In the last few years there has been a subtle shift in the paradigm of the doctor-patient relationship.

The trend toward collaborative decision-making, where patients actively participate in decisions instead of clinicians deciding on their behalf, is becoming more popular.

It think it's exciting news.

I’ve recently realized that it comes with some challenges, though.

The fields in which this practice is already pretty common are, for example, obstetrics, nutrition, pediatrics; areas in which we deal mostly with physiology and this leaves room for an attitude that is more open to diversity and individuality.

Physicians consult patients preferences mostly in situations in which there is not a unique medical conduct to opt for or a so called "Gold-standard".

The problem is that, although it feels like a paradox, these are actually the scenarios in which patients need our help the most! This is where education and information are really essential.

We should take time to explain thoroughly the different options/solutions available, exploring our patient’s needs and preferences.

We shouldn't influence in any way the process of decision making.

But remaining impartial isn’t easy, we’re all human.

I think for us, doctors, specifically it’s very hard because we hate when we're not in control. We really struggle when we can’t tell people what to do.

And I also think it’s genuinely a matter of how we were taught. We freeze when there is no clear recommendation, no single rule to follow. We just can’t stand the ambiguity.

So what happens is, instead of remaining flexible and educating ourselves in an open and inclusive manner, we usually choose the "current of thought" or "theory" that resonates the most and just stick to it.

But because we know that our view is not the only one out there I think what happens is we compensate for our own insecurity on the matter by being overly rigid in defending our opinion.

And this not only becomes apparent to our patients, influencing their decision-making, but, more significantly, I believe it lays the groundwork for the creation of extremisms and cult-like behaviors.

And unfortunately I fear that this is what sometimes happens in the breastfeeding field.

The existing evidence on the benefits of human milk and breastfeeding is mostly derived from observational studies rather than experimental ones which makes it a bit less strong in a way (I'll explain better in the next paragraph).

Plus, unfortunately, and for many reasons it's still an area that doesn't get the attention (and fundings) it deserves.

So there are still many things yet to discover and we still lack clear guidelines on many topics.

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Little note on why research is so complex when it comes to breastfeeding.

So, two main types of studies exist: observational studies and experimental ones. Observational studies evaluate subjects in their natural environment without any intervention. Like watching a movie.

Researchers might, for example, observe and collect data on mothers and babies to see if there's a correlation between breastfeeding and certain health outcomes → they might look at a group of formula-fed babies and see if they get sick more often than a group of breast-fed babies.

So now imagine they do observe higher rates of diseases in the formula-fed group; how can they actually determine that it is indeed due to feeding method?

It’s complex.

Various aspects such as the mother's health, socio-economic status, and genetic factors can each have a distinct influence on how infants are fed while also, at the same time, impact the baby’s overall health.

A mother with a low socio-economic status, for example, might choose to formula-feed because she doesn’t have easy access to the healthcare that could support her through breastfeeding (or inform her on its benefits).

At the same time if a family has limited resources, the baby might not receive timely medical attention, potentially impacting its overall health and susceptibility to illnesses.

The "low socio-economic status" is one of the so-called potential "confounders”.

There are strategies (statistical techniques) to “correct” the effect that this confounders might have, to minimize the influence of extraneous variables that may affect both the exposure (breastfeeding) and the outcome (health status).

But the easiest solution would be to simply complement the evidence we obtain from this type of studies with the ones we get from experimental ones, like we usually do in the other fields of medicine.

In an experimental study, like a randomized controlled trial (RCT), participants are randomly assigned to two distinct groups— for example - one breastfed and the other formula-fed.

This automatically ensures that any confounding variables, such as maternal health, socio-economic status, or genetic factors, are equally distributed among the groups and thus don’t have a causal role in determining a certain outcome.

The problems is that RCTs are obviously not feasible in this context as it is not ethical to instruct one group not to breastfeed their baby when breastfeeding is recommended for its known health benefits.

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To sum up, the complex nature of breastfeeding, the ethical constraints, and the limitations of observational research contribute to a limited amounted of evidence in this field.

For the moment.

The evidence we have is however precious and should be shared with emphasis between health professionals and with mothers.

We should, nonetheless, maintain an open attitude when it comes to topics where we still don't have an univocal answer.

Opinions should remain opinions and should not be offered as medical advice.

Adopting an "extremist approach" carries the potential danger of unintentionally undermining the positive elements of our message or, worse yet, linking our cause with a negative perception.

I believe that, above all, the patient should come first.

Or in the case of breastfeeding, the mother should come first.

My takeaway from all of this is that, in assisting new mothers facing breastfeeding challenges, my goal is to ensure that they possess all the necessary tools to make decisions they deem right, free from external influence or pressure.

Rather than simply focusing on teaching breastfeeding I would like to ideally facilitate the success of the solution that each woman considers best for herself, overall promoting her wellbeing.