Doctors and Nurses

Doctors and Nurses

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Linked are two articles, from which all in healthcare can learn and reflect. The original article is On Breaking One’s Neck: by Dr. Arnold Relman, with a complimentary article :A Patient’s-Eye-View of Nurses by Dr. Lawrence Altman.

There are compliments in both articles for nurses, as well as warnings that should be considered.

. As quoted from the original article :On Breaking One’s Neck:

“What personal care hospitalized patients now get is mostly from nurses. In the MGHICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”

The review article in the New York Times, written by Dr. Altman,  brings to light the thought provoking differences between physicians and the nursing staff. Dr. Atman expresses concern at the movement towards technology, citing technology as objects that can “Deflect the doctor’s attention.”

I think that nursing as a profession should also heed this concern-does our bedside report become just a huddle in the hallway? Are we including the patient? Are we prioritizing our time between the computer and the patient?

Hopefully we are not, as nurses, using as our starting point of care the review of notes-or as Dr. Relman so memorably states:

“Lengthy notes in the computerized record, full of repetitious boilerplate language and lab data, but lacking in coherent descriptions of my medical progress, or my complaints and state of mind.”

This is referring to the MD notes-but what about our nurses’ notes? Do they adequately reflect the patient? Do they just present the data, or the whole person? I have a tendency as a nurse to at times subconsciously rely on previous documentation-but our starting point needs to be the patient, not the notes. How are we doing? Do we clarify what we saw in the record with the living person in front of us?

Another nice quote, by Dr. Altman, complimenting nurses is as follows:

“Nurses’ observations and suggestions have saved many doctors from making fatal mistakes in caring for patients. Though most physicians are grateful for such aid, a few dismiss it — out of arrogance and a mistaken belief that a nurse cannot know more than a doctor.”

I think that nurses everywhere should read these two articles and be thankful for the recognition. But we should also realize that what is wise for the doctors is wise for the nurses.

We should never forget, in this healthcare system that is changing faster and becoming more difficult every day, the patient is first-and someday the person in the bed could be me or my family.

I had a nursing instructor once that said:

When you enter a room, and you see lines, and IVs, and ‘stuff’, don’t worry about all of those lines, start at the patient, and work your way out.”

Will our patients, will we, our families, be reduced to hallway huddles and medical note jargon and technical terminology? Or will our care be about the individual, the person, with a cautious inclusion of technology as needed?

These articles provide warning signs about our healthcare and we will do well to heed them, whether doctor or nurse.

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