The coming of age of sports medicine

Bringing nurses and doctors closer togetherGreater cooperation will benefit patients H igh quality health care depends crucially on doctors and nurses working well together. 1nd every day throughout the world they do.Yet centuries after the professions of nursing and medicine were founded they remain curiously apart. [1]][3] Doctors and nurses train separately, keep separate patient records, 4 report to different hierarchies, read different journals, and use different jargon.Sometimes these differences result in misery and conflict. [1]2][3][4][5][6] The BMJ and the Nursing Standard, for instance, recently described the sad case of a nurse who was suspended after cooperating with a doctor over the management of a disturbed elderly patient. 6 7The professions and, most importantly, patients stand to benefit from closer cooperation, 1 3 8 particularly as nurses take on more work that has traditionally been undertaken by doctors.Nursing is currently experiencing an intense debate over its future. 9Throughout this century first doctors and then strong nursing theorists and leaders have shaped professional and public thinking about nursing.Now nurses agree that the art of nursing needs to be underpinned by a foundation in science.That scientific foundation is being built, and nursing is emerging as a scientific discipline that is distinct from but complementary to medicine.Politicians, however, increasingly see nurses as the lower part of a medical pyramid of knowledge and skills.This is unhelpful and wrong.If we treat nurses as "minidoctors" then patients will lose the enormous benefits that only nurses can offer.There are, of course, important areas of overlap between the professions, and Terence English, a former president of the Royal College of Surgeons, delivered the Dame Kathleen Raven lecture on this subject at the Royal College of Nursing. 10 On page 661 he describes how nurses have taken on some tasks previously done by doctors. 11His experience with the team in Cambridge performing heart transplantation taught him how important it is for nurses, doctors, and other health professionals to work still more closely together.But it also taught him the difficulties.He warns that "unless there is dialogue and trust between the groups, one or more of them are likely to feel threatened as their roles are changed."One way in which doctors and nurses will come to understand each other is through receiving some of their training together and understanding more of each others' roles from the start of professional training.On page 682 two medical students describe how much they learnt from a week working as nurses. 12