Nurse's Station

“A Patient’s-Eye-View of Nursing” – Did you read it?


iStockphoto | ThinkStock

iStockphoto | ThinkStock

In the February 6 issue of The New York Review of Books, Dr. Arnold S. Relman wrote about his recent medical emergency (he cracked his skull and broke three vertebrae in his neck and more bones in his face) and what happened to him during his time in the hospital.

Why is this news? Well, Relman, 90, has taught hundreds of young doctors at Boston University, the University of Pennsylvania (where he was chairman of the department of medicine) and Harvard. So he’s of great importance to the medical field, though he hasn’t spent a lot of time as a patient…which is part of what makes his testimony so interesting.

Lawrence K. Altman of the The New York Times wrote about Relman’s view of nurses in his recent story, “A Patient’s-Eye-View of Nursing,” and we thought it would resonate with you.

Here are some excerpts from the article:

“Amid the disciplined medical havoc, his heart stopped three times. Resuscitation efforts saved his life, but at the cost of several broken ribs. His condition remained precarious as he developed complications and endured still more medical procedures.

Astonishingly, he lived to write about all this. After a painful 10-week hospital stay and months of rehabilitation, he can walk — gingerly, with a cane — and is largely recovered, with his mental faculties intact.

His riveting account of the medical adventure is a testimonial to the best emergency medical care and a tremendous will to live. At the same time, however, it betrays a surprising lack of awareness of some critical aspects of the medical profession and the nation’s fragmented health care system.”

He continues…

“Despite decades as a medical educator, researcher, author and editor of The New England Journal of Medicine, Dr. Relman confesses that he ‘had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled.’ Nor did he appreciate the hypnotizing effects of technology, which robs patients of the physician’s bedside manner and affects the training of younger doctors.

How is it that a leading medical professor like Dr. Relman — who has taught hundreds of young doctors at Boston University, the University of Pennsylvania (where he was chairman of the department of medicine) and Harvard — might not have known about the value of modern-day Florence Nightingales?

A number of doctors who have talked to me about Dr. Relman’s article suggest that the culture of medical education may be largely to blame. For example, younger doctors in hospitals spend part of the day on rounds, following professors in their long white coats. Many of these august figures are supremely confident in their observations and opinions; others are more compassionate.”

And gets to the heart of the issue for nurses…

“But technology’s monitors, images and devices can deflect that doctor’s attention, as Dr. Relman learned when he reviewed his hospital records and the notes he wrote to nurses and his wife, Dr. Marcia Angell (particularly while he was unable to speak because of the breathing tube).

Instead of descriptions of his appearance and feelings, the doctors’ progress notes in his electronic medical records were filled with technical data.’Conversations with my physicians were infrequent, brief and hardly ever reported,’ he wrote, adding:

‘What personal care hospitalized patients now get is mostly from nurses. When nursing is not optimal, patient care is never good.’

Many hospital administrators have cut nursing staffs. They say it is to make ends meet; many doctors say it is usually to increase the bottom line.”

And concludes…

“Nurses’ observations and suggestions have saved many doctors from making fatal mistakes in caring for patients. Though most physicians are grateful for such aid, a few dismiss it — out of arrogance and a mistaken belief that a nurse cannot know more than a doctor.

In many ways, Dr. Relman’s insights reflect changes and generational gaps in training doctors, nurses and other health professionals. Because these disciplines have traditionally been taught in separate silos, they often do not work as tightly as they should.

Now, as health care financing changes and doctors spend more time training in outpatient settings, a growing movement demands coordinating the education of health professionals to prepare them to work more smoothly in teams. If these efforts succeed, perhaps the next generation of doctors will no longer be surprised at the importance of nurses and other allied professionals.”

Read the entire story here, then tell us: Are you amazed that it took Relman this long to get a real sense of the value of nurses, or does this not surprise you? Did you read his original story? Share your thoughts in the comments below.

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