Changing how the world thinks about nursing

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Feel Good, Inc.

July 14, 2005 -- In an episode aired on April 14 and again today, "Stories of Survival," the Dr. Phil show looked at the experience of two victims of "senseless" violence who are living with permanent facial disfigurement. They are a former deputy sheriff named Jason and Dr. Phil's sister-in-law Cindi Broaddus. The idea seemed to be to help Jason and his family, using Cindi as an inspirational example. At one point, the show introduced a nursing assistant who had helped Cindi during her recovery. Dr. Phil, Cindi and Clarice Marsh, director of pediatric nursing at UCLA, then offered brief testimonials for nursing as the under-appreciated "backbone" of health care, as Dr. Phil put it. This seemed to be part of the show's efforts to make amends for its host's November 18, 2004 remarks suggesting that many nurses were simply looking to marry a physician. We commend the effort. The image presented here is certainly better than Dr. Phil's comments last year, and Marsh did have time to say that nurses were "incredibly intelligent." But the testimonials mostly suggested that nurses were virtuous, hard-working hand-holders. No one said what nurses actually do to improve physical outcomes, or suggested what it really takes to provide skilled emotional support. The nursing assistant literally said nothing. Of course, nursing assistants, who have minimal training, are not nurses, despite Dr. Phil's suggestions to the contrary. Jason finally received a series of large promotional "donations," including the services of a Hollywood plastic surgeon and a dentist, who were presented as highly skilled professionals. These limited, possibly illusory "donations" form a striking contrast with nursing's holistic public health focus, and they send a dubious message to those facing serious adversity without access to show business largesse.

The show's theme appeared at first to be how "ordinary people" could overcome senseless, random acts of violence like those Jason and Cindi experienced. Jason, as a deputy, had apparently been answering a domestic violence call when, without warning, he was shot in the face with a shotgun. A large part of his mouth was torn away. He apparently spent about a month in the hospital and had 16 reconstructive surgeries. He reported the loss of his career and financial hardships, chronic pain, and an inability to eat solid food. His prominent facial disfigurement apparently led to some alienation from society, and a loss of intimacy with his wife. He said that the counselors he had seen had listened to him for a while, then offered to write prescriptions.

Dr. Phil's sister-in-law Cindi had apparently been driving her car when someone threw a vat of acid from an overpass. The acid broke through the windshield and burned her face and body, causing internal damage as well. She spent about three weeks in the hospital and eventually had 15 surgeries. However, her experience differed from Jason's. She went back to work six weeks after the accident. One year after her injury she went on the Dr. Phil show to tell her story, and, at his urging, she wrote a book about her experience called "A Random Act." (Dr. Phil, who wrote the foreword, pushed this book during the show.) Cindi noted that Dr. Phil had been a huge help to her, and we see footage of him offering a large cash reward for the arrest and conviction of the culprit. Cindi also apparently had a state law, making it a felony to throw things from a bridge or overpass, named after her. Cindi stressed that she had made a choice to set aside her anger so she could move forward.

At slightly more than half way through the show, with Cindi still on stage, Dr. Phil introduced a person whose "hard work and dedication" had helped Cindi in her "physical battle" and been an inspiration. This was Daphne Evans, a nursing assistant at the University of Texas Southwestern Medical Center in Dallas. Daphne was dressed in scrubs and sneakers. Cindi suggested that Daphne had kept her spirits up at crucial times during her recovery. Dr. Phil said that nurses are "the backbone of the medical industry," that they are among those who take "the laboring oar and do the work," even though they are "often unfairly overlooked." He noted that because he wanted to talk about nurses' contributions, he had invited Marsh, the director of pediatric nursing at Mattel Children's Hospital at UCLA, who sat in the front row of the audience in business attire. Dr. Phil asked her why it is that nurses are often swept aside when they are so critical to the "relationship" with the patient. Marsh said that many people don't know what nursing is until they experience it as a patient. She also said that nurses are "incredibly intelligent" and that their work is "multi-faceted." She stated that in nursing "the art is the relationship," and noted that nurses get to help people at the worst times, to heal, and to form a "bond" that can't be found anywhere else. Dr. Phil noted that Daphne was a "wonderful example" of this, and that he did not think Cindi would have made it without the "tremendously inspired and dedicated" nursing staff. Cindi agreed, noting that nurses were "wonderful, wonderful," and that nursing was especially dear to her heart because her oldest daughter was a nurse. This daughter, Angela, was sitting in the audience with Cindi's other daughters, dressed in smart casual clothes. Dr. Phil briefly bantered with Angela about whether she was playing hooky from the hospital where she worked; Angela smilingly denied calling in sick. During the four minutes or so of screen time that Daphne spent on stage, she did not utter one word audible to viewers. The last shot in this segment was a close-up of Daphne and Cindi holding hands.

After a commercial break, only Jason and his wife were on stage with Dr. Phil. Dr. Phil asked Jason if he could arrange for him to meet with some people as part of a plan that Dr. Phil had to help him. Jason, of course, agreed. The rehabilitation plan appeared to consist of showering Jason with large gifts of money and services, obviously in exchange for promotional consideration for the "donors." Dr. Phil introduced Dr. Randall Hayworth, a Hollywood plastic surgeon in an expensive suit, who had agreed to donate plastic and reconstructive surgery to Jason. Dr. Phil was down-home effusive about Heyworth's skills: "The boy is good!" Next, the equally telegenic and well-dressed Dr. Sherry Worth, a cosmetic and reconstructive dentist, appeared to "donate" her services. She noted modestly that she has a "gift" and it's time to give back. Heyworth and Worth stressed how much they admired Jason for risking his life as an officer, and for his courage in battling through his injuries. Then two representatives of a named major credit card company expressed similar sentiments in discussing their gift of $50,000 to help with Jason's financial difficulties. Dr. Phil announced that a named major airline and named local hotel would be donating their services so that Jason and his family could go back and forth to receive the medical and dental services. During this parade of largesse, Dr. Phil used irony, basically checking to see if all this was OK with Jason, to underscore just how amazing and wonderful what he had arranged was. At the close of the show, with a state trooper who had helped Cindi on stage with her, Dr. Phil pointed to all the heroes present, including the nurses that he noted once again were the "backbone" of health care. At this point, we got a quick shot of Daphne in the audience.

We appreciate the show's efforts to highlight the importance of nursing, and Dr. Phil's passing reference to the profession's image problem. The image presented here is certainly better than Dr. Phil's 2004 comments suggesting that nurses are clock-punching gold-diggers. Unfortunately, like Dr. Phil's initial efforts to make amends, what viewers got here was an inadequate account of what nurses do, and one that, sadly, may have served to reinforce stereotypical views that nursing is pretty much about hand-holding and unskilled physical labor. We learn nothing of what Daphne has actually done for Cindi beyond giving generic emotional support--indeed, the most powerful image of her is the shot of her holding Cindi's hand. Of course, a basic problem is that she's not a nurse in the first place; nursing assistants typically have six weeks or less of training. And frankly, the fact that Daphne said said nothing during the segment did not enhance the nursing image.

Presumably the producers realized how this would look, and invited Marsh to compensate. We commend Marsh for her efforts, and for the public role she has taken over the last few years in press accounts about UCLA's care of formerly conjoined twins from Guatemala. But she had very little time here, and her general comments about nurses' "intelligence" and "multi-faceted" work could not make up for everything else. Moreover, her comments about the nurse-patient "bond" and the "art of the relationship"--without anything concrete about nurses' advanced clinical skills--are unlikely to counter hand-holding stereotypes. Perhaps we should be glad to see nurses at least associated with emotional support, since most Hollywood shows assign even that to physicians. But that won't be enough to attract the resources nursing needs. Do nurses save lives? Are they health care experts? And with regard to emotional support, does that require skill and experience, or is it something any decent person could do? Maybe nurses really are just noble "backbones." Doctors, of course, were presented as highly skilled professionals, people with "gifts" whom you might fly across the nation to see--after all, "the boy is good!"

Ironically, Dr. Phil's "plan" for Jason seems to present a contrast with nursing's holistic, public health focus. Of course, it may be a great help to Jason and his family to get the services of the reconstructive and cosmetic professionals who appeared; perhaps they can offer something that his 16 prior surgeries did not. And the $50,000 will obviously be helpful. But what will the millions of viewers who have not won the Dr. Phil lottery--especially those who have to live with comparable health problems--take away from this? Cindi's words and example are great, but the Cinderella climax of the episode subverts her message. And it's not clear if these measures will address Jason's chronic pain or allow him to resume his career and family activities. Would it have made sense, for Jason and the millions watching, to discuss the benefits of better counseling, social workers, pain specialists, physical therapists? Would it have been appropriate to question whether Jason actually should be treated as a scary pariah because of the way his face looks, rather than taking it as a given that only high-end cosmetic surgery can address? Of course, none of these more fundamental care avenues provide an obvious vehicle for the kind of promotional consideration we saw at the end of the show. It's especially unfortunate given the show's earlier focus on Jason's "choice" not to continue being a victim, which presumably referred to overcoming his physical and social isolation by changing his inner focus. But the plan presented here will not help Jason or other "ordinary people" emulate Cindi's inner strength. This is show business, and it seems to confuse product placement with health care.

We applaud the Dr. Phil show's efforts to let viewers know that it appreciates nurses. But we are still waiting for the show to demonstrate that it understands that nurses are not just nice and noble, but highly skilled professionals who save lives.

See the original offensive remarks by Dr. Phil (November 18, 2004)

His initial response (November 30, 2004)

His on air response (December 20, 2004)

This later attempt to make amends (still inadequate) mentioned above (July 14, 2005)

 

 

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