Private or intimate relations between doctor and patient: is zero tolerance warranted?

This article reviews and comments on the five categories of arguments used to defend zero tolerance with regard to sexual contacts resulting from the physician-patient relationship as summarised by Cullen. In addition it puts forward a hypothesis-"fear of loss by third party"-as a psychological explanation for the collective insistence on a zero tolerance policy.

Promoting successful breast feeding among women with a low income.

OBJECTIVE: To identify those factors which promote or discourage successful breast feeding in a sample of women with a low income. DESIGN: Qualitative research using in-depth, semi-structured interviews. SAMPLE: All women with a low income who were identified as having breast fed their latest baby at least once and who had delivered at a district general hospital in the south west of England from 17 September 1996 to 5 February 1997. FINDINGS: Three behavioural areas which determined whether or not women with a low income continued to breast feed were identified: individual and social environmental, baby and midwifery practice factors. In terms of individual and social environmental factors those women who continued to breast feed were more likely to have: positive attitudes; realistic expectations; greater levels of self-esteem; a supportive mother/friend; a partner who was not against breast feeding; and the ability to cope with the perceived temporary social isolation. In terms of baby factors those women who continued to breast feed had babies who were more likely to: have three- or four-hourly feeds; be perceived as a contented baby; and have gained weight. And finally, in terms of midwifery practice factors, those women who continued to breast feed were more likely to have: not been separated from their baby; not been given supplementary or complementary feeds; received good advice, especially with regard to positioning the baby at the breast; had greater continuity of midwifery input; had sufficient quality time with a midwife; and had the opportunity to solve problems with a community midwife's help. IMPLICATIONS FOR PRACTICE: Midwifery practice can be improved to promote successful breast feeding among women with a low income by: 1) creating realistic expectations and increasing women's confidence/desire to succeed in breast feeding; 2) providing good quality advice and support to mothers of newborn babies, particularly with regard to positioning the baby at the breast; 3) improving social-support networks available to breast-feeding mothers, perhaps through educating grandmothers (or partners) in breast-feeding matters.