work within my scope of practice and the doctor

works in his/her scope of practice. I don't tell a doctor how to treat a

patient's asthma and he/she doesn't tell me how to manage breastfeeding. And I

know medical issues come up when we would work together, but I mean in general.

I think one of my son's doctors (a sleep specialist) said it best. He dx my son

with low iron stores and the pediatrician disagreed and said they were normal.

The specialist said " yes, technically the levels are normal, but I know that

Ferritin levels below 50 can cause leg pain and restlessness in children. That

is why I am the specialist and he is the Generalist. " He was right. When my

son started the supplement I stopped hearing " my legs hurt " every day.

I apologize for misspellings and bad grammar. I'm not a very good speller and

it is probably too late to send such a long email. Good night.

Heinz

Beach Babies Lactation Support, LLC

> >

> > I work off a physician.Ã‚Â I take physician referrals. If the patient

self-refers, I always report back to the physician.Ã‚Â That's my training as a

nurse. If you are not a nurse, it may be different. I don't know. I was a nurse

first.

> >

> > Ã‚Â

> >

> > Dana Schmidt, BS, RN, IBCLC

> > Cradlehold, Director

> > Breastfeeding Education & Support

> >

> > www.cradlehold.net

> > http://breastfeedinghomevisitservices.weebly.com/shop.html

> >

> > Providing the minimum amount of intervention for the minimum amount of time

for maximum benefit to mother and baby

> >

>

November 20, 2011

I cannot imagine!

I know these Dr.s read the charts I send because they: Thank me, call me, e-mail

me, fax me!

And they refer to me.

And in the hospital they ask me to see their patients!

>

> >

>

> > I do the same thing. Ã‚Â it's a courtesy issue for me... as well as an

opportunity to market myself and an opp. to teach physicians (or usually

nurses). Ã‚Â never been a nurse, never will be one... Ã‚Â but always report.

>

> >

>

> > Beebe, M.Ed., IBCLC

>

> > Lactation Consultant/Postpartum Doula

>

> >

>

> > www.second9months.comwww.facebook.com/thesecond9months.

>

> >

>

November 20, 2011

i get plenty of referrals from docs--but some office person files my reports... Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months.--- Subject: Re: Consents for Breastfeeding Support Group?To:

Date: Saturday, November 19, 2011, 9:17 PM

I cannot imagine!

I know these Dr.s read the charts I send because they: Thank me, call me, e-mail me, fax me!

And they refer to me.

And in the hospital they ask me to see their patients!

>

> >

>

> > I do the same thing. Ãƒâ€šÃ‚ it's a courtesy issue for me... as well as an opportunity to market myself and an opp. to teach physicians (or usually nurses). Ãƒâ€šÃ‚ never been a nurse, never will be one... Ãƒâ€šÃ‚ but always report.

>

> >

>

> > Beebe, M.Ed., IBCLC

>

> > Lactation Consultant/Postpartum Doula

>

> >

>

> > www.second9months.comwww.facebook.com/thesecond9months.

>

> >

>

November 20, 2011

this is off topic, but i have to get IV iron after a sleep specialist did a sleep study on me and found I was kicking my legs all night long. got the iron.. suddenly got more restful sleep. i'm with ya on that one!! and the whole specialist thing. there are quite a few drs in my town who say--"whatever says..." love it. Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months.--- On Sat, 11/19/11,

catharineheinz wrote:Subject: Re: Consents for Breastfeeding Support Group?To: Date: Saturday, November 19, 2011, 8:50 PM

Okay, wow! I've been following this conversation and I think I am a bit confused.

I understand where you are coming from Dana. With the RN this chain of command has been drilled into you. But I don't see an IBCLC in PP as "under" anyone. Yes we should report to the primary physician. I see that as a good practice to do because that way the physician is aware of any issues and he/she can follow up with the patient next visit. However if I am "under" the doctor and he disagreed with my care it would be his prerogative to tell me what I should do and I have to follow that. I think that's where I'm having an issue.

I know it is customary to send a write up when you receive a referral, but I know that my allergist never ever sends any information to my primary physician. He sees me as a self referral as the original doctor referring me moved to another state and I haven't seen him since the day he referred me 15 years ago. And honestly I think he would never send a write up unless asked anyway. He's a very old school military doc.

It reminds me of when I was seeing a sub specialty physical therapist. I was referred by a specialist that I was referred to by my primary care physician (so two referrals deep). The PT did send reports to the referring physician and as a courtesy sent those reports to my primary physician (not that he ever looked at them). When I asked a few questions during an appointment with the specialist about my physical therapy he said I should ask my physical therapist because this was her specialty and he didn't know as much on the subject as she did.

So my physical therapist was not "under" any of my physicians. She was a partner with them in my care. My primary physician disagreed with her a few times, but he simply said "go ask her such and such and see what she says." He never said she was flat out wrong. Really it boils down to a difference in opinion and it might be 20 years (if ever) that we'll figure out which one was right.

So if I spend two hours with a mom and come up with a care plan that includes something like frequent STS and nursing as often as baby desires and the doctor feels baby should be on a strict 3 or 4 hour feeding schedule so baby isn't "spoiled" he/she can disagree all he/she wants, but he/she can't make me tell her to do it his/her way. I work within my scope of practice and the doctor works in his/her scope of practice. I don't tell a doctor how to treat a patient's asthma and he/she doesn't tell me how to manage breastfeeding. And I know medical issues come up when we would work together, but I mean in general.

I think one of my son's doctors (a sleep specialist) said it best. He dx my son with low iron stores and the pediatrician disagreed and said they were normal. The specialist said "yes, technically the levels are normal, but I know that Ferritin levels below 50 can cause leg pain and restlessness in children. That is why I am the specialist and he is the Generalist." He was right. When my son started the supplement I stopped hearing "my legs hurt" every day.

I apologize for misspellings and bad grammar. I'm not a very good speller and it is probably too late to send such a long email. Good night.

Heinz

Beach Babies Lactation Support, LLC

> >

> > I work off a physician.Ãƒâ€šÃ‚ I take physician referrals. If the patient self-refers, I always report back to the physician.Ãƒâ€šÃ‚ That's my training as a nurse. If you are not a nurse, it may be different. I don't know. I was a nurse first.

> >

> > Ãƒâ€šÃ‚

> >

> > Dana Schmidt, BS, RN, IBCLC

> > Cradlehold, Director

> > Breastfeeding Education & Support

> >

> > www.cradlehold.net

> > http://breastfeedinghomevisitservices.weebly.com/shop.html

> >

> > Providing the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby

> >

>

November 20, 2011

While I am completely in favor of writing reports, I am not in favor of it

becoming an obligation. I know of NO other medical profession that requires

reports to be written to all other practitioners that see a client. If it is a

" courtesy " for other medical professionals and it should be a " courtesy " for us.

Based on the need and the responsiveness of the other health care professionals.

Are you really going to track down every single care practitioner for each and

every patient? Does any other health care practitioner do that? It is done on

a case by case basis and on the basis of the way people practice. If you are a

member of a team, of course you share information. On the other hand, if you

are not really considered part of the team, why should you have to send the

reports, especially to someone who may throw it in the round file? HIPAA was

designed as a protection for clients so they could say no to having their

information shared. Not as a means of tracking every little thing they do. And

the laws on reporting in cases of abuse are the loophole when a mother is really

harming her baby.

Basically I use the consent form in my groups as a CMA because of the pediatric

group that doesn't follow the American Academy of Pediatrics guidelines on

jaundice, breastfeeding, and SIDS. They single handedly have provided me a lot

of information that I have tracked on WHO charts showing failure to thrive

linked to severe sleep training methods. Complete with heartbreakingly clearcut

permanent stunting. And in those cases I actually did NOT have the wherewithall

to tell the mothers that they had permanently stunted their children because

they were working so hard to recuperate and feed their babies. Usually I do

find a kind way of sharing full information, but it made me so disheartened to

think that one wayward pediatrician can cause so much permanent damage and be

totally ignorant and unrepentant of the impact of his older than the 1950s

advice.

Best regards,

E. Burger, MHS, PhD, IBCLC

November 20, 2011

,

Curious -- do you send an actual copy of your evaluation and assessment or a written summary? I've always sent a one page (seldom two page, but occasionally) summary of assessment, evaluation, plan of care and plan for followup, and try to keep it as brief as possible so that (a) it will be read and ( the doc won't think, "Oh, this is what Jan did in this situation for this last baby so pass the information on to another mom without sending her to me.

And yes, this is the best marketing tool ever as well as keeping you together as part of the health care team.

I do not consider it working FOR or UNDER a physician. I consider it working WITH a physician, in collaboration. In fact, in 1988 when I first started working with our pediatric practice, the (then only) pediatrician insisted my business cards stated that I was in practice WITH them, not FOR them, even though they paid me. I thought that was a huge difference.

I would think that in working "under" a physician, if you saw a dyad in PP, you would have to call and get permission for whatever "treatment" you were recommending (according to how I read the CT nurse practice act), not send a consult letter after the fact stating this is what you did. But maybe I'm picking nits?

Jan -- RN, MA, IBCLC, FILCA

I agree , sharing the evaluation and assessment is a courtesy, and marketing opportunity.However it should be the standard of care for all IBCLC services because we are part of the healthcare team and we should be collaborating with the patient's physician to facilitate communication, and continuity of care.I also work in a hospital and when we call in specialists (physical therapy, ultrasound, anesthesia) for a consult, they always report back to the patient's provider. Because we are part of the same team.I report back to both the mother and the baby's provider.>>

November 20, 2011

So I read CMA in someone's post. Or call it a courtesy or call it marketing. However, the pediatric provider is going to see this kid a lot longer than we are and should have a comprehensive history in his chart (whether or not the doc reads it). Also, if the mom does not take our advice AND never calls us back AND something happens adversely to that baby and we have not documented and reported to the person who she IS going to call back and see, then what? Remembering that when we gave that advice to the mother, we had full intention that she was going to follow it and return to us (pp visit or group). We don't know that we will never (in some cases) see her again.It is a grey area. As a nurse, I probably SHOULD call the doctor

first before I see a client that self-refers and I don't think that's a bad idea. "This is what I am going to do on this day at the mom's request, is there anything else that you would like to me check while I am there? I will call you and report the baby's weight, feedings, etc. Perhaps this can replace a "weight check" in the office, etc. " That sounds more collaborative to me. Yes I think that's what I am going to do from now on. Added work? Yes. CMA? definitely. Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby To: Sent: Saturday, November 19, 2011 9:44 PM Subject: Re: Consents for Breastfeeding

Support Group?

I agree , sharing the evaluation and assessment is a courtesy, and marketing opportunity.

However it should be the standard of care for all IBCLC services because we are part of the healthcare team and we should be collaborating with the patient's physician to facilitate communication, and continuity of care.

I also work in a hospital and when we call in specialists (physical therapy, ultrasound, anesthesia) for a consult, they always report back to the patient's provider. Because we are part of the same team.

I report back to both the mother and the baby's provider.

>

> I do the same thing. Ã‚ it's a courtesy issue for me... as well as an opportunity to market myself and an opp. to teach physicians (or usually nurses). Ã‚ never been a nurse, never will be one... Ã‚ but always report.

>

> Beebe, M.Ed., IBCLC

> Lactation Consultant/Postpartum Doula

>

> www.second9months.comwww.facebook.com/thesecond9months.

>

November 20, 2011

I encourage clients to give my reports to their doc - and to anyone else they work with for that matter. Happy to collaborate but it doesn't happen v. much that I get to talk to a doc really. I could start to send reports myself I guess.......maybe it would matter but I doubt it. Everything is documented and available to whomever wants/needs it. All clients sign a consent form allowing info to be shared. As I mentioned in my previous brief post I am really surprised about both current threads (and they are threads of the same question when it comes down to it, aren't they?). Professionalism, autonomy, maybe licensure. I am not a nurse and will never be one though have considered it just as a way to be more validated (mostly by other LCs, maybe by some docs but I don't think that would work really, sorry). though since I come from the same location as Fleur maybe our perception is different.

I am really bothered by the idea of someone being 'more' qualified because they are a nurse - not that anyone on this list has said this outright, a similar thread has been on LactNet lately too regarding the nurses being let go in Mass. and it came up in a recent local discussion re: licensure as well - differently qualified perhaps, where one person has one undergrad (or graduate) degree and one person has another. Both are undergrad degrees, equal. Both have qualified for and written and passed the IBLCE exam. Both are LCs. One may have a different specialization or interest than the other but that isn't really due to whether one is a nurse or not.

Hmmmm bit vent-y there.......sorry. Just think of myself as an independent practitioner, part of health care system the way a massage therapist is (who doesn't send reports to docs that I know of).

beth BA IBCLC

in Ottawa

MARKETPLACE

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..

November 20, 2011

I fax over the whole thing! 1 page for the mother, 1 page for the infant.

2 total pages.

> >

>

November 20, 2011

CRADLEHOLD

Dana A. Schmidt, RN, IBCLC, CLE

Phone

cradlehold@...

www.cradlehold.net

February 18, 2011

MD

RE:

Reason for visit:

The Consultation Included

Technique taught:

âª Correct latch-on âª Electric Pump

âª Correct

positioning âª periodontal syringe

âª Milk supply

support âª Hand pump

âª Hand Expression âª Supplemental Nursing System

âª Milk collection

& âª Nipple shield

Storage âª

Baby weigh scale

âª Other: âª Other:

Referred to:

Subjective/Relevant History:

Objective:

Mother:

Baby:

Breastfeeding Evaluation:

Assessment/Impression:

Plan:

Follow

up:

Sincerely,

Dana Schmidt, RN,

IBCLC, CLE

Select: All, Read, None

ShowAllUnread

Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby To: Sent: Sunday, November 20, 2011 9:30 AM Subject: Re: Consents for Breastfeeding Support Group?

I fax over the whole thing! 1 page for the mother, 1 page for the infant.

2 total pages.

> >

>

November 20, 2011

that is a great idea! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months.--- Subject: Re: Re: Consents for Breastfeeding Support Group?To: " "

< >Date: Sunday, November 20, 2011, 5:35 AM

So I read CMA in someone's post. Or call it a courtesy or call it marketing. However, the pediatric provider is going to see this kid a lot longer than we are and should have a comprehensive history in his chart (whether or not the doc reads it). Also, if the mom does not take our advice AND never calls us back AND something happens adversely to that baby and we have not documented and reported to the person who she IS going to call back and see, then what? Remembering that when we gave that advice to the mother, we had full intention that she was going to follow it and return to us (pp visit or group). We don't know that we will never (in some cases) see her again.It is a grey area. As a nurse, I probably SHOULD call the doctor

first before I see a client that self-refers and I don't think that's a bad idea. "This is what I am going to do on this day at the mom's request, is there anything else that you would like to me check while I am there? I will call you and report the baby's weight, feedings, etc. Perhaps this can replace a "weight check" in the office, etc. " That sounds more collaborative to me. Yes I think that's what I am going to do from now on. Added work? Yes. CMA? definitely. Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby To: Sent: Saturday, November 19, 2011 9:44 PM Subject: Re: Consents for

Breastfeeding

Support Group?

I agree , sharing the evaluation and assessment is a courtesy, and marketing opportunity.

However it should be the standard of care for all IBCLC services because we are part of the healthcare team and we should be collaborating with the patient's physician to facilitate communication, and continuity of care.

I also work in a hospital and when we call in specialists (physical therapy, ultrasound, anesthesia) for a consult, they always report back to the patient's provider. Because we are part of the same team.

I report back to both the mother and the baby's provider.

>

> I do the same thing. Ã‚ it's a courtesy issue for me... as well as an opportunity to market myself and an opp. to teach physicians (or usually nurses). Ã‚ never been a nurse, never will be one... Ã‚ but always report.

>

> Beebe, M.Ed., IBCLC

> Lactation Consultant/Postpartum Doula

>

> www.second9months.comwww.facebook.com/thesecond9months.

>

November 20, 2011

I went through 5 months of physical therapy for a ruptured achilles tendon and

my PT faxed over copies of my contact with her to my Ortho after every visit.

I really think we should all be doing it as a matter of routine!

>

> I encourage clients to give my reports to their doc - and to anyone else they

work with for that matter. Happy to collaborate but it doesn't happen v. much

that I get to talk to a doc really. I could start to send reports myself I

guess.......maybe it would matter but I doubt it. Everything is documented and

available to whomever wants/needs it. All clients sign a consent form allowing

info to be shared. As I mentioned in my previous brief post I am really

surprised about both current threads (and they are threads of the same question

when it comes down to it, aren't they?). Professionalism, autonomy, maybe

licensure. I am not a nurse and will never be one though have considered it

just as a way to be more validated (mostly by other LCs, maybe by some docs but

I don't think that would work really, sorry). though since I come from the same

location as Fleur maybe our perception is different.

>

> I am really bothered by the idea of someone being 'more' qualified because

they are a nurse - not that anyone on this list has said this outright, a

similar thread has been on LactNet lately too regarding the nurses being let go

in Mass. and it came up in a recent local discussion re: licensure as well -

differently qualified perhaps, where one person has one undergrad (or graduate)

degree and one person has another. Both are undergrad degrees, equal. Both

have qualified for and written and passed the IBLCE exam. Both are LCs. One may

have a different specialization or interest than the other but that isn't really

due to whether one is a nurse or not.

>

> Hmmmm bit vent-y there.......sorry. Just think of myself as an independent

practitioner, part of health care system the way a massage therapist is (who

doesn't send reports to docs that I know of).

>

> beth BA IBCLC

> in Ottawa

>

> MARKETPLACE

> Stay on top of your group activity without leaving the page you're on - Get

the Yahoo! Toolbar now.

>

> Switch to: Text-Only, Daily Digest . Unsubscribe . Terms of Use.

>

November 20, 2011

And my Ortho and my PT are entirely unaffiliated. I chose my physical therapist

myself.

She asked me for my Ortho's information, and she contacted the office for their

fax number!

> >

> > I encourage clients to give my reports to their doc - and to anyone else

they work with for that matter. Happy to collaborate but it doesn't happen v.

much that I get to talk to a doc really. I could start to send reports myself I