Is the doctor-patient relationship really more sacrosanct than the nurse-patient relationship?
That’s the provocative question asked by Theresa Brown in a recent column from Well, the New York Times’ health blog.
She discusses an instance when she had a disagreement with a physician over a patient care issue.
I couldn’t believe that this doctor, who had always worked well with the nurses on my floor, had just suggested, at least in my mind, that a nurse’s opinion on patient care matters less because patients don’t directly make appointments with us.
And she has a point. In a hospital setting, nurses spend significantly more patient contact time than doctors. Smart doctors will seek out a patient’s nurse and ask his or her’s opinion on how the patient is doing.
So, when she asks whether a doctor-patient relationship takes priority over the relationship between a patient and a nurse, the answer is clearly no:
Physicians have the ultimate responsibility for treatment decisions, but because nurses spend so much more time with hospital patients than doctors do, we have a unique view of how the patient is really doing. And at times, patients present very different faces to nurses and to doctors — complaining to a nurse in a way they never would to a doctor.
We are shifting away from a paternalistic model of care, and more towards a team-based approach. This is especially true in the hospital, where not only a doctor takes care of a patient, but also nurses, social workers, physical therapists, dietitians and discharge planners, to name a few.
Primary care, of course, is heading towards a team-based model as well — especially as accountable care organizations and medical homes become more prevalent.
So, instead of asking whether a patient has a good relationship with his doctor, it’s going to be more important to know whether he has a good partnership with his team.
Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.