Medicine and Nursing: A True Collaboration

Special Post for the end of March: Here is a recent "Ted-Talk" I gave with a friend and colleague Abby Muller of the UVa School of Nursing as part of a Student Ambassador of Resiliency (STAR) Workshop retreat. The talk is thematically based on the ideas of 1). Overuse in Medicine 2). Inter professional Collaboration 3). Mindfulness and Resiliency. The workshop was organized and funded through the Lown Institute and is currently being conducted in similar academic settings between nursing and medical students. Enjoy!

Imagine yourself wearing a white coat, stethoscope around your neck, walking into a patient’s room with a small plastic cup of 2 acetaminophen tablets and a slightly larger cup with a little water. The situation seems fairly routine, the patient rustles from the bed to acknowledge your presence and sees you have brought in some potential relief for the nagging headache that just won’t go away.

Now imagine yourself, wearing a white coat, stethoscope around your neck, walking into a patient’s room with a printed visit summary, some scanned MRI results and a gaggle of other white-coated individuals in toe. The situation also seems fairly benign, and the patient doesn’t appear to be bothered by the herd of people, yet still seems quite content to stay asleep and avoid whatever confrontation is about to follow. Meanwhile the family members in the corner pull out their I-phones to check their messages or direct their attention to the TV, which happens to be showing a re-run of House.

So here’s the question, where is the nurse?

If you said checking in on another patient, charting on EPIC or simply outside of the room at the moment, you would actually be incorrect.

In scenario one, it turns out that the trusty white coat sporting individual was a nurse coming to administer a medication order placed by the doctor a few minutes prior, and in the second, it just so happens that everyone in the gaggle of health care providers: resident, attending, medical student, nurse and nursing student were all wearing white coats

So then it seem the real question should be: What does it mean to wear a white coat?

Not surprisingly, if you ask most patients- white coat=doctor and doctor=the one responsible for making me better. So who do you want to be, a doctor or a nurse, a white coat, or somebody in scrubs? Does appearance and expectation make a difference?

Our perceptive world is so vast and our subconscious and unconscious perceptions practically invisible to our awareness. In pondering this dilemma, we sought to ask a few more probing questions: How do patients view their care in the hospital, is it a team with nurses, doctors, therapists all communicating effectively to bring about healing? Was it a somewhat disconnected, yet still productive system of individuals performing a specific trained task leading to improved wellness? And within the process of healing, did the patient feel like they were being treated as a human being?

While we certainly cannot answer these questions in a 10-minute talk, it took only a short Saturday afternoon of simply being with 7 sets of patients in the UVa Hospital to discover much more than we could have ever imagined.

First, as alluded to in our introduction was the idea that white coat=doctor. Without fail nearly every room we entered was perplexed or had to clarify that Abby, dressed in a her white coat, was indeed a nursing student and I, also dressed in my white coat was a medical student.

Second was the fact that yes ,indeed, there was a student nurse and a student doctor in the room at the same time, engaged in conversation and not simply carrying out separate tasks hoping to achieve a desired outcome.

Everyone would argue that communication is paramount to successful care, and we wondered, did the patients ever see nurses and doctors communicating effectively or even carrying out tasks together in the same room at the same time? While nearly every patient expressed great satisfaction with their care and shared knowledge of great teamwork by the staff, most did not experience nursing and medicine as one, but rather as a cohesive and effective summation of the parts. So while everyone seemed to be happy, and the health care providers were carrying out their duties, couldn’t we still do more, or could there be another way of engaging both nurses and physicians?  Would you be willing to change from the status quo, continuing to search for ways to improve the ultimate goal- proving healing to the patients in need

Third, and perhaps the greatest shock to the patients, was that we were there now not to put a stethoscope on their chests, push on their feet or make them follow our fingers from side to side, but simply to be, to listen and hear how they were doing, what was on their mind, what about the hospital stay was pleasant or unpleasant, did they get enough sleep, was the food any good?

 Without any previous knowledge of any of the patients’ medical conditions, we encouraged them to talk about their family, friends or spiritual faith and not about the history of their present illness. Quickly you could see a light shining in most people eyes as they realized, we were just 2 students checking in to see that they were doing all right and that it was okay to talk about something other than their recent surgery or upcoming chemo treatments. What was even more of a shock to many, was that fact that we were visiting on a Saturday just because we wanted to be with patients and not because of any school obligation. In all the cases, family was close by and engaged in the conversation, often even to a greater degree than the patients themselves. Some even confessed to a starvation for talking about anything that came to mind, avoiding any topics related to their illness or current hospital condition. It was like they needed some IV fluids in the form of 2 pairs of receptive ears, and 2 hearts willing to engage in a healing, compassionate interaction.

While we can never discount the benefits of modern medicine to heal such devastating diseases, there comes a time when we must understand that patients are human, and humans desire more than anything to be reminded that we are human, and more importantly that we are loved. It is often joked that one should treat a headache with Advil because one has a deficiency of ibuprofen. What if instead of treating illness with only procedures and drugs, we could write prescriptions for meditation, yoga, time spent with family, walking in the outdoors, and human conversation with a therapist/doctor/nurse? What if we could order a 15 minute conversation regarding your hopes upon leaving the hospital just as easily as another 2 L’s of Normal Saline?

You can see that for all the answers we found in this 3-hour adventure, we came up with even more questions that are well worth some deeper thought. And while it may not seem fair to give a talk where you end up asking more of your audience than you provide, we challenge you to see that in the end, becoming a resilient healer isn’t about how many questions you can answer, but instead about how many people you can reach to start asking the right questions. And most importantly, from the wisdom of Dr. Abraham Verghese, author of Cutting For Stone how can we connect with the spiritual heart of our patients, and through the ritual of the healer/patient relationship establish a place where our own self awareness and the patient’s being are one.