Does it take a village nurse?

April 18, 2004 -- The "Medicine 2004" feature in today's New York Times Magazine, which addresses some serious health care practice and financing issues at great length, is very focused on the training and current practices of physicians. But none of the six articles discusses nurses or nursing in any depth, and most fail to address nursing at all, even when it would be highly relevant to the specific subject matter at hand. Thus, on the whole, the feature reinforces the belief that the only health care workers who matter are physicians.

One piece does describe the willingness of Illinois nurses to care for a recent monkeypox patient when many physicians balked, though even that piece is marred by some physician-centric elements. In another piece, a physician discusses what she views as the decline of primary care without mentioning nurse practitioners once. A long piece about narrative medicine, which encourages physicians to relate better to their patients through literary and other strategies, fails even to mention the approach of nurses, who outnumber physicians three to one and who have far more extensive contact with patients. And the lead piece, a very broad discussion of the outlook for public health and health care delivery and financing by Sen. Hillary Rodham Clinton, fails to even mention the nursing shortage.

Gretchen Reynolds' "Why Were Doctors Afraid to Treat Rebecca McLester?" describes the reluctance of some Illinois health care workers to treat a girl with monkeypox in 2003, and more generally discusses the issue of health care workers' refusals to care for patients with life-threatening infectious diseases, often on the basis that the workers have young children. This piece is not as physician-centric as it could be. Two of the three central health care figures discussed in the monkeypox case are physicians, but the other is nurse Linda Wildey, SwedishAmerican Hospital's "director of women's and children's services," whose experience forms a kind of frame for the story. The reluctance to care for the Illinois patient, at least as depicted here, seemed to be more that of physicians, especially the partners of the lone attending physician on the case, Michael Anderson. Six nurses volunteered to care for the patient, including Wildey and Stephanie Anderson, who is married to Michael. In discussing disease outbreaks in the U.S. generally, as well as outbreaks of Ebola in Africa and SARS in Canada, the piece often discusses the risks to both nurses and physicians.

Unfortunately, there are some troubling elements in the piece. All nine of the outside experts who are quoted personally--generally experts in infectious diseases, bioethics, and/or public health--appear to be physicians. None appear to be nurses. At a number of points, the piece discusses treatment by physicians alone and risks to physicians alone, though in most infectious disease scenarios, nurses are more at risk because they have far more contact with patients--as the recent SARS outbreaks suggested. The one photo accompanying the online article, of physician Michael and nurse Stephanie Anderson, is a classic snapshot of physician-over-nurse (and perhaps male-over-female) bias. In the posed photo, both subjects face the camera, but Michael is in the foreground, and he dominates. Stephanie stands several feet behind her husband, smaller and apparently less important. The caption describes the two as "Dr. Michael Anderson and his wife, Stephanie, a nurse"--can anyone spot the difference? And the headline seems unfair to both professions--to physicians because it suggests that only they were reluctant, and to nurses because it suggests that only physicians matter.

In "The End of Primary Care," Lisa Sanders, M.D., recounts the history of primary care medicine and what she describes as its current decline, as physicians have become squeezed in their new roles as managed care gatekeepers. Ms. Sanders makes some valuable points in her long, wide-ranging article, but because she is at least as concerned with how patients can and should obtain the care they need in general as with describing the specific experiences of physicians, her article's total omission of any mention of nurse practitioners is glaring. In fact, well over 100,000 U.S. advanced practice nurses now provide vital primary care as family nurse practitioners, adult nurse practitioners and pediatric nurse practitioners. Surely their growing role in providing more cost-effective, accessible primary care at a difficult time would have been worth at least a mention, if not extensive discussion.

See the New York Times Magazine front page from the April 18, 2004 edition of the paper.