The amount of hostility among health care professionals seems to be at an all-time high. Are “scope of practice” and “turf” battles really escalating, or is it just more palpable in the modern era of anonymous comments and viral online posts? I don’t know for sure, but lately, the conversation seems louder and uglier to me.
In medical school, I heard derogatory comments (“jokes”?) from physicians and nurses alike about pretty much everyone else in the hospital. Emergency medicine physicians are “GTNs” — glorified triage nurses. (Wait — are we insulting ER docs or triage nurses here?) General surgeons professed that obstetricians and gynecologic surgeons aren’t “real” surgeons. Some guy in an elevator told me that the “ABCs” for anesthesiologists — referring to the life support mantra of “airway, breathing, circulation” — are “airway, bagel, coffee.” (I know, I know – now circulation comes before airway — but this was back in 2001.)
Orthopedic surgeons are basically carpenters, with saws and hammers. And who knows the difference between an optometrist, optician, and ophthalmologist anyway? The ICU nurses’ station displayed a cartoon portraying medical residents as babies dressed in diapers, sucking on pacifiers, their stethoscopes training behind them on the floor like a security blanket. I’m not sure why these insults are so pervasively embraced and tolerated in health care culture, but it is disheartening.
In my own specialty, there’s been a lot of recent buzz about scope of practice. In particular, I’m thinking of two political proposals currently under consideration that would reduce or eliminate physician participation in care of veteran patients within the VA system (the “VA Nursing Handbook” and Senate Bill S. 2279, “Veterans Health Care Staffing Improvement Act”). This has naturally sparked vigorous advocacy activity from both physician and nursing organizations and clinicians. Unfortunately, sometimes the discourse is far from respectful and professional.
Patients are complex, and medical care is multifaceted. My patients show up with a host of pre-existing problems (some known, and some yet to be diagnosed), have an operation that may be short or long, hugely invasive or minimally so, have good luck or bad, receive care from probably at least 20 different clinicians during their stay, all of whom are most likely well-trained and well-intended. Patients are sometimes resilient and get better even when we make mistakes, and patients sometimes are so ill or injured that they simply can’t be fixed even when everything is done right.
Quality measures, expertise, and skill of any individual is tangled up in the machine of the perioperative experience. It’s tough to measure.
As a medical doctor who specializes in anesthesiology, I can’t comment on other education programs (nursing school, physical therapy school, pharmacy school, chiropractic school, dental school, etc.). Like you, I only truly know the experience of my own chosen path. My respect for others (and their respect for me) should not be based upon hours or years of training, number of nights and weekends sacrificed, or initials after our names.
Here’s one thing I know with conviction: We all have value. It is not necessary to marginalize each other to take pride in our own worth.
Doctors are critically important, whether MD or DO. Nurses are critically important, whether BS or MS or NP or CRNA or DNP. Pharmacists are critically important, as are dentists, therapists, aides, technicians, and — dare we say it — health care executives. Have we forgotten? We all exist to help patients, not to put each other down in some kind of battle for supremacy.
When I get up in the morning, I come to work to take care of patients to the best of my ability. I can’t do it without the rest of you, and from time to time, you can’t do it without me. You can trust me not to put you down, but also be assured that I won’t devalue what I bring to the table. As a fellow health care professional and human being, I expect the same from you. Please join me by leaving your comments below, and sharing this sentiment with your colleagues, no matter what title they wear on their hospital badge.
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