Changing how the world thinks about nursing

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Q: Does The Truth About Nursing have some issue with physicians? It seems like you sometimes minimize their role in health care, or criticize something a physician has said or done.

A: We believe that physicians are critically important members of the health care team. Our concern is that the media appears to view physicians as the entire team, or the only part that matters, with nurses and others relegated to insignificant peripheral roles. That vision is grossly inaccurate, and damaging to nursing and public health.

Most journalists today have a tendency to cover physician-intensive aspects of health care. The work of nurses is given relatively little attention, even when it is of obvious significance. For example, the innovative health care financing proposal of Columbia University nurses in October 2004 received virtually no mainstream press attention. And pieces that discuss matters in which both nurses and physicians play key roles, such as hospital patient outcomes and community health, often completely ignore the role of nursing.

Influential health-related television shows focus on "medical" aspects of patient care. Today, popular health-related television dramas and comedies are--without exception--dominated by physician characters. Given current TV practice, that means that those characters will usually perform virtually all important on-screen care tasks, regardless of who does them in real life. Thus, such shows regularly feature physician characters doing exciting, important work that in real life would be done by nurses, social workers, respiratory therapists or other members of the health team. Indeed, members of the public could be forgiven for thinking that most health care professionals are physicians.

However, although there are perhaps 700,000 physicians in the U.S., there are also about 2.3 million practicing registered nurses, and hundreds of thousands of other highly trained, critical members of the health care team. They include social workers, pharmacists, respiratory therapists, physical therapists, speech language pathologists, psychologists--the list is very long. If the public were to gain understanding of and appreciation for the great majority of skilled health care professionals who are not physicians, it could have positive effects not just on these professions but on public health generally, as people would come to understand valuable alternative approaches to health care and maintenance.

Not coincidentally, physicians now dominate the provision of expert advice to the media. Journalists tend to consult only physicians as expert sources for health stories, even when pieces concern issues as to which other health professionals are generally more expert, such as patient emotional support, patient education, pain management, nutrition or breastfeeding. Physicians are far more likely than nurses to be the authors of health care stories in mainstream publications with wide circulations. And they provide expert advice to Hollywood as to the scripts that dictate how care is portrayed. Some physicians actually write Hollywood dramas, such as "ER" episodes. Physicians have long worked hard to influence media depictions of their profession and health care generally. Thus, we notice when a damaging depiction of nursing appears to have been created or influenced by a physician who we might expect to know more about nursing than someone who is not a health professional.

Unfortunately, in our experience, most physicians do not understand nursing well. At the same time, despite recent malpractice complaints, the medical profession enjoys essentially unmatched and unquestioned economic and social power. We think it is fair to say that physicians are rarely asked to consider the limits of their expertise or importance relative to other professions, and it is our understanding that their training generally includes little information about other health professions. Thus, it may not be surprising when a physician-influenced media product presents physicians as the providers or controllers of all meaningful health care. But it is important that we focus on physicians who influence the media and try to educate them about nursing.

Naturally, when one group has disproportionately great power, influence and public esteem compared to another group, it is difficult for the disempowered group to calibrate its reactions to the powerful group precisely. Thus, it may be difficult for many nurses to react in a measured way to physicians. This dynamic is also reflected in some media depictions. Some of the best film portrayals of nursing could be accused of unfairness to physicians. However, The Truth About Nursing tries hard to be fair to physicians. We are always eager to praise a physician or physician-influenced media product that recognizes the real contributions of nurses. That has occurred in several short pieces in the print press. For instance, the Center praised a November 19, 2002 New York Times article by physician Abigail Zuger called Prescription, Quite Simply, Was a Nurse, and a December 20, 2003 letter to The Baltimore Sun by Maryland physician John Irwin about the importance of supporting nursing as a key way to reduce health care errors.

last updated: December 1, 2004

 

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