Let's celebrate the difference between doctors and nurses

EDITOR—The BMJ issue on doctors and nurses does not define or describe nursing but repeatedly talks about nurses doing doctors' jobs.1 The predominance of the theme of substitution of doctors' work by nurses undermines the ideas of multidisciplinary working, cooperation, and collaboration that also feature in this issue. Unless doctors are clearer about the role of nurses in health care, discussions about their relationships with nurses will appear patronising and uninformed.

The importance of difference emphasised by Davies frames the debate.2 This idea should be the foundation of the utility of the relationship between doctors and nurses. But following Davies's paper, every article strives to seek common ground between medicine and nursing, with nurses seen primarily as an economic substitute. This continues until the final personal view by Radcliffe, which, with admirable symmetry, closes the debate opened by Davies.3 But, between their two papers, who is actually celebrating the difference?

As a general practitioner I do not expect nurses to do the things I dislike doing more cheaply and more efficiently. I expect nurses to take on the tasks they do better than me and to share the tasks they do equally well. Sometimes nurses are less costly because nurse training is shorter and the opportunity to specialise can therefore come earlier. We should be thinking of the most cost effective services we can provide.

If the relation between medicine and nursing is really to bear fruit then medicine will have to recognise more explicitly that nurse training prepares different professionals. In their letter Laurent et al epitomise the need for a more penetrating conceptualisation of the nursing role in talking about substituting nurses for doctors to improve quality and optimise the (cost) effectiveness.4

Davies highlights the importance of difference—it is not what people have in …