Re: What do you think about this?

November 11, 2008

personally, i do not believe telephone consultations can fully and safely assess and address lactation difficulties adequately - so i would be with your mentor on this, in terms of being very careful not to overlook anything - or at least careful to give *very* clear instructions for when/if to follow up for a more thorough consult. but even given that, i have a hard time imagining being able to gather adequate history AND observe a feeding/address any issues (or even HEAR all the issues) in a short period of time. and 10-15 minutes seem ludicrously short. our newer consultants in our practice have a enough time keeping hte visits under 1.5 hours! i could maybe imagine a 10-15 minute check in that was JUST for doing a "breastfeeding intake" - asking all the relevant questions on a consultation intake form and finding out if mom or baby is having ANY trouble with feeding. and then if there is any trouble at all scheduling for a full consult. like if there are even the slightest sore nipples, milk isn't in yet, baby still losing, etc...

but even that, i'd think you would need 1/2 and hour at least...?

i look forward to hearing what others think.

warmly, Lyla

[sPAM] What do you think about this?

Hello all --

I have a meeting tomorrow with a local peds office. I'm working to set up an arrangement with them to use some exam space in their offices for a limited number of hours per week. I would not be their employee. I would function as a separate business, just using their space. So, any consults I do with their patients would be on a fee-for-service basis, completely separate from whatever brought them to the doc's office in the first place.

I'm pondering offering a brief consultation to their patients who already have a well-baby check on the day I'm in the office. This is what I'm picturing.... ped sees baby for check, immediately after dr's exam, mom/baby see me for 10-15 minutes. Primary focus is AAP rec for a formal, observed evaluation of breastfeeding for all breastfed infants at 3-5 days of life, but would also see 1 or 2 weekers who missed me at the first well baby check. my portion of check would include observation of position, latch and milk transfer and very brief history (looking for red flags). Outcomes could be referral back to ped, referral to local breastfeeding support groups, extend visit to full consult or schedule a future consult.

My mentor thinks this is a bad idea on several fronts. Her primary concern is liability. What if I don't touch on something in the brief history then baby/mom has bad outcome and I get sued? Or I miss something because it's a brief visit? She also feels like there is potential for me get overscheduled and not be able to accomodate full consults when I need one.

What do others think of the brief consult idea? Does anyone else out there do them and if so, how do you make it work? I guess in my mind, I don't see it as all that different from a telephone consult but being new to the field, I don't want to be shortsighted either.

Thanks!

Carroll

November 11, 2008

personally, i do not believe telephone consultations can fully and safely assess and address lactation difficulties adequately - so i would be with your mentor on this, in terms of being very careful not to overlook anything - or at least careful to give *very* clear instructions for when/if to follow up for a more thorough consult. but even given that, i have a hard time imagining being able to gather adequate history AND observe a feeding/address any issues (or even HEAR all the issues) in a short period of time. and 10-15 minutes seem ludicrously short. our newer consultants in our practice have a enough time keeping hte visits under 1.5 hours! i could maybe imagine a 10-15 minute check in that was JUST for doing a "breastfeeding intake" - asking all the relevant questions on a consultation intake form and finding out if mom or baby is having ANY trouble with feeding. and then if there is any trouble at all scheduling for a full consult. like if there are even the slightest sore nipples, milk isn't in yet, baby still losing, etc...

but even that, i'd think you would need 1/2 and hour at least...?

i look forward to hearing what others think.

warmly, Lyla

[sPAM] What do you think about this?

Hello all --

I have a meeting tomorrow with a local peds office. I'm working to set up an arrangement with them to use some exam space in their offices for a limited number of hours per week. I would not be their employee. I would function as a separate business, just using their space. So, any consults I do with their patients would be on a fee-for-service basis, completely separate from whatever brought them to the doc's office in the first place.

I'm pondering offering a brief consultation to their patients who already have a well-baby check on the day I'm in the office. This is what I'm picturing.... ped sees baby for check, immediately after dr's exam, mom/baby see me for 10-15 minutes. Primary focus is AAP rec for a formal, observed evaluation of breastfeeding for all breastfed infants at 3-5 days of life, but would also see 1 or 2 weekers who missed me at the first well baby check. my portion of check would include observation of position, latch and milk transfer and very brief history (looking for red flags). Outcomes could be referral back to ped, referral to local breastfeeding support groups, extend visit to full consult or schedule a future consult.

My mentor thinks this is a bad idea on several fronts. Her primary concern is liability. What if I don't touch on something in the brief history then baby/mom has bad outcome and I get sued? Or I miss something because it's a brief visit? She also feels like there is potential for me get overscheduled and not be able to accomodate full consults when I need one.

What do others think of the brief consult idea? Does anyone else out there do them and if so, how do you make it work? I guess in my mind, I don't see it as all that different from a telephone consult but being new to the field, I don't want to be shortsighted either.

Thanks!

Carroll

November 11, 2008

Hi all,

I agree with Lyla: 10-15 minutes is just about enough to say hello to mom and baby and tell her what a beautiful child she has! ;o)

Then again... we're not that 'liability-minded' as the US, but I don't see how seeing moms could be worse than not seeing them at all.

I would not regard it a consultation, though, but a possibility for mom to see you, so that she can become familiar with your face and voice.

If she encounters problems later on, it is likely that she doesn't experience such a high barrier to call a 'stranger', as you no longer áre a stranger.

However, I would not pretend to be able to anything substantial in 10-15 minutes. Mom may tell how she feels, and that could be a way to decide for a full consult.

Maybe you can handout a little leaflet from your own practice? Or suggestions as to what could be a reason for a consult...?

Warmly,

nne

[sPAM] What do you think about this?

Hello all --

I have a meeting tomorrow with a local peds office. I'm working to set up an arrangement with them to use some exam space in their offices for a limited number of hours per week. I would not be their employee. I would function as a separate business, just using their space. So, any consults I do with their patients would be on a fee-for-service basis, completely separate from whatever brought them to the doc's office in the first place.

I'm pondering offering a brief consultation to their patients who already have a well-baby check on the day I'm in the office. This is what I'm picturing.... ped sees baby for check, immediately after dr's exam, mom/baby see me for 10-15 minutes. Primary focus is AAP rec for a formal, observed evaluation of breastfeeding for all breastfed infants at 3-5 days of life, but would also see 1 or 2 weekers who missed me at the first well baby check. my portion of check would include observation of position, latch and milk transfer and very brief history (looking for red flags). Outcomes could be referral back to ped, referral to local breastfeeding support groups, extend visit to full consult or schedule a future consult.

My mentor thinks this is a bad idea on several fronts. Her primary concern is liability. What if I don't touch on something in the brief history then baby/mom has bad outcome and I get sued? Or I miss something because it's a brief visit? She also feels like there is potential for me get overscheduled and not be able to accomodate full consults when I need one.

What do others think of the brief consult idea? Does anyone else out there do them and if so, how do you make it work? I guess in my mind, I don't see it as all that different from a telephone consult but being new to the field, I don't want to be shortsighted either.

Thanks!

Carroll

November 11, 2008

i developed 2 handouts "reasons to consider a prenatal consult" an "reasons to consider a postpartum cosult" and they can be viewed (and feel free to adapt them and use them) here:

http://beyondbirthservices.com/WhyConsult.html

i also have versions of them for physicians/midwives - reasons to REFER (just slightly different wording)

warmly, Lyla

November 11, 2008

How are you going to do this in 10 to 15 minutes, and how are you going to assure that every baby will be ready to nurse at the time you are ready to see them? While it is wonderful in theory, I'm not sure it's terribly practical in reality.

Would you charge the patient for this? Which means, of course, they have the option of not seeing you.

When I see moms and babies for our peds group in the hospital, I'm not always there in time for a feed, but I do have the opportunity to take a history (I wouldn't worry about missing something on the history if you have a good form and ask the right questions!!), do some teaching and give some handouts. However, this can certainly take more than 10 to 15 minutes even if I don't observe a feed....and I expect that these parents will have more questions since they've been home with the baby for a couple of days.

Wonderful idea -- needs a bit more tweaking I think.

Jan Barger, RN, MA, IBCLC, FILCAMy blog Year of the MC

my portion of check would include observation of position, latch and milk transfer and very brief history (looking for red flags). AOL Search: Your one stop for directions, recipes and all other Holiday needs. Search Now.

November 11, 2008

For example, can you simply explain what do you make and tell

moms that "in case of (etc etc)" you are there?

or a "group meeting" about bf advantages?

**There are *no* advantages to bf.

;o))

:-)) yes I know, but they don't and in 15 minutes I think it is

difficult to weissingerize them :-)).

It is enough shocking to tell many of them that

"all-mothers-can-have-milk" and "nipple-pain-is-not-normal"

So I think that in order to approach mothers who are not 'bf-minded' by

themselves, sometimes we have to go step by step

Group meetings are a good idea,

but they would also need more than 15 minutes! ;-)

Bye,

nne (lucky enough to have her

practice at home, with a separate entrance and toilet!)

wow!! this is fantastic nne!!!

hugs

martina

November 11, 2008

Hi ,

I think 10-15 minutes would not be enough for even a brief evaluation of breastfeeding. But the idea is really good. I think this time would allow you to introduce yourself and give a hand-out with basic information. I found Lyla's "reasons to consider" papers very useful. You can ask some important questions (nipple pain, weight loss etc.) and the answers would indicate if there is a need for an urgent consultation.

Good luck!

Ibolya Eva Rozsa, LLLL, IBCLC

Hungary

What do you think about this?

Hello all --

I have a meeting tomorrow with a local peds office. I'm working to set up an arrangement with them to use some exam space in their offices for a limited number of hours per week. I would not be their employee. I would function as a separate business, just using their space. So, any consults I do with their patients would be on a fee-for-service basis, completely separate from whatever brought them to the doc's office in the first place.

I'm pondering offering a brief consultation to their patients who already have a well-baby check on the day I'm in the office. This is what I'm picturing.... ped sees baby for check, immediately after dr's exam, mom/baby see me for 10-15 minutes. Primary focus is AAP rec for a formal, observed evaluation of breastfeeding for all breastfed infants at 3-5 days of life, but would also see 1 or 2 weekers who missed me at the first well baby check. my portion of check would include observation of position, latch and milk transfer and very brief history (looking for red flags). Outcomes could be referral back to ped, referral to local breastfeeding support groups, extend visit to full consult or schedule a future consult.

My mentor thinks this is a bad idea on several fronts. Her primary concern is liability. What if I don't touch on something in the brief history then baby/mom has bad outcome and I get sued? Or I miss something because it's a brief visit? She also feels like there is potential for me get overscheduled and not be able to accomodate full consults when I need one.

What do others think of the brief consult idea? Does anyone else out there do them and if so, how do you make it work? I guess in my mind, I don't see it as all that different from a telephone consult but being new to the field, I don't want to be shortsighted either.

Thanks!

Carroll

November 11, 2008

Hi and others...

I too am in the process of working out a " contract " with a private

pediatric group. I have worked as an RN in the practice for 5 years,

so I have already been seeing patients, but now feel it is time to

start focusing all of my attention on breastfeeding, as there is such

a need. 15 minutes is certainly not enough time. Perhaps it may be

if the baby is gaining and mother has no complaints. This is when

you need communication with a dr. They need to say, hey ,

everything looks and sounds good, can you just go and introduce

yourself and answer a few questions, or the alternative, , they

are having some real issues, baby is down weight and they need a

consult, I've given them your fees, pamphlet and asked them to

schedule with you today, if possible. Of course, we can't make the

Dr.'s do this and I, like you have 1 out of 3 Dr.'s who have just now

started to see the light.

You just don't know what is going to walk in on a 3-5 day visit and

what do you do when they are a trainwreck and need 2 hours

emediately. Do you walk in and explain the fees and services and

hope they are willing to stay for a consult?? I am really struggling

with payment. My patients are accustomed to their' services being

covered by insurance. I arrived at work Saturday morning, as an RN

and started my day off with a 3-5 day visit, that as an RN I would

weigh, briefly discuss breastfeeding, sleep, etc. and assuming all is

well, triage to DR for exam. Well, to make a long story short, the

baby hadn't eaten in hours, mom had such severe areaolar edema from

the 4 liters of fluid and pit she received in her 20 hour labor,

there was NO way the baby was latching, I did spend 2 hours with her

and we billed as a typical routine visit with a problem modifier.

Not much for reimbursement for the practice and I was paid my typical

hourly rate. What do you do when this happens? Should I have said,

you are in desperate need of a lactation consult, in which we can

start now, but there will be a charge of XYZ...What if they cannot

afford or would rather see the far inexperienced physician for

support, who would have given a bottle of formula and have their'

insurance cover the visit.

, getting off topic of your initial question, but will you be

giving them a superbill that they can submit to their' insurance?

What does a lactation consultant need to do this? I have applied for

an NPI, but where do I go from here and what is the chance that

reimbursement will be received from the insurance companies. Do you

need to be a provider for each insurance company?

I'm so confused about payement and fear people will not want to pay

for consultation.

Good luck!

>

> Hi ,

>

> I think 10-15 minutes would not be enough for even a brief

evaluation of breastfeeding. But the idea is really good. I think

this time would allow you to introduce yourself and give a hand-out

with basic information. I found Lyla's " reasons to consider " papers

very useful. You can ask some important questions (nipple pain,

weight loss etc.) and the answers would indicate if there is a need

for an urgent consultation.

>

> Good luck!

>

> Ibolya Eva Rozsa, LLLL, IBCLC

> Hungary

>

> What do you think about this?

>

> Hello all --

>

> I have a meeting tomorrow with a local peds office. I'm working

to set up an arrangement with them to use some exam space in their

offices for a limited number of hours per week. I would not be their

employee. I would function as a separate business, just using their

space. So, any consults I do with their patients would be on a fee-

for-service basis, completely separate from whatever brought them to

the doc's office in the first place.

>

> I'm pondering offering a brief consultation to their patients who

already have a well-baby check on the day I'm in the office. This is

what I'm picturing.... ped sees baby for check, immediately after

dr's exam, mom/baby see me for 10-15 minutes. Primary focus is AAP

rec for a formal, observed evaluation of breastfeeding for all

breastfed infants at 3-5 days of life, but would also see 1 or 2

weekers who missed me at the first well baby check. my portion of

check would include observation of position, latch and milk transfer

and very brief history (looking for red flags). Outcomes could be

referral back to ped, referral to local breastfeeding support groups,

extend visit to full consult or schedule a future consult.

>

> My mentor thinks this is a bad idea on several fronts. Her

primary concern is liability. What if I don't touch on something in

the brief history then baby/mom has bad outcome and I get sued? Or I

miss something because it's a brief visit? She also feels like there

is potential for me get overscheduled and not be able to accomodate

full consults when I need one.

>

> What do others think of the brief consult idea? Does anyone else

out there do them and if so, how do you make it work? I guess in my

mind, I don't see it as all that different from a telephone consult

but being new to the field, I don't want to be shortsighted either.

>

> Thanks!