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It may be a "Doctor's World," but do nurses even live in it?

September 16, 2003 -- Two recent national media products--Lawrence K. Altman, M.D.'s "The Doctor's World" piece in today's New York Times about U.S. Marines with malaria, and the 13-part documentary/reality show "Resident Life" currently airing on The Learning Channel--both illustrate the ways in which the media can marginalize the important work of nurses, to the point that the average observer might wonder whether nurses even exist.

New York Times article

"Resident Life"

New York Times article

The Times article, entitled "Medical Teams Fight Outbreak of Malaria Among Marines," focuses on the "military medical team" that cared for several dozen U.S. Marines who had become ill after spending two weeks ashore in Liberia in mid-August. The team examined the Marines when they began arriving at Andrews Air Force Base in early September, and then cared for them at Bethesda Naval Medical Center. The Marines turned out to have malaria, and all but a few have now been discharged from the hospital, but because of the severity of the symptoms, the staff were at first concerned that some may also have had other dangerous infections common in West Africa. The piece focuses in particular on the Navy captain who "led" the team, Dr. Gregory J. Martin, and his work, under great pressure, to properly diagnose the Marines.

The good work of Dr. Martin and the other physicians deserves attention, but so does the manner in which the article discusses what happened. Though a health care effort of this size surely drew on the work of many different personnel, the article mentions only one specific kind of health professional: physicians. Doctors worried about the symptoms, doctors aboard a ship were sending more sick Marines, doctors started injections, doctors inserted breathing tubes and connected patients to ventilators. Whenever it might not be credible to suggest that physicians alone performed a task, more general terms are used: the sick Marines were greeted by "a medical team" in full protective gear, the "military medical team" examined and cared for them, "the hospital" cleared out a ward to isolate them and instructed them to pour bleach in the toilet to avoid contamination. Alternatively, the passive voice is employed, so that things are not done by any particular human, they simply occur: the Marines "were allowed visitors."

The net effect of this is to give readers the impression that only physicians are doing anything worthy of note, or indeed, only physicians are doing anything at all. Granted, the article is mainly about diagnosis, but as indicated above it also focuses on care, and surely military nurses were a critical part of the extended care of so many seriously ill patients--a few of whom are still in the hospital. Tellingly, though symptoms and a few interventions are described, it is never clear just what the Marines experienced hour-to-hour during their illnesses, nor exactly how they recovered. This is the province of nursing. But no nurse is identified, nor does the word "nurse" even appear in the 39-paragraph article. Of course, the article also lacks specific discussion of any of the patients; perhaps even they are not particularly noteworthy in "The Doctor's World."

See the NY Times article "The Doctor's World" and send your comments about the article's exclusion of nurses to the editor of the New York Times.

"Resident Life"

"Resident Life" is a 13-part documentary/reality show focusing on the lives of resident physicians at Vanderbilt Medical Center which is airing on The Learning Channel between early September and mid-December 2003. The show obviously differs in many respects from the Times article on malaria, but it appears to present a disturbingly similar vision of all significant health care being provided by physicians, and none by nurses.

An obvious initial response might be that this show is explicitly about the training of physicians, not health care in general, so understandably it deals only with physicians and their experience. However, the rarely acknowledged reality is that nurses are a big part of "resident life." Experienced nurses play a crucial role in providing informal training to resident physicians, from imparting significant technical knowledge and practical expertise in a variety of hospital tasks, to helping the residents avoid mistakes that can have catastrophic results for patients.

But nurses appear to play virtually no role in "Resident Life." If someone who may be a nurse appears, it is to comment briefly on someone's nickname or some other personal matter. And the show is not just a series of scenes showing the residents talk about their lives. It focuses on treatment, with lengthy segments devoted to patients in surgery, the emergency department, pediatrics, and other areas. These segments are not limited to residents, since attendings and fellows are clearly involved in such treatment, and the show is very interested in how the residents learn from them. But the scenes have been scrupulously cleansed of nurses, creating the impression that only physicians are significantly involved in patient care. Occasionally a nurse can be seen in the background, but it is generally not clear what he or she may be doing. In other cases, the nurse seems to be simply standing and watching. That may be because the physicians and camera crews have told her to vacate the "Doctor's World," but it may give viewers the mistaken impression, at some level, that nurses just stand around watching physicians do the real work.

Unfortunately, this is not an anomaly. The television industry has regularly awarded physicians this kind of obsessive, doting attention, with shows from extended reality series to popular network dramas like "ER" tracing every step of their training, from medical school through senior attending status. These shows regularly distort, minimize or ignore the central role nurses play in modern health care. Indeed, with the partial exception of the very good five-part documentary "Nurses" first aired in 2001 on the Discovery Health Channel, we are aware of no recent television program devoted to the training of nursing students, the professional development of practicing nurses, or the training of advanced practice nurses. If you are, please let us know.

See TLC's web site on "Resident Life."

Contact TLC's "Resident Life" to let the producers know your thoughts about their exclusion of nurses.

The Center hopes that major media organs like the New York Times and The Learning Channel will in the future consider providing accounts of modern health care that accurately reflect the training and important contributions of nurses. Their failure to do so is a significant factor in the current nursing shortage, which in turn is one of the nation's most urgent public health crises.