Well today, the floodgates did indeed open, and the Doctor vs Nurse debate broke out in the blogosphere. It all started with an angry nurse who posted a rather inflammatory comment about a patient being unnecessarily sent to A&E. She diagnosed the patient as having Quinsy, but showed little sympathy for him hollering for the paramedics after a little inflammation:
"Excuse me sir - could I have a look at your throat? What's that I see? Inflammation? Things with pus in clinging to other red swollen things?Ever had tonsillitis? Oh you have ? And it was just like this except this is worse?"
Quinsy is indeed an emergency, but to be unable to have even done the most basic of examinations before getting all excited and calling the blue light boys....well.(this Nurse Ratchet is not to be confused with the nice Nurse Ratched in my links, who thankfully keeps her diagnoses to herself.)
Not only that, but in a previous post she makes very clear her opinion of doctors:
For too long now Nurse Ratchet has been reading blogs by erstwhile members of the Medical profession; and while the views and observations on the whole are to be commended, there runs a theme throughout of "Nurseism", or "Nurseogynism" - or even "Nurse-o-phobia". These self-satisfied, pompous, narcissistic fellows (I assume they are fellows?) take great pleasure in patronising nurses who have the temerity, nay the bare faced cheek to aspire to something greater than lovingly wiping an arse, mopping a piss soaked floor…Now, anyone who knows me (and watches enough Russell Peters) will know that I have a theory that once in a while, just for the fun of it, God looks down upon the Earth from His throne in High Heaven, and in all His infinite wisdom picks a random person on the street, and BOOM. All hell breaks loose, with hilarious results. Now usually that person is me, but today as luck (or rather, God) would have it, this little nurse gets lucky. And along comes none other than Dr John Crippen of NHS Blog Doctor, who reads the post, and decides to add a doctorly riposte:
Oh dear me, nursey, you have, to coin a phrase, just crapped all over yourself by demonstrating the classic nursey intellectual inability to have a "DIFFERENTIAL" diagnosis. You do not have the mental card-index of diseases that all experienced doctors flip through their mind as they are assessing a patient. You can think of two diagnoses. A doctor can think of twenty.Now usually Dr Crippen is quite civil in his lambasting of the NHS, but in this one he seems to have gone over the top a little. Unfortunately for poor Nurse Ratchet (but very fortunately for God's amusement) his is the first post, and sets the tone for about 50 other commenters who promptly materialise and proceed to take turns gang-raping the nurse and making very clear their opinions of her intellect:
Was he ill? Yep.
Was it serious? Yep.
Did he need to be in hospital? Yep.
Quickly as possible? Yep.
Could I have harmed him by delaying? Yep.
Let me guess, Nursey. You haven't been on the course yet.
Render under Caesar that which is Caesar and leave to the physician that which he knows namely the art of differential diagnosis which passeth the understanding of the ignorant.
Nurse Ratchet - we don't interfere in your job, why don't you lot stop interfering in ours and stop all the nay-saying and bitching from the side lines. If you want to diagnose, manage and treat patients - go to medical school. In the meantime, stick to the bedpans.Then Dr Crippen decides this shows a dangerous lack of medical knowledge and respect on the part of nurses, and decides to make Nurse Ratchet the focus of a whole post on his blog.
(This is also about the time when God decides to go into Ultra-Gag-Mode.)
And so the shit truly hitteth the fan. DOCTORS.NET picks up the article and has their say, while visitors to Dr Crippen's well-known blog take potshots at Nurse Ratchet on both her blog and Dr Crippen's. Even Singapore's Angry Doctor picks up a pitchfork and joins the fray. At this time, of course, I (having a perpetual death wish) try calling for diplomacy. Strangely enough, I do not get fragged, and instead Dr Crippen backtracks and agrees with me that the debate has descended into vulgarity:
I tend to agree with you, Angry Medic. It is getting a bit vulgar and out of hand over on Nurse Ratchet's site.He then very cleverly diverts the argument to the real problem, that of what he calls the "dumbing down of the NHS", including (as I mentioned in a previous post) the endless reorganisations, the target-setting, and general nonsense that the NHS has taken from prophet of doom Patricia Hewitt. And thus the real villains of the story are revealed.
Her article has been picked up by DOCTORS.NET and battalions of angry doctors have mobilised and are on the attack.
I suspect Nurse Ratchet is writing with a little bit of tongue in cheek. As was I in the first comment I made under her article.
*dum dum DUMMM*
Okay maybe not. But Dr Crippen, in his reply to me, pointed out that the line between doctor and nurse is a fine one, particularly nowadays that Patricia Dimwitt is trying to replace doctors in A&E with nurse-practitioners and community matrons.
It is fascinating to look at the job requirements to be a "community matron"Spot on. The NHS is messed up, but that's not what I'm getting at here. Nurses take a lot of crap, sometimes more than doctors do, and I've worked with enough nurses to know that they can make or break a doctor, especially in his junior years. They also have a far greater impact than doctors do on the quality of a patients' stay in hospital, and the work they do cannot be undervalued. However, the hospital is sometimes a jungle, and as I saw on a National Geographic documentary so long ago, the "key to survival is respect". If we all just respect each other, let each other do their jobs, and stay the hell out of each others' way, the hospital will be a much better place.
• take a comprehensive patient history
• carry out physical examinations
• use their expert knowledge and clinical judgement to identify the potential diagnosis
• refer patients for investigations where appropriate
• make a final diagnosis
• decide on and carry out treatment, including the prescribing medicines, or refer patients to an appropriate specialist
As far as I can see, that is EXACTLY what I achieved after 5 years at medical school and three or four years as a junior hospital doctor.
Thank God I'm still in med school.