February 6th, 2012
By Jennifer Olin, BSN, RN
As the case of Amanda Trujillo continues to garner attention one of the many areas of concern the story has raised is the relationships between nurses and physicians. Collaboration and communication are at the heart of any successful work relationship. In the environment of healthcare nurses and doctors are the two most important groups of people involved and yet there are still huge disparities in how these two professions work together.
The Game
In 1967 Leonard Stein, MD wrote an article for the Archive of General Psychiatry entitled The Doctor-Nurse Game. In it he describes a relationship where nurses make suggestions for patient care frequently and physicians “willingly and respectfully” consider them. If the nurse can make the suggestion without appearing “insolent,” the doctor can seriously consider the suggestion and neither will violate the rules of the game.
“Object of the Game.—The object of the game is as follows: the nurse, is to be bold, have initiative and be responsible for making significant recommendations, while at the same time she must appear passive. This must be done in such a manner so as to make her recommendations appear to be initiated by the physician.
Both participants must be acutely sensitive to each other’s nonverbal and cryptic verbal communications. A slight lowering of the head, a minor shifting of position in the chair, or a seemingly non-relevant comment concerning an event, which occurred eight months ago, must be interpreted as a powerful message. The game requires the nimbleness of a high wire acrobat, and if shattered; the penalties for frequent failure are apt to be severe.”
Sound familiar? Did Amanda Trujillo violate the rules of the game by requesting case management provide a hospice consult? Were the consequences that she was accused of stepping out of her scope of practice and fired? How can that be? Stein’s article was published almost 45 years ago and we all know the paradigm between men and women, doctors and nurses has so advanced from that. Or has it?
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