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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


Another nurse who objects when I say that medicine is potentially more rewarding than nursing

Q: I just wanted to comment on the following quote I found on your site:

In my opinion, there is a correlation between the difficulty of something and its potential reward. Perhaps I am biased from being a physician instead of a nurse, but I do think that when a patient on the verge of death becomes my patient, it is more rewarding to be the one who determines the cause of the problem and what to do about it, instead of the one who carries out the orders of someone else. When things go well, as they usually do, nurses should take great pride in knowing that they contributed to the outcome. However, I personally cannot fathom how it could be equally rewarding to, for example, administer a drug that someone else ordered than to be the one who determined what drug was needed. I could cite numerous other examples that illustrate my basic point: namely, that occupational reward is commensurate with occupational demands. This correlation is not unique to the healthcare professions; there are many other examples of it. Being President is more demanding but potentially more rewarding than being a civil servant who does not determine policy or shoulder the burden for it. Would anyone contend otherwise? Or who would think that it is not more demanding but potentially more rewarding to be a corporate CEO than to work in its shipping department packing boxes? I am astounded that anyone could dismiss this correlation between difficulty and reward. This association is well-known and not limited to occupational tasks.

From what I can tell, you feel that nurses are there to administer a drug without question. I have to tell you that I believe that this thought process is a rather dangerous one. While physicians do order medications, it is highly inappropriate for a nurse to just give it without first ensuring that it is appropriate to give. If for some reason, the physician in question orders something that the patient is allergic to (or the patient is on an incompatible medication), and the nurse gives it anyway, then he/she will be the one going to court. Since graduating, I've had to remind myself that although the docs (and even the residents) have enormous egos, I cannot just trust they're the gods they think they are. I have to make sure I know my patients, their history, and what's going on with them at that moment. Otherwise, I can kiss my license goodbye.

To be completely blunt and honest: if you've never been a nurse before, you shouldn't speak about the nursing profession. It's a whole other animal in itself. Other than the aforementioned blunder, I find the information you've presented on the physician's role, is very informative. I appreciate your efforts.

An OB Acute/Neonatal RN

Answer by , MD: You seem to be a smart nurse who knows what she is doing. I agree with you that nurses should not blindly follow doctors' orders, but I still think that being a doc is more challenging than being a nurse—no doubt why our educational and training period is longer—and thus potentially more rewarding. Of course, that's just my opinion, and admittedly I've never been a nurse, so perhaps there are rewards inherent in that profession that I don't realize.

To be completely blunt and honest: if you've never been a nurse before, you shouldn't speak about the nursing profession.

I've read countless books by nurses, and they all seemed quite vocal in discussing doctors. Probably everyone does this. If we all were confined to commenting on our profession and ONLY our profession, then our potential conversational topics would be very limited. Could I even criticize my builder, because I am not a licensed builder, even though I do know how to build homes? (And very fancy sheds, too!)

Nurse examining childIncidentally, I noticed that you are an obstetrical/neonatal nurse. I can't think of any branch of nursing more rewarding than what you do. In fact, while I think that medicine is generally more rewarding than nursing (for the reasons presented in my site), I can easily appreciate how being an obstetrical or neonatal nurse could be even more rewarding than being a physician specializing in obstetrics or neonatology because nurses have more direct patient contact in those fields. Unlike many other branches of medicine/nursing, obstetrics primarily deals with generally healthy people during one of the happiest times of their lives. The joy surrounding the birth process can be so intense and moving that I began to cry the first time I witnessed a delivery in which a loving couple was relishing the imminent delivery of the baby they clearly wanted very much. The emotions of that experience were in stark contrast to what I felt during my earlier training in Detroit, where the husband or boyfriend was invariably absent and the women often evinced little warmth for their babies, instead yelling at us to "just get that thing out of me."

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Finally, I would like to comment on your statement about doctors having big egos. Certainly, some do. My girlfriend (a nurse) and I often kid about some of the local egomaniacal doctors. However, I think that nurses tend to exaggerate the number of docs with huge egos. I've met my share, and I know what jerks they can be. I think that nurses sometimes mistake confidence, self-assuredness, or pride for egotism. Perhaps physicians should be less ostentatious in evincing their pride, but passing medical school and obtaining a medical license is something that very few people can do. The power that goes along with that ability can sometimes go to their heads. Personally, I do not gloat over that power or use it for my own betterment, but I can appreciate how doctors routinely make decisions that determine who lives and who dies—thus, doctors possess power that some might term "God-like." For example, let's say that I have three simultaneous codes, involving Donald Trump, a state police officer shot in the line of duty, and Mother Teresa—assuming she were still alive, of course. Who would I choose to code if I had three simultaneous codes in a small ER in which there was one doctor (me) and one nurse? That's it; no ER techs, no other nurses, and no backup. In such a case (which really happened, by the way, except that the patients were not famous), I would have to make a snap decision as to who would have a chance to live. Some might say that such a decision was playing God, but yet it is something that doctors must do in the course of their work. If there was no compelling medical evidence to suggest that one patient had the best prognosis, I know exactly who I would choose. So am I whimsically playing God? No, I am just making a decision that needs to be made in a split-second, based on my own morals and convictions. Other doctors might choose someone else. Would I effectively tell Donald Trump that he is fired? Wouldn't that be an interesting poll!

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