L'associazione delle Infermiere/i americane/i si sono rivoltate contro House per come vengono ignorate o al massimo umiliate le infermiere nella ns serie preferite. So che è lungo e d è in inglese, ma dateci un'occhiata, giusto per ri-sottolinerare il fatto che nelgi USA non hanno altro da fare che stare sempre a polemizzare..
http://www.nursingadvocacy.org/news/archiv...s/2005/nov.htmlEverybody lies
November 16, 2004 -- Tonight's series premiere of Fox's "House," written by David Shore, takes a firm stand against one thing: lying. Specifically, the lies patients tell physicians, but also the lies of physicians themselves. In fact, "everybody lies." Only one physician tells it like it is: the brilliant, caustic Gregory House (Hugh Laurie), a master diagnostician who tries to avoid patients, even as he guides his diverse "CSI"-like team of "genius doctors" toward the elusive truths of life-threatening mystery diseases at a Princeton hospital. Unfortunately, the show's key premise is itself a damaging lie: that a team composed entirely of physicians would rove the hospital providing all significant care to desperately ill patients, as the few nurses and other professionals stand silently in the background or simply disappear. In fact, in a kind of extreme irony, the mystery disease that nearly eludes all the genius physicians and kills the first episode's main patient (tapeworm) could have been discovered by a skilled nurse's standard evaluation of the patient's stool--yes, the bedpan. With six out of six major characters as physicians, this may be the most physician-centric new TV show of the last decade. There is talent, wit and intelligent (if reactionary) life in "House," but the show's early promise only underlines the disservice it does to nursing.
House, whose bitter demeanor is linked to the childhood disease that still causes him pain and requires the use of a cane, is an infectious disease specialist who heads up the hospital's "Department of Diagnostic Medicine." We aren't aware that such departments typically exist in U.S. hospitals, but to the extent they may in Canada or elsewhere, they appear to be laboratories that examine bodily fluids and tissue samples. But House's team includes a neurologist, immunologist, oncologist and intensivist--in short, it is an all star team of young hotshots who solve cases that no one else can. (What was that about lying again?) Obviously, one key model here--as in NBC's new "Medical Investigation"--is "CSI," with mysterious disease as the stand-in for wily criminals, though "House" owes a debt to detective fiction as well. These new shows are a kind of "Health Scene Investigation," and it is easy to see why nurses are even more marginalized than they are under the "ER" model, which is far more focused on interactions between care providers and patients. Here, the main theme is the interactions among the physician detectives as they work out the diagnostic puzzle through debate and analysis of physical evidence.
Of course, even the primacy of medicine in diagnosis is overstated, and "House" takes it way beyond reason. Comprehensive nursing assessments are often critical to patient survival--and to physicians' own medical diagnoses. For instance, the main focus of the first episode is a kindergarten teacher with unexplained seizures and neurological problems. This patient is ultimately diagnosed with a tapeworm infection in her brain (neurocysticercosis). Though this disease is unusual in the developed world, thus the novelty to the makers of "House," in fact over 50 million people worldwide have it. Some neurocysticercosis patients pass tape worm segments into their stool, and an observant nurse may note this obvious symptom of the disease as part of his standard nursing assessment. In some other cases, tape worm eggs are present in the stool, which is collected by nurses for a laboratory analysis. The physician-centric media often ridicules the "bedpan" aspects of nursing, but in both of the above situations, nurses would have played key roles in identifying or helping to identify this deadly infection.
It is ironic that this largely nurse-free episode unwittingly shows the potential for disaster when nursing is ignored. We assume it would never have occurred to the creators of "House" to have a nurse weigh in on this patient's condition, or that nursing might be the key to her survival. No nurse is ever part of the House team's discussion of the condition or care of the teacher. And no nurse is shown doing anything of significance for her or any other patient.
But we wouldn't want to suggest that the episode completely ignores nursing, because what it does show is also revealing. We did spot one nursing mention, and three fleeting appearances of characters who seemed to be nurses. At the beginning of the episode, the patient has a seizure in front of her class, managing to scrawl "call the nurse" on the white board before collapsing. That's nice, but the scene cuts there. Whatever the school nurse did is of no interest to the producers. In the first nurse appearance, a faceless hospital nurse regulates an IV pump before leaving a patient's room so an important physician can interact with the patient. In the second, a nurse silently complies with the great Dr. House's request that she leave the patient's room; obviously, they have something important to discuss and nursing could not be relevant. And in the last, a nurse actually delivers a line, telling Dr. House that a patient is here to see him (those nurses are critical to care after all! they help people get to Dr. House!). This was one of the clinic patients House had very reluctantly agreed to see, back for more of the sugar pills House had craftily given him for his self-diagnosed fibromyalgia, which the show clearly suggests is a fictional disorder.
The clinic scenes give the show a chance to vent its reactionary ire at certain modern health and social trends, as House wittily mocks the role of the Internet in informing patients, the reluctance of parents to pump their kids full of whatever drugs physicians happen to prescribe, and so on. Without necessarily defending the failures of some people to be ideal patients, this perspective would seem to be another barrier to the show recognizing the contributions of nursing. Nursing does have a more holistic, patient-centered approach to care (so touchy-feely!). And it is focused on educating patients, rather than just telling them what to do, and dismissing them if they question it or show weakness in compliance. What House really misses is the old world--not in terms of racial or gender equality, because the show is clearly with the prevailing Hollywood program on that--but the world where patients and other care givers were so cowed by the almighty physician that they would do whatever he asked, without question and without regard to whether it made any sense. Knowledge is power, and nothing is worse than a rabble awakened by it. And in fact, the success of "CSI" and its descendants may owe something to a post-9/11 desire to see things in simpler, more traditional terms, as we gain comfort from the skilled elite using high tech tools to avert shadowy threats, even if that may require a little more power concentrated in fewer hands. This traditionalist agenda is ironic given that "House" has been marketed and received as a radical presentation of a gruff physician who doesn't seem to like or even care about his patients or colleagues, a kind of anti-Marcus Welby. Actually, just suggesting that such physicians are rare seems like an outdated and uninformed notion to us, but evidently it has been widely accepted. In any case, even the first episode makes clear that House is really an interestingly wounded man who does care in his way. He just has trouble showing it, or suffering fools. Such has always been the lot of genius.
While the nurses are doing whatever trivial things they do, the physicians provide all meaningful care, doing jobs that real physicians would clearly never do. In this respect, the show is very much in the Marcus Welby tradition, and that of "CSI," which typically shows CSI's doing the jobs of several different real life criminal justice professionals. Even by Hollywood standards, "House" is impressive in this regard. The physician characters in the first episode have virtually all patient interactions. Nurses have none. And in one short, priceless scene, two of the young physicians are shown doing the jobs of at least three other professionals. These two physicians have accompanied the main patient to an MRI scan. If anyone were to do this, it would of course be a nurse, though because the patient is not critical that might not have been deemed necessary. Then the two physicians actually take over the conduct of the MRI scan from the MRI technician, who simply disappears. When the patient goes into anaphylactic shock and subsequent cardiac arrest, the two physicians pull her out and begin to resuscitate her by themselves. Of course, in real life, a code would have been called, and that would have meant the quick arrival of a team of nurses, physicians, and a respiratory therapist.
Yes, yes, we can hear the response of Hollywood now: "We must be allowed some dramatic license, and we really can't fit all those different real-life characters into an effective scene (or show). We have to work with the major characters we have, and those just happen to all be physicians." The problem is that we become a little suspicious of "dramatic license" when, just by coincidence, it virtually always seems to result in the inaccurate portrayal of one type of health care professionals as the brilliant, exciting providers of all meaningful health care, and in the inaccurate portrayal of other types of health professionals as peripheral subordinates, to the extent they are portrayed at all--even though real nurses provide at least as much interesting, dramatic care as physicians. Thus, it just so happens that NBC's "ER" has nine major physician characters and one nurse, that "Scrubs" has five major physician characters and one nurse, that "Medical Investigation" has three major physician characters and no nurses. What would we think if all Hollywood portrayals of men showed them to be smart and strong, and all portrayals of women showed them to be slow and weak? What would we think if a tossed coin always came up heads?
"House"'s web site is www.fox.com/house
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"House"
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And on the eighth day, the Lord Physician created nurses, to clean up the mess
November 15, 2005 -- Both Fox's "House" and ABC's "Grey's Anatomy" have shown utter contempt for nursing. But the two new prime time hits have taken somewhat different approaches. "House" is addicted to physician nursing. Its six physician characters are constantly doing key care tasks that nurses do in real life. The rare nurse characters are silent, barely visible clerks, like wallpaper that assumes human form to move or hold objects. "Grey's Anatomy," with nine physician characters, has at times had nurses utter a minor substantive line. However, it has often insulted nursing directly. Its interns regard the word "nurse" as a slur, and the nurses who do appear tend to be bitter or fawning losers, whose lives revolve around the godlike physicians. But two recent episodes of "House" (Thomas L. Moran's "Daddy's Boy," aired on Nov. 8, 14 million viewers, and Sara Hess's "Spin," aired on Nov. 15, 13 million viewers) prove that the Fox show is more than capable of its own specific anti-nurse slurs. In these, "House"'s brilliant physician heroes suggest that they consider nurses unskilled clean-up staff, "nurse-maids" who are good for handling stool and patients who have fallen down. The money quote? Über-diagnostician and wit Greg House has just temporarily relieved a patient's thymoma with a Tensilon injection, and gone off on a "playing God" riff. When the drug wears off, as expected, the patient falls to the floor. House says this is "exactly why I created nurses," then calls out into the hallway, "clean-up on aisle three!"
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The inclusion of pointed nurse-as-unskilled-menial-worker themes in back-to-back episodes was remarkable. In the November 8 episode, two physicians on House's team are examining a young patient who is having unexplained seizures, and who ultimately turns out to have radiation poisoning. As the physicians speak with the patient, he has stool incontinence due to sphincter paralysis. One physician notes: "We're going to need a nurse." Given everything the show has done to marginalize nurses, we laughed at this uproarious tribute to what nurses are good for. Then the other physician reassures the surprised and embarrassed patient: "It's OK. We'll take care of it." We ? We laughed even harder. But no one on the show did, suggesting that the joke was on us. No one is going to see this scene as a wry criticism of some physicians' reluctance to help with care tasks they view as beneath them, nor of the tendency of some to take credit for the efforts of the rest of the health care team. What "we" have here is more like a solemn endorsement of these practices.
Later in the November 8 episode, the show offers an example of its standard way of endorsing the idea of physician superiority: a put-down from House himself. House intercepts the ambulance crew bringing in the main patient's similarly afflicted friend as soon as they get through the ED entrance. House, who wants to examine an infection nears the friend's groin for clues, commands: "Take off his pants." One of the paramedics says politely: "He's vomited in excess of three units of blood. He needs to be admitted before you--" House knocks him back: "If you wanted to be a doctor, maybe you should have buckled down a little more in high school." The paramedic responds, sneering but impotent: "Bite me." That doesn't exactly disprove House's underlying point about whose mind is functioning at a higher level, though we suppose it is better than the hurt silence with which "ER"'s nurse characters have often responded to physician slurs. But as on "ER," the take-away message will be that House is obnoxious and people don't like it, but there is a harsh, kind of sexy truth in his words. Physicians are academic stars, and by comparison the rest of the health care team are uneducated flunkies. House can't really mock people for being black or female, but class-based slurs are fine. Because the show doesn't care about the paramedic, House pays no dramatic price here. What would we have had the paramedic say in response to House's gratuitous putdown? "And if you wanted emergency care expertise, maybe you should have spent less time consoling your sad little self with obscure diagnostic masturbation, and more on learning to save lives."
But the November 15 episode has far more striking examples of the joking-or-am-I? method of mocking the rest of the health care team. These scenes feature explicit anti-nurse views that the show has never given viewers any real reason to question. This episode focuses on a professional cyclist who collapses during a race. But the main subplot is about House's relationship with old flame Stacy, a lawyer at the hospital who is now married to someone else. House and Stacy's love-hate relationship includes House tormenting her husband, who is recovering from a serious illness. House crashes a group counseling session with the husband. At first House, who uses a cane, seems to make a genuine effort to bond about what it's like to be the needy, disabled man in Stacy's life. But he ends up playing inadequacy mind games with hubby about why Stacy might not stick around. The kicker: "She didn't get married to be a nurse-maid. She wants a man."
The antiquated term "nurse-maid" neatly connects nursing care with maid service, and also suggests that a lawyer could do it, in both cases sending the message that nursing does not require training or skill. It also suggests that this kind of old-time hand-holding would be beneath a smart, ambitious, modern person like Stacy. Of course, in reality nursing requires years of college-level training, and hundreds of thousands of nurses hold graduate degrees in nursing.
Near the end of the episode, House determines what has been causing the cyclist's myasthenia gravis and PRCA: thymoma. House walks into the patient's room and plunges a syringe of Tensilon into his leg. This eases his symptoms for a few minutes, so much so that the patient gets out of bed, while having the following exchange with House:
House: You are healed. Rise and walk.
Patient: Are you insane?
House: In the Bible. Just say, "Yes, Lord," and start right in on praising.
Patient: What did you do?
House: No, "What did you do, Lord. " [Then, seeing the patient collapse on the floor] This is exactly why I created nurses. [Stepping to the doorway and calling down the hall] Clean-up on aisle three!
Yes, we get that House is being facetious, he doesn't literally think he's "God," he's just having fun with the miracle of modern drugs, and celebrating his usual brilliant diagnostic skills, which have proved too much for yet another wily illness. It's even possible that the show's producers are aware of the "God complex," the affliction in which physicians whose work involves life and death, and who enjoy excessive social and economic status, may come to believe they are more than human, and therefore need not play by the rules that bind everyone else.
But House and his colleagues, patients, creators, and audience all really do regard him as something of a flawed demi-god, a world-famous Holmesian curmudgeon who saves lives while shredding every ego and illusion within 10 yards. And this brings us to the Physician-God who created nurses so that they can clean up messes. Since many people do associate nursing with unskilled clean-up work (e.g. bedpans), House's comment allows us to laugh at the poor nurses' icky jobs, while absolving us of any responsibility, because he's just "kidding." What if House had said this is why He created women? Would he still be so endearing and sexy?
Of course, to balance out these slurs, the episodes show nurses as the skilled life-savers they really are, autonomously monitoring and treating patients, providing key psycho-social care, teaching and advocacy. Ha ha--kidding! As usual, on "House" the nurses essentially do not exist. On the rare occasions they appear, they do not speak. Their job is to hand the physicians something, or just stand there.
Oh, but "House," like every other Hollywood show about hospitals or health workers, just "happens" to focus on physicians, so we can't expect it to show nurses or what they do, right? Except that, like the other shows, "House" has plenty of nursing--it just has physicians doing it. The show's physicians do virtually all patient monitoring, all medication administration, all resuscitation, all psycho-social support, all patient advocacy and education. Silent nurses may occasionally appear, in blurry background or at the edge of the frame, but that's it. The result is not that viewers conclude that this show just happens to focus on physicians, while nursing is a whole other interesting world that just happens never to appear on their TV screens. Viewers conclude that physicians provide all important care, and that nurses are mute, subordinate clean-up crew whose unskilled work is of no interest whatsoever. Bright, ambitious people don't get married to be a "nurse-maid." Ha ha--joking! No, really. No, joking!
This relentless, persuasive degradation of the nursing image is a major factor in the nursing crisis that continues to claim lives worldwide. Of course, real physicians are not qualified to do a great deal of what nurses do to save lives and improve outcomes. So if hospitals really worked the way "House" pretends they do, there would be countless unnecessary fatalities, including in the Hollywood area. Clean-up on aisle three!
What do nurses do all day?
November 29, 2005 -- Hi kids! My name is Peter Blake. I'm a Hollywood screenwriter, and I'm going to tell you a story. My story is called "The Mistake." It is actually just part of a much longer story called "House." "House" is on television every week, on the Fox network. And millions of people watch it--like the 15 million who are watching right now. My story is about what physicians do in hospitals to make sick people better. Physicians are really smart and cool and pretty and they save people's lives every day. But they have a few flaws, and when they make a mistake, people may die! Oh, and nurses help patients get to see physicians. Nurses also move objects around for physicians, and do secret naughty things with big powerful male physicians. See how it works? Let's begin!
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Look here. This woman is sick. Something is wrong with her liver. That is sad because she is nice and she has two nice daughters. Now look at the handsome young physician! He is Dr. Chase. He is going to help the woman. Dr. Chase knows lots of big words. And he has a nice smile. If he and his physician friends find out what is wrong with her in time, she automatically gets better! Step one: diagnosis. Step two: life saved. Dr. Chase tells the patient to ask a nurse to make an appointment, so she can see another really important physician. Dr. Chase also says he's going to tell a nurse to take a sample from the patient's body, so the smart physicians can learn more about what is wrong. They do, and she gets better. Or seems to...
Oh no! The paramedics have brought the woman back to the hospital. Her tummy hurts! Dr. Chase meets the paramedics all by himself. He does everything! He uses really cool tools to see what is wrong inside her--like a TV camera that goes inside her belly. Wow! And then he fixes her. But wait. Here is another physician, Dr. House. He is older, and maybe a little mean. But he is the smartest and coolest of all! Dr. House knows right away--like magic--that the woman has another problem in her stomach. It is very bad.
So Dr. Chase takes action! He orders that the patient be rushed to the operating room. But physicians don't have time to push gurneys, so suddenly some people appear and push the patient out of the room. Who are they? That's right: nurses! There have been no nurses here until now. The physicians did not need them, because they were busy saving the woman's life. Can you see the nurses' faces? Almost? They aren't so young and pretty as the physicians, are they? Well, where did the nurses come from? Maybe they were hiding under the bed? Very good! What's that--maybe they were part of the wallpaper, and just popped off to help when Dr. Chase needed to move something around? Well, I hope the surgeons can save the nice lady! Don't you?
Here is Dr. House again. He is talking to another physician--a surgeon! You know what surgeons do? That's right. They go inside people's bodies and move things around. They save lives, and they are so powerful, and they make big money! Isn't that cool? Anyway, Dr. House wants this surgeon to give our nice lady patient a new liver, because her old one is no good. No good! The lady's brother will donate the liver from his own body. But the surgeon does not want to help. He says the woman is too sick for the liver to help. He is afraid he will be blamed.
Now, here's the part of the story where I want the youngest kids to close their eyes and cover their ears. How young? Let's say, everyone who's too young to write for Hollywood. So, everyone under eight. Now, Dr. House tells the surgeon that if he will not operate, Dr. House will tell the surgeon's wife about naughty things the surgeon has been doing with lots of nurses. Naughty nurses! See, kids, that's what those nurses do--find them a rich, powerful surgeon and get busy, because that's their ticket out of having to work as a nurse! Anyway, the surgeon says he will help the nice lady after all. He has some problems, but he is a life-saver! Awesome!
What's that, Michael? Do physicians make mistakes? Yes, sometimes even they do. And when physicians make mistakes, patients may die, because physicians are just that important. Look at poor Dr. Chase. He was very upset about his Daddy passing away, and he did not find out the nice lady's problem soon enough. He made a mistake, and I'm very sorry to say, the nice lady died. But that Dr. House--he is so smart--he found out that the nice lady's brother was sick too. There was cancer in his liver. Dr. House found out in time to save her brother's life! That's what happens when physicians bring their "A" game. And with Dr. House, that is pretty much all the time.
And what do we have here? All the physicians are talking to the hospital lawyer Stacy. She's beautiful too! And kind of smart, though of course, no one's as smart as Dr. House. They all want to know how they can avoid paying for the mistake Dr. Chase made. Some people don't understand how important it is that physicians be able to do whatever they want, do they? Can you hear what they are saying? They are talking about important things in a very important way. And they are all so pretty. And witty. In fact, they're so pretty, and witty, if not gay, that they pity anyone who isn't a physician today!
What's that, Maya? Do nurses talk? Of course they do. That's a good question, though, because nurses almost never talk on "House." But nurses do say, "Yes, Doctor." Once in a while they say "No, Doctor." Can you say that? Very good! Why, you could be a nurse right now. Except you might not be quite big enough to wheel those patients around. And I think your Mommy and Daddy might like to see you "buckle down" and go to college instead.
Well, that's the end of our story. Next week, we'll have another story. It's called, "Oh, the Places You'll Go--If You're Smart and Cool Enough to Be a Physician!"
