Column

No mere appendix

Eric is as outraged as everyone else over the story of the Little Nurse who Could

A surgeon slips away from the operating table one day and a nurse finishes the operation. The patient recovers normally and the world explodes with indignation. Banner headlines scream about safety and standards, journalists press microphones under the noses of nervous and bewildered NHS managers, and a succession of besuited bigwigs drone on pompously about the disgrace of it all.

Disgrace it is, but not because some uppity theatre sister overstepped the mark. In a wise health service the trust chief executive would give her a pay rise, sack the surgeon and send scouts searching for like-minded nurses wanting to branch out. Alas, the chief executive will be too spineless to do any such things, fearful of the finger-wagging press, the barmy banner-wavers forever spotting ‘cuts’ in the NHS, and the angry men of the British Medical Association.

These latter characters are the panzers of medicine, and few dare take them on. The enterprising nurse has really upset them, and they will not rest until job demarcation is properly re-established, for something sacrilegious has been performed, not just an appendicectomy. A mere nurse, who is also a mere woman, has demonstrated that appendicectomy is a technical task that can be learned by observation and repeated, with no detriment to the owner of the appendix. She has made the surgeon, with his five years of undergraduate training and another umpteen years of postgraduate drudgery and bookwork, redundant. Someone trained for a different task — a handmaiden, in fact — had picked up part of his trade.

Surgeons, like all doctors, are fond of their own expertise and wallow in the mystique of their craft. Surgery as a discipline is not friendly to women. By doing an appendicectomy the objectionable nurse has delivered a double whammy to professional pride, and violated the rules of restrictive practice.

Of course, something could have gone wrong. She might have perforated the bowel of the hapless patient, whose subsequent peritonitis might have carried him off. Since such things never happen when vary junior surgeons working astonishingly long hours perform emergency procedures, that would have been scandalous. But it did not happen, perhaps because the nurse was actually more experienced than the doctor, and worked sensible shifts that do not undermine professional competence through sleep disturbance.

The fuss about the boundaryless nurse was a fuss about power, and it tells us all we need to know about ‘skill mix’ and ‘skill sharing. Professionals resist change because they are secure inside their well-defined roles, not because they are the best people for the job in question. The patient’s role is to fit into an existing job description. In India technicians can flick out cataracts and do vasectomies after brief training, but here we must have ‘only the best’..... because ‘the best’ say so.