Many patients prefer nurses to doctors

Since the days of Florence Nightingale, there has been a debate over which medical tasks a nurse should perform. Trained nurse practitioners offer primary care that appears to be just as good as the care that doctors can provide, say researchers.

University of Bristol researchers reviewed all published studies comparing the primary care offered by nurse practitioners to that of doctors. Because of inconsistencies in definition and qualifications, they included all studies in which a nurse "provided first point of contact, made an initial assessment, and managed patients autonomously."

The studies – which include some randomised control trials conducted in the United Kingdom in the 1990s – are remarkably consistent in their conclusions:

Nurses spent more time with patients.

Nurses conducted more tests.

Patients did no better or worse when they saw a nurse instead of a doctor.

However, patients treated by nurses were more satisfied with their care.

Nurses cannot completely replace doctors; but for patients wishing same-day medical care nurse practitioners provide a very good standard of care, according to study leader Chris Salisbury.

The American Medical Association opposes independent practice by nurse practitioners, although it recommends that doctors work in close collaboration with them. The AMA's president-elect, Yank D. Coble Jr., said the British study fails to account for the fact that most primary-care patients aren't very sick. Coble says nurses simply don't have the rigorous scientific background needed for subtle or complex illnesses.

However, nurse practitioner advocates point out that not every physician is trained in every disease. General practitioners routinely refer patients to physicians with specialised knowledge; nurse practitioners could easily do likewise.

Source: Daniel DeNoon, Many Patients Prefer Nurses to Doctors, WebMD, April 4, 2002; Sue Horrocks, Elizabeth Anderson, and Chris Salisbury, Systematic Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors, British Medical Journal, April 6, 2002.

For BMJ text http://bmj.com/cgi/content/full/324/7341/819
For text Medical Personnel http://www.ncpa.org/pi/health/hedex7t.html

FMF Policy Bulletin\6 May 2002