Care relationships
Care relationships

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Care relationships

1.5.3 The doctor-nurse relationship

In reality, however, the nurse spends much more time with patients and often knows a lot that the doctor does not. Somehow the nurse needs to be able to communicate essential knowledge to the doctor, in the patient’s presence, without appearing to undermine the doctor’s ‘omniscient’ status. According to Leonard Stein’s research in America, they achieve this through playing ‘the doctor–nurse game’.

The cardinal rule of the game is that open disagreement must be avoided at all cost. Thus, the nurse can communicate her recommendation without appearing to be making a recommendation statement. The physician, in requesting a recommendation from a nurse, must do so without appearing to ask for it.

(Stein, 1978)

The doctor–nurse game

Nurse to patient: This is Dr Jones. An open and direct communication.
Nurse to doctor: Dr Jones, this is Mrs Brown, who learned today of her father’s death. She is unable to fall asleep. This message has two levels. Openly it describes a set of circumstances: a woman who is unable to fall asleep and who that morning received word of her father’s death. Less openly, but just as directly, it is a diagnostic and recommendation statement: Mrs Brown is unable to sleep because of her grief, and she should be given a sedative.
Doctor to nurse: What sleeping medication has been helpful to Mrs Brown in the past? Dr Jones has accepted the diagnostic and recommendation statements but, not knowing the patient, is asking for a further recommendation from Nurse Smith, who does know the patient, about what medication should be prescribed. Note, however, that his question does not appear to be asking her for a recommendation.
Nurse to doctor: Pentobarbital mg 100 was quite effective the night before last. Nurse Smith makes a disguised recommendation statement.
Doctor to nurse: Pentobarbital mg 100 before bedtime as needed for sleep, got it? Dr Jones replies with a note of authority in his voice.
Nurse to doctor: Yes I have, and thank you very much, doctor. Nurse Smith ends the conversation with the tone of the grateful supplicant.
(Source: adapted from Stein, 1978)

Through subtle teamwork, doctor and nurse together sustain the presentation of an ‘omniscient’ doctor

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