Send a letter to the Good Housekeeping Health Editor Toni Hope

To:*

Subject: (please sum up your feelings here*
A modified version of our executive director's letter is below--feel free to use it. However, an original letter from you is more powerful. If you have a moment for even one original sentence, please delete the form letter and write one of your own. Please write as much as you'd like, but keep your paragraphs to 3 sentences because we are having a problem with our wrapping function. If you choose to keep some of our letter--make sure you put your own thoughts up front to make sure they get read. Don't bury them in our letter. If you do write one of your own PLEASE SPELL CHECK IT because our system cannot do that. If words are misspelled, it allows the recipients to undervalue your letter and the nursing profession. Also, please DRAFT IT IN YOUR WORD PROCESSOR and then paste it into the window below. A rare glitch with our web site has twice deleted letters that were drafted on this page--so it is safer to draft it elsewhere and save a copy. Please--be as professional as possible. Thank you very much.
Message:*	Dear Ms. Toni Hope, Ms. Janet Bailey, Ms. Janice Graham and Ms. Leslie Pepper: I am writing to urge you to rectify the damaging statements made in your November issue of Good Housekeeping that includes 75 "surprising" health tips from "doctors" nationwide, by telling your readers exactly what nurses really do to save and improve their lives, among other measures. I was disheartened to see that among the 75 health tips offered, not one was offered by a nurse, even though nurses focus closely on educating the public about just these kinds of pragmatic issues in health care. A notable example is Pat Carroll, whose recent book "What Nurses Know and Doctors Don't Have Time to Tell You" <http://www.truthaboutnursing.org/media/books/pt_educ/carroll.html> has countless similar pieces of advice. The lack of a nurse expert's tip is not "surprising," since the media routinely ignores the expertise of nursing, but I was a bit puzzled by the contempt for nurses I saw in several tips. Michael Roizen, MD, of the Cleveland Clinic, advises readers to "get better [hospital] care" by "supplying the staff with treats." "Dr. X," whose ED tips are presumably considered so hot that his or her identity must be shielded, tells patients to lie to the triage nurse about when symptoms began in order to be seen faster, but to "tell the doctor exactly when symptoms began." In addition to being offensive, uninformed, and likely to backfire, this advice shows real indifference to public health. But several tips betray a more direct disrespect for nursing. Perhaps the most striking is the triage tip. Tip Nos. 36-39 come in a box headlined: "From Dr. X: How to Get Good Care in the ER." This tipster's identity was presumably kept confidential in part because he or she is telling readers how to game the hospital system by getting physician contacts to call ahead and make special arrangements, and by asserting the right not to use the physician on call. Perhaps there was also awareness that some might not take kindly to tip No. 38, which tells you how to jump the line by fooling the silly triage nurse: "The first person you'll meet at the ER is the triage nurse, who decides how quickly you need to be seen. No matter when your problem actually started, never say more than four hours ago; it will seem less pressing. (But tell the doctor exactly when symptoms began.)" This advice isn't just an astonishing dismissal of the vital and complex triage function, or just a blatant insult to nurses generally. Sure, it does suggest that skilled nursing judgments should be undermined by lying about symptoms, and assumes that experienced ED nurses will not be able to see through at least some of the lies. But it also sends several messages with broader implications for public health. The tip is a remarkable example of a health professional telling patients to mislead clinicians about their conditions, though getting candid information from patients can be one of the major challenges of clinical practice. It invites patients to pick and choose which clinicians deserve the truth. We guess the tipster thinks that physicians need it, since their judgments matter, but that nurses are pretty much filling out forms. Would Dr. X appreciate Nurse X telling patients never to report their pain as less than an eight out of ten, because otherwise physicians will never prescribe adequate pain medication? In any case, back in the real world, inviting patients to decide which symptoms can be lied about and when, could easily backfire, in the ED and many other clinical settings. For instance, telling an ED triage nurse that your sore throat started four hours ago could result in your being seen much later than if you told her it started several days ago. Likewise, a nurse evaluating a patient with a fever that was only four hours old might wonder why such a patient would bother to show up at all and put the patient on the slow track to the back of the ED. Such practices would distort the triage process and result in unacceptably poor care, even though there would be some poetic justice in that the immediate suffering would be done by the liar. But if the lies Dr. X is recommending actually achieve their desired result, and the lying patient is seen more quickly than she needs to be, then public health is harmed because more emergent cases are delayed. Patients have been known to leave the ED when the wait is too long. Then they suffer more--and cost more--down the line. If large numbers of people start lying about their symptoms in order to be seen faster, the entire system could break down. Of course, more generally, Dr. X's advice could also be seen to reflect a "me-first" hostility to the public interest that some feel infects much of the current U.S. health care system. The last thing the public needs is a respected health professional telling it to act with unenlightened self-interest. Other tips just show disrespect for nursing, and may present no special threat to the public, unless you count exacerbating the deadly global nursing shortage. Michael Roizen, MD, evidently felt no need for anonymity in giving tip No. 54: "Get better care in the hospital by supplying the staff with treats. Offer individually wrapped cookies or chocolates, or little packets of nuts." I'm not sure whether to laugh or cry. Of course, people do appreciate small gifts, and they might get you a slightly better attitude. But suggesting--as part of a series of serious health tips--that you will actually get "better care" by giving hospital professionals "treats" is an insult. And while the tip speaks generally of "staff," there's little doubt that Roizen means nurses and other non-physicians. Nurses do more than smile and hold hands. Would anyone suggest that you would get "better care" from a physician by giving her "individually wrapped cookies?" This "treats for nurses" concept was a theme in a recent episode of NBC's "ER", but we did not imagine that an actual health professional would recommend it as a strategy for "better care." On the other hand, if we titrate that dopamine drip correctly and get your blood pressure off the floor, could we get some of those little Belgian chocolate thingees they have in the gift shop? Like, oh my God, those are so excellent. And tip No. 35, from Evan Levine, MD, of New York City's Montefiore Medical Center, offers the following information: "When choosing a doctor, remember you're also choosing a hospital. If you ever need to be admitted, radiologists, pathologists, and many others will be treating you too." To start, this tip ignores nurse practitioners in discussing what we assume are decisions about primary care professionals. But the tip also suggests that patients go to the hospital to get care from physician specialists. In fact, hospitals exist primarily to provide nursing care. Any analysis of hospital quality that focuses only on physician skill is dangerously flawed, as patient safety research shows. If you're choosing a hospital, you're choosing the nurses who may well make the difference between whether you live or die. Please make amends to the nursing profession for this series of inaccurate statements and insults by: apologizing to nurses in a form that will reach its 22 million readers, such as an editor's note, and perhaps printing a letter from a nurse about the piece; telling readers not to lie to the ED triage nurse about their symptoms if they want good care for themselves and their society, and that life-saving nursing care does not depend on cookies; telling readers that hospital quality depends to a large extent on nursing care; hiring nurses to serve on Good Housekeeping's board of directors; routinely using nurse experts as sources for health stories; and publishing an article with a positive, accurate portrayal of nursing, such as "75 Surprising Tips Nurses Wish You Knew About Your Health."
Please put your name and contact information only in the boxes below and not in the body of the letter above. Your contact information and your email address will precede the message. Thank you. We do not share your name or contact information with anyone or any organization (except, of course, with the recipients of this email). We keep it private.

Closing:
Full name* and credentials:
Position
Organization
Street Address:*

City:*
*State/province:
Zip or postal code:
Country:*
From (email):*

Select Review to review the e-mail. The e-mail will not be sent until you confirm it by clicking "Send" on the following page.

* indicates a required field