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The Difference Between a Doctor and a Nurse

Kendracampbell572x724Kendra Campbell -- While rounding today, I auscultated a patient’s heart and then reported my findings to the resident. Luckily, I was correct in my diagnosis of aortic stenosis, based on the murmur I heard. My resident applauded my findings and then said something which offended me a little bit. He said, "see, now that’s the difference between a doctor and a nurse... You were able to diagnose aortic stenosis based on a clinical finding. A nurse would have to read the echocardiogram report to make the diagnosis." While I know that he was trying to give me a compliment, I felt that he was doing so at the expense of criticizing nurses.

Today was not the first time I heard a physician utter the phrase, "that’s the difference between a doctor and a nurse." Actually, I’ve heard many doctors use the phrase to demonstrate the ways in which doctors are superior to nurses. I’m sure sometimes doctors use the statement to simply point out the differences between doctors and nurses, but I happen to feel that the words are a bit diminutive towards nurses.

I’ve never worked as a nurse, but I did work as a technician for over three years and was a part of the nursing team. While I didn't have as many duties and responsibilities as the nurses, I did take vitals and performed other nursing types of procedures. Because of this experience, I have a good idea of what nurses go through every day. I’ve been on that side of the equation.

Now that I am a physician in training, I am on the other side of the equation. I see everything from the doctor’s perspective, and the nurses are now the ones that I ask to do things, instead of the other way around.

The conflict between doctors and nurses has been around since the beginning of both professions. Most physicians would agree that nurses can be your best friend or your worst enemy, and it’s hence a good idea to stay on their good sides. However, I’ve seen a lot of variation in the ability of physicians to interact with nurses positively.

Having been on the nursing side, I feel like I’m more hyperaware of the importance of maintaining an excellent working relationship with the nurses (and for that matter, every other member of the clinical team). I also realize that condescension and superiority complexes can lead you into precarious waters with the nurses.

Ultimately, our patients are what matter the most, and we should all be able to put aside our differences in order to provide them with the best care possible. I think it’s important to recognize and appreciate the unique contributions that each member of the team makes. I’ve seen some physicians who are quite skilled at working well with the other team members, but I’ve also seen ones who have a touch of the god complex, and can’t seem to come down from their high horse for long enough to appreciate the work of the techs and nurses, in particular.

Perhaps it would be easier if we all walked a mile in each other’s shoes. If every doctor had to spend at least a few days working as a nurse and vice versa, maybe there would be a lot more respect for each other’s jobs, and for the so-called "differences."

December 19, 2008 in Kendra Campbell | Permalink

Comments

I don't think so you need to be in other's shoes for a while to understand the their importance, it just about understanding, or moreso, being humane.

I've not worked as a nurse or an assistant but I realize how important not just for patients but for 'us'.

Its not the doctors having the sense of the superiority all the time.

Its not about the difference between a doctor or a nurse either, actually there will always be a difference between both professions (no, I am not having a bout of my 'Godly sensation' running down my nerves at the moment).

The conflict starts when we start 'disbalancing' ourselves.

The job of a nurse and a doctor are completely different. Nurses are as important as we are- so are lab assistants, technicians and all other people maintaining the health care system.

It all works out as a human body (at a less complex level that is); Your brain cannot work without your heart, your heart cannot pump effectively without a appropriately functional SA Node and your body cannot work without the blood vessels providing them oxygen. Sameways, you cannot expect the heart to give your body the orders and the brain to help you eat your food!

Nonetheless, a good point raised.

We do need to get of this self-obsession of our 'superiority' to keep the balance.

Posted by: Ume Habiba | Dec 21, 2008 2:39:56 AM

Nurses don't diagnose disease. We have our own set of nursing diagnoses that help the patient deal with the aftermath of the doctor's diagnoses. It's important that the physicians help in the patient's education by letting them know that nurses would never be making that kind of diagnosis - period. We make up a different part of the medical team that is just as important as anyone else involved in a patient's care.

Posted by: Kasey Miller | Dec 23, 2008 1:52:18 PM

As a former (and currently licensed) nurse and a medical student, I have a unique perspective on that issue as well. The fact that I am a nurse really didn't make much of a difference in the academic portion of medical school, but it has made a tremendous difference in my clinical rotations. My current preceptor in IM found out right away that I had a critical care background. In addition to being his team leader, he won't let anyone else take care of his ICU patients. Training should be put in perspective. A nurse may not be able to diagnose aortic stenosis on physical exam, but a nurse is also not trained to do so. An experienced nurse will be able to inform the physician that indeed a murmur or extra heart sound is present and by looking at the patient know when an emergent call to the doctor is indicated. In the hospital where I am currently, the nurses and ward clerks have a tendency to blame the medical students for anything that goes wrong (namely, where IS that chart??). I don't remember ever treating medical students that badly as a nurse. However, anywhere we are as students, and later as physicians, every person on your team demands a certain amount of respect. In order to get respect, you have to be big enough to give it when no one else will.

Posted by: Erin | Dec 23, 2008 2:53:06 PM

Nurses are technicians, not scientists or professionals like doctors are. The comment was not diminutive towards nurse, it was factual. Nurses have a fraction of the healthcare training that physicians have. A nurse couldn't work a few days as a doctor.

The "conflict" between doctors and nurses hasn't been there from the start of both professions; it is a recent phenomenon which has come with nursing's attempt to encroach on the professional scope of physicians without adequate training.

Posted by: Justin | Dec 23, 2008 4:08:57 PM

Comments that diminish one to elevate another are not the correct thinking. Most of the doctors I know still think they are gods- one kept telling me he was an orthopaedic surgeon like I should kiss his feet. Sorry, mutual respect is due, not worship of one group over another.

Posted by: Nadia | Dec 23, 2008 6:10:41 PM

Justin.....Justin...Justin.....I look forward to your experiences with nurses in the future. Wish I could be there.

Posted by: Nancy Chardt | Dec 23, 2008 6:30:53 PM

I am an RN and the comment "encroaching upon the physician's scope of practice" rang a bell with me. This was a truthful statement. Many of us who are experienced nurses have been shoved into what previously has been physician's territory. I would like all of you to know as nurses we are feeling forced to work beyond our training due to the sheer speed, and volume of patients being forced through our hospitals. Methodologies in use such as the Toyota LEAN production continuum strategies, as well as the current patient demography is making it not only unsafe for patients - but if you are all honest, these factors are pushing all of us to our limits of knowledge and tolerance. I am sorry that we must bear this. It will only become worse as the economy continues to equalize. We will be needing each other more with each passing month just to survive the call to service we have accepted in this turbulent global shakedown.

Posted by: Jaye | Dec 23, 2008 8:42:59 PM

Sounds like Justin is trying make somebody angry to start an argument

Posted by: Tom | Dec 24, 2008 7:00:40 AM

My first hands on introduction to the medical field was as a translator. I was able to be the voice of both doctors and nurses in their various roles. As a result of that experience, I decided to become a certified nurse midwife.

The educational expectations of doctors and nurses are different and hence so are the clinical responsibilities. It was the overwhelming arrogance of the doctors that made me decide to pursue advanced nursing instead. My character is not so strong that I felt I could avoid becoming like the doctors I translated for: believing I am better than the nurses, pharmacists and patients.

There are wonderful, humble doctors and I am friends with several them. It is just sad they seem to be the exception to the rule. We are all no better than the person we treat the worse.

Posted by: Amber | Dec 24, 2008 8:28:00 AM

AS a nurse for 27 years, a nurse-midwife for 4 and a nurse-educator, I feel I have to comment. The provider-nurse relationship should be a team. The nurse is present for long periods of time and can offer professional, informed assessment of the patient's condition over that time, the responses to medications, and their functional ability. Being there for long periods of time, we can offer situational perspectives and relevant family information that may not be apparent by being in the room for 10 minutes or asking questions.
Patients don't always know what is pertinent. Nurses do. Nurses give important information that ADDS to the quality of care.
As a nurse-midwife, I take care of normal, healthy women. I am more than happy to refer those who have problems to the obstetrician, so I am not "encroaching upon the physician's scope of practice". I love a good physician, and a good physician knows that they don't need to denigrate what I do as a nurse or as a nurse-midwife in order to elevate or enhance what they do.

Posted by: Marianne Moore | Dec 24, 2008 9:15:46 AM

Justin,
I am a psychiatric nurse practioner and a pediatric nurse practitioner. Nursing is not trying to encroach upon medicine. The lack of qualified health providers has necessitated other professions to fill in the void. Not once have I assumed to be a MD,nor would I want to practice without a team of psychologists/psychiatrist; health providers work better as a team. (Have u ever watched HOUSE). How many residents want to go into child and adolescent psychiatry or are eager to manage bipolar patients.
Instead of generalizing to the whole population of nurses, it may be wiser to treat each situation individually.

Posted by: Sue | Dec 24, 2008 9:23:50 AM

One thing i know: we do most of thinking and they do most of the working..that's why always pay respect to the nurse..they work more physically than doctors..and if nurses feed you with vital information about the patient then they are indispensable...

Posted by: Oscar | Dec 24, 2008 11:04:36 AM

being a current RN and in medical school, i regularly get questions about the differences between RNs and MDs. it's funny to me how both groups of RNs and MDs who bring up the differences issue seem to have (stereotypical) biases against the other group, mostly to point out what the other group is missing (MDs who comment on their depth of training vs RNs who comment on the "poor" therapeutic communication skills of many MDs). i can't understand all this defensiveness from both groups as it is clear that their education was tailored so, in order to meet the different needs of the patient. i agree with Kasey M that nurses have their own diagnoses that are different from MDs'. this diagnosis of the "human response to illness" by the nurses vs the diagnosis of the illness itself by the MDs is just as important to the patient's management and recovery, who is after all, the most important member of the health team.
and i am biting the "nurses are not scientists" statement. while i chose nursing to be my premed over the other sciences, my experience with nursing students and their critical thinking/reasoning and interpersonal skills in the clinics and in their research work, leave me with a deep respect for their training. at this point, most medstudents i met are pretty good with spouting off words from the textbook, but i have not yet worked with anyone who was able to think and answer well on their own two feet. but yes, we do have more years of studying. :-)

Posted by: maia | Dec 24, 2008 11:45:24 AM

Nice post and a valid point. You'll be happy to know that some medical schools require students to do a nursing attachment as early as the first year as they recognise this is an invaluable experience for the students.

Posted by: - | Dec 25, 2008 8:48:22 PM

good cooperation between doctors nd nurses gives the chane for good health care and assesement but ths cooperation may be broken by individual's behaviour as many health workers r arrogant and cooperation may be so difficult.

i work in nephrology department as a resident ,nurses are so important in this section and have a great value in helping patients as they are near to the patient all the time while the doctors make round check up all the day .

so god cooperaion between doctor and nurses make strong network of knowledge about the atiet and patient's background.

Posted by: ahmed | Dec 26, 2008 12:09:23 AM

Hi, I'm a female physician and my husband is a nurse. We have a wonderful relationship both at work and at home. How about that?

Posted by: Martine | Dec 27, 2008 5:01:13 PM

I am a 4th year med student, as well as a nationally registered paramedic. I am married to an NICU/ER nurse. We have lived through most aspects of this argument, and we both agree that each profession depends on the other. The nurse is the final safeguard for the implimentation of the orders that we physicians give. We should all keep in mind that it will most likely be a nurse that saves our @$$ when we screw up on the wards.

Posted by: Richard | Dec 27, 2008 10:21:41 PM

I have to put in my two cents as a nursing student, I dont think for a second the nurses are being left out where credit is due.

Most people understand that there is a differense between nurses and doctors, that would also explan why there are different stste board test foe each, I know that there are some doctors who might sound like they are the gods of medicine, but face it they really have reality checks! I feel like doctors understand how hard nurses are working and a what great jobs they are doing and also nurses understand what responsability that the doctors have . So why not admit it nurses and doctors could not make it without the other and we should all just get aalong and put the clients first . I indeed have the upmost respect for nurses and doctors, if it was as easy as it sounds then we would be over the demand for nurses insteed of needing alot more nurses.

Posted by: linda | Dec 27, 2008 10:55:21 PM

i am currently in my final year of med school and i must say i have had the chance to work with nurses practically throughout- during my nursing atachment and on the wards now. i value the role of nurses- it was a nurse that taught me how to suture, it was a group of nurses that convinced the surgeons i worked with to assist at surgeries, it was nurses that taught me how to inject, set up infusion lines etc. for me nurses are as important as doctors and in the wards where they are there with the patient for most of the time the patient is on admission they may play an even more important role. i have known some nurses who have saved many a doctors backside by correcting certain treatment regimen. the two professions should learn to treat each other with respect since we need each other to deliver the best of care to the patient

Posted by: Dickson | Dec 28, 2008 4:23:14 AM

all i can say is in the hospital where im in, they doctors and nurses more or less respect each other, while leaving the med students and interns out of that picture. and it hurts to be blamed for any and every mishap (i.e. the missing chart) or disturbance, when actually you are, albeit temporarily, part of the workforce. i am not generalizing, it's just how it is where im in. you sometimes function as a nurse, while at the same time you have to think as a doctor. frankly, there were times when i had to ask myself, 'is this still part of my job, or am i already beyind my job description? what precisely is my job description anyway?'

Posted by: | Dec 28, 2008 8:52:15 AM

I really enjoy your site,because it gives me a very good insight of how to live and how to live my life.I just to say that continue the good work you are doing.
Thanks

Martins Foster.

Posted by: Martins Foster | Dec 29, 2008 12:56:35 PM

While it must always be borne in mind that every healthcare has a unique contribution to the overal management of the patient, it also must be realized that changing social realities necessitates that the dividing lines between the profesions undergo changes as determined by the context of practice. In Nigeria and India, for instance, patients request for laboratory teests on their own volition in rivately owned and licenced laboratories, and by consequence the laboratory scientist issuing the results finds himself making decisions that would normally have been taken by a physician in the hospital setting.I have also seen scenarios where one person is forced to act as both physician and nurse ...

Posted by: Sylfad | Dec 31, 2008 8:42:16 AM

Nurses are helpers and slaves of a doctor..i'm also a nurse,then lets accept the fact that we only carry out orders of physician.........

Posted by: jopetcute | Jan 5, 2009 7:26:35 PM

Hi Gendra,

This is a nice article and explained the practical thing. I have observed in developed countries that doctors are simpler than in developing countries. In developing countries doctors are respected by patients and society like the God. This is not the doctor’s fault but the tradition. When I was student I felt many times, it’s Ok to respect like that because they were taking that much responsibility and care in those poor patient’s management with the limited facilities. Same time nurses also do their job in same way.

I have few years experience in working as a doctor in developing country in hospital setting. If you didn’t get along well with nurses, very difficult to do our job well. There, nurses were over loaded with work. Some times I had done their work for e.g. C&D in surgical ward when I was working as SHO. During that time I have noticed our small initiation and participation gave lot of inspiration to them, especially when shortage of staff or heavy post admission day. Team sprit do a lot in our duties. If I recalled my working period, when I was starting residency I have learnt many things from nurses, then each and every accomplishment in my duty their participation was there. Most of the time we treat the paper they treat the patients.

Still I remember one incident; around 1988/ 1989 I had been working as a GP in a doctor office with 2 nurses. Actually they are nursing assistance, their duty dispensing medicine and helping me. I still remember their tea; I can’t make that kind of tasteful tea. Those days no more internet and computer so my brother some how got a form for USA lottery Visa, getting the form in my country was very difficult and people are not giving to others because of big competition. He had sent one copy to me. One day evening I took the form to my work place to fill it out. While I was reading the form these people asked me what is this. I had explained and asked them if you want you all could apply only thing you have to take 2 photos. They are good with me so I pushed them little bit. One person said I don’t have money for photo, fortunately I got some money in my purse so I had sent them to take the photo and gave 2 form to them.

Those days our country situation was terrible and I was wished a lot to win the lottery. Ultimately one of the nurses won the lottery and came with her husband to USA around 1990/1991. She doesn’t know about this Visa and never dreamed USA life. This is the way luck work. Some how I came to North America in 1994. Though I live in neighboring country I have no contact with them, but I wish to let them know that I am here. When I recall nurses and doctor’s relationship this came to my mind.

Posted by: Pat | Jan 7, 2009 4:10:21 PM

actually ,truely...sometimes i can see that,some nurses hate medical student...why/i'm oso do not know...probably they have been scolded by doctor...But sometimes doctor also had been scolded by nurses especially junior doctor,,,as a med student,i have alot of experience about being hated,and scolded by nurses without no reason...For example,when we copying bed head ticket,they suddenly said they one to make a notes.But they are n't...Actually we need each other...doctor and nurses....some nurses quite a good teacher..They teach me about wound dressing..bla bla bla...sometimes patient prefer nurses doing dressing not by the medical student!!huh,see how amazing the nurses!so as a doctor wanna be,just learn from the good side of nurses.....respect them,so they can respect us...No superior or inferior...forget about this>>>...

Posted by: fuyoo | Jan 11, 2009 8:20:48 AM

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