Whatever people say I am, that's what I am not

March 12, 2006 -- Today the Sunday Times (U.K.) ran a piece by Sarah-Kate Templeton that was completely unbalanced, but well headlined: "Doctors spit blood over plans to let nurses operate." Of course, physician opposition to the expanding responsibilities of advanced practice nurses is hardly novel. But the U.K. government's plans to permit nurses to perform what the piece calls "routine" operations have led to reactions from physicians at the Doctors.net.uk web site that reveal far more about the speakers than they do about nurses. (Readers may recall this site as the source of many physician comments praising Mattel for its "Nurse Quacktitioner" doll.) Now the Times reports that hundreds of physicians have expressed support for comments on the site including suggestions that nurses are as "stupid" as Beavis and Butt-head, that the British Medical Association (BMA) should "put the boot in," and that allowing nurses to perform "minor" surgery is like letting "air hostesses" fly planes. The Times fails to include any response whatsoever from nurses. Perhaps the paper thought the physician comments were so extreme that they undermined themselves. Indeed, the comments are oddly reminiscent of a Beavis and Butt-head exchange ("Nurses suck." "Yeah. Heh. Heh heh heh."). But the public continues to hold physicians in such high regard that the comments merit a response. For example, the Times might have found someone to explain that nurses are in fact educated health professionals who save lives and improve patient outcomes every day--sometimes by deftly working around attitudes like those festering at Doctors.net.uk--and that research overwhelmingly shows that the care of advanced practice nurses is at least as good as that provided by physicians.

The Times notes that the physician comments were made in response to National Health Service plans to give nurses "the right to carry out routine operations." It goes on to explain that government reforms allow nurses to do surgical tasks "previously performed by junior doctors," including "investigations into the gullet or stomach and minor surgery to remove small lesions, benign moles and cysts." The piece says that nurses doing these things "are often called nurse practitioners or nurse consultants." The piece notes that "nurses are also starting to prescribe medicines," an apparent reference to plans that caused an uproar from U.K. physicians last year. Physicians are "particularly concerned about a new grade of NHS staff called medical care practitioners," who will reportedly be "nurses or science graduates who have carried out two years of training." The piece does not explain what that job entails, how many total years at university would be required or how many in health science, or how many years of university training U.K. nurse practitioners typically receive.

At the heart of the piece are some actual physician comments on nurse practitioners from Doctors.net.uk:

"I would not have anyone who is not medically qualified doing any sort of medical procedure on any member of my family."

"I want the doctors to do the doctoring and the nurses to do the nursing. Old-fashioned I may be, but would you let an air hostess fly the plane with your family in it?"

"A nurse who learns how to do a carpal tunnel (an operation to release trapped nerves in the wrist) instantly thinks they are the best thing since sliced bread. Unfortunately, they do not realise they have a tad more to learn than one uneventful procedure before becoming a surgeon. In effect, they are stupid but don't realise it. Just like Butt-head."

According to the Times, "[m]ore than 130 doctors [on the site] agreed" with this last comment, and "more than 200 postings" supported a physician who "urged the BMA to 'put the boot in.'" The piece also includes physician suggestions for ad texts the BMA might run:

"For financial advice I don't ask a bank teller, I ask an accountant. For legal advice I don't ask a policeman, I ask a lawyer. For medical advice I choose to speak to a doctor."

"Top grades at A-level, five years of university training, then a minimum of three years further practice. Make sure you take your advice from someone who has done their [sic] homework."

The comment about five years of university strikes us as somewhat comical, given that the 140,000 U.S. nurse practitioners have at least 1 year more than that, and some have 5 years more than the UK physicians, along with many years of relevant bedside experience. In any case, the piece reports that the BMA is in fact creating a "Who's Who" campaign to "inform the public of the rank and qualifications of the NHS staff treating them." The piece says this campaign is "unlikely to run such hostile adverts" as appeared on the site. It's unclear from the piece whether the BMA plans to inform the public of the "rank and qualifications" of professionals other than physicians, or how the BMA might go about determining the supposed "rank" of different health workers. The piece does include a quote from BMA representative Alan Russell: "Patients should have the right to be treated by a qualified doctor."

Responsible policy discussion of such reforms would seem to entail information about what is actually being proposed, and whether the personnel in question are qualified based on their demonstrated skills and any available research. This article contains little of that, but in fact, a great deal of research confirms that nurse practitioner care is at least as good as that provided by physicians. Of course no one should be permitted to assume professional responsibilities for which he or she is not qualified, but we see no evidence that that has occurred here. It seems safe to say that when the discussion of these issues is dominated by playground insults and specious analogies, it is more a product of fear and ignorance--you know, a "failure to do your homework"--than of reason. Perhaps it is not surprising to find that such views are so widely held on a site that is largely closed to the public, and that can thereby insulate its elite membership from facts and developments that do not fit its preconceptions. More to the point, the above comments seem to reflect the baseless assumptions that only physicians can perform the tasks they have traditionally performed, and that nurses lack significant knowledge of relevant health areas simply because they are not physicians, or perhaps because they are automatically "stupid."

However, nurses have a great deal of the health care knowledge that physicians have, and a great deal of health care knowledge that physicians do not have. Nurses are trained in a holistic care model that has been proven highly effective in the detection and management of both acute and chronic conditions. Nurses consider the patient's overall, long-term interests. They are trained to listen, and to communicate effectively. Perhaps these factors help explain why advanced practice nurses are able to achieve results that compare well even to that subset of physicians who have more years of formal university training. As for the analogies to other jobs, we would observe that advanced practice nurses undergo years of rigorous university training to do exactly what they do, which is provide excellent health care. We are not aware that flight attendants receive years of rigorous training to fly planes. If they did, then they would presumably be qualified to fly planes.

We encourage Ms. Templeton and the Sunday Times to consider whether the objects of vicious, unsupported public slurs like those that dominate this article are entitled to some opportunity to respond. Old fashioned we may be, but we just want the journalists to do the journalism.

See the article: Doctors spit blood over plans to let nurses operate" by Sarah-Kate Templeton in the March 12, 2006 edition of the Sunday Times of London.

Send your comments to Sarah-Kate Templeton at comment@thetimes.co.uk

We are sorry that we don't have any email addresses for the physicians quoted in this article. The doctors.org.uk subscription policy requires that you be a medical student or physician in order to access the site. As we suggest above, this insular approach may help explain the sad lack of understanding of nursing that many of the site's members display. Be assured that we have made our thoughts on their behavior available to them during our Mattel campaign.

You can also translate this Center for Nursing Advocacy page from English into your own language by clicking on the appropriate flag on the right.