ManipulatioRN

One of the founding precepts of Nation Indivisible -- if you can the loose association of cat herding principles that constitute our founding document "precepts" -- it's that all writing is biased and should be trumpeted as such.

So let me say that when it comes to articles written about bitter, unhelpful surgery residents, I'm really biased. Because I know that situation really well, and I always perceive a certain amount of bias on the part of the reporter, who presumably hasn't been paid minimum wage to stay up for 30 hours straight, working 80 hours a week trying to keep a bunch of people alive while also trying to keep both nurses and attendings happy. Which task is seldom fun and frequently impossible.

This article in the NYT is a classic example of a growing literature on this subject. Let's look at one section in particular, from among many of a similar theme:

It was the middle of the night, and Laura Silverthorn, a nurse at a hospital in Washington, knew her patient was in danger.

The boy had a shunt in his brain to drain fluid, but he was vomiting and had an extreme headache, two signs that the shunt was blocked and fluid was building up. When she paged the on-call resident, who was asleep in the hospital, he told her not to worry.

After a second page, Ms. Silverthorn said, “he became arrogant and said, ‘You don’t know what to look for — you’re not a doctor.’ ”

He ignored her third page, and after another harrowing hour she called the attending physician at home. The child was rushed into surgery.

“He could have died or had serious brain injury,” Ms. Silverthorn said, “but I was treated like a pest for calling in the middle of the night.”

Her experience is borne out by surveys of hospital staff members, who blame badly behaved doctors for low morale, stress and high turnover. (Ms. Silverthorn said she had been brought to tears so many times that she was trying to start her own business and leave nursing.)

Sounds bad, I know. I know. But I promise you this is a question of denominators. I would love to talk to the resident in question here and ask him how many other pages he'd gotten that night, and how many of them were from Ms. Siverthorn about matters that were not pressing in the slightest. I'd bet that this lady has a reputation for calling residents with medical pronoucements, telling them that she knows the condition better than them, and generally making a pest of herself with no appreciation for the complexity of the resident's job. And I have to wonder whether the conversation was really this cut and dried.

Ms. Silverthorn is clearly a biased source -- one of the many people, both nurse and physician, who seem to love to create territorial battles between what should be mutually supportive professions. That's made all the clearer by the closing quote, also given to her:

Professionals like Ms. Silverthorn, the nurse in Washington, said the change was overdue.

“We go to school, we have a very important job, but there’s no respect,” she said.

She recalled a particularly humiliating moment on Dec. 25, 2006. Working in the pediatric emergency room, she called a drug by its generic name rather than its brand name.

“I was quickly shouted out of the trauma room and humiliated in front of everyone,” she said. But while “everyone knew the doctor was actually the one who didn’t know what he was doing,” she continued, no one said a word.

Boo hoo.

This lady is clearly a whiner. But the bigger fault lies with the reporter, who gave someone with a clearly self-serving agenda the open and the close of her article, filling the middle with a variety of one-off horror stories and weak statistical pablums. There's no analysis of the systemic issues that they alternately illustrate and obscure the real issues. Instead, we get a bunch of relatively meaningless anecdotes that seem carefully designed to swing favor towards nurses and away from doctors in a PR battle that shouldn't be happening at all, much less in the most-emailed article in the NYT.

JEK
Neither pawn nor pawner.