View from the Nurses' Station: Too Little Attention Is Paid to Care of Patients Compared with Medical Treatment

By Buresh, Bernice | Nieman Reports, Winter 1993 | Go to article overview

View from the Nurses' Station: Too Little Attention Is Paid to Care of Patients Compared with Medical Treatment


Buresh, Bernice, Nieman Reports


Last summer, when surgeons at The Children's Hospital of Philadelphia decided to separate the Lakeberg "Siamese" twins, the event comprised the elements of a medical super bowl. Described as "surgical wizardry" by The New York Times, the operation by world-class doctors included the win-lose risks of all great contests - only one conjoined twin, if lucky, would survive because there weren't the two hearts needed to support both lives.

Reporters covered the medical drama by rounding up experts for both pre-and post-event handicapping. Those who argued for no intervention were quickly superseded by surgeons who could give scalpel-by-scalpel details of the five-and-a-half hour operation. Controversy also shaped the post-event analysis. Journalists sought out medical ethicists who questioned both the priorities of the game plan and its costs, especially at a time when the inequities of the medical system are being widely debated.

Of course family players were part of the event. Attention shifted from the mother, Reitha Lakeberg, who had pressed for a high-tech solution to the tragedy, to the father, Kenneth, who had gotten into trouble with the law. Follow-up articles reported the condition of Angela Lakeberg, who survived. Then the story passed from the scene, ready to be replayed in the event of the infant's death.

When a story with all the right dramatic elements comes along, no journalist even has to think twice about how to cover it. But suppose we do think twice about this one, and decide to enlarge its frame from medical spectacle to real-life health care. The content, the types of news sources and the time period immediately expand.

In this health-care version, the reader and viewer are taken not only to the operating theater, but also to the pediatric intensive care unit, where Angela is cared for around the clock by critical-care nurses in the cardiothoracic wing. There, and in talks with nursing ethicists, the emphasis subtly shifts from prognosis about the duration of Angela's life, to the quality of her remaining life. The nursing sources explore what kind of disabilities the infant has and will continue to have if she survives, and the type, quantity and cost of the ongoing care that she will need, not just the price tag on the surgery. Some nursing ethicists also pointedly question whether the operation conferred greater benefits on the learning curve of surgeons than to the well-being of the patient. Nurses and social workers raise questions about what was done to support the Lakeberg family through this horror and their attempts to arrive at decisions at every stage. Expanding the frame on the story this way makes care, as well as treatment, visible. Not at all coincidentally, the roster of experts in this version now includes many women, instead of mostly men. The story is also more textured, real and continuing. In its more limited medical frame, the focus is on cleaving the twins, a frame shaped by the familiar and thrilling "fix-it," or "find-the-magic-bullet," motif. Now, with care being brought into balance with "cure," the story is more ongoing, and a lot more reflective of the real issues in health care.

As this story illustrates, journalists generally bring a bias to reporting of health care. They see medicine as synonymous with health-care. This bias is quite understandable in its origins. It is not just the marvels of modern medicine that have permitted physicians, who make up 10 percent of the healthcare work force, to so thoroughly dominate health care discourse in the media. The depiction of doctors as the proprietors of the healing arts has depended just as much upon organized medicine's tough and uncompromising political campaign for dominance waged throughout most of this century.

The consequences, however, of journalists' refracting almost all health-care issues through the prism of medicine undermines the accuracy, balance and fairness of reporting on health care, and it limits the views, and ultimately the health-care choices, of readers and viewers. …

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