why do people think doctors are so superior? - page 2

in the last 6 months i decided not to go to med. school and to be a clinical nurse specialist in oncology instead. i also intend on getting my PhD so i can do research as well. SOOOOO when i told my... Read More

  1. by   epiphany
    One of the reasons is that nurses don't take enough credit for themselves. True, the AMA has more power, and money talks, but to a certain extend some of us allow this to happen. I started at school, one of the first nurses I encountered would use the "make them think it's their idea" approach to correcting a physician's mistake. She was clinical superior, but everytime she realized the patient needed some intervention, she had a way of gently nudging the doctor to write the order, in a way that his ego remained intact. It was interesting to watch - she often winked at me when she got the doctor to do what she wanted for the patient. She thought she was being clever, but I thought she was selling herself short. And I thought it was sad how someone so experienced and concerned about the patients ended up invisible, whilst the doctors probably got patted on the back for her efforts.
  2. by   KCIN
    In the beginning the relationship between doctors and nurses was clear and simple. Doctors were superior. They had the hard knowledge that made ill people better. The nurses, usually women, were good but not necessarily very knowledgeable. They were in charge of folding pillow cases and mopping brows. Nurses didn't cure patients; on the whole they still don't. They were just nice to them while they waited to get better.

    In 1967 Dr Leonard Stein first outlined the doctor-nurse game. He said that the interactions between the two were carefully managed so as not to disturb the fixed hierarchy. Nurses were bold, had initiative, and were responsible for important recommendations. While being bold, however, they had to appear passive. In short, nurses were able to make recommendations as long as they made it look as if they were initiated by doctors. So the nurse was responsible for the wellbeing of her patients and the nourishment of the doctors' sense of professional self.

    A missed opportunity for nursing and a bit of a bore for doctors



    In 1990 Stein revisited the game and found that the nurses weren't playing any more. It seems they had unilaterally decided to change the way that they related to other health professionals. Nurses were tired of the handmaiden image and sought to invest their existence with a professionalism and value that they had previously been denied. Being a nurse was more than being a good woman; it was about being a well educated practitioner with independent duties, skills, and responsibilities.

    After the 1970s nursing reconstructed itself as an independent profession which sometimes stood up to doctors. They did this in various ways, an example being the investment in university education and the social affirmation that went with it. Nursing was reinvented, increasingly as an associate science to medicine. But, why didn't these quasimedical nurses simply train as doctors? Is it because they believed in the distinguishing nature of nursing? Or because they didn't have enough A levels? Was the pursuit of equality motivated by a belief in the value of nursing or an inferiority complex?

    For all the jostling for position over the past 20 years little has changed. This is primarily because the power in the relationship is mediated by the patient. If in doubt ask the patient who is in control. The public may love its angels but it holds its medics in awe.

    In the struggle with doctors, nursing has made a fundamental error. It has mistaken equality for uniformity.

    The frailty of nursing in the modern world is born of its intangibility. Nursing is more than treating ill people. It's about nourishment, problem solving, and easing a patient's experience of suffering, medical invasion, or death. It's always been hard to pin down, so it's not surprising that nurses have turned to the material world of postgraduate recognition, evidence based practice, expanded roles, and mimicking the medical career structure--nurse consultants, nurse practitioners, etc--in order to redesign their sense of self. The doctors, however, are still having their needs met by nurses.

    Surely doctors are more than happy to see nurses do tasks that usually take up time and quite frankly bore them. Nurses are taking over tasks from junior doctors--administering intravenous drugs, doing endoscopies, preoperative assessment, and some prescribing.

    Doctors are a simpler breed than nurses. Everyone knows what the doctor's job is. Doctors are the conduits of medical knowledge. They don't have to constantly redefine themselves. Doctors are little more than what science allows them to be. They are a totem. They don't rethink themselves, they don't need to. This gives them plenty of time and opportunity to redefine nursing.

    Medicine remains in the ascendancy. The capacity to cure has greater market value than dealing with distress. And frankly so it should. But in the face of that might not nursing have done better than "if you can't beat them join them"?

    In a short time nursing has built up an infrastructure of credibility from the wards to the universities, stopping off on trust boards and policy groups along the way. Nursing has garnered more governmental respect than ever. Unfortunately, this has been achieved by moving nursing towards convention, and the opportunity to move convention and credibility towards the core strengths of nursing has been missed. Nurses now have more power but arguably this has done little for nursing.

    What feminism has done for nursing is to make young women choose to be doctors. As for the game, it doesn't matter. It is an irrelevant unsophisticated squabble. The key to the success or failure of the doctor-nurse relationship is the patient experience. Unfortunately, in the past the relationship has often been motivated by jealousy, self doubt, insecurity, and arrogance. You cannot help believing that this has been a missed opportunity for nursing and a bit of a bore for doctors.
  3. by   Jessy_RN
    Great responses. I just hope that sometime (in my lifetime) this mentality will change and that the public is actually educated in what it takes to be a nurse and what they actually do.
  4. by   Mirai Kangofu
    @KCIN: That was great! Thanks for the history and sociology lesson!
  5. by   nursing 101
    This mentality is encouraged by hospital administrators as well. I am a new grad and I couldn't believe my ears when I heard the instructor (a nurse) during an orientation explain the hospital's computer system to us, that we had to "help" the physician if we "saw" them (not if they asked) struggling with the system:angryfire . I gave her such a look that she asked me what was wrong. I explained to her the same way I had to take a "mandatory" five hours to come to class and hear the info in order to manage the system is the same way physicians should come to class as well. I got a collective "Amen" from our group and she was very embarassed by her comment. Her answer to me was that she is from the old school... I didn't even answer her after that because I know I won't go out of my way to help a dr.
    Now of course I will point out what they need if the ask for help.
    So this mentality will always exist if people like her encourage it. I do think that physicians should be respected just like any individual but others should be recognized just as well.
  6. by   Indy
    One way this mentality will change is through educating the public, and we can do this one patient at a time. I've had occasion to do this sometimes and usually take advantage of it when I can.

    Example: This week I had a patient who refuses to have any cardiac drips. Okay. She's scared of them. Really thinks her doctor is gonna kill her with an amiodarone drip. I have to explain to her why she needed it, that the incidence of the bad side effects is low or we wouldn't be using it in the first place. Then I have to explain that the reason the doctors feel they can order these drips is because the nurses monitor the patients for side effects. And that her doctor got huffy because really he didn't feel that she trusted him when she refused that medication.

    When I recieved this patient she was so fed up with the whole bruhaha over her refusal of a med that she wasn't taking any meds. After this line of teaching she decided to trust her nurse and take everything that wasn't a cardiac drip. Prior to that evening she didn't know that the nurse actually did more than feed and clean her; now she knows the nurse's job includes actually making sure she lives through her treatment.

    I don't feel I have time to educate more than one person at a time (or one roomful of family members), so I have to believe that change can occur from such small steps. I wouldn't have taken this job if I didn't think that what I do matters.
  7. by   StevenRN
    It's a matter of public relations. When physician's screw up, nobody knows. When nurses do the same, it's all over the news and the grapevine.

    I've been a nurse for over 35 years and I've seen my share of idiotic nurses. They give us all a bad name. But I've also seen nurses who are far superior in actions and knowledge than physicians. You rarely hear about them! Why? Because they make the decisions and the physician gets the credit.

    Nurses, for whatever reason, do not stand by one another. Physicians do!

    Nursing organizations do NOT stand by grass roots nurses. Physician organizations back them to the hilt!

    The only way we can beat this is:
    1) Stop the back biting
    2) Rid ourselves of incompetent nurses
    3) Support one another
    4) and organize outside of the bureaucracy
  8. by   MellyOne
    Last edit by MellyOne on Dec 1, '05 : Reason: felt a little too whiny
  9. by   nursing 101
    Quote from StevenRN
    It's a matter of public relations. When physician's screw up, nobody knows. When nurses do the same, it's all over the news and the grapevine.

    I've been a nurse for over 35 years and I've seen my share of idiotic nurses. They give us all a bad name. But I've also seen nurses who are far superior in actions and knowledge than physicians. You rarely hear about them! Why? Because they make the decisions and the physician gets the credit.

    Nurses, for whatever reason, do not stand by one another. Physicians do!

    Nursing organizations do NOT stand by grass roots nurses. Physician organizations back them to the hilt!

    The only way we can beat this is:
    1) Stop the back biting
    2) Rid ourselves of incompetent nurses
    3) Support one another
    4) and organize outside of the bureaucracy
    Can you elaborate in what way do nursing organizations don't stand by grass roots nurses... Thanks
  10. by   ali_gator
    Believe it or not, this subject was brought up in my Philosophy class. Because we live in a Capitalist society (and Capitalism is strongly rooted in Liberalism) work that is physical is not as valued as work that is purely intellectual. In Liberalism, it is believed that the mind exists seperate from the body, and that the mind is more important than the body. This is known as Normative Dualism. Naturally, because nursing is more physical than medicine, medicine is valued more.

    Just my 2 cents.

    Now, if a tree were to fall in the forest and there was nobody there to hear it...
  11. by   KCIN
    just a small reminder to those of you who might be discouraged by nursing.

    1. the good samaritan acted as a nurse ( in the bible)

    2.nurses have had the highest ranking in terms of public opinion in the united states. Nurses again topped Gallup’s annual survey on the honesty and ethics of various professions. Nurses beat doctors, veterinarians, pharmacists, and dentists.dont just take my word for it, click the link. http://nsweb.nursingspectrum.com/Nur...em.cfm?ID=1330
  12. by   epiphany
    KCIN, thank you for your insightful original post regarding the development of nursing. I would like to comment on your second post, and this "most trusted profession" tagline that's so often used for us.

    Quote from KCIN
    2.nurses have had the highest ranking in terms of public opinion in the united states. Nurses again topped Gallup's annual survey on the honesty and ethics of various professions. Nurses beat doctors, veterinarians, pharmacists, and dentists.dont just take my word for it, click the link. http://nsweb.nursingspectrum.com/Nur...em.cfm?ID=1330

    We are the most trusted people and yet, we are not the happiest people. The job satisfaction that we experience when we are allowed to do what we do best, is frequently offset by many obstacles, including the one that's being discussed in this thread.

    In a recent AJN article, polls also show that if given the choice, people will choose a physician over a nurse practitioner even though these same pts felt that they had much better satisfaction in their previous experience with NP's. I know NP's don't represent the majority of nurses, but this study does compare these two services on a level field for the sake of observing people's attitudes. In the end, patients will go to someone they feel have the authority over their health, and they don't necessarily really feel that way about nurses.

    So what is the good of being trusted if you don't feel the appreciation, enough to make you want to stay around? How long can you continue to put up with being used as a disposable pawn in the profit games of the hospitals, because they just don't respect you? For trust doesn't always mean appreciation and respect. And being trusted doesn't mean that we don't get abused. That's why, for all the wonderful things we claim that come with nursing, you only need to look at this forum, and look at attrition rates of nurses, to see that we cannot live on public opinion alone. Being trusted is a nice bonus, but at the end of the day, I want to be treated well.
  13. by   lee22
    Nursing is truly a caring profession-after years of experience I am not so sure doctors fit in this category. So good for you. I have witnessed some extremely abhorent behaviour by doctors. Yes they perform tremendous strategical feats with their knowledge and skill, but when it comes to caring and compassion, nursing is usually miles ahead. Good luck

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