Step. Away. From. The. Mini-Consult.
I say it so much to my IBCLC colleagues on social media that I was gifted this case from a wonderful private practitioner.
It goes something like this. Parent calls you, or texts you (a whole ‘nother problem; see my take on that here), and wonders if they can “Just ask a question.” Or they sound sniffly and weepy (cuz they are), and as a compassionate IBCLC, you jump in and offer support and advice to “tide them over.” Or you are hosting the new parent support group meeting, and you’ve been eyeballing that scrawny kiddo, so when the Parent asks about weight gain you dive in with all the relevant clinical queries, while the entire group is spell-bound to see your Lactational Excellence demonstrated right before their very eyes!
All of which is no good. Not ethically, not professionally, not for breastfeeding promotion, not for your lactation consultation practice. And least of all, no good for the parent with whom you are having this brief convo.
Why? Because that parent will walk away from the exchange thinking they have had a full-on consultation from a skilled IBCLC. And they have NOT. No consents-to-be-seen were taken, no history of Parent or Bub, no physical assessment of a feed. You don’t know who the primary healthcare provider is (to whom a report of healthcare concerns must be made), you don’t know how to follow up with the family. And you have not received a dime for your services.
Meanwhile back at the ranch, things don’t get better for the family. They report to their pediatrician that “Yes, I saw an IBCLC …” and now the doc thinks you are a slacker for not helping this family or sending in a report of the contact. The parent complains to their friends and relatives that “seeing an IBCLC is a waste of time!” You even see unfavorable reviews of your business on social media sites. Yikes.
Parents can tell parents any dang thing they want, with impunity, in any place, or on any social media platform. One parent does NOT hold a duty of care to another parent. Parents have been giving each other all manner of good-and-bad breastfeeding advice ever since the first gathering of parent-commiseration many millenia ago.
Clinicians like IBCLCs, however, DO have a duty of care to their clients/patients. The IBCLC “constructively” creates a professional relationship with any parent with whom they engage, offering specific information on their specific situation (versus, say, a social media post of general interest to anyone). Because it is reasonable for that parent to assume — based on the fact-specific exchange — that you are talking about their individual circumstances. Voila. You just bought yourself a client/patient.
ALL of the professional and ethical obligations attach when you create a professional relationship. You do not get a “bye” because the parent was broke and couldn’t afford your services. Pro bono clients are entitled to every bit as much of your professionalism as those with a fat wallet. You do not get a “bye” because this is a neighbor, or your sister’s friend, or someone from church.
Extracting yourself from the snare of a mini-consult is as easy-peasy as memorizing this line: “It sounds like you need to schedule an appointment! Let’s see what my availability is….” Or, direct the parent to other resourcces for scheduling an in-person evaluation. If they press (“But … but … it’s just a few questions
Would this also apply if a patient calls in and speaks with a hospital based LC? We give advice over the phone all the time, not always scheduling a clinic appt with them. It’s always encouraged, but sometimes declined.
Excellent question, Kristin … and the answer is: Your hospital’s “warm line” phone calls are not the same (and do not trigger the same sort of legal responsibility) as does a “mini-consult.”
BUT. Make sure your facility is doing it right, because many are NOT. There should be a policy for how the warm line is run. Who answers the phone: IBCLCs, or RNs with-or-without extra lactation training, or anyone walking by the phone? Is it available 24 hours a day? Can any member of the public call, or only discharged patients? Do you CHART for the former patients in your system? When do you declare that this phone call is beyond regular ol’ run-of-the-mill information and support, and instead is an indication the caller should be seen in person? If the latter, to whom do you refer?
There should be some sort of minimal record keeping of calls in (date, time, parent’s name, their phone no., one or two phrase description of the presenting issue); who answered the call and when; resolution of call (advised parent to call HCP, or information on plugged ducts offered, whatever). Every call should conclude with the general good advice that the parent should reach out to their own or the baby’s doctor at the first and slightest hint of “something is wrong here.” And your policy should indicate that this call log will by kept for XYZ amount of time. A nice rule of thumb is that any call that takes more than five minutes to answer is an indication that the parent should be seen in person.
In essence, you just want the **cursory** support that a warm line represents to somehow be methodically recorded, and stored. You don’t have to get all the details and history because this is a warm line, was advertised as a warm line, is not going to be anything more than a warm line. But in some remote or under-served areas, the warm line may be the *only* community-based lactation support a new parent can readily access. You don’t want to deny this sort of care, but you want to define what it is (in your policy), explain how it is to be used (to the new parents), and then have solid enough documentation to show the higher-ups that in fact the warm line is being professionally conducted.