Response to the 2013 Question of the Year
Doctors and Nurses Through the Patient’s Eyes Sueann Mark, PhD, RN
T
o understand the roles of doctors and nurses in today’s health care system requires clear expectations of the accountability, responsibility, and functions of each within the larger health care team. Ideally these expectations would be rooted in respect for the knowledge and skills of each team member and would encompass an understanding of the scope of practice for each discipline represented.1 A teambased approach to patient-centered care also demands that patients, family, and caregivers not only have a seat at the table but also are encouraged to actively engage in setting goals, evaluating outcomes, and revising treatment plans as necessary. Thus, I describe the roles of doctors and nurses from the perspective of the most important person on the patient-centered health care team: the patient. The role of a doctor on the patientcentered health care team focuses on prevention, diagnosis, and treatment of disease. Our current reimbursement system limits doctors to activities that can be billed—namely, doing procedures, ordering tests, and determining diagnoses—but this does not leave doctors with adequate time to develop a partnership with the patient. A February 2013 report by the American College of Physicians (ACP) on the state of the nation’s health care identifies removing barriers to the patient–physician relationship as one of two approaches to improving our current health care Dr. Mark is a Masters student, School of Nursing, University of California, San Francisco, San Francisco, California. Correspondence should be addressed to Dr. Mark, 2430 Balboa St., San Francisco, CA 94121; telephone: (415) 573-7395; e-mail: sueann.mark@ ucsf.edu. Acad Med. 2013;88:1614. doi: 10.1097/ACM.0b013e3182a7fae7
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system.2 Lack of time with patients is cited as a significant barrier in the ACP report, and the report implicates the increasing burden of administrative tasks in taking a toll on the physician– patient relationship. As it stands, the patient’s experience of care from a doctor is limited to brief encounters in which doctors must distill their vast knowledge of the treatment of disease into succinct statements. Opportunities to engage in lengthy conversations are often supplanted by the task at hand—diagnosis and treatment planning or monitoring. Despite the frustration that this generates for both patients and physicians, patients continue to view doctors more as the gatekeepers of health care access and less as the partners in health that they truly are. According to the Gallup Honesty and Ethics Poll, nurses have been ranked as the most trusted profession every year since 1999, when they were first included in the survey, with the exception of 2001 when firefighters took the top honor.3 This finding is not surprising, as nurses are often seen as nurturing and caring individuals; however, it is the role that nurses play within the health care team that truly demonstrates why patients hold them in such high regard. The most important and meaningful role that nurses play is patient advocate and facilitator of patient-centered care. For example, nurses are responsible for educating patients about procedures and medications. In this role, nurses must translate the complex language of medicine so that patients can actively participate in their own care. As the member of the health care team who typically has the most contact with the patient and family, nurses are privy to patient preferences that are not always directly communicated to the doctor. In this respect, the nurse is a vital bridge
between the patient and the health care team. Even when functioning within an advanced practice role, such as a nurse practitioner or a clinical nurse specialist, nurses retain their focus on the health of the patient, family, and their community to achieve health care goals. While the care of patients by both doctors and nurses revolves around the best interests of the patient and a genuine desire to relieve suffering, their roles within the context of today’s health care delivery system significantly shape how they interact with the patients they serve. From the patient’s perspective, and in the most simplistic of terms, doctors treat diseases and nurses treat people. What is most important, however, is the way in which doctors and nurses rely on each other and the expertise of other professionals on the health care team in the delivery of care. The exchange of knowledge between doctors and nurses is a two-way street, and one cannot effectively function without the other. Understanding a person’s disease requires understanding both the person and the disease, and it takes the combined perspective of doctors, nurses, and countless other health care providers to accomplish this goal. References 1 Lusk JM, Fater K. A concept analysis of patient-centered care. Nurs Forum. 2013;48:89–98. 2 American College of Physicians. A TwoPronged Strategy to Improve American Health Care: Make the Health System More Effective and Remove Barriers to the Patient–Physician Relationship. http://www. acponline.org/advocacy/advocacy_in_action/ state_of_the_nations_healthcare/assets/ snhcreport13.pdf. Published February 20, 2013. Accessed July 23, 2013. 3 Jones JM. Nurses top honesty and ethics list for 11th year. December 3, 2010. http:// www.gallup.com/poll/145043/Nurses-TopHonesty-Ethics-List-11-Year.aspx. Accessed July 23, 2013.
Academic Medicine, Vol. 88, No. 11 / November 2013
Doctors and Nurses Through the Patient’s Eyes Sueann Mark, PhD, RN
T
o understand the roles of doctors and nurses in today’s health care system requires clear expectations of the accountability, responsibility, and functions of each within the larger health care team. Ideally these expectations would be rooted in respect for the knowledge and skills of each team member and would encompass an understanding of the scope of practice for each discipline represented.1 A teambased approach to patient-centered care also demands that patients, family, and caregivers not only have a seat at the table but also are encouraged to actively engage in setting goals, evaluating outcomes, and revising treatment plans as necessary. Thus, I describe the roles of doctors and nurses from the perspective of the most important person on the patient-centered health care team: the patient. The role of a doctor on the patientcentered health care team focuses on prevention, diagnosis, and treatment of disease. Our current reimbursement system limits doctors to activities that can be billed—namely, doing procedures, ordering tests, and determining diagnoses—but this does not leave doctors with adequate time to develop a partnership with the patient. A February 2013 report by the American College of Physicians (ACP) on the state of the nation’s health care identifies removing barriers to the patient–physician relationship as one of two approaches to improving our current health care Dr. Mark is a Masters student, School of Nursing, University of California, San Francisco, San Francisco, California. Correspondence should be addressed to Dr. Mark, 2430 Balboa St., San Francisco, CA 94121; telephone: (415) 573-7395; e-mail: sueann.mark@ ucsf.edu. Acad Med. 2013;88:1614. doi: 10.1097/ACM.0b013e3182a7fae7
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system.2 Lack of time with patients is cited as a significant barrier in the ACP report, and the report implicates the increasing burden of administrative tasks in taking a toll on the physician– patient relationship. As it stands, the patient’s experience of care from a doctor is limited to brief encounters in which doctors must distill their vast knowledge of the treatment of disease into succinct statements. Opportunities to engage in lengthy conversations are often supplanted by the task at hand—diagnosis and treatment planning or monitoring. Despite the frustration that this generates for both patients and physicians, patients continue to view doctors more as the gatekeepers of health care access and less as the partners in health that they truly are. According to the Gallup Honesty and Ethics Poll, nurses have been ranked as the most trusted profession every year since 1999, when they were first included in the survey, with the exception of 2001 when firefighters took the top honor.3 This finding is not surprising, as nurses are often seen as nurturing and caring individuals; however, it is the role that nurses play within the health care team that truly demonstrates why patients hold them in such high regard. The most important and meaningful role that nurses play is patient advocate and facilitator of patient-centered care. For example, nurses are responsible for educating patients about procedures and medications. In this role, nurses must translate the complex language of medicine so that patients can actively participate in their own care. As the member of the health care team who typically has the most contact with the patient and family, nurses are privy to patient preferences that are not always directly communicated to the doctor. In this respect, the nurse is a vital bridge
between the patient and the health care team. Even when functioning within an advanced practice role, such as a nurse practitioner or a clinical nurse specialist, nurses retain their focus on the health of the patient, family, and their community to achieve health care goals. While the care of patients by both doctors and nurses revolves around the best interests of the patient and a genuine desire to relieve suffering, their roles within the context of today’s health care delivery system significantly shape how they interact with the patients they serve. From the patient’s perspective, and in the most simplistic of terms, doctors treat diseases and nurses treat people. What is most important, however, is the way in which doctors and nurses rely on each other and the expertise of other professionals on the health care team in the delivery of care. The exchange of knowledge between doctors and nurses is a two-way street, and one cannot effectively function without the other. Understanding a person’s disease requires understanding both the person and the disease, and it takes the combined perspective of doctors, nurses, and countless other health care providers to accomplish this goal. References 1 Lusk JM, Fater K. A concept analysis of patient-centered care. Nurs Forum. 2013;48:89–98. 2 American College of Physicians. A TwoPronged Strategy to Improve American Health Care: Make the Health System More Effective and Remove Barriers to the Patient–Physician Relationship. http://www. acponline.org/advocacy/advocacy_in_action/ state_of_the_nations_healthcare/assets/ snhcreport13.pdf. Published February 20, 2013. Accessed July 23, 2013. 3 Jones JM. Nurses top honesty and ethics list for 11th year. December 3, 2010. http:// www.gallup.com/poll/145043/Nurses-TopHonesty-Ethics-List-11-Year.aspx. Accessed July 23, 2013.
Academic Medicine, Vol. 88, No. 11 / November 2013
