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Telling doctors what they ought to try

July 18, 2005 -- As a result of a Center campaign started July 8, over 500 nurses, physicians and others from Canada, the United States and beyond have written to protest the "Nurses' Song" sung by some University of Alberta medical students at their recent "MedShow," an irreverent annual event. Lyrics called nurses "whores" and "bitches" whose "incompetence" and persistence in "telling doctors what they ought to try" threatened to "make our patients die." On July 14, the Edmonton Journal ran a fairly detailed piece on the Center's campaign. In response to the campaign, university officials again expressed regret about the show, and stated that the students responsible do not really hold the views stated in the lyrics. In addition, the University's Medical Students Association has issued a commendable apology to nurses. The University and many students have argued that given the self-mocking context and the extreme nature of the stereotypes involved, the students felt the song would be understood as a "parody," not an endorsement, of the views expressed. But because the context was ambiguous and the lyrics are a mix of toxic views that many physicians and members of the public actually do hold, the Center finds it more plausible that the song was intended as a comic "roast," as other medical students have argued. Even if intended as a parody, the song's reckless presentation of views that are driving the global nursing shortage in a "comic" context suggests a dangerous lack of understanding of nursing. The Center continues to urge the university to discipline the individual students responsible, and to establish a permanent program to ensure that future medical students understand the vital role nurses play and how physicians can avoid contributing to the nursing crisis and poor patient care.

This analysis goes in depth. For some signposts:
Edmonton Journal article on July 14
Letters and apologies from deans and students
Our comments on the letters and dialogue
Proposed remedy we would find sufficient
Was it a "parody" or a "roast"?
How you can help pressure University of Alberta officials to create a sufficient remedy

Edmonton Journal article on July 14

The Edmonton Journal piece, Jodie Sinnema's "U of A Med Show sparks protest letter flood: Song lyrics about nurses deemed offensive by medical practitioners," described some of the results of the Center's campaign. It also included quotes from Center executive director Sandy Summers, who cited the "disdain" for nurses that was evident from the imagery and "sexual violence" in the lyrics. The piece reported that Summers had heard from medical students who called the song a parody or "innocent roasting," but noted that Summers felt that the accentuation of the common current stereotypes of nursing, including the handmaiden and the naughty nurse, suggested an effort to "poke nurses in the ribs." The piece also explained that the Center has called for the students responsible to send individual apologies and attend gender relations training sessions, and for the University to "set up permanent sessions where nursing leaders educate medical classes about what nurses do." It quotes Summers as hoping that the University will choose to "make lemonade out of lemons" and "make the University of Alberta into a place where nurses and physicians get along better than anywhere in the world."

The Journal piece also quotes two of the hundreds of letter writers. Alan Fein, MD, a professor at the University of Florida, argued that "[w]e physicians have a long and checkered history when it comes to our treatment of our nursing colleagues. We cannot provide health care without them. Physicians who treat nurses as 'handmaids' are doomed to be third-rate practitioners." Canadian nurse Leah Joanis wrote that she and her husband were "both RNs and were in the process of choosing to relocate to Alberta. This absolutely will not happen with these attitudes. ... This embarrasses me to be a Canadian."

The piece also had several quotes from the University's dean of medicine, Tom Marrie, MD, who noted that he had directed the students to submit a "plan" to avoid problems at next year's MedShow. The piece reported that there would be several "small group meetings" between medical and nursing students in the fall to discuss the issue. Marrie stressed that there were no plans to single out the medical students who wrote the song, as the song was an "anomaly," and that the students were "hurt" because they felt they had been "taken a bit out of context." In fact, this article, like Ms. Sinnema's original piece on the controversy in May, might have benefited from a fuller presentation of the views of medical students, especially female medical students.

Letters and apologies from deans and students

On July 8, the day the Center's campaign began, the Center received a letter from Dean Marrie noting that he "share[d] []our concerns about the MedShow 2005," and that he had "conveyed [his] profound disappointment to the participants." He assured us that the "inappropriate skit" did not "reflect a widespread disrespect for the nursing profession, but rather a poor decision by a small group of students." He also stated that he had "discussed this matter in depth with the students involved," and that the students have written to the Dean of Nursing (but not that former Dean Genevieve Gray had found their "apology" inadequate). He also noted that "in the fall, nursing students will speak to our medical class to ensure they fully understand the impact of this type of behavour [sic]."

On July 14, the same day the Journal article appeared, Dean Marrie and the University's acting Dean of Nursing, Rene Day, PhD, wrote a joint letter to the editor expressing regret for the students' "very failed attempt at humor." In the letter, they argue that "the views expressed in the song were meant to convey mockery of an antiquated stereotype," that the students "deeply regret" that some interpreted the performance as an endorsement of those views, and that the deans were satisfied that the students involved do not hold those views. The letter notes that the "organizers" had previously apologized to former nursing dean Gray (but again, not that Dean Gray found the apology inadequate). It also notes that these "organizers" had "met again today" where the president of the Medical Students Association had "reiterated" that apology "on behalf of the medical students." The letter notes that "[t]here will be no such MedShow in the future," and it concludes by assuring readers that "[t]his has strengthened our resolve as Faculties to be second-to-none when it comes to graduating health science professionals who multiply the impact of individual excellence by working seamlessly as members of a health-care team."

Also on July 14, the president of the University's Medical Students Association, Tong Lam, issued a statement offering the students' "heartfelt" and "deepest" apologies to all nurses for the "lapse in judgment" the song represents. This statement likewise argues that "it was felt" that the"outrageous" lyrics and fact that it was sung by "The Cretin Choir" made it "obvious" that the views expressed were being "lampooned," not "covertly endorsed." Lam notes that the students "were clearly very wrong in this assumption and it represents a regrettable lapse in judgement." He goes on:

We are fully aware of the pivotal role nurses play in our health care system and in society in general. We wish to convey our full respect for the skill, compassion and dignity of all members of the nursing profession. In addition to their roles as care givers, managers, researchers and health advocates, nurses play a crucial role in the education of every medical student and we gladly acknowledge this.

Our comments on the letters and dialogue

The Center commends the medical students for their apology and their explicit recognition of the value of nurses, including the role nurses play in the education of medical students. Even the medical students who wrote to excoriate us for the campaign--which is to say, the great majority--assured us that they rejected those stereotypes. One U of A medical student actually agreed with us about the "Nurses' Song," and felt that it was just an example of the deep-seated, somewhat threatening aggression that underlies the MedShow--aggression that also reportedly showed up in the reactions of MedShow supporters to some who had questioned the show's appropriateness in the past. We also commend Dean Marrie for the actions he appears to have taken prior to our campaign, specifically expressing his disapproval to the students responsible and arranging with former Dean Gray for the medical students to speak with nursing students in the fall. Of course, we realize that one way to read the responses of the students and the University is that they're really sorry and surprised that nurses were too stupid to understand that the song was just a well-meaning parody. But since they did resist coming right out and saying that, we'll give them a pass.

Proposed remedy we would find sufficient

However, the Center continues to believe that the conduct of the students responsible for the "Nurses' Song" indicates the need for the further remedies we have sought, in order to address the underlying attitudes the song reflects and, in the stirring words of Deans Marrie and Day, "multiply the impact of individual excellence." Specifically, we still believe that the students responsible for the song should issue individual public apologies (failing which a letter about the incident should accompany their academic records); that they should further attend training in gender relations, including sexual harassment; and that the University should establish a permanent program under which all medical students receive training from nursing leaders in the nature of nursing, including its autonomy, its patient advocacy focus, its key role in patient outcomes, and its current crisis, in which poor relations with physicians are a significant part.

(We want to note here that many who have joined our campaign have called for far more drastic remedies, such as the students' suspension or expulsion from school.)

Was it a "parody" or a "roast"?

We believe the above remedy is called for whether the "Nurses' Song" was really a "parody" or a "roast." However, because we believe it does matter which it was, we share our analysis of the question below.

In a nutshell, we believe that given the lyrics and ambiguous context, it is more plausible that the song was a comic "roast" intended to make fun of nurses for their perceived foibles, as other elements of the show made fun of others. In fact, one medical student--who wrote to us anonymously and assured us that he knew the song's writer well--specifically argued to us that it was a "roast." The idea of a roast is basically, "there's some truth in what we're saying, but we still like you." But you can't immunize this kind of ugliness by saying 'just joking'--not when you're pushing views of a profession in the midst of a shortage driven in large part by these same views. We acknowledge that there were self-mocking elements in the medical students' performance of the song. But there were none in the lyrics, which hammered home stereotypes and ugly attitudes that remain common (contrary to the claims that they are now "antiquated" or widely understood to be "outrageous") without any clear indication that the speakers were seen as idiots, such as suggestions that they were technically unskilled. The handmaiden image is the prevailing societal view of nursing, and naughty nurse and battleaxe images appear regularly. Even more troubling, many of the lyrics express pointed views of nurses that are very plausible coming from a group of would-be physicians, including the mistaken belief that nurses are there to serve physicians, and the resentment of nurses who meet their professional responsibilities by expressing views on care, or who can't get their work done--a huge issue now that short-staffing is rampant. Few nurses would be unfamiliar with these attitudes. And the creepy sexual aggression in the song is not reassuring at a time when physician abuse remains a key factor in nursing burnout. Frankly, it is difficult for us to imagine that the uncommonly strong, enlightened support for nurses of a true parody in this vein would appear at a notoriously irreverent event designed to allow medical students to let off steam, one that seems to actually pride itself on offending people, based on accounts in the university newspaper (account 1, account 2). It seems far more likely that such support would come from persons who would avoid MedShow. In any case, even if the performance was intended as a parody, the recklessly ambiguous presentation of these misogynous, anti-nurse views in a supposedly "comic" context suggests a dangerous lack of understanding of the nature and current situation of nursing, and carries a real risk of reinforcing and perpetuating the views it was ostensibly mocking. It is more than enough to merit the remedies we have proposed.

The Center obtained the written program for the March 2005 MedShow. While it was obvious that there was self-mockery involved, there is no strong indication there that the "Nurses' Song" was meant to mock the attitudes expressed. Rather, the program is consistent with an effort to present the attitudes under the cover of a raucous "just joking!" environment in order to bond about just how stupid and annoying those nurses can be, which, sadly, would strike most nurses as the more likely intent at such an event. The song is not called "Dr. Malpractice Song;" it is called "Nurses' Song." The "Disclaimer" does not say "We couldn't have done it without Professor X," perhaps someone widely known as a Neanderthal; it says "We couldn't have done it without you nurses." Those elements are strong indications that the song is not focused on mocking physician attitudes, but nurses themselves.

Some students have argued that because the song was delivered by a "Cretin Choir" of students who were dressed as "clowns" and who used "silly" body language, the audience should have seen that the attitudes depicted were being mocked, rather than endorsed or offered for amusement. It appears that a significant number did not see it that way, and it's worth exploring why that might have been, aside from a simple failure to understand such sophisticated humor.

The "Nurses' Song" provides a virtual tour of reigning nursing stereotypes; they may be longstanding, but they are far from "antiquated." The naughty nurse stereotype remains influential even in developed nations, and the handmaiden stereotype is perhaps the prevailing social and media image of nursing in the world today. Anyone who doubts it should consult any Hollywood health care drama of the last decade, bar none. Unfortunately, too many practicing physicians also still hold a handmaiden view of nursing. And the views expressed in the song go well beyond the usual handmaiden stereotype to well-targeted hits that may seem even more persuasive coming from a group of medical students: the resentment that some nurses actually assert their rights and their professional autonomy, the notion that modern nurses think they're experts and want to weigh in on care plans, and the idea that they are not getting their work done, which in the era of short-staffing is guaranteed to infuriate any nurse. No part of the song shows the singers to have poor technical health care ability, which might have made it clear that they were being presented as idiots (e.g., "You moron! Why are you putting that preemie on the mother's bare chest?"; or "How many times do I have to tell you: doctors don't cause nosocomial infections!"). No lyric hints at the potential real world results of these kinds of attitudes (e.g., "what do you mean, you hope I've enjoyed having a family, a house, and a medical license?"; or "Why can't you ever find the patients I want to operate on?")

But what if, despite all of that, it really, really was intended to be a parody, the most enlightened, pro-nurse performance ever seen at a raunchy gathering of stressed-out medical students with a license to say whatever they think? Then the views expressed in the song hit far too close to home and are far too widely held in modern society to be the subject of such a breathtakingly maladroit parody. This is not Randy Newman's "Short People," which mocked stereotyping by transferring it to an obviously ludicrous context, thereby avoiding the most virulent real word epithets. Even Newman, with his skill, reputation and fairly gentle lyrics, was misinterpreted.

And the creators of MedShow are not, it's safe to say, Randy Newman. The University publication "The Gateway" ran a story on April 7, 2005, Chloe Fedio's "Faculty of Medicine discussing future of Medshow," about Jewish students who objected to the recent MedShow's depiction of "Hitler singing and dancing in an imitation of the Teddy Bears Picnic." The Jewish students felt that this was not an appropriate "source of hilarity." But graduating medical students Brendan Halloran and Michael Pierse, who were reportedly instrumental in writing the Hitler skit and others for the 2005 show, announced to the Gateway readership that "humour" was an important way for physicians to deal with stress. Halloran noted that "[y]ou can't have a brain surgeon weeping into the cranium." (The piece does not explore whether this important "relief of physician stress" defense could be applied more broadly, perhaps to justify sexual harassment, or at least throwing a few little things around the OR, she asked for it anyway.) Halloran also informed the Jews that there was actually "nothing offensive or anti-Semitic" about the Hitler skit, and anyway, as Pierse noted, it's okay if you "put comedy before being offensive" and "don't put things out there just to offend." It's not clear if Halloran or Pierse was responsible for the "Nurses' Song," but the sense of humor and social development evident in their remarks does not suggest that the MedShow would be an ideal forum for would-be physicians to present a zany "parody" of pernicious attitudes about nursing that are too widely held by...physicians.

In fact, it is very difficult to employ specific, toxic stereotypes that are still commonly held and that appear to draw on some real understanding in a song context where conceptual cues are so ambiguous. It would not be a good idea for a group of white singers, even dressed as clowns and acting silly, to stand up and start singing about ignorant, lazy n------, how they're all on drugs and commit crimes and so on, nor for a group of young men to get together to rant and rave about how a group of women are ignorant whores and bitches who should be subjected to sexual abuse--oh, sorry, that is what happened.

Indeed, the misogynist views in the song are so creepily, relentlessly aggressive that we're not sure in what musical context they could have been responsibly delivered. Certainly, those views could be explored in a film or novel, but it's hard to imagine it coming from "silly" "clowns" in a "funny" song in the midst of some university student show. "Show us your boobs, whore! You sure give good head!" Ha ha ha ha ha ha ha ha ha! Ha ha ha ha ha ha ha! Sorry--sometimes we just can't help ourselves, it's so gosh-darned funny. Or are we supposed to believe that the raucous partying and vicious insults stopped for a moment so that the medical students could offer some enlightened social criticism on behalf of nurses and women everywhere? (We found photos of the 2004 Medshow--does it look like anything enlightened happened that year?)

Nor is it an answer to say that other parts of the show mocked physicians and medical students. They have not been subject to decades of devastating stereotypes that have contributed to a desperate lack of resources and a global shortage that threatens lives worldwide. It is a very different thing for the most socio-economically powerful professional group in modern society to poke fun at itself, and quite another for it to present scorching (and at best highly ambiguous) images of an oppressed group that it has been instrumental in marginalizing for over a century, as Suzanne Gordon recently explained in "Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care (2005). Perhaps mockery of nursing stereotypes is best left to nurses and media professionals.

How you can help pressure University of Alberta officials to create a sufficient remedy

We urge all supporters to continue putting pressure on the University of Alberta to individually discipline students involved in "Nurses' Song" and to set up a permanent, nurse-taught program to ensure that all future medical students have a basic understanding of the nature and situation of nursing.

Please send our second letter--or preferably a second one of your own--as a follow-up to the communications from University officials. Thank you!

Our current letter count is over 550. Let's make it 1000 by the end of the week. Please ask your colleagues, friends and families to join the campaign.

Copies of your letter will also be sent to:

Michael Robb, Medical School Public Affairs;
Verna Yiu, Assistant Dean, Student Affairs;
Jennifer Bailey, Med Show Representative;
Rosemary Conliffe, Canadian Federation of Medical Students; General Manager;
Mitesh Patel, Medical School President;
Desiree Fofie, VP External, Junior CFMS Representative;
Meghan Elkink, Communications Officer;
Karen Kam, Univ. Alberta Medical Alumni Association;
Momoe Hyakutake, Kristin Haugrud, Student Affairs Representatives;
Rick Sultanian, Class Representative, Med 2005;
Ni Lam, Class Representative, Med 2006;
Ashish Mahajan, Class Representative, Med 2007;
Steven Schendel, Class Representative, Med 2008.

For reference, the lyrics of the Nurses' Song are below.

Nurses' Song

Nurses we are overjoyed
To meet you face to face
You've been getting quite a name
All around the place
Being bitches
Screwing up meds
Now we understand you're whores
But at least you give good head

So you are a nurse
You're a wonderful nurse
Prove to me that you're the best
Let me look upon your breasts
If that you will do
Then my hats off to you
Come on show me those boobs

Nurses you just won't believe
The shit you've stirred up here
Your incompetence is all
So very fucking clear
Oh telling Doctors
What they ought to try
When in fact your management
Would make our patients die

So you are a nurse
You're a competent nurse
Show me all that you were taught
Go fill up my coffeepot
And then go berserk
When I ask you to work
Come on show me those boobs

Nurses like to bitch and moan
They often go on strike
They somehow think their job is more
Than just the village bike
Oh... if you really
Want to get respect
Come right here
And tell me why
The vitals aren't done yet

So you are a nurse
Yes a superstar nurse
Prove that you're as good as me
Do this Neurosurgery
Or maybe instead
You should just change the bed
Come on show me those boobs

DISCLAIMER: We couldn't have
done it without you nurses.

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