The Doctor as God

A terrible mistake… maybe it can’t be fixed.

This idea, universal in America, is a bad foundation for building the reciprocal problem solving relationship among health care professionals essential to a good outcome.  The game changes from ‘let’s solve this problem together’ to the dysfunctional game of adults; Parent /Child.

The doctor as god assumption-stereotype is untenable for the doctor and dangerous for everyone else. The doctor is expected to make a god-like judgement immediately or he will be suspect,  he knows it and it terrifies.

How did this happen and why does it continue?  Media stereotyping, commercials, fear of lawsuit demands to: “Consult your physician first.” for normal vitamin advertisment, for exercising, even for walking agrandizes the doctor and mandates the idea of ‘my doctor’ and of dependance.

Patients are complicit also.  Looking for the ideal ‘daddy’, patients and particularly isolated, lonely and frightened elderly women visit too frequently giving too much fine, minute detailed information and leave unsatisfied and adrift.  They are assuming that the doctor is listening to each word, deeply involved in their problem and always interested in only them.  The reality is that while listening, the doctor is thinking with each new bit of information:  “How can I be sued.”

No longer is doctor synonymous with family friend.  The country doctor of my grandfather’s time, the understanding, wise and measured problem solver of my childhood may still be a med student’s dream but the time-money demands of business, insurance carrier interference, malpractice rampages and peer pressures destroy that dream.  The nurse practioner is the old country doctor of today.

A story:

  • I recently had a doctor who (after I had explained that my shake began with Polio at age 19 and that it’s essential tremor, a familial shake, my mother had it and most of my children have it…) told me that it was Parkinson’s, a completely different type of shake, and in fact antithesis to essential tremor.  She took my wrist, bent the arm, percieved a certain movement in the elbow and with a smile on her face and a nod said to me:  “Yep, you have Parkinsons.”  What happened here?  It was not about me, it became an issue of her being right, the smile was smugness on her part for discovering something that she believed made her right, but perceived by a patient to be glee at having delivered a worse-than-death-sentence diagnosis.

The Nurse as Handmaid-Tart

Read why this stereotype is so wrong and dangerous for the patient…

TV, novels, films  and much of the internet portray the nurse as secondary.  As emptier of bedpans and bringer of water.  Period.  As someone killing time until she marries a doctor (G_d forbid!).

The great majority of doctors see nurses as annoyance, as threat, as hated mother and as handmaiden.  Someone once said: “Doctors treat all nurses like old dry dog shit and they treat outspoken nurses like warm, steamy dog shit.”  She was right.

In former times, the nurse was the core of a team.  Because there was no machinery, the doctor was forced to rely on assessment and information from those closest to the patient, the nurses.  They functioned as a problem solving team and physicians were not control-avoidant, they listened and together made plans, set goals and moved on to the next step.  This system worked extremely well and it was heady.

Joys of the job.

The nurse has a goal, driven by fear of failure and the absolute fun of achieving this goal AND THE PATIENT BENEFITS.  The goal is to return every body system and function to normal.  To do this, she must know exactly what is happening physiologically with the patient, assesses every change and define and watch for the next problem.  She watches pressures, body chemistry, neuro changes, heart and lung symptoms and any improvement or degeneration of status.  In addition, she gives medical treatments, medications, personal physical care, and emotional support and kindness to the patient.

She knows the status of her patient, minute to minute but she has a problem.  She can’t tell the patient’s doctor.  She can’t even tell him in private.  The best she can do is drop hints and clues… I use she for nurse and he for doctor because this defines the underlying dynamic of the exchange.  It is the same, however, with nurses and female doctors which means the dynamic is  actually about power, not gender. AND THE PATIENT SUFFERS.

And then there is the sub-text woo woo, (behind the scene and mostly invisible to the patient).  Bully managers that don’t ‘get it’, control avoidant doctors who don’t listen and administrations that have no idea what is going on in their hospital and have only one goal, money, and who make sweeping changes of doubling the nurse’s patient load to save money, (This destroys her ability to do the job correctly, a very, very expensive error.)

As for the tart!  That’s the last thing on our minds and we are generally not delicious, young, compliant and adoring subjects.  We are tired, overworked, sick of hospital politics and pissed-off.


Doctors Are Not Fond of Nurses

There are physicians who are exceptions of course and these people are precious to the patient, to the nurse and to the profession and they are deeply loved and honored.

Hospital nurses are with the patient for long periods of intense assessments. Contrary to the American myth that casts the nurse as maid /secretary /tart, nurses are extremely skilled and if education hasn’t cultivated it, experience certainly has.  So, the nurse understands the minute picture and the big picture about the patient and she knows very well what needs to be done to fix the problem.  But she is not allowed to tell the doctor (unless she wants to destroy the rest of her professional career).   She must drop hints or give information in such a way that the doctor understands the solution and believes it was his idea.

Because of this dynamic, doctors become control-avoidant, much as the child becomes control-avoidant of the parent (or in later life, the parent of the child).

  • A STORY:  Very small preemie boys often develop large inguinal hernias because the inguinal ring is sloppy and every cough or strain pushes their bowel into the scrotum.  We had a baby, born at 25 weeks and at the point of discharge, weighing over 5  pounds, with a hernia so big the scrotum was to his ankles.  We asked the surgeon why he was not fixing it and he said he couldn’t fix it until the child was 3 years old.  I asked why and he said because the epididymus (the tiny tube that sperm goes through) was so small there was risk of cutting it.  I suggested he operate with magnifying glasses so he never spoke to me again.  One morning this surgeon was making rounds, followed by residents, interns and med students and as they entered the quiet back room where this baby was, his nurse opened the diaper and shrieked:  “Oh my God, it’s going to burst, it’s going to burst. Something has to be done about this.”  and everyone ran over to the crib to see what she was talking about.  The hernia was repaired that morning and the nurse was never seen again.

Doctors treat nurses like old dried dog shit, and they treat nurses like me like warm, steamy dog shit.

Who suffers?  The patient, the system and health care costs.  This goes on in every hospital in America and it’s very, very bad.