Doctors and nurses: doing it differently

Abstract

Research evidence How are the professions responding?The contributions to both journals this week, ranging from research to analysis to opinion, display a multitude of perspectives. The research shows that nurses can do some of what doctors do, usually to the greater satisfaction of patients.5–8 The research also shows that nurse consultation over the phone can safely reduce hospital admissions for both adults and children and save NHS costs and that there seem to be high levels of satisfaction with NHS Direct, a system of nurse run telephone triage.9–10 Some of the commentators think medicine is not changing, or only reluctantly, or that change is being imposed from outside by political expediency. Others argue that nursing has changed substantially in the past 20 years and, sacrificing manyof its best values and practices, has lost its way. There seems to be a sense that the core dynamic is thesame: nursing, for all its new independence and expertise, is still dancing around the medical maypole. These are complex issues, too often reduced to crude simplification because the relationship is so emotionally charged.Nurses, more assertive, educated, and competent than ever before, resent what they see as continuing put downs by a profession holding all the cards. Doctors, puzzled and unaccustomed to being challenged, are themselves resentful at the apparent undervaluing of their competence, knowledge, and skill by nurses, the public, and policymakers. Everyone is confused. In preparing our joint issues we have had the invaluable help of a guest editor who belongs to neither tribe but who is a close observer and critical friend of both. Celia Davies, professor of health care at the Open University, argues that the stranglehold of gender thinking must be loosened and the old doctor-nurse stereotypes must go.11 For decades we understood the professions as a conventional nuclear family, with doctor-father, nurse-mother, and patient-child. But our hope for total wisdom and protection from father is forlorn, our wish for total comfort and protection from mother unachievable, and the patient has grown up. A new three way partnership should displace this vanishing family. Changes in relationships within health services are, of course, being driven by broader changes. Women are increasingly powerful in most sectors, and the medical profession now includes many more women. At each level of the medical hierarchy women now make up a higher proportion than they did a decade ago, and this trend will probably accelerate. This offers the potential for different kinds of relationship and practice and starts to undermine the equation of female sex with low status. As we asked in our joint editorial last August, 12 how can the professions forge good working relationships in a context where an opportunity for one becomes a threat to the other? Commitmentto open minded dialogue from both professions' leaders would be a good starting point. They need to understand how the past is shaping the present and tackle the inequalities which still mediate the relationship.