Doctors, nurses and medical records

February 10, 2020

An alert Ophthalmology Times reader shared with me a recent editorial from that other respected publication, The New York Times. Titled “Doctors, Nurses and the Paperwork Crisis That Could Unite Them,” the editorial is written by a professor of medicine at New York University and a faculty member at the University of Pittsburgh School of Nursing.

Previously by Dr. McDonnell: Perils of Project Nightingale 

Broken system
As suggested by its title, the article posits that physicians and nurses don’t get along in an American healthcare system described as “broken, wasteful, inhuman, expensive, deadly.” They assert that “too often, each profession sees the other as fighting separate battles, and sometimes against each other. 

Doctors blame nurses, and vice versa, for the failings of a system that punishes us all, and our patients. Physicians earn more than nurses and have much higher status in the medical hierarchy, which can lead to resentment from nurses when that higher status is abused.

It noted that “the gendered history of both professions also contributes to a view of nurses as fundamentally subordinate to physicians.”

The authors go on to say that “nurses and physicians must come together” to oppose a shared unfair burden: excessive demands for documentation in electronic medical records.

Related: Hospital closures hurt

Citing a report from the National Academy of Medicine that says the average doctor and nurse are spending 50% of the workday documenting in the computer, they feel that the two professions should speak with one voice to address this problem and the associated burnout. 

“Doctors would be wise to let nurses take the lead” say the authors, because nurses have strong unions and doctors don’t. “The Service Employees International Union and National Nurses United represent nurses all over the United States and in general are good at getting their demands met.”

I found myself having a couple of reactions to this argument. My first reaction may relate to my being an ophthalmologist, or it might relate to the culture of the institution where I work, but I have never heard one of my physician colleagues blame nurses for any ills of our U.S. healthcare system. 

Related: Ars longa, vita brevis

Dedication of nurses
Rather, I frequently hear praise for the skill, dedication and caring exhibited by our nurses (and I am told this in private conversations when there is no ulterior reason that might be attributed).And that goodwill is reciprocated, as far as I can tell.

Each of us can have a bad day, perhaps, when we get a little cranky, but my experience tells me that the typical doctor-nurse relationship that I observe is one of mutual respect and admiration, and nothing like the finger pointing and blaming for healthcare ills described in the Times editorial. 

But I do agree with the thesis that the burden of documentation has become excessive. The authors state that the model we should move toward is that of the Veterans Administration hospitals, where we are told the clinicians like their electronic records system.

Related: Blue-state blues

The reason given for this is that “billing concerns don’t shape the records at government-run V.A. hospitals. They document only what’s necessary to deliver better care.”

I would love to know what you, dear Ophthalmology Times readers, think about this issue. Do you ever find yourself or hear physician colleagues blaming nurses for the ills of the U.S. healthcare system? And do those of you who work in the Veterans Administration system actually like your electronic records and think it should be the model going forward?  Read more by Dr. McDonnell