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.

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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.

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