Physicians are awesome
July 22, 2010 -- Tonight ABC will air the fifth episode of Boston Med, the eight-part documentary about the work and personal lives of health care workers at Massachusetts General, Brigham and Women's, and Children's hospitals. Overall, Boston Med is almost as physician-centric as producer Terence Wrong's previous "greatest hospitals" efforts Hopkins 24/7 (2000) and Hopkins (2008), focusing overwhelmingly on physicians and generally presenting them as the brilliant providers of all meaningful health care. But the new series has received an amazingly positive reaction from some reviewers and even some nurses because, along with the 16 physicians and surgeons profiled in the four episodes that have aired so far, there is one nurse! In a few scenes, this MGH nurse, Amanda Grabowski, displays technical knowledge and gives viewers some sense of nurses' roles as patient advocates and autonomous practitioners. But as the episodes go on, the show steadily forgets her clinical work, focusing instead on her social life. This approach undermines the sense of her as a serious professional, and even flirts with the stereotype that nurses are mainly about romance. The episodes do portray the personal lives of some of the physicians, but the show also continues to focus on their work as esteemed health experts. The ABC web site suggests that there will be another MGH ED nurse profiled in at least the fifth episode, Mike O'Donnell; perhaps his segment will convey something of what it is to be a man in nursing. But it's unlikely the nurse elements will have much impact alongside what will likely be profiles of some 25 physicians, especially since those profiles utterly ignore the nurses who actually provide most of the skilled care to the patients portrayed. The overall message is that physicians, especially surgeons, are the life-savers who do everything that matters. Boston Med is probably a small step forward for Terence Wrong, since the nurse profiles here may be more substantial than the fleeting nurse appearances in Hopkins two years ago. But the new series could not be compared to a documentary like Richard Khan's Nursing Diaries (2004), or even a drama like Mercy (2009-10), which feature strong, sustained portrayals of nursing skill and care.
Background: Physicians and Nurses in Boston Med
Terence Wrong's documentaries matter both because they air on a major broadcast network in prime time, which means many millions of viewers, and because they tend to attract a great deal of praise from television critics. The shows are compelling enough, given the stakes for the real people confronting death, and they are not too exploitative by television standards. But on the whole they are little more than reality show versions of Grey's Anatomy, somewhat subtler exercises in physician glorification and melodrama, complete with blandly yearning pop music. Maybe critics want to encourage more prime time network shows that at least make a stab at serious subjects, or perhaps it's that the series air during the summer, which is seen as more of an intellectual wasteland than usual for network television.
Viewers of Boston Med and its predecessors get virtually nothing they haven't seen many times before. We do see briefly how serious health conditions affect a few patients and their families. But mostly we learn, again and again, that physicians are brilliant, hard-working life-savers whose stress and long hours exact a toll on their personal lives; they may be a bit arrogant or troubled, especially when they're new, but when you're that amazing, people make allowances. No one really criticizes the way U.S. health care is delivered today. And so far we've gotten little to no sense of current health issues, even those that concern physicians in particular, such as the efforts to limit physician resident hours, or medical students' increasing tendency to avoid specialties like primary care that are less lucrative or more time-intensive. And there is nothing about broader issues like health care financing, the shift toward preventative care models, the role of new technologies, or avoiding hospital errors. Even apart from the physician-centrism, some elements of Boston Med may mislead in the same ways prime time dramas do. In the first four episodes, we saw no bad outcome for a patient to whom the show devoted significant attention, arguably misleading viewers about likely outcomes for critical patients. And the show's obsession with heroic one-time surgical interventions gives a wildly distorted impression about the true scope of important health care, which includes a vast array of other critical work.
Boston Med doesn't really make you think about or see the world in new ways, as serious documentaries do, unless it counts to spend eight hours thinking, "serious illness is bad, but physicians are awesome." The ABC News web site provides a great snapshot of this. It includes portraits of all the major clinical figures on the series, and after the fourth episode aired, that meant portraits of the care givers in the first five episodes: 18 physicians, one dental surgeon, and two RNs, Amanda Grabowski and Mike O'Donnell. (The heading for the portraits section is "Doctors and Nurses," as if there were a rough parity.) The number of physicians will expand further as the remaining episodes air; whether there will be any more nurses is unclear. The physicians' glowing profiles generally include some detail about their educational background and briefly describe their areas of specialization, sometimes explaining why they chose that specialty, their research interests, or some other notable aspect of their work. The nurse profiles have nothing comparable, giving little sense that the nurses are professionals, though they do at least provide a link at the bottom to the MGH Department of Nursing site.
Amanda Grabowski's profile simply says she is a "nurse in the emergency department" who "received her clinical training at Salem State College." Her "clinical training"? In fact, that is a four-year academic program, and we assume Grabowski got a Bachelor of Science in Nursing degree, which requires rigorous courses in anatomy, physiology, chemistry, and biology. The profile also notes that in Grabowski's four years at MGH she has twice been voted the "Harvard Med Nurse of the Year" by the ED physicians. It says her friend O'Donnell shared the award with her in 2008. We're sure this is an award for clinical work and not just about the two telegenic nurses' social skills, but we're not sure why the one bit of professional recognition for these nurses on the site is something chosen by physicians, when the nurses who actually practice nursing are in the best position to assess nursing skill. Of course, the existence of this award is not the show's fault, but its inclusion is indicative of what the show finds important, and it may also suggest that physicians direct nursing care, since they are the ones choosing the "nurse of the year."
Mike O'Donnell's profile notes that he "has been a nurse" in the MGH ED for 10 years, that he is a second-career nurse who "attended the Somerville Hospital School of Nursing," that he is married with two kids, and that he and his male nurse friends, "sometimes referred to affectionately as the 'murses,'" take an annual trip to Florida to watch baseball. The closest thing to a description of his nursing work is a quote from him to the effect that nursing "forces you to look at yourself as a person, who we are…our morality, our ethics, our spiritual views, our religious views, how we view politics." The posted videos suggest that O'Donnell has a sense of humor, as he banters about scrub colors and an unusual term for measuring drug volume. But there is nothing much here about O'Donnell's actual work, or the particular skills he brings to it, and this suggests that while his segments may convey helpful information about men in nursing and second-career nurses, they are unlikely to add greatly to the limited sense of nursing skill and autonomy that Grabowski's segments provide. We do wonder how men in nursing will feel about embracing the "murse" term; our sense is that the term is not universally admired.
"We love you, Dr. D!": The many physicians in the first four episodes of Boston Med
The first four episodes of Boston Med are overwhelmingly about surgeons and emergency physicians, as if no one else practicing "med" in "Boston" is of much interest. The first episode may be the purest in this sense, since perhaps a dozen physicians are identified and profiled to some degree, and even Grabowski does not appear in the episode to get in the way of the overall theme. But even in the other episodes, her appearances do not disrupt the flow. When the cameras are following the physicians, they are the sole focus, as they explain things to us and the patients. Even in clinical scenes in which nurses are around, the film crew keeps the focus on the physicians, and no nurse intrudes with any significant dialogue. Even if Wrong's people did not forbid that, most nurses, even at elite hospitals, have learned not to intrude when physicians are getting all the glory from the media or VIPs, and so the nurses tend to melt into the corners. Nurses receive no credit from physicians or patients for their work for the patients in the physician segments that dominate Boston Med. Perhaps this is most comically illustrated by the suggestions that the post-surgical period is one of "hope" and "faith," as if the skilled nursing that actually keeps patients alive during that time simply did not exist. (See those Quicktime clips at broadband or dialup speed.) The series more than once shows us grateful patients leaving the hospital a week or more after an operation, with no indication that any skilled care has occurred in the interim, and all credit for the outcome clearly going to the surgeons. Of course, things are not all wonderful for the physicians. The long hours take a toll on family relations, and the newer physicians in particular seem to struggle to mediate between their considerable, socially-reinforced self-esteem and the sometimes unexpectedly harsh reality of their medical practice. But without adversity, there would be no heroes.
Nine physicians--six surgeons, two ED residents, and a cardiologist--receive the great majority of the show's attention in the first four episodes. The only female who receives significant attention is Pinal Patel, an ER resident who, by her own account, needs to become more assertive, even more cocky. She says that she has to endure slights because of her gender, but seems to suggest that she should be free of them at least partly because she's a physician. We see her struggle with what she describes as "crowd control" during a code, and with being "in charge" of the code. She receives criticism from attending physicians after she is unable to intubate an obese patient in a timely way. This patient dies, and Patel seems upset, wondering what would happen if she did not make it as a physician, but she also draws confidence from the memory of a medical school mentor ("the smartest guy I ever knew") who showed confidence in her. Patel gets time to explain how she feels about becoming a physician, and we see her graduate from her residency, on her way to an attending position in California. She notes that her parents are "ridiculously proud," but that does not stop them pressuring her to get married. And she muses about her romantic prospects, as friends reassure her about how attractive she is.
Another non-surgeon is Brigham ER resident Richard Reish. He informs us that he was valedictorian of his undergraduate college class and that he received a $300,000 graduate school scholarship, but now he is in a position that seems less exalted, trying to deal with an uncooperative, apparently drug-seeking patient in the ED. We also see Reish sitting around as security personnel subdue a violent patient nearby. Another patient is seriously altered, and Reish and an ED attending discuss whether he is bipolar. Reish explains that he is a big believer in the hospital's hand washing rules. And we see him giving advice to his surgical resident friend Andrew ElBardissi about what to do on a date, advising him to rent the Woody Allen film Vicki Cristina Barcelona, apparently because the film's sexual subject matter will set the appropriate mood. At another point we see the two at a somewhat formal social event, bantering with a female physician about whether persons of the same race are more romantically compatible. As with some scenes involving Patel, some viewers may not be especially impressed with some of what they see here, but there is no indication that the producers share that critical perspective.
The fourth episode also includes a few portrayals of Children's cardiologist Elizabeth Blume. We see her discussing the case of Sarah, a teenager with hypertrophic cardiomyopathy who needs a heart transplant. We see Blume discussing Sarah's case with Sarah and her mother. Apparent nurses are nearby caring for Sarah, but they never speak, so viewers are unlikely even to notice them. Actually, Blume herself does not receive as much attention from the show as many of the other physicians do, and we suspect that may be because Sarah's case becomes a surgical one, and the most important thing for Boston Med seems to be to illuminate the world of the surgeons.
So we move pretty quickly to Sarah's cardiothoracic surgeon Francis Fynn-Thompson. He explains her condition and the plan to get her a new heart. The show spends a lot of time with Sarah and her supportive family (her younger brother will someday need a similar transplant). But it also follows Fynn-Thompson as he monitors the progress of the organ harvest team, which travels and works to assess the donor heart's fitness. There are delays, and Fynn-Thompson says they are getting closer to the outer limit. However, the team decides the heart looks good, and Fynn-Thompson says they can proceed. In the OR, Fynn-Thompson explains the procedure, comparing himself to a cook who will be making a meal, and we see bits of the process as it goes forward. Fynn-Thompson notes that the heart is starting to beat, but suddenly there is bleeding, and they must go back on bypass to repair it. They appear to succeed, and Fynn-Thompson goes to update the family, who are by now somewhat distraught about the long lack of information. But as Fynn-Thompson is reassuring them, and receiving all the credit, he is paged back to the OR, making them apprehensive again. The problem turns out to be that Sarah's blood pressure keeps spiking, but Fynn-Thompson says there is really nothing that can do except take her to the ICU: "We'll just have to see how the next 12-24 hours go." (See clips at broadband or dialup speed.) This implies that nothing much happens except waiting after the time a surgeon leaves a patient in the OR. Sarah recovers well, and it appears to have been due solely to Fynn-Thompson, since he is the only care-giver we see. In fact, skilled nurses work hard 24/7 to keep critical patients alive for weeks after surgery, administering complex drug regimens and other treatments, monitoring their conditions with advanced technology, and teaching patients to understand and adapt to their conditions.
Another heroic cardiothoracic surgeon is Daniel DiBardino, a resident. In an early episode, it is his job to travel to another part of New England to harvest lungs from one donor that will go to two different patients at Brigham and Women's. The cameras follow him there and back, letting him explain the basic procedure and how he feels about it, watching as he politely pushes transport personnel to move quickly with his precious cargo. We also see him interacting with other physicians and the patients. These segments ignore the nurses; only physicians, patients, and families talk. The families express sentiments that we are invited to share at some level: "We love you, Dr. D!" "We knew you could do it!" Another calls him "Dr. McDreamy DiBardino." These comments are made with a good-natured sense of irony, but it's also clear that these members of the public really do assume that DiBardino alone deserves credit for the successful operations, and the show gives us no reason to question that assumption. After DiBardino arrives with the lungs, he notes that "both surgeons are ready for us, so we are good to go"--as if only their readiness matters, not the readiness of the OR nurses who play an essential role in major operations. And when one lung recipient is discharged many days later, viewers can marvel at how well the new lung works, but not at the nursing that kept the patient alive. (See the clips at broadband or dialup speed.)
The treatment of the other surgeons is similar. Consider Jon Daniel, the chief cardiothoracic resident (sensing a little cardiothoracic theme here?). His segment illustrates both his focus on psychosocial care and the stress his elite job places on his family. One of his patients is an older man with mesothelioma who needs a lung transplant. Daniel is happy to do it, and he tells us about how important it is for him to form a bond with a patient, to be with the patient through the "whole journey." But it's nurses who are actually with surgical patients through the "whole journey." Surgeons do the cutting and visit patients a few times before and after. Anyway, Daniel's segment also presents the drama of whether he will be able to make his daughter's recital. We see him rushing to the recital after completing his life-saving surgery, which is a success. Thank goodness the surgeon was there for the whole journey!
William Curry is a neurosurgeon who operates on a young man with a brain tumor. We see him talking to the family, and there is some dispute about the critical issue of whether Curry is cuter than Barack Obama. Curry tells a story about one time when, after an operation, his attending surgeon left the room. The patient woke, thanked the scrub nurse, and asked if Curry was there to clean up, apparently because of Curry's race. This segment has another example of the show's embrace of a surgeon's perspective on what happens to patients after the operation ends. At one point Curry says that the family will just have to hold their breath till the patient wakes up, because it's just a "leap of faith until then." And the segment also underlines the sense that no skilled care happens after an operation by showing only Curry's periodic checks on the patient. (See the clips at broadband or dialup speed.)
Andrew ElBardissi is a surgical intern who admits that he is arrogant, and that this can lead to problems with his colleagues. But he vows not to change! It's clear that ElBardissi's chief resident has some issues with him, though both he and attending Amy Rezak make clear that ElBardissi is talented, as his contributions to one procedure reveal skills that are above average for his level of experience. ElBardissi also lets us in on some inside information about dealing with nurses: He says that you always worry if a nurse you encounter is cute, because then the older nurses are likely to converge to prevent you from "eating their young." (Our first thought was, right, because the senior nurses want to eat their own young.) ElBardissi seems to mean senior nurses want to protect the cute nurses from his romantic overtures, rather than from any anti-nurse animus, but it's still pretty regressive to regard nurses mainly as potential romantic objects, and the show gives us no particular reason to question whether that's OK. (See the clips at broadband or dialup speed.)
Another interesting figure is MGH trauma surgeon Jeff Ustin. In the fourth episode he gets a lot of attention, explaining his views on trauma care and exuding authority as he walks the halls and complains about the inability of others to meet his standards of care, though it appears that he is only a fellow at the time of filming (he is now an attending at MetroHealth Medical Center in Cleveland, according to the ABC web site). At one point, Ustin is displeased because a car accident victim has apparently been given Versed and intubated when he did not think that was necessary. Ustin gets to explain why he feels this way, but the show offers no response from whoever was responsible. The main patient in his segments is a pregnant woman who has been shot. Ustin, on the way to see this patient, informs us that they will be working to "optimize" her care. In the code of this patient, the physicians are commanding experts; nurses are there working, but they say nothing we can hear, suggesting that they are simply doing what the physicians tell them to, which of course is not the case. Trauma nurses do a wide variety of critical tasks in pursuing their autonomous care, and they must communicate to do so. In the OR, Ustin repeatedly says that they will save the baby by saving the mother, arguably bullying the obstetrician and OR nurses who may favor a different approach on an issue in which it is not clear he is correct. From what we see here, it appears that Ustin prevents his colleagues from monitoring the baby during the surgery (saying "you can't have the belly!") even though the mother's life is in grave danger, and that if she were to decompensate enough to affect the baby, the baby might still be saved through an emergency C-section. Research has found that 40% of clinicians remain silent in the face of intimidating colleagues, and nurses often struggle to advocate for patients with more powerful physicians. (This scene suggests that an ethics committee should be available 24/7 to resolve issues like this.) In any case, viewers see no one counter Ustin's views or question his approach. Later, an apparent abnormality in the baby's heart appears on the ultrasound (while the baby is still in the womb), and Ustin is dissatisfied with how quickly they are able to get a cardiologist to come examine it. He wants to know who the responsible attending is, and as he stalks away, he knocks into an unrelated health worker, apparently without slowing down or offering an apology. When a cardiologist does arrive to assure them that what they see on the ultrasound is not a problem, Ustin deems her "wonderful." The patient recovers, and we see Ustin visit her. Once again, there is no suggestion that anything has happened since he was last there, except for brief daily visits from the OB. We also see Ustin at home and meet his family, including the person the show identifies as "Pauline Ustin, Dr. Ustin's wife." (See the clips at broadband or dialup speed.)
So much easier if they would listen: The one nurse in the first four episodes of Boston Med
The one nurse who breaks up the surgical lovefest is Amanda Grabowski. Appearing early in the second episode, she is the only nurse who is actually identified onscreen ("Amanda Grabowski, RN, ER nurse"); at least she gets a specialty. We briefly see Grabowski providing emergency care and providing comment about it, particularly in the second episode, and in decreasing amounts in the third and fourth episodes. She comes off as fairly articulate, and she even uses some technical terms, though she does not really get as much time to explain procedures as the major physician characters do. Perhaps partly because she practices in the ED, where patients can be difficult and do not stay long in any case, viewers do not get the same sense of sustained connection between her and any of her patients as we do with the surgeons who appear.
Grabowski begins with the great observation that many people undervalue what nurses do, thinking it is pretty much about bedpans, while nurses actually do far more. In one early scene, we see Grabowski explain to the team that a patient has a "do not resuscitate" order. She is unhappy that the hospital from which the patient came began a resuscitation on the patient. And at another point, we see Grabowski essentially directing security personnel when she needs help with a patient. This is a rare bit of television reality in terms of who handles difficult ED patients. (See the clips at broadband or dialup speed.)
We also see her with an older man who has arrived, joking about how he is having a number of attractive young females cut his clothes off. Separately, she tells us that she enjoys flirting with older male patients. It is possible that some nurses would see these scenes as presenting a less than ideal image, perhaps even as having naughty nurse overtones. (See the clips at broadband or dialup speed.)
Another patient has arrived after having consumed a great deal of alcohol. A nearby physician explains that the young male patient will be "nursed back to health by our angels." His tone is ambiguous, so it's not clear whether this is more of an endorsement or a subversion of the angel image. We believe he's being ironic, suggesting that it will be a challenge to manage the very altered young patient. Grabowski explains that the patient almost choked on his own vomit. Later, the fairly coherent patient wants to leave to go turn in an exam due in 3 hours, but Grabowski insists that he stay, earning his wrath. Some nurses might have simply let him go, though we doubt most viewers will register this as poor care. Of course, it might have been nice to see Grabowski having a more constructive interaction with an ED patient as well. (See the clips at broadband or dialup speed.)
At another point Grabowski addresses her relations with new physicians. She notes that residents might not listen to a nurse at first, but that she tries to guide them, noting that she does not have that "fancy MD" ..."but it would make people's lives a whole lot easier if they would just listen to us."
We see her pushing just such a reluctant physician intern to prescribe enough of the sedative Haldol for an agitated patient. The physician wants to prescribe 1 mg., but far more, perhaps 5 mg., is probably needed for a patient of this size, age, and agitation level. Grabowski negotiates for 2.5 mg., explaining that 5 mg. comes in each 1 ml., so drawing up 2.5 mg. in a syringe is easier than drawing up 1 mg. In fact, registered nurses are fully capable of measuring out and administering 0.2 ml. of a liquid drug. But explaining the real reason for Grabowski's request would involve a nurse expressing a contrary opinion on a matter that physicians generally regard as their exclusive turf. So it appears that Grabowski's admirable patient advocacy takes the form of a standard nurse-physician dance, as she hides what she is really doing in order to preserve the physician's ego and avoid a larger confrontation. This is understandable but unfortunate, and not least because very alert viewers may think the issue really is that Grabowski can't measure such a small amount of Haldol. For nurses to play a more effective role as patient advocates, they must start speaking the truth about what they know and can do, even if that means letting physicians know that sometimes nurses know more than they do about patient care. (See the clips at broadband or dialup speed.)
Near the beginning of the third episode, we see Grabowski preparing to receive a pediatric trauma patient arriving by helicopter. She tells us a little about the nature of treatment--this patient has lots of internal bleeding--revealing some technical knowledge, and she also notes that she will have to assert herself to manage the chaos of the code. She describes how hard it is to treat a critical ill child, how devastating it is to lose a child, which they do in this case.
Later in that episode, we briefly see Grabowski treating an injured motorcyclist who appears to be about her father's age. Here there is less focus on her technical skill, and more on providing emotional support for the patient, who is in pain. She notes that if it was her father, she would want someone to hold his hand.
But mostly, we get Grabowski's non-clinical interactions, both inside and outside of what she describes as the "fun" work environment at MGH. This is not just her bantering with a physician who forgets her name--she does not let him forget it, actually constructing an oversized name tag for herself--but a lot of screen time is also devoted to her romantic prospects and experiences. This certainly is "fun," and she is not being singled out to too great an extent, as we get similar elements in some of the physician portrayals. But it greatly lessens the time Grabowski has to do some of the things the physicians do, to show and tell viewers about the challenges and rewards of nursing, to have meaningful interactions with patients, to teach more junior nurses and learn from more senior ones.
In an early scene, Grabowski discusses dating colleagues, noting pointedly that there are no "McDreamys" or "McSteamys" there (she must not know about Dr. DiBardino over at Brigham and Women's!), but instead they have "McDumb" and "McDud." She explains that some people are "cute" in the hospital setting --"hospital cute"--but much less charming outside of it. She says her prior dating of colleagues was disastrous. Yet when ER resident Rob Miller asks her out on a date--on camera, as she herself emphasizes--she says yes. We see them go tango dancing with some of his friends. Later, she tells him that he passed the test of being cute outside the hospital. And separately, she tells us that Rob is a great guy, so she'll see what happens. (See the clips at broadband or dialup speed.)
Expanding on these themes, the fourth episode includes almost no clinical portrayals of Grabowski, but focuses instead on her search for love. We do initially see her in the ED, caring for a 90-year-old man who has fallen and hit his head at the mall. She introduces herself:
Hello, I'm Amanda, one of the nurses. There's going to be lots going on right now, OK?
This briefly suggest nursing's interpersonal skills, but it doesn't really go anywhere, and we don't hear any more about the patient's injuries, treatment, or outlook. Grabowski says again that she tries to put herself in her patient's place, because behind every diagnosis is a patient. She also briefly suggests that she may have gotten into nursing, a field that involves taking care of others, because she basically had to raise herself after her parents divorced when she was young. Her patient's female companion is there and expresses concern for him, and Grabowski hopes that she will be able to find a love as enduring as theirs. There are overtones of romantic relations here, so even this one fleeting clinical interaction seems strategically placed to reflect Grabowski's central romantic plotline (just as it might be on Grey's, if the show had nurse characters). Grabowski notes that the resident Rob was a nice guy, but it did not go anywhere. (See the clips at broadband or dialup speed.)
The next we see of Grabowski, she is recruiting for what she calls her "girls' cruise," and soon we are following her on the cruise with her two friends, as they get drinks by the pool, and Grabowski does a Marilyn Monroe imitation with the ocean breeze. She and her friends discuss their relationships. Grabowski notes that she once went to her ex-boyfriend's Facebook site and saw pictures of his new girlfriend, which was painful; one friend notes that that had been a long relationship for her. Grabowski notes that she doesn't like "random losers" who hit on her when she goes out, telling a story about one guy who, after she declined to dance with him, told her she had big hips. She responded that he probably had a small penis. Then we see Grabowski and her friends dancing on the ship as the DJ plays Beyonce's "Single Ladies (Put a Ring on It)" (get it?). (See the clips at broadband or dialup speed.)
Back in the ED, Grabowski notes ruefully that the familiar ED environment hits her like "a punch in the face," and the "party is over." But there is a happy ending: Near the end of the episode, the camera finds Grabowski eight months later. She reports that she got back together with her ex-boyfriend soon after the cruise, and they are now engaged. We see them happy together, playing Wii Sports. (See the clips at broadband or dialup speed.)
Some nurses may react negatively to some things we see Grabowski say and do, but the real problem is not so much what Grabowski does in her non-clinical activities but the fact that they occupy most of the limited time the series devotes to her, and that the actual nursing we see is so limited. Grabowski does get to display a little expertise here and there, but there is an obvious focus on emotional support and other patient relations that most viewers will not see as requiring advanced skills. In contrast to the physicians, Grabowski gets little chance to describe emergency nursing or what she is doing with a particular patient in any detail. Some of the physician segments also include romance or family interactions, but those themes are not generally so dominant, and in any case, physicians can count on a huge reserve of respect for their advanced professional skills among viewers. Nurses cannot; it has to be spelled out. The result of the first four episodes' approach is arguably to reinforce a stereotype that nurses are more concerned with romance and relationships than with their work. On the bright side, it is clear that Grabowski is not looking to catch a physician, subverting at least one part of the stereotype.
On the whole, Amanda Grabowski's clinical role in Boston Med is negligible, and it seems unlikely that Mike O'Donnell's role will be much better. The series is a long, influential advertisement for the misconception that only physicians really matter in advanced hospital care.
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