Discussions with Doctors
I went to San Francisco, because I never been there, in 1999 to attend an AAP meeting so that I could get some needed continuing medical education credits. One of the speakers, ABM member Dr. Nancy Wight, spoke on breastfeeding. Almost every word was news to me. Medical school, residency, chief residency and part of a neonatology fellowship and I did not know about any of the content she was presenting. One of the other speakers lectured on lice- that I knew something about. But breastfeeding? Nope. How did Dr. Wight know this stuff when I didn’t? Who taught her yet set me loose on an unsuspecting patient population armed only with my personal 7-week breastfeeding experience?
I went back home after that conference and talked my hospital’s IBCLC and asked her why she had let me get away with being so, so…wrong. I’ve learned so much since then, thanks to my colleagues at the ABM, AAP and that very patient lactation consultant.
The point is most physicians don’t ruin breastfeeding intentionally.
Sometimes, as a lactation professional (or as an informed breastfeeding mom) you have to deal with a physician who is not knowledgeable about breastfeeding. It’s a hard task if that physician isn’t receptive to your ideas, evidence-based as they may be. Those of us who are members of the ABM are often having some of the same discussions you are, and we share your frustrations.
Most physicians are “under-educated” about breastfeeding. But it’s important to know how we are educated if you are going to make a difference in how that physician responds to your attempts during teachable moments. My brother is a lawyer and often complained about the tactics of the Socratic method employed in law school where you are randomly picked to answer a question and have the potential, if you don’t know the answer, to look like an idiot in front of your classmates. Now take that Socratic method and put your client in the room, so that person, who has hired you, sees you look like an idiot too and you pretty much get the idea of medical bedside rounds. That’s how we learn. Potential public humiliation. We don’t like that.
In fact, we get very good at avoiding it. We are the doctors, taught from our first day that we are the final end point. Not knowing something is simply not acceptable. We study hard but when the answer to the question isn’t in our head, then we have to have alternate strategies. The first response is generally activation of the fight or flight response (or as in my favorite episode of “Scrubs,” the doctor with antlers strapped to his head looking into the oncoming headlights of a truck). So, we are given a topic about which we know very little and we react as if we are ready for a fight. And we weren’t taught about breastfeeding. We might be ready for a fight.
Then, we need to sound confident about whatever answer we give. (I had a friend who answered a question on rounds with “antibodies to the ovum of a sperm whale” but said the ridiculous answer with such confidence that even my attending physician, who had to know my friend was making it up, paused to think about the potential correctness of the answer.)
If we have no answer, or confident witty retort, then we start poking holes in the question or statement, asking for literature and pointing out flaws, real or perceived, in what has been presented. And we can counter every one of your stories with one of our own experiences. Starting to sound familiar? And please, never, ever underestimate the role of potential medical malpractice plays in all of this. You may be sure you are right, but the threat of legal action because of a high bilirubin or a low blood sugar that went untreated is very real. Meaning, your goals may not match those of the physician.
And, while you’re doing all that, here’s something else to think about, too: maybe you aren’t right. On my first day of medical school my Dean welcomed us by saying “Fifty percent of what we are teaching you is wrong. We just don’t know which fifty percent.”
I know it’s worth the effort, even if it’s one physician at a time. I’m not the only member of the Academy of Breastfeeding Medicine who needed the right message at the right time to hear you.
Interested in programs that work to teach physicians?
Pennsylvania EPIC-BEST program (pages 7-8)
Dr. Jennifer Thomas is a pediatrician in Wisconsin and is Chief of the America Academy of Pediatrics Chapter Breastfeeding Coordinator Leadership Team. She shares her expert advice on breastfeeding and pediatric care at DrJen4kids.com.