monkeyfrog asked: Nurses have an entirely different approach and philosophy from doctors. Our tasks overlap, but the approach is so different on some issues it's like choosing between a surgeon and a chiropractor. The biggest problem the nurses I know have with doctors is close minded arrogance, not knowledge problems. Just ego. I could go on at great length about this, having worked in hospital, clinic, and home health environments.

Thanks so much for responding. This is so helpful. And I wish you would go on about it at more length, it’s an important dialog.

My research included a number of nurse practitioners and physician assistants but only one nurse, an advice nurse. I had some great conversations and interviews with the NPs and PAs about their roles, and I absolutely agree: Based on what I learned in this experience, the approach and philosophy is different. This is why I think there can be a real symbiosis between NP and physician, or doctor and nurse, or any configuration. I saw it happen. I’d like to talk more about it, so maybe you and I can talk about it here together.

You hit on two really important points: close-minded arrogance and ego. I have given a lot of thought about them, and they are worth a larger discussion. They relate to two points I made in my previous posts. The close-minded arrogance relates to the idea of professional knowledge and credentialing. Whose knowledge is it? Who is “the doctor” and who is not? I think we even see it between specialties of doctors. I’ve seen specialists dismiss generalists in very arrogant ways, and vice versa. 

The ego issue is connected to the idea of the whole system, and how we begin fixing it at the top. I try and separate out “healthy ego” - the confidence and ability to trust in one’s self and decisions, something I think is important in any professional practice, particularly one in which a person has to make life and death decisions - from “unhealthy ego,” the kind you’re talking about here. 

Not everyone who wants to become a doctor does. I think Ian Welsh’s point about schools sometimes not admitting people who care too much is true, as well as about medical schools grinding down the care out of people. So the selection bias on ego may be skewed slightly. Medical school, internships, and residency are all about plucking the best and the brightest and dropping them back to the bottom of the totem pole and pushing them to climb back up, repeatedly. What does that to to your ego? It either breaks it or builds it up substantially. Plus,  what is taught in medical school and beyond is the antithesis of teamwork. Sure, making a mistake in medicine is about someone’s life, but in medical school it also means you’re an asshole. It’s an opportunity for public humiliation. So the ego becomes a protective mechanism, and this is on top of an already fairly strong ego.

This isn’t to defend doctors, because I really do believe there are a lot of  naturally egotistical jerks in the profession. I also happen to believe there are a lot of egotistical jerks in every profession. But it’s also a huge problem within the training process, the credentialing mechanism. There has been a fairly recent movement to focus on and teach teamwork in medical schools, because that’s how it should be. Few patients, over the course of their lives, see only one provider forever, and no provider works in a vacuum. Doctors, nurse practitioners and nurses, physician assistants, medical assistants, support staff, and the patient - team effort.