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A Modest Proposal

March 11, 2005 -- Today the Baltimore Sun published a piece by Stephanie Shapiro about local oncology nurse practitioner Caryn Andrews, who recently completed her doctorate at the University of Maryland with research examining the role of "modesty" in the reluctance of some Jewish women to get regular mammograms. The story obviously conveys the helpful message that nurses can earn doctorates in nursing, and it is a pretty good account of important nursing research, though it fails to explain the full clinical significance of Andrews' work--i.e., how it could mean the difference between life and death.

The piece, "Medicine and modesty," explores the potential conflict between the traditional strictures of some cultures, including certain Jewish and Muslim communities, and utilization of vital health care services including mammograms, colonoscopies and other screening tests. The piece explains in some detail how Andrews went about designing her dissertation research, describing how she found participants through her local community, designed questionnaires to measure women's views, conducted interviews, and actually developed a "modesty scale," which can be used as a tool for further research. (Surprisingly, the piece never quite comes right out and says that Andrews' research confirmed her hypothesis that modesty impedes care.) The piece does stress how Andrews has put her findings to work, noting that she encourages sensitive practices such as drawing curtains shut and maintaining the privacy of consultations. The piece also provides some broader context, pointing out that there has been an increase in midwives training specifically to serve the Orthodox Jewish community, and that one hospital in Maine has designed and created its own gowns to encourage Muslim women from Somalia to seek care. On the whole, the piece gives readers a good example of advanced nursing research, which often examines barriers certain communities may face in seeking and receiving good health care, and how those barriers can be overcome.

We see a few issues. First, though the piece does a fine job of explaining some of what Andrews has done, it could have done far more to let readers know just how important health care utilization is to patient outcomes. This may not be obvious to everyone. The title of the piece suggests that Andrews is practicing "medicine," or alternatively that "medicine" is what the modest patients are gaining access to. It seems to us that patients are getting access to medicine and nursing, and that since the article is about a nurse and her research, "Nursing and modesty" might have been more appropriate. Though Andrews has earned her Ph.D. in nursing, she is not referred to as "Dr. Andrews," though it is the Sun's practice to refer to all physicians as "Dr. ___." This presumably reflects the Sun's adherence to Associated Press style, which we understand mandates that only physicians be recognized as having earned doctoral degrees, thereby reinforcing the baseless physician-centric bias that remains all too common. At the end of the piece, there are a few bits of basic biographical data about Andrews' family, education, and work. The "job" item states that she "[m]anages the care of chemotherapy patients for a team of oncologists" at a local hospital. However, nurse practitioners do not manage care "for" physicians. They provide care based on their own advanced training, and may collaborate with physicians in doing so. Research has shown that care provided by nurse practitioners is at least as good as that provided by physicians.

See the article "Medicine and modesty: Nurse is studying cultural impact on health care of women" by Stephanie Shapiro in the March 11, 2005 edition of the Baltimore Sun.


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