July 2004 -- The "Everyday Heroes" department in this month's Reader's Digest features Lynn Rosellini's "Medicine Woman," a generally good profile of rural nurse practitioner and Penn State nursing professor Mona Counts, RN, PhD, CRNP, FNAP, FAANP. Despite a few physician-centric elements and a failure to note Dr. Counts' academic and professional stature, the piece effectively underlines the value of nurse practitioners' willingness to listen and speak plainly to their patients, and to endure the financial stress of practicing in poor, underserved areas of the nation.
According to the article (on p. 33), Dr. Counts runs a primary care clinic in the "Appalachian village of Mount Morris, Pennsylvania," which has 900 residents and no full-time physician. The story emphasizes Dr. Counts' focus on taking the time to listen and respond to patients. The main anecdote in the piece is about a patient who came to Counts after several physicians had failed to find the cause of her serious symptoms. After Counts saw the patient for two lengthy visits, she suspected Crohn's disease, a diagnosis confirmed by a gastroenterologist to whom Counts referred the patient. The piece also stresses Counts' availability at all hours, her willingness to treat patients without insurance, and her effective use of plain, even blunt speech. Commendably, the article does not pretend that Counts is an angel who is glad to work for nothing, describing the financial stresses of running a clinic that is financed by a second mortgage on Counts' house and that serves patients who pay what they can--such as a sack of tomatoes. Evidently, the clinic is now in somewhat better financial shape, with eligibility for reimbursement by Medicare, Medicaid, and "some insurance companies that had formerly refused to recognize nurse-practitioners." The piece makes clear that the people of Mount Morris appreciate Counts' work tremendously.
The piece notes that Counts has continued "working" as a nursing professor at Pennsylvania State University while running the clinic, and that one patient found that Counts was a different kind of "doctor"--"the 'Dr.' before Counts' name stands for her PhD." The article might have have included a little more detail about Counts' scholarship--what does she teach? what are her areas of research? what was the subject of her dissertation? In fact, Dr. Counts has taught nursing for four decades, has conducted and published significant research in rural and geriatric care, and has received numerous academic and professional honors. Mention of any of this might have served to highlight even more her ability to care effectively for the residents of Mount Morris and her willingness to endure the resulting financial hardship. We also wonder if a physician would have been described as "working" (as opposed to "teaching") as a medical school professor. The article might also have explained a little more of what nurse practitioners are, and made clear that they are still nurses--not "medicine" women, as the title suggests.
In recounting the story of the patient with Crohn's disease, the article states that Counts "knows there are limits to what she can diagnose and treat herself," which is very much like saying that she knows her place, that she is not a real "doctor." In fact, primary care physicians would have needed to send the patient to the same kind of gastroenterological specialist for the indicated workup. But we doubt an article would have paternalistically assured us that a primary care physician "knows there are limits" to what she can do. In fact, many research studies find that care delivered by Advanced Practice Nurses like Dr. Counts is equal to or better than care delivered by physicians. Moreover, as an experienced nurse, Counts has a great deal of nursing knowledge that no physician has, and we might just as easily say that a particular physician "knows there are limits to the care he can provide" to patients, since nurses are the experts in many key aspects of health care.
On the whole, though, the article is a strong, positive profile of a nurse practitioner whose work is representative of primary care NP's who provide vital care to underserved communties, whether in rural, small town or urban settings, for very little money. Reader's Digest and Ms. Rosellini deserve credit for bringing the work of Dr. Counts--who really does appear to merit the overused label "hero"--to the attention of their many millions of readers.
The Reader's Digest, the second most popular magazine in the US with 13 million subscribers, accepts nominations for their "Everyday Heroes" awards. Nominate the most heroic nurse you know for these awards to increase media coverage of nurses. (Please consider emphasizing the nursing heroes' committment to saving and improving lives rather than nominations for self-sacrifice and other angelic qualities.)