Paging Dr. X to the triage booth
February 2006 -- This month's issue of Good Housekeeping includes a letter from a nurse protesting the magazine's November "What Doctors Wish You Knew" feature, which offered dozens of health tips from physicians. One tip advised readers to lie to ED triage nurses in order to be seen faster. Another urged readers to get better hospital care by plying staff with "treats." The letter, by Berni T. Martin, RN, MSN, CEN, is a strong piece of nursing advocacy, and we salute her for writing it and the magazine for printing it. However, the "editor's note" accompanying the letter is so non-committal as to whether the triage tip actually is a good idea--and so apparently deferential to the mysterious "Dr. X" who provided the tip--that we are inviting this "experienced" physician to debate us (confidentially of course) as to the tip's merit.
The last letter in the letters section of the February Good Housekeeping (at p. 16) is headlined "Nurse know-how." In the letter, Ms. Martin notes that she is the trauma program manager of a Level 1 trauma center, and that she has a master's degree and extensive ED nursing experience. She wrote that she found the health tips article
insulting not only to nurses but to health care in general. The triage nurse in an emergency department has a most important job, one that requires a high level of skill and decision making. Advising your readers to give false information in a critical-care environment is unsafe. As for the comment regarding "treats" for the nurses, we are not pets.
This makes the key points well. We might have appreciated a little more detail as to exactly what triage nurses do, and why it would be so damaging to patients and public health if their judgments were undermined. Obviously, if some patients are lying to be seen faster than they otherwise would be seen, more critical patients may not receive timely care. In addition, the specific tip in question suggested that readers be seen quickly by never admitting that their symptoms began more than four hours before. As we noted in our earlier analysis, this could actually backfire on the lying patient himself, as some conditions may appear less emergent if symptoms began more recently. It may be that the letter did make such points, but was shortened for publication. In any case, it is still a strong piece of advocacy.
Following Ms. Martin's letter, the magazine ran the following "Editor's Note": "We heard from many nurses who share this view. Our suggestion came from an experienced doctor who has many years in a large hospital. We thought readers would benefit from his advice." In fact, the magazine heard from over 200 nurses who "share this view" through the Center's campaign alone.
The note's explanation/justification is also very interesting. We assume the "suggestion" the magazine is discussing is the triage tip, since that is the most egregious, and the one on which the letter spends more time. It may be that the magazine is merely saying it felt like it could rely on the tip of an experienced physician from a large hospital, apparently regardless of the tip's content. We wonder if the magazine would also think its readers might benefit from a physician tip advising them to jump off a cliff. But since the magazine remains non-committal as to whether it erred in running the ED tip, and describes Ms. Martin's position as merely one "view," we wonder if the editors still believe the tip is a good idea, regardless of everything they have heard. We would welcome the opportunity to debate the "experienced" physician responsible as to whether it's a good idea to lie to the triage nurse. But his ED tips were listed as coming only from "Dr. X," perhaps in part because some other tips told readers things his hospital might not appreciate. So we don't know who he is.
Will Dr. X have the courage to send us a justification for his "lie to the triage nurse" advice? We guarantee confidentiality for his identity and work affiliation(s), and we will publish what he sends exactly as he wishes. Stay tuned.