Praise nurses without comparing them to physicians

Doctors vs. nurses (or doctors vs. nurse practitioners, or doctors vs. physician assistants, or what have you). The debate is old, tired, unimaginative, divisive, and wrong-headed–for reasons that are too obvious even to list. Does it get perpetuated because it garners comments (175 of them, to be exact)?  Snarkniess is not appreciated by this reader, at least.

The New York Times recently ran a column by one of its editors, “In Praise of Nurses.”  Nothing wrong with gratitude for nurses, who are certainly under-appreciated or mistreated, both in real life and in media portrayals of them.  Where it gets gnarly, apparently, is how to praise nurses in a vacuum, without comparing them to physicians.

To generalize: Nurses are warm, whereas doctors are cool. Nurses act like real people; doctors often act like aristocrats. Nurses look you in the eye; doctors stare slightly above and to the right of your shoulder. (Maybe they’re taught to do that in medical school?)

Well. This is what we learn in medical school about how to interact with patients.  Keep in mind this highlights solely psychological factors.  How we put together the relevant information to generate a differential is another story for another time.

  • Consciously keep “patient as a person” in mind while we conduct our interviews. While starting, we even had a separate category entitled this, which would often include vocation, home life, and hobbies.
  • Ask for a patient’s explanation of his/her illness. “Why do you believe that?” is usually a good question and leads to better care.
  • It’s not an interrogation.  Seat ourselves during the interview at a slight angle to 180 degrees, so that we are not directly facing the patient.
  • Body language, body language, body language.  It’s like a first date.  Encourage conversation; it’s information you need.  Make direct eye contact, nod, say “mmhmm” or “go on.”
  • Attend an AA meeting.  Watch alcoholics who have been sober for decades counsel alcoholics who have decided yesterday to quit.  ”Today is a new day.”
  • Listen to victims share their domestic abuse stories. Ask questions. Listen some more. It happens at the most unexpected times to the most unexpected people.
  • Learn how to take an appropriate and sensitive sexual history.  Don’t assume anything–married or not, “straight” or not, “educated” or not.
  • Make a home visit to a patient.  We see “disease”; he experiences “illness.”  What is it like?

If something is going wrong with the author’s doctors, it is certainly in spite of what our dedicated and caring preceptors teach us in medical school, thanks.

Shara Yurkiewicz is a medical student who blogs at This May Hurt a Bit.

 

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  • Catherine Hintz

    Excellent! Catherine E. Hintz, R.N. (an old school nurse)

    • Catherine Hintz

      P.S. Appreciated the NYT link and saved the article.

  • Katen Moore

    Excellent discussion! I have found that my favorite physician-colleagues do exactly that — not compare us! We all and each have skills to utilize and together provide the best care.

  • http://www.emergiblog.com Kim McAllister

    Well said! I not only have seen this, but I’m pretty sure I’ve been guilty of it myself. It certainly isn’t necessary and it is definitely not productive. Now that I’m aware of it, I’ll call it out when I see it!

  • Jo

    As NPs are starting to be touted by some as the “replacement” for residency trained and board certified primary care physicians, the comparisons must be made and stated, especially the differences in their training and medical knowlege.

    All who work together should get along and be kind to each other, but some things must be stated and remembered as the American healthcare system changes and some states are giving NPs solo practice status without physician oversite.

    NPs do not go through medical residencies. They do not sit for medical board exams. They are not regulated by the state Medical Board. They are regulated by the state Nursing Board.

    Let us be very clear that some of them may (or may not as has been my experience) be “nicer” than some primary care physicians, (as the physicians I know are very personable and their patient’s love them, and yes they look into their eyes when talking to them), but training is and always will be the difference.

    Unless nurses go through medical school and a medical residency and have to stay Board Certified in Medicine there will always be a gap in their medical knowlege. If the trend continues, there will be more and more concern going forward as stories increase of misdiagnosis and the “zebras” that got away.

  • Catherine Hintz

    Agree Jo.
    Physician Assistants were replacing physicians with physician supervision, and regulation by the states medical boards.
    Regarding NPs – being substitutes for physicians and regulated by the states board of nursing – keep going down the line . . .RN duties are now LPN responsibilities, former RN and LPN duties being reassigned to Medical Assistants regulated by state medical boards and CNAs by the states nursing boards. For awhile the hospitals had an internal policy for Nursing Assistants/Aides and MAs before the states nursing boards regulated them.
    Honestly, if I had wanted to be a physician, I would have attended medical school – not advanced practice nursing (NPs and CNPs).
    It’s a health business practice to continue substituting
    less expensive PAs, NPs and technicians for physician responsibilities.
    Or as I said thirty plus years ago – those who don’t want to do the time in medical school and residencies.
    This doesn’t remedy the continuing need for quality and available of health care. It’s alphabet soup. Bottom line – profit as always, not quality of care. Misdiagnosis and yes, the non-disclosure settlements for injuries, and the zebras got away.

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