Intended for healthcare professionals


Doctors and nurses

BMJ 2000; 321 doi: (Published 16 September 2000) Cite this as: BMJ 2000;321:698

This article has a correction. Please see:

Let's celebrate the difference between doctors and nurses

  1. Patrick White (, clinical senior lecturer
  1. Department of General Practice and Primary Care, Guy's, King's and St Thomas's School of Medicine, London SE5 9PJ
  2. Oxford Radcliffe Hospitals NHS Trust, John Radcliffe Hospital, Oxford OX3 9DU
  3. Intensive Care, William Harvey Hospital, Ashford, Kent TN24 0LZ
  4. West Anglia Resource Centre, Upwell, Wisbech PE14 9BT
  5. Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Leicester LE5 4PW
  6. Department of Epidemiology and Public Health, University of Wales College of Medicine, Cardiff CF4 4XL
  7. Ashgrove Surgery, Pontypridd CF37 2DR
  8. Bristol BS6 7SF
  9. Accident and Emergency Department, St Thomas's Hospital, London SE1 7EH
  10. Walderslade Village Surgery, Walderslade ME5 9LD
  11. Communication Skills Unit, Chantler Clinical Skills Centre, Guy's, King's and St Thomas's School of Biomedical Sciences, Medicine and Dentistry, London SE1 9RT
  12. Sussex Weald and Downs NHS Trust, Chichester PO19 4FX
  13. Royal West Sussex NHS Trust, St Richard's Hospital, Chichester PO19 4SE

    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 …

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