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Judas in a lab coat: "ER" takes on that whole "female-physician-mistaken-for-a-nurse" thing

April 28, 2005 -- Most of tonight's episode of NBC's "ER," written by Lydia Woodward and Lisa Zwerling, M.D., was fairly unremarkable from a nursing perspective. It featured the standard portrayal of nurses as skilled but peripheral physician assistants. However, one scene did call upon intern character Abby Lockhart--also a nurse--to address a patient's dismissive reference to her as a nurse. So, did the show have Lockhart mount a brief but spirited defense of the widely disrespected profession-in-crisis in which she herself spent many years saving lives and improving outcomes? You make the call, based on her indignant response to the patient: "I am not a nurse. I'm a doctor."

Most of the episode, "Ruby Redux," is business as usual. Physician characters perform all important procedures, conduct all patient interactions, and are the overwhelming focus of all the plotting that relates to health practice. At one point, major nurse character Sam Taggart captures this perfectly, as she tells an emergent patient who asks about her abusive husband that "the doctors are working on him"--at which point we immediately see her husband whiz past with nurse character Chuny Marquez (right) ambubagging him.

The show also includes one of its standard messages that nurses report to physicians. Attending Luka Kovac tells his girlfriend Taggart (right)--who is not feeling well, possibly because she is pregnant--that she can leave early, and "if there are any complaints, you can tell them to talk to me." Of course, "them" would be the nurse managers "ER" generally pretends do not exist, and "they" would not just have "complaints," as if they were simply nagging underlings who all report to Kovac, instead of managers struggling to staff the unit with enough nurses to provide quality care. Physicians have no involvement in nurse staffing, which is complex, and Kovac would have neither the authority nor the expertise to weigh in on it. Other than that, the scene was totally fine.

But let's get to the fun part. Early on, Lockhart (right) is trying to begin treating an elderly patient who seems far too fragile for the cardiac surgery the hospital's surgeons will eventually persuade him to undergo. This patient seems to respect only older male physicians, and he is very angry because of the hospital's ill treatment of his deceased wife long ago. Resisting Lockhart's efforts, he snaps that he does not "want some nurse calling the shots around here." Lockhart responds, with measured but clear indignation: "I am not a nurse. I'm a doctor."

Well. At least they didn't have Lockhart deny nursing three times! In fairness to the writers, actress Maura Tierney and director Paul McCrane bear some responsibility--Tierney could have delivered the lines more calmly, or in a way that suggested the distinction was irrelevant to the issue at hand. And yes, no doubt the nurse "slur" would have special resonance for a person who has left nursing, so we can't expect an ideal response. But the exchange is distressing not only because Lockhart actually is a nurse, but because she will go on to spend the rest of the episode pushing hard to have the patient consider non-surgical options despite vigorous opposition from senior surgeons. It's not that an intern would never challenge senior attendings this way, but it isn't likely, and it seems more likely that Lockhart's determined "patient advocacy"--as attending John Carter specifically describes it--would be coming from a strong, experienced nurse whose profession stresses such advocacy. And perhaps some very astute viewers will actually get that Lockhart is pushing this alternative perspective at least in part because of her nursing background. But for the great majority, this will likely operate as a new variation on the classic "ER" theme in depicting anti-nurse bigotry: have a negative, ignorant and/or angry character utter a vicious anti-nurse slur, then have the nurse character respond only with hurt silence, leaving viewers to conclude that the speaker's words are unnecessarily cruel, but essentially well-founded. Here, though nurse Lockhart still has nothing to say, physician Lockhart has moved from silence to voice.

We recognize the quandary thoughtful female physicians face when patients or others wrongly assume they are nurses. People want to be viewed accurately in a professional setting, and obviously such assumptions generally reflect unacceptable gender bias. Therefore, as a service to the producers of "ER" and other Hollywood shows, as well as dedicated female physicians everywhere, the Center humbly offers the following Top Ten responses that the Lockhart character might have made to this difficult, anti-nurse patient:

1. "Today I am practicing as a physician. But as a nurse I would be just as interested in giving you good care, and my work as a nurse would be just as critical to that care."

2. "You're absolutely right--no nurse or physician should decide what happens to you. That is your right. As it happens, I am a nurse and a physician."

3. "Ahem. To become a physician, I worked hard to unlearn the interpersonal skills and holistic focus I developed in my years as a nurse, so I'll thank you not to denigrate my achievement."

4. (Conspiratorially.) "Sir, you are so right to be concerned--did you know that many nurses push unnecessary, life-threatening procedures on their patients, just to feed their investment portfolios and their egos? Can you imagine?"

5. "Nurse? In the managed care era? Sure, and maybe if you plant a Truffula seed, the Lorax and all his friends will come back too."

6. "Nurse? This is 2005--do I look like I've been lured here from some impoverished Asian or African nation whose health system has gone completely to hell? Do I look like I cry every day because my own children are thousands of miles away?"

7. "Sir, let's be real. Do you think a nurse would spend this much time at your bedside, monitoring and talking to you at length about your critical condition, providing vital physical and emotional support in spite of your oppositional personality, and trying to explain the incomprehensible techno-babble that comes out of most physicians' mouths, so you can make an informed decision about your care? Haven't you ever seen 'ER?'"

8. "Don't you call me a nurse again. Just because I couldn't hack it as a nurse, that's no reason..." (uncontrollable sobbing)

9. "Ahh...I gather you don't like our nurse-centered model of care." (Picking up a phone.) "Hello, is this psych.?"

10. "Don't worry, sir--the nurses only help the patients we want to live."

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