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Some U.K. physicians to Mattel: Keep that anti-nurse hatred coming!

January 9, 2006 -- The Truth About Nursing made no effort to publicize its campaign to have Mattel's "Nurse Quacktitioner" dolls removed from U.S. store shelves, because we suspected that the doll's name might prove irresistible to those lacking wit and maturity. Our fears were confirmed after the campaign become known to a group of physicians, probably through the huge network, which is not accessible to the general public. As of this writing, at least 11 U.K. physicians have sent letters to Mattel urging the company to keep selling the doll because it will foster contempt for nurse practitioners. Their letters (excerpted below) display varying levels of ignorance and disregard for public health. Many are primary school-level inversions of language from our model letter. But all provide powerful support for nurses' argument that the doll will reinforce widespread stereotypes that threaten lives worldwide by exacerbating the nursing crisis, encouraging health care errors, and reducing access to care. We trust that those 11 ugly letters, though a drop in the bucket of 2000+ letters Mattel has so far received urging it to withdraw the doll, will be a persuasive advocacy tool in our effort to help the company see just how damaging the doll is and why it must go. Incidentally, the Truth thanks and salutes several other physicians who have written to Mattel in support of their NP colleagues.

Some of the U.K. physician letters urging Mattel to keep selling the Nurse Quacktitioner are substantially identical, and they seem to be based on a short form model which is in turn based on the Truth's model letter. These physician messages state, in part:

I am deeply impressed that Mattel has placed a product on U.S. store shelves - the Furryville "Nurse Quacktitioner" - this [sic] apparently denigrates over-sensitive nurse practitioners, and I AM VERY HAPPY THAT THE COMPANY HAS NOT WITHDRAWN THE PRODUCT. I urge you NOT to do so and refuse to allow retailers to sell them back to you (unlike the spineless Wal-Mart). I will continue to buy Mattel products, and I will urge my family and friends to do the same.

Do you see what they've done there? They've put the word "NOT" in front of some of our statements, so that the meaning is REVERSED, and Mattel is being told to do the exact OPPOSITE of what we want! We haven't encountered wit on that level since the last time we flipped past the Benny Hill Show.

The physician letters come with subject lines such as "well done Mattel," "an excellent product," "keep up the good work," "They're a great idea, even better if they had been an intentional tease," and "I want to buy one--where are they sold in the UK?"

The letters that deviate from the form are even more interesting. In a message to the Truth, physician Christian Destree begins his measured analysis of the doll by calling us a "bunch of insecure wannabees." He also suggests that Mattel "got" us because the title quacktitioner is the "correct" one for NPs. Destree advises nurses who want to "do good in [their] job[s]" to "try nursing patients." But any who wish to "play doctor" will have to attend medical school.

Dr. Destree is apparently a part-time clinical assistant in an accident and emergency department in Winchester. Based on this message, which is oriented mainly toward name-calling, we doubt Dr. Destree knows much about NP practice. But the assumptions underlying the message are that nurses become NPs because they wish to be physicians, and that only physicians are able to diagnose and treat patients. In fact, though it is not commonly acknowledged, bedside nurses spend a great deal of time diagnosing and treating patients, and NPs build on this background to provide excellent practitioner care, as extensive research shows and millions of patients can affirm. NPs, most of whom have graduate nursing degrees, have no wish to be physicians. They seek to provide high quality, cost-effective care under the holistic nursing practice model, which considers all factors relevant to health and wellbeing. It is hard to imagine a person who would write the message above operating under such a model, but its public health benefits are clear.

The letter that may be our favorite went to Mattel from a Sheffield general practitioner whose C.V. (available online) indicates that he has been practicing for over 20 years. His letter systematically inverts virtually all of the Truth's model letter to Mattel [bold emphasis added]:

I urge you NOT to [withdraw the Nurse Quacktitioner. If it remains available,] hundreds of amused doctors will buy the product . When can we see it on sale in the UK?

Selling a doll called "Nurse Quacktitioner" would seem to reflect little regard for nurses or public health, but it does point out to these jumped up idiots how far from reality they have gone. The name suggests that nurse practitioners (NPs) are "quacks," a term that has long been understood to refer to untrained persons who pretend to be physicians and dispense medical treatment, and consequently I think you have hit the nail on the head.   ... [Claims that NP care is unsafe] have a scientific basis, and they illustrate the entrenched interests and widespread biases that NPs confront. These are problems your dolls are likely to exacerbate, a position that I fully support.

Nurse practitioners think they are highly trained professionals who practice autonomously in a variety of settings, including major teaching hospitals. The typical NP has Bachelor of Science and Master of Science degrees in nursing, and many NPs have doctoral level education, mostly of no relevance to diagnosis and treatment . A tiny body of research shows that NP care is at least as good as that provided by physicians < >, but I am sure you will agree this should be ignored due to its bias. NPs think they are skilled at cost-effective preventative care, management of acute and chronic disease, and health maintenance. Because many NPs focus on underserved poor and rural communities, they are a vital health resource for millions of people who would otherwise receive little or no health care at all, and would die any way so thier [sic] conciences [sic] are clear.

The Nurse Quacktitioner is an excellent product because research shows that even fictional media products affect how people think and act with regard to health care < >. In particular, it is wonderful that a product that seems to be directed mainly at girls who have yet to choose their careers presents this mocking vision of nurses. In the view of the nurses who continues [sic] to claim lives worldwide, selling this doll is not a constructive way to make money. [Presumably this physician neglected to remove the "not" from our original here]

This veteran physician's CV also indicates that he received a total of five (5) years of university education (at Sheffield University) including his medical education. He now holds medical school teaching posts. The only real substance in the letter is the blithe suggestion that the research showing NP care to be safe is "tiny" and reflects "bias." These claims are completely unsupported. If anyone knows of research showing physician care to be superior, please send it to us.

Other letters offered variations on these themes. An Oxford physician pronounced himself "extremely amused," but "sorry" that Mattel seemed to have "backed down under pressure from these rabid NPs. I would certainly have bought one! ...   Perhaps you should try marketing the toy in the UK, where people would appreciate the humor of the toy - even the NPs." A Manchester physician expressed the hope that the dolls would "help a few people realise that they're getting care on the cheap when they see a real quacktitioner instead of a doctor."

A physician from Reading sent the basic form paragraph quoted first above, then added that he had "deleted the rest of the verbose psycho-babble [in the Truth's model] in the interests of our mutual sanity." "Psycho-babble" refers to the excessive, often inaccurate use of psychological jargon. The Truth's model letter had no psychological jargon, and we assume this physician meant to use a word more like "gibberish" or simply "babble." We can only speculate that this physician's aversion to the verbose may explain his lack of familiarity with that ultimate example of verbosity, the English dictionary.

Perhaps the most thoughtful letter came from a Manchester nephrologist. She wrote, in part [bold emphasis added]:

While I appreciate that no harm was intended when Mattel named the Nurse Quacktitioner doll it is still a superb effort. I would not claim a large knowledge of medicine in the US, but in the UK the Nurse Practitioner is increasingly being seen as a cheaper alternative to a fully trained physician. Since the NHS is funded by public money, the role is proliferating rapidly.

I accept that senior Nurses have a large role to play in the management of our patients, especially in a complicated speciality such as my own (Nephrology). However, it takes us many years to train and we all have to undergo a basic, general training before we are allowed to specialise.

It is this general training that Nurse Practitioners are missing - meaning that no matter how knowledgable (sic) and experienced they are they will still miss important issues and diagnoses outside their speciality. For this reason, I argue that it is correct to describe Nurse Practitioners as Quacks (An untrained person masquerading as a physician) because they do not have the rounded training necessary to consider all the issues and diagnoses possible.

Don't back down in the face of pressure - you have the support of British Doctors!!

This analysis wrongly assumes that NPs' years of general training in nursing are irrelevant to diagnosis and treatment. (We note also that most NPs would appear to have more years of university health training than physicians like our friend from Sheffield who is quoted above.) The nephrologist's argument also ignores features of the nursing practice model, such as its holistic focus and the far greater time spent listening to and examining patients, that are invaluable aids to diagnosis.

We assume that all of these physicians saw our initial analysis, which discussed NP practice and the extensive research showing that NP care is at least as good as that of physicians. Therefore, these messages appear to be based on some mix of unfounded bias and economic self-interest, and not on scientific evidence. It is sad that so many physicians would endorse a product that trashes the hundreds of thousands of NPs who have spent their careers saving and improving millions of lives. And we assume that these 11 represent the views of countless others.

The physician attitudes reflected in these letters are significant factors in nursing burnout and the nursing shortage, as well as in practice environments that encourage poor care. Nurses who encounter such unthinking hostility are less likely to challenge flawed care plans, including medication errors. Thus, such attitudes exacerbate the nursing crisis and reduce the care available to underserved populations worldwide.

We want to stress that several other physicians wrote to Mattel in support of their NP colleagues. We assume these physicians have actual experience with excellent NP care. We salute these forward-thinking physicians. Their letters confirm our view that good physicians have nothing to fear from NPs, because they will always be able to compete on the basis of quality, cost, and the other factors that govern the market for professional services in the absence of an unjustified monopoly.

The physicians who praised the Nurse Quacktitioner, on the other hand, Mahatma Gandhihave proved our point that the doll will reinforce virulent anti-nurse bigotry that remains widespread, even among nurses' health care colleagues. As for the long-term outlook for these physicians' views, we observe that over 140,000 NPs now practice in the US alone. And we offer this quote from Mohandas Gandhi:

First they ignore you,
then they laugh at you,
then they attack you,
then you win.

January 26, 2006 -- Due to the time expenditure necessary to keep up this part of the Mattel campaign, we have suspended it for now. But please be sure to educate the physicians you work with, who may have similarly wrong ideas about nurses and their value to patients.