The doctor-patient relationship is based on an assumption that, as a general rule, the doctor knows more about health care than the patient does. This is as it should be: obviously, a patient cannot continue to seek care from a doctor if she comes to believe that the doctor is lacking in skills or knowledge. And a doctor cannot continue to work with a patient if his decisions are constantly being second-guessed. But there is often a grey area between competence and incompetence: what if a patient really respects and admires her physician, but finds one very well-defined area of medical care in which he does not appear to have the expertise demanded of him by his profession? Under such circumstances, it would not be inappropriate for the patient to raise the issue with his doctor and work with him in a constructive and tactful manner to find a solution. But how?
This is not easy. Doctors are slow to change their practices and their ways of thinking. It’s not just a matter of ego. To be effective, doctors must have complete confidence in their abilities and their knowledge base. The stakes are too high to leave any room for self-doubt or equivocation. I would certainly not want to undergo a coronary artery bypass procedure if I knew that my surgeon really didn’t think he was up to the task! But every now and then an issue arises which requires redress, even when the doctor is otherwise at the very top of his game. Such is often the case with breastfeeding management.
According to the Surgeon General’s Call to Action on Breastfeeding, “Inadequate education and training of clinicians has been identified as a major barrier to breastfeeding, and education on breastfeeding is not a core element of most medical schools or residency programs or of programs in nursing education. Unfortunately, there are few opportunities for future physicians and nurses to obtain education and training on breastfeeding, and the information on breastfeeding in medical texts is often incomplete, inconsistent, and inaccurate.” It’s therefore not surprising that many of even the best and the brightest of our physicians may be ill-equipped to provide the families under their care with the breastfeeding assistance and guidance to which they are entitled.
There’s a wonderful quote from Mahatma Gandhi: “There go my people; I must follow them, for I am their leader.” Patients must learn from their doctors, but doctors must also learn from their patients. This is easier said than done. When a competent, conscientious physician realizes that he has been providing the wrong advice about something as central to primary care as infant feeding and nutrition, the lesson can be quite unsettling, even painful. It’s never easy to admit that we’ve been doing an important part of our work the wrong way, especially if we take great pride in our work and we’ve been doing it a long time.
Patients can indeed teach their physicians. First and foremost, in order to be effective, they should listen to what the physician is actually saying (just as they would want their physician to be listening to them). Most acrimonious situations can be prevented if misunderstandings can be avoided. It could very well be that the patient and the physician are closer in their thinking than either might suspect, and finding common ground is the first step toward resolving a problem. One should avoid assuming an adversarial posture and looking for counterproductive “gotcha” moments, which will only make meaningful communication more difficult, if not impossible. A more effective approach is for the patient to frame the disagreement as a question, so that the physician is impelled to think about it and give an honest response. The answer at the moment may not be entirely satisfactory, but if the patient can gracefully disengage from the encounter, neither conceding the point nor pressing his position, there’s a good chance that the physician will give the matter further thought during a more private moment and commence with the uncomfortable process of re-examining untested assumptions. This is especially likely if he hears the same message from other patients. He can dismiss it once or twice, but if he hears it often enough, he is bound to give it his serious attention.
People tend to listen to their own kind. It’s human nature. Musicians listen to musicians, businessmen listen to businessmen, engineers listen to engineers, and doctors listen to doctors. A mother who disagrees with her physician’s approach to a breastfeeding issue might follow up on the matter by discreetly giving him some literature published by an authoritative medical society. If the mother has a strong, mutually respectful relationship with her physician, it is likely that he will take the time to review it. The Academy of Breastfeeding Medicine has published just such a set of protocols, specifically targeted to physicians. The protocols address medical management of common breastfeeding issues and are extremely well researched and rigorously peer-reviewed. They are also designed to be read relatively quickly and can serve as a handy reference for physicians who work with breastfeeding families on a regular basis. Providing the physician with just one protocol (which can be downloaded for free on the Academy website) can serve as an incentive to use many others, and so enable the physician to educate himself on breastfeeding matters about which he may not have been adequately trained.
The mission of the Academy of Breastfeeding Medicine is to fill the gap in medical education identified so well in the Surgeon General’s Call to Action on Breastfeeding. Most physicians were brought up in the same culture as every other American citizen. They learned very little about breastfeeding from their own families, communities and schools, because at the time breastfeeding was an uncommon practice generally assumed not to be of much importance. Today we are beginning to understand just how important it really is. Most mothers now want to breastfeed their infants. They expect their physicians to help them. The Academy of Breastfeeding Medicine will serve as an important resource to provide physicians with the knowledge and skills they will require in order to be effective breastfeeding supporters and advocates in the years ahead.
Gerald Calnen, MD, FABM
President of the Academy of Breastfeeding Medicine
Editor’s note: The ABM clinical protocols cover mother/baby issues that effect breastfeeding and even how physicians can make their offices breastfeeding-friendly. They are printable from the ABM’s website and are a great resource for moms to share with their care providers!
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