In the latest issue of The New York Review of Books, eminent medical educator and editor Arnold Relman detailed his hospitalization and recovery from a serious accident. Despite spending six decades in medicine, Relman writes that it wasn't until he became the patient that he truly understood "how much good nursing care contributes to patients' safety and comfort."
Writing in the New York Times' "Well" blog this week, physician Lawrence Altman asks: "How is it that a leading medical professor like Dr. Relman… might not have known about the value of modern-day Florence Nightingales?"
Altman spoke with a number of doctors about Relman's inpatient ordeal. Relman's article is a "testimonial to the best emergency medical care and a tremendous will to live," and at the same time "it betrays a surprising lack of awareness of some critical aspects of the medical profession and the nation's fragmented health care system," Altman writes.
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Relman: A patient's-eye-view of nurses, doctors
Relman was rushed to Massachusetts General Hospital (MGH) in Boston after a fall down the stairs left him with a cracked skull and three broken vertebrae. At the major teaching hospital, students, interns, and residents provided the 90-year-old physician with around-the-clock treatment. Later, he moved to a rehabilitation hospital, where he described the nursing care as "sometimes excellent but often inadequate" and noted that no single physician appeared to be taking charge of his case.
Reflecting on what he learned from his hospitalizations, Relman wrote that physicians "now spend more time with their computers than at the bedside." As a result, "What personal care hospitalized patients now get is mostly from nurses."
He explained, "I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good."
Altman: Why doctors underappreciate nursing
In Altman's discussions with other physicians, many suggested that the culture of medicine may be responsible for physicians failing to understand the value of nurses, and training is an important component of that care.
For instance, young doctors are trained during rounds in which they follow physicians through the hospital as they teach and impart wisdom that will have a major impact on how doctor trainees practice medicine for years to come. During rounds at MGH, many physicians preferred to remain in the hallway outside the patient's room, relying on test results and vitals to plan further care.
This behavior can appear "impersonal, perceived perhaps as a way of shielding bad information," Atlman notes, adding that instead of going to the bedside, physicians rely on nurses for the "crucial elements in patient care—the physical touch and the personal touch."
Further complicating the matter is the recent surge of medical technology, that has made work "vastly more complicated" for hospital staff, Altman says. "[T]echnology's monitors, images, and devices can deflect [a] doctor's attention," as evidenced by Relman's hospital records, which Relman described as consisting mainly of technical data and little descriptions of his actual progress and mental state.
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"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," Altman writes. But as efforts to increase care coordination pick up steam, "perhaps the next generation of doctors will no longer be surprised at the importance of nurses and other allied professionals" (Altman, "Well," New York Times, 2/10; Relman, New York Review of Books, 2/6).
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