A Physician's Letter Was Demeaning to NursesI was...


July 24, 1993

A Physician's Letter Was Demeaning to Nurses

I was distressed by the inaccuracies in Dr. Brian Briscoe's July 17 letter against nurse practitioners.

Dr. Briscoe began his letter with the promise not to demean or undermine the role of the nurse practitioner, then proceeded to do just that for eight paragraphs.

Our overburdened health care system is dependent on safe, effective, non-traditional methods of health care delivery for quality care and cost containment. The role of the nurse practitioner is one of these innovations.

A physician's expertise is not needed to care for the common acute illness, stable chronic disorder or routine check-up.

Frankly, these everyday problems make up about 85 percent of the physician's daily practice. By using less costly, skilled "middle-level practitioners" to care for these needs, the physician's high level of expertise can be better utilized.

The nurse practitioner role is not a new role. Actually, it was established about 30 years ago in an attempt to improve primary care delivery to areas under-served by physicians. It is due to the great success of this role that we are seeing nurse practitioners in an ever-expanding arena of health care delivery.

Dr. Briscoe repeatedly interchanges the terms "nurse" and "nurse practitioner" and suggests that after the "nurse" botches up a treatment, the physician must pick up the pieces at some legal peril to his own license.

Nurse practitioners do not practice under a physician's license. They are granted their own licenses after undergoing an intensive training (over and above basic nursing education) and a grueling certification exam which incidently requires a master's degree to even be eligible to take.

There are uncountable numbers of people who do not receive adequate health care because the old system cannot serve the needs of the world we are living in. Dr. Briscoe's uninformed resistance serves only to promote this tragedy.

Deborah Cofield Forrest



I am curious where Dr. Briscoe obtained his information concerning the qualifications of nurse practitioners. As a radiologist, I wonder how much contact he has had with nurse practitioners.

A U.S. Office of Technology study found that "physicians who work with N.P.s express more satisfaction with N.P.s' performance and more willingness to delegate higher level tasks than do physicians whose contact is indirect or nonexistent."

Diana Heffner

Ellicott City

It would be advisable that Dr. Briscoe gets his information clear.

The absurd claim that I.Q. levels of medical doctors are superior to registered nurses -- or any other profession, for that matter -- is truly from the archaic notion that M.D.s are better then anyone else.

To indicate that nurse practitioners give substandard care is also an indication that Dr. Briscoe has not kept up with modern medicine.

Johns Hopkins, which has just been named the best hospital and research institution in the U.S., uses N.P.s in every specialty area. I should know, I work with the AIDS service at Hopkins.

I would challenge anyone who would claim the care our N.P.s and physicians' assistants give is substandard. They provide knowledgeable, compassionate and affordable care that is needed in today's high-tech and high-cost medical system. N.P.s and physicians' assistants are a part of this system that keeps health costs down yet provides expert medical care. Hillary Rodham Clinton would do well to look into their success.

Ask any nurse why he or she chose their profession and specialty and the answer will always be the same. We are all committed to care for people -- without much thought to large monetary rewards. Believe me, if anyone goes into nursing expecting huge salaries, he or she won't stay in nursing long. You won't see N.P.s driving BMWs with vanity tags.

Karen Sova-Grimm



I would like to take issue with a few of the chauvinistic, arrogant statements concerning nursing contained in Dr. Briscoe's letter.

The tone of his letter seems to suggest that the I.Q. of nurses is inferior to physicians, when in reality it may at times be greater. Nursing has evolved over the years, and nurses now assume responsibility for patient care unheard of in recent years.

The issue of responsibility and authority may be complex in terms of meeting community medical needs vs. the availability of services.

Perhaps the doctor is more concerned about control and money involved in medical care than he is in sharing responsibility and money with intelligent, compassionate and well-trained nurse practitioners.

Ann Faith


All the writers are registered nurses or nurse practitioners.

Quick Fixes

I would like to offer two new ideas regarding our national problem of increasing crime and violence. These two suggestions will try to provide a "quick fix" to this problem and will not cause any increase in cost to our criminal justice system; in fact, they should decrease these costs.

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