In its issue of April 15, the British Medical Journal started a discussion
of the complex relationship between doctors and nurses, and how it was changing
in the light of new shaping of the National Health Service. The differences
of power, perspective, education, pay, status and gender between professions
have created a state of tension over the years. A two-tier system of health
carers has become inevitable in the face of the readiness of nurses to give
way when challenged by the doctors, who stoutly maintain their supremacy and
undisputed authority when it comes to clinical decisions. Indeed, doctors as
a class have recently been described as arrogant and inconsiderate, whereas
nurses have generally been seen as sympathetic and caring.
Some of what doctors have traditionally done in managing the interface between
disease and treatment in the presence of the patient is now done by nurses.
The change has not occurred without some resentment on the part of the doctors,
and it has demanded much assertion on that of the nurses. This is a pity, since
it tends to impair the collaboration of professions which should be directed
towards offering sick people the maximum benefit with the minimum of delay.
It is generally recognised, except by the diehards in the professions, that
transformations at present being undergone in concepts of health care must necessarily
alter the balance of power in the interests of progress.
Letters published in the September 16 issue of the BMJ indicate a diversity
of opinions and emphases, some rather patronising, others more constructive,
on the subject of interprofessional relations. On principle it is suggested
that differences in professional roles in health care, and not the common factors,
are what makes interprofessional collaboration a powerful factor for good. If
the role of nurses is no longer to be the handmaidens of omnipotent doctors
exercising unchallengeable supervision, there might be a case for creating another
group of health care workers of intermediate status, perhaps medical students.
Educational differences between doctors and nurses are no longer sufficient
to create a distinction, and differences of salary are no fit excuse for a differential
status.
A similar change of emphasis is taking place in the more extended area where
doctors, nurses and pharmacists are concerned in interprofessional activity.
It seems that the differences in the consulting time available from different
professionals influences the shape of things to come, and those in turn are
determined by the availability of suitably trained doctors, nurses or pharmacists.
Doctors have at present extremely limited time available for consultation, and
so tend to displace some of their functions on to nurses or pharmacists. This
situation demands very careful forward planning, and cannot be devoid of friction.