Wars of the House of Bourbon

“First, find a crocodile. Two, poke it in the eye with a stick. Three, stand back and report what happens next.”
- John Sweeney

Well, it looks like I stirred up a bit of a hornet’s nest with Dr Crippen and co. Slip a truth serum into my tea and bourbon biscuits and I might be forced to admit that the nest-stirring effect wasn’t entirely unintentional on my part. Give ‘em enough rope etc.

Still, a day on, I feel it’s now time to munch on a bourbon and reflect on yesterday’s blogfight. Here’s my observations.

1. The argument over on NHS Blog Doc has pretty much settled into the usual screaming match between doctors and nurses over nurse specialists/practitioners/consultants. The usual arguments are being wheeled out. Doctors aren’t good communicators, nurses aren’t intelligent enough, yadda yadda yadda. This argument will probably continue for some time, and probably all be repeated again verbatim next week.

2. My original post was basically intended to make two points. First, that despite the impression one might get from the medical blogosphere, not all doctors are opposed to advanced nursing roles (just as not all nurses are in favour of them). Second, that despite claims repeated by various blogging doctors (including Dr Crippen), these roles are not restricted to the NHS; the private sector uses them too - this undermines the argument that it’s nurse specialists for the poor and doctors for the rich. Both of these points were quickly lost in the mudslinging. I don’t think either of these have been particularly addressed.

3. With certain comments, Dr Crippen really didn’t do himself any favours. The classic of course being, “And note, she has been there for a mere 15 years but in that time has not learnt how to diagnose epilepsy. She is not clever enough to do that. She has not been to medical school. She was probably not clever enough to do that either.” Even those who broadly agreed with his opposition to nurse specialists/practitioners tended to feel that this was excessive and insulting.

4. Just what is Dr Crippen’s fixation with bourbon biscuits?

5. As I’ve said, the argument over advanced nursing roles will continue. Perhaps a little less heat and a little more light might emerge if there was more debate about the relative roles and differences between nurse specialists, practitioners and consultants, rather than treating those three roles as though they’re indistinguishable from each other. From what I’ve seen of the three, one could argue that nurse specialists and nurse consultants occupy a more identifiably nursing (rather than doctor-substitute) role than nurse practitioners.

6. One comment by Dr Crippen that got lost in the maelstrom: “However, what we do have in mental health now is the CMHT which is composed of a collection of people, most of whom are not even trained nurses never mind trained doctors”. Eh? Obviously I can’t speak for what happens in Dr Crippen’s local CMHT. However, in my local CMHT every team member is a registered practitioner of some kind (doctor, nurse, social worker, psychologist) with the exception of one social work assistant and of course the admin staff. Unless there’s something seriously amiss in his local CMHT, what on earth is he on about?

So there’s my thoughts on the whole episode. We must do this all again some time.