Mending Doctor-Nurse Relations

A little respect for fellow health care providers can go along way. A few months ago, the New York Times ran a piece by Theresa Brown, an oncology nurse, about being bullied by doctors. Brown, an eloquent writer, is a frequent contributor to the New York Times, usually writing about caring for patients. In this piece, called “Physician Heal Thyself,” (May 8, 2011), she wrote:

When a doctor thoughtlessly dresses down a nurse in front of patients or their families, it’s not just a personal affront, it’s an incredible distraction, taking our minds away from our patients, focusing them instead on how powerless we are.

That said, the most damaging bullying is not flagrant and does not fit the stereotype of a surgeon having a tantrum in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults.

Not surprisingly, her article prompted a slew of comments to the New York Times. It follows another New York Times opinion piece by Dana Jennings, a writer who has been chronicling his battle with an aggressive stage 3 prostate cancer. In his anti-doctor article (December 29, 2010) , he writes that his frequent hospital admissions have taught him this:

Nurses are warm, whereas doctors are cool. Nurses act like real people; doctors often act like aristocrats. Nurses look you in the eye; doctors stare slightly above and to the right of your shoulder. (Maybe they’re taught to do that in medical school?)

It’s a shame that doctors are held in such low esteem among the lay public—our consumers. But rather than grumble about the bad press, perhaps the response should be to encourage collegiality and ensure that our doctors-to-be are trained in humanistic medicine. I’m hopeful And that is why I was happy to receive this piece from Victor O. Kolade, an academic ambulist at the University of Tennessee College of Medicine in Chattanooga.

2001 is significant in the American medical landscape for 9/11 and the associated loss and illness of landmark proportions (Thomson & Wilson, 2005). That same year, I was an intern in a community hospital eight miles away. My first senior resident worked with me for four weeks on an inpatient medicine rotation on the combined medical, surgical, gynecology and podiatry ward. He taught me one skill, how to perform arterial puncture for blood gas analysis, which I hardly use now as a general internist and ambulist – a physician that devotes his practice to outpatient medicine. But the advice he gave me early on that month has stuck with me ever since.

‘Know the names of the nurses,’ he said to me. ‘When you write an order, you need to know who to ask (to get it done).’ Our program director – who doubled as department chair – had warned us in his introductory talk that the relationship with members of other health disciplines is more like a partnership than it may be in other countries. (This turned out to be good advice. I am an international medical graduate, and although I had learned to deliver medical care as part of a multidisciplinary team in Nigeria prior to residency, I had spent some time as an ‘independent’ practitioner, and that was not the prevailing milieu I had worked in.)

I believe the human soul is designed to live by the same core values throughout the day, at work or at play. My wife and mother are both nurses; surely I could not be super-bossy at work and all loving at home. Work-life balance has another meaning for me!

More than nine years after this incident, I am opportune to teach residents and medical students internal medicine in ambulatory and inpatient settings. I regularly ask my trainees to identify the nurses we work with by name. Doctors and nurses need to maintain collegial collaboration with each other and all members of the multidisciplinary health team to provide safe, timely, efficient, effective and patient-centered care.

By Dr. Victor O. Kolade

Reference:

Thomson G, Wilson N. Policy lessons from comparing mortality from two global forces: international terrorism and tobacco. Global Health 2005; 1: 18.