Healing the rift between nurses and doctors

I recently heard a Yale-trained advanced practice nurse discuss the human connection in healing and how critical cultivating a relationship is to best position a patient to achieve a health goal. She shared best practices and offered strategies to avoid typical pitfalls that lead to what clinicians call "patient non-compliance."

After the conference, her talk generated much discussion. Attendees said that every office should have a practitioner like her.

But not everybody agreed with the speaker.

"I buy some of what you said but much of it is woohoo," a well-respected physician leader told her.

Woohoo? Ensuring human connection is maintained during the healing encounter is woohoo? Focusing on how best to connect with your patient and position this individual to achieve a health goal is woohoo?

Could it truly be the case that this physician's views are representative of our health care "system?" Are financial drivers incentivizing less human connection in the healing encounter?

Or could the exchange between the physician and nurse simply be a reenactment of the historical conflict between doctors and nurses?

As John Weeks wrote in his August 17th integrator blog, even a Robert Wood Johnson Foundation-funded project aimed at developing better team care from medical doctors and nurses in a clinical managed care environment flopped. The project wasn't able to deliver an effective teamwork model. "Since the first nurses and first doctors began working in modern health care in 1900, nurses have felt that doctors treated them as their handmaids to do the dirty work and take orders," he writes. As the nurses aspired to do more, what they did encroached on what doctors considered to be their turf. When doctors opposed their trespassing, the nurses got mad. "And that conflict remains alive today," Weeks notes.

Perhaps the interaction at the conference reflected that conflict. Of course I cannot know for sure as I do not inhabit the hearts and minds of these two practitioners. But if we are truly going to fix our broken health care "system" the financial drivers must be directed toward improving the healing encounter and the historical conflicts between doctors and nurses must be resolved.

In my organization, during its formative stages,folks realized quite quickly that this conflict between doctors and nurses existed. We also witnessed it between clinicians and complementary and alternative practitioners; as well as between healers and administrators. To address these conflicts, they shared thousands of hours together, developing true relationships and a safe space for authenticity and sharing from the heart, the mind and the spirit.

They eliminated titles and initials after last names (so no more "Dr. Smith" and "Nurse Jones" but rather Jill and Paul); they eliminated hierarchy and they connected on a much deeper level, beyond titles, degrees, or positions. They continued to define and refine their intention as a group. Over time, together they began to share stories and experiences and identify what true healing looks like and what barriers existed. Then they began to develop action plans to replace the barriers to healing.

Today there's excitement in the market to begin to address the broken health care "system" with the concept known as the Patient Centered Medical Home (PCMH), which involves creating teams of physicians and nurses (and ideally other practitioners) that collaborate on patient care. And yet the medical home model currently does not go far enough to addressing existing financial drivers and has done very little to address the challenges of creating a true collaborative team.

Based on the RWJ-funded project outcomes and my organization's experiences, the health care system and the medical home will not achieve their true potential without first improving nurse/doctor relations.

Healing those relations is critical to our success if we want to truly reform the health care system. It's time to step up and face the challenge...together.

Thomas H. Dahlborg, M.S.M., is executive director of the physician practice True North Health Center, where he focuses on improving growth while ensuring access for the uninsured and the elderly. He has 21 years of experience creating competitive advantages, analyzing customer expectations, and developing and implementing focused and aligned strategic deployment plans. Formerly he served as the chief business strategy officer at Network Health, a comprehensive Medicaid health plan based in Cambridge, Mass.; and was COO of the U.S. Family Health Plan at Martin's Point Health Care in Portland, Maine.

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