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Dr. Kevin Pezzi presents an

If you're a nurse who thinks I'm being overly critical of nurses, you might want to read this discussion by a person who was a nurse before he was a doctor.  Therefore, he's been on both sides of the fence.

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I'm probably wading in pretty deep, but here goes.

Many years ago before I was a doctor, I was an ER nurse.  When I realized that what I really wanted was to take the responsibility for the entire patient, I went to medical school because that's the way things work in this country.  While a nurse, I never felt any "collegiality" with the doctors — they had their duties, I had mine, and we both worked for the benefit of the patient.  If they had things to teach me, great.  I was a willing student and learned much.

But familiarity breeds contempt, or at least a "shared equality" which is anything but equal.  In the last few weeks I've had nurses tell me, "I knew you should have intubated that patient earlier," "I knew that patient had a dissecting aorta" (when nobody, including the intensivist, cardiologist, or surgeon knew any such thing), and, when a patient last Sunday suddenly dropped his pressure and went into a-fib, "I thought that was a pulmonary embolism when he hit the door" (with a set of vague complaints which matched absolutely nothing).

The retrospectoscope is a marvelously accurate tool.  Unfortunately, it's of no help in the present tense, and causes mostly resentment if used in the past tense.  I would love nothing more than to be right 100% of the time in the present tense, but that will never happen.  That's why I subscribe to Emergency Medical Abstracts, Audio-Digest, Topics in Pediatric Emergency Medicine, Critical Decisions in Emergency Medicine, Medical Letter, Journal Watch, Annals, AEM, JEM, EM News, etc.  That's why there are well-thumbed copies of Rosen & Barkin, Tintinalli, Roberts & Hedges, Nelson's Pediatrics, etc. on shelves in my ER (and rarely looked at by the nurses, I might add).  That's why our department on-line computer has bookmarks for emedicine, eMedHome, NEJM, BMJ, Pub Med, NCEMI, etc. (if I can get access to it, in which case the comment is "There's Mark...playing on the computer again").  That's why I am active in Emergency Medicine organizations at the local, state, and national levels.  That's why I'm on this list . . .

. . . and that's why my malpractice insurance runs about $30,000 / year, because I can never be right 100% of the time.

I've worked with some damn good nurses whose opinions I've learned to respect and trust, but they had to earn that trust.  I expect to earn trust and respect from nurses in the same manner.  But this malarkey about "Listen to the nurse, because the nurse knows" is hard to swallow.

And yeah I wasn't going to say anything, but this IS a topic which needs to be discussed.

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Incidentally, when I wrote to request permission to quote him, the author of the above discussion wanted anonymity.  His reason for that is quite pithy:  "Anonymous only, please, but you may quote.  Remember Rule #1 of the ER:  1. Nurses can hurt doctors far worse than doctors can hurt nurses."

He's correct about that, and fear of retribution has kept many doctors from speaking out against nurses even when nurses have made serious errors.  Why can doctors be so cowered?

Rule #2 of the ER:  There are always a lot more nurses than doctors.
Rule #3 of the ER:  Nurses occasionally fight amongst themselves, but if there is discord between a nurse and a doctor you can bet your last dime that the nurses will band together to assail the doctor.
Rule #4 of the ER:  Cognizant of the above, ER doctors bend over backwards trying to avoid conflict with nurses.

Believe it or not, but I'm not anti-nurse, nor are most doctors.  Physicians are generally appreciative of the work performed by nurses and we give respect when it's due.  Personally, I can think of several nurses that I hold in such high esteem that I think their faces should be chiseled into Mount Rushmore alongside those of Presidents Washington, Jefferson, Roosevelt, and Lincoln.

I received this e-mail from another doc who used to be a nurse:

I was a nurse for ten years before I became a doctor.  While I was a nurse, I often thought I knew just as much as the doctors, and so did many of the nurses I worked with.  Then I went to medical school.  Let me tell you, it was hard . . . REALLY hard.  If I'd known as much as I thought I did, I guess it wouldn't have been such a challenge, right?  Having been both a nurse and a doc, I know what nurses know, and I know what doctors know -- and I know there's a world of difference between them.  So, Pez, I have to say I agree with you that doctors do know more.  In retrospect, it's amazing that anyone would doubt something so obvious.  This probably won't set too well with your readers who are nurses, but I have one thing to say to them:  go to medical school, and THEN tell me you really think nurses know as much as docs.

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