Several polls conducted yearly consistently rank nursing as the most trusted profession in the U.S. Gallup’s most recent result in 2021 was the 20th consecutive year in which nursing made the top spot, leading everyone at 81%, followed by physicians at 67%. Members of congress rated 9%, just above car salesmen (8%).
As a physician who works with many other physicians, and with many nurses, the data made me think about the possible reasons for both the high rankings and the disparity between two professions that work together with a mission to improve people’s health and, when possible, to cure or manage disease.
I don’t contest the No. 1 ranking for nurses. In a hospital, nurses are the ones who spend the most time at the bedside. I have always disagreed with the notion that doctors and nurses “provide care” for patients. We care for our patients, and no one exemplifies this better than our nurses. They are well-trained in medical care, but most have gone into nursing because of the human connection with those they are helping. That comes through to their patients. Nurses will be hard to displace from first place.
It’s good that physicians are in second place among professionals, but why so far behind our nurse friends? The relationship between physicians and patients needs to be based on trust, too.
We physicians certainly own a big part of this. The vast majority of doctors I’ve known care very much about their patients, but we’re not all equally good at showing it. People who are sick are going to have the most trust in a provider they believe cares about them. If we don’t show it they can’t know it.
There are also aspects of health care today that make trust more difficult. Primary care practitioners rarely have time to take care of hospitalized patients, so if we’re admitted to a hospital we have a hospitalist physician whom we have probably never met. Each hospitalist, by national standards, may be responsible for 15 patients or more, so their time and attention is divided more than their patients would like. Someone has to be the 15th patient seen today and we may be unhappy that our hospitalist hasn’t been here by noon.
Acute hospital care is for conditions that can’t be properly treated on an outpatient basis, up until they can be. Published guidelines are used by Medicare and health insurers to define “medical necessity” for length of stay. This means that as patients, we may not feel as recovered as we would like when we are discharged by our physician.
Hospitalized patients sometimes ask their doctors to evaluate conditions other than what brought them in. To a limited extent this may be possible, but payers won’t cover tests or procedures for conditions that are normally treated on an outpatient basis. We may end up unhappy with a doctor who follows the rules and sends us elsewhere.
Have you ever felt you needed an antibiotic and been told it wasn’t indicated? Overuse of antibiotics has made many of them less effective and helped lead to the evolution of resistant “superbugs.” Or maybe we only got a few days prescription for a narcotic and thought we needed more. In Maryland and most states now, the law limits the amount that doctors can prescribe.These and other requirements may sometimes make patients feel at odds with their doctors. Rest assured, physicians will continue to work to be their patients’ advocates, even if the necessity of playing by the rules sometimes makes it seem otherwise. At least we come in second.
About Dr. Joseph Moser
Dr. Joseph Moser is the Chief Medical Officer at University of Maryland Charles Regional Medical Center. He has over 40 years of experience in the health care field and now oversees all of UM Charles Regional Medical Center’s doctors on staff.