NBC News Broadcast Standards
December 15, 2005 -- NBC has responded to the 3500+ letters sent as part of our campaign about the "Today" show segment on nurse practitioner (NP)-staffed quick clinics that aired November 14, 2005. Please see their letter below, and our response to them below that. Although the Center is not satisfied with the position of NBC News on the segment, we do appreciate its consideration of our views, and especially that the "Today" show has agreed to work with a new group of nursing organizations to improve its coverage of nursing issues going forward. In fact, we understand that "Today" has already run a segment about the worrisome school nursing shortage, although the Center has not yet seen that piece. So we are ending our "Today" show campaign as to NBC today. But Dr. Edward Hill and the AMA refuse even to respond to the Center or (to our knowledge) any of the thousands who have written to protest Dr. Hill's unfounded comments denigrating NP care. So we are continuing our campaign as to the AMA; to participate, please see the bottom of the page. Thank you.
Dear Ms. Summers:
The report was intended to give consumers background information about these novel medical facilities. We see no evidence within it of degradation of nurse practitioners, nor was any intended. While the report did pose questions, such as "could you be putting your health at risk?," we are certain that consumers, seeing these clinics for the first time, wonder whether it's appropriate to get medical care in an unfamiliar setting.
Your organization takes issue with the quote from a representative of the AMA, who expresses concern about whether the non-physician providers are properly supervised. But the very next quote is from the medical director of the Minute Clinic, who says they are "not a replacement for primary care relationships ... we value them as well." The clear impression left by the report is that these clinics are a useful addition to, but not a replacement for, a physician-patient relationship.
It is worth noting that the spot included interviews with patients who praised their experiences, and ended with the reporter receiving a flu shot from a nurse practitioner. These elements would have no place in a report critical of the care these clinics provide.
In short, while "Fast, Cheap and Out of Control" is a great movie title, it is an unfair description of our report.
We understand you have been in contact with the producer of the segment, who encourages you (as do we) to send story ideas and updates. If you have additional questions or comments about this particular report, please direct them to firstname.lastname@example.org ...
Very truly yours
NBC News Broadcast Standards
Dear NBC News:
Thank you for your response to our concerns about the "quick clinic" segment on the November 14 edition of the "Today" show. We and thousands of supporters wrote to you in protest of the segment's suggestions that the care of the nurse practitioners (NPs) who staff the clinics was unsafe and rudimentary, and the segment's failure to present any NP to rebut those unfounded allegations.
In many cases, if major media entities even respond to such concerns, their responses are largely form letters that make no effort to address our specific analysis of the product in question. And admissions of error do not seem to be on the program. However, you have clearly made some effort to analyze our views, and we commend you for doing so.
Of course, since the theme of your response seemed to be that the "Today" segment was journalistically flawless--despite the concerns of the 1473 nurses, physicians and patients who wrote you original letters countering its depiction of NPs--we're sure you will understand if we beg to differ with your analysis. (An additional 2053 people sent you our form letter.)
Perhaps the most striking feature of your response was that it did not try to defend the segment's failure to include any NP comment. The response seems to reflect the view that the MinuteClinic physician's assurance that quick clinics are not meant to replace primary care, along with the piece's focus on consumer appreciation for the quick and cheap aspects of the clinics, was a defense to the attacks on the quality and comprehensiveness of NP care. That is not the case. No one in the piece defended NP training or care. If anything, the elements supposedly providing balance subtly confirmed the impression that NPs were marginally trained physician subordinates with no important role in primary care.
Let's look at the specifics. At the start, Ms. Couric asks whether consumers are "putting [their] health at risk" in getting a "quickie diagnosis on the cheap" at the quick clinics. Ms. Lieberman says that "critics are concerned that MinuteClinics are staffed by nurse practitioners who are licensed to treat patients and prescribe medications, but have far less training than doctors." Dr. Hill says that "[o]ur only concern is that we don't confuse convenience and affordability--even affordability with quality. And...there's a concern about supervision of these non-physician providers." Then MinuteClinic's medical director assures viewers that the clinics are "not a replacement for the primary care relationship." Later, a patient notes: "I go to a regular doctor when it's a mystery, I don't know what's going on."
Please examine the italicized language above. It shows that the issue in the piece is not just whether quick clinics might be a bad idea generally. A distinct concern is clearly the "quality" of care provided by the NPs who staff the clinics, NPs who allegedly have "far less training" than and require "supervision" from physicians. The "regular doctor" comment suggests that NPs cannot diagnose, and that they are not involved in comprehensive primary care. The piece includes powerful attacks on NPs as NPs, and these are never rebutted, by NPs or anyone else. Your response suggests that the segment was merely noting that consumers might hesitate to get care in "unfamiliar" settings. We acknowledged in our analysis that nurses practicing in supermarkets would have to live with some banter. But the segment suggested, without real contradiction, that the setting was not just unfamiliar, but unsafe.
Your response stresses that the MinuteClinic physician's assurance that the clinics did not replace primary care was enough because it made clear that patients still needed a "physician-patient relationship." This suggests that you have not yet grasped the key points that NPs provide comprehensive primary care that research has shown is at least as good as that of physicians, that NPs have no need for physician "supervision," and that most patients do not need any regular primary care "relationship" with a physician. We note that Dr. Hill seems to be pursuing a national program of using quick clinic press pieces as a vehicle to bolster the dangerous (but lucrative) illusion that physicians should and do control all health care (e.g. a recent piece in the Atlanta Journal Constitution). But many thousands of highly educated nurses and their patients do not agree that NPs require physician supervision.
In our view, it is unacceptable to include harsh criticisms of an entire professional class--including comments by the the main group representing their competitors--and offer no response from that class. Would you do a piece about physician care and include comment from nurses, but no physicians? Perhaps it surprises you to hear that physicians are not qualified by themselves to provide balance in every health care piece. Perhaps you are not aware that physicians do not train, license, regulate, or professionally manage nurses, social workers, or other autonomous health professionals. Perhaps you did not know that NPs, who have master's or doctoral degrees, have professional associations (see AANP and ACNP) whose representatives would be very willing and able to counter the disinformation presented in your piece. The fact that organizations like NBC News seem oblivious to all this is a major reason that the Center for Nursing Advocacy exists.
Your segment wandered into part of a much larger debate among nurses, physicians and others over the scope of NP practice, a debate that is playing out across the nation and around the world. We think you owe it to the public to be aware of such issues, and not to allow yourselves to be used by one side to pursue its agenda. It is ironic that the piece associates NPs with "quick care" and a lack of diagnostic ability, since NPs generally spend far more time with patients than most "in-and-out" primary care physicians, and some feel that the NPs are thus more likely to discover key underlying health conditions.
You suggest that the segment's indication that some patients like quick clinic care and its portrayal of an NP giving a flu shot somehow proves that the piece could not have been "critical" of NPs. That is absurd. The piece clearly suggests that NP care is very limited and possibly unsafe in the absence of direct physician supervision. Would you say that our inclusion in this letter of some praise for your response to our campaign means that the letter as a whole is not "critical" of NBC News?
We're glad that you got our reference to "Fast, Cheap, & Out of Control." However, our main goal in alluding to Mr. Morris' film was not to suggest that its title described the "Today" segment (we'll resist the urge to design an apt title for the segment). Instead, we were suggesting that the segment left its six million viewers with the impression that NP care was fast, cheap, and out of control. That is an impression that over 110,000 NPs and millions of other registered nurses look forward to seeing you correct as soon as possible.
To that end, we are very pleased to have the opportunity to work with "Today" show producers going forward to present viewers with an accurate and balanced picture of the role of nurses in the health care team, and their efforts to improve health. And we commend you for your willingness to work with nursing organizations to strengthen your coverage.
Thank you again for your substantive response to our concerns.
Sandy Summers, RN, MSN, MPH
Executive Director, Center for Nursing Advocacy
We are ending our "Today" show campaign as to NBC (but not AMA). We are doing so mainly because show producers, in contrast to most of their television colleagues, have agreed to work with nurses going forward to present a more accurate and balanced view of nursing. We have put together a working group of nursing organizations and a few schools, and the group plans to float story ideas to the "Today" show on an ongoing basis. Please let us know if you, as a representative of your organization, would like to participate in this group.
Please also join our campaign to start a conversation with the AMA about how we can work together to present a more accurate view of NP care. AMA president Edward Hill has refused to speak with the Center on the telephone. And to our knowledge the AMA has not responded to any of the 3700+ emails it has received regarding Dr. Hill's unfounded comments on the "Today" show. On the contrary, Dr. Hill apparently continues to provide such comments to the mainstream media, which, sadly, continues to do pieces on quick clinics with no NP input. Dr. Hill is quoted in a December 6, 2005 Atlanta Journal Constitution quick clinic piece as questioning the ability of NPs to diagnose even one of the most common of conditions--a heart attack. Such uninformed, paternalistic statements must end if the nursing image is to improve. One result of the public's lack of understanding of nursing is that the profession cannot obtain the resources it needs to educate and support nurses.
Ask Dr. Hill to speak with you, or the Truth, so that we can explain why his comments damage nursing and public health, and explore how we might work together to resolve the nursing shortage.