A Physician's Letter Was Demeaning to NursesI...

THE BALTIMORE SUN

A Physician's Letter Was Demeaning to Nurses

I was distressed by the inaccuracies in Dr. Brian Briscoe's July 17 letter against nurse practitioners.

Dr. Briscoe began his letter with the promise not to demean or undermine the role of the nurse practitioner, then proceeded to do just that for eight paragraphs.

Our overburdened health care system is dependent on safe, effective, non-traditional methods of health care delivery for quality care and cost containment. The role of the nurse practitioner is one of these innovations.

A physician's expertise is not needed to care for the common acute illness, stable chronic disorder or routine check-up.

Frankly, these everyday problems make up about 85 percent of the physician's daily practice. By using less costly, skilled "middle-level practitioners" to care for these needs, the physician's high level of expertise can be better utilized.

The nurse practitioner role is not a new role. Actually, it was established about 30 years ago in an attempt to improve primary care delivery to areas under-served by physicians. It is due to the great success of this role that we are seeing nurse practitioners in an ever-expanding arena of health care delivery.

Dr. Briscoe repeatedly interchanges the terms "nurse" and "nurse practitioner" and suggests that after the "nurse" botches up a treatment, the physician must pick up the pieces at some legal peril to his own license.

Nurse practitioners do not practice under a physician's license. They are granted their own licenses after undergoing an intensive training (over and above basic nursing education) and a grueling certification exam which incidently requires a master's degree to even be eligible to take.

There are uncountable numbers of people who do not receive adequate health care because the old system cannot serve the needs of the world we are living in. Dr. Briscoe's uninformed resistance serves only to promote this tragedy.

Deborah Cofield Forrest

Baltimore

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I am curious where Dr. Briscoe obtained his information concerning the qualifications of nurse practitioners. As a radiologist, I wonder how much contact he has had with nurse practitioners.

A U.S. Office of Technology study found that "physicians who work with N.P.s express more satisfaction with N.P.s' performance and more willingness to delegate higher level tasks than do physicians whose contact is indirect or nonexistent."

Diana Heffner

Ellicott City

It would be advisable that Dr. Briscoe gets his information clear.

The absurd claim that I.Q. levels of medical doctors are superior to registered nurses -- or any other profession, for that matter -- is truly from the archaic notion that M.D.s are better then anyone else.

To indicate that nurse practitioners give substandard care is also an indication that Dr. Briscoe has not kept up with modern medicine.

Johns Hopkins, which has just been named the best hospital and research institution in the U.S., uses N.P.s in every specialty area. I should know, I work with the AIDS service at Hopkins.

I would challenge anyone who would claim the care our N.P.s and physicians' assistants give is substandard. They provide knowledgeable, compassionate and affordable care that is needed in today's high-tech and high-cost medical system. N.P.s and physicians' assistants are a part of this system that keeps health costs down yet provides expert medical care. Hillary Rodham Clinton would do well to look into their success.

Ask any nurse why he or she chose their profession and specialty and the answer will always be the same. We are all committed to care for people -- without much thought to large monetary rewards. Believe me, if anyone goes into nursing expecting huge salaries, he or she won't stay in nursing long. You won't see N.P.s driving BMWs with vanity tags.

Karen Sova-Grimm

Joppatowne

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I would like to take issue with a few of the chauvinistic, arrogant statements concerning nursing contained in Dr. Briscoe's letter.

The tone of his letter seems to suggest that the I.Q. of nurses is inferior to physicians, when in reality it may at times be greater. Nursing has evolved over the years, and nurses now assume responsibility for patient care unheard of in recent years.

The issue of responsibility and authority may be complex in terms of meeting community medical needs vs. the availability of services.

Perhaps the doctor is more concerned about control and money involved in medical care than he is in sharing responsibility and money with intelligent, compassionate and well-trained nurse practitioners.

Ann Faith

Timonium

All the writers are registered nurses or nurse practitioners.

Quick Fixes

I would like to offer two new ideas regarding our national problem of increasing crime and violence. These two suggestions will try to provide a "quick fix" to this problem and will not cause any increase in cost to our criminal justice system; in fact, they should decrease these costs.

Before presenting these ideas, it is important to appreciate the real root cause of the problem which must be corrected in order to effect a long term solution.

Although poverty and education are part of the problem, they are not its main source.

The genesis of our problem has been our declining morals. We have increasingly become an egocentric, materialistic, secular society. We have so magnified our individual importance that we are less inclined to submit our will to the laws of God and the state.

Many of us think that we can use our personal conscience to control our actions. Our egos are so great that we do not feel obligated to live under the authority of God and the state.

To change this false philosophy will require the efforts of our leaders, religious, political, literary, etc. over a long period of time.

Quick Fix No. 1: It is generally agreed that what we feed to our minds lead to the actions we take.

We know that we average in excess of 25 hours per week feeding our minds with television. TV, movies, magazines and books present a profusion of sex and violence. This stimulus, as recent studies have shown, can lead to criminal behavior.

In order to curb this stimulus, I propose that our legal system come to the rescue. We could pass a law that would allow the producers, actors, writers and distributors to be sued for the consequences of their shows. If it could be determined that a crime was committed due, at least partially, to viewing a TV show, for example.

Quick Fix No. 2: One major deterrent to crime is fear of swift and harsh punishment. In our society, the punishment is neither swift nor harsh.

Why is our crime rate so much worse than other countries of the world? If we were to look and compare their systems with ours, I think we would learn that their punishment offers more deterrent because it is more swift and harsh.

We have prisons run by prisoners and their lawyers and not by guards. We offer a warm bed, reasonable food, TV, radio, recreation, newspapers, magazines, etc., etc. It is apparent that there is too little fear of incarceration. This idea offers the added benefit of lowering the cost of running a prison.

William G. Sturm Sr.

Baltimore

Muslim Bias

I wish to express my concern with the way the media are handling issues dealing with the Muslim world community.

You have succeeded with every article -- particularly with those regarding the bombing of the World Trade Center, Egypt's Sheik Omar Abdel-Rahman and the most recent alleged plot to bomb various parts of New York City -- to ridicule the religion of Islam to a degree that seriously makes me question this country's pretense regarding religious tolerance.

Allow me to cite just a few examples.

When the time comes for Muslims to offer prayer five times dailywe come together at whatever mosque happens to be in proximity.

While prayer can take place anywhere, the unity exemplified by praying with the community (in a mosque) makes it more desirable. Thus you could find yourself in a different location of the city or state each time prayer becomes due.

Coincidental, prior or subsequent attendance at a particular mosque does not make one guilty of complying with someone who happens to be speaking or just sitting in that same mosque.

The men accused of the World Trade Center bombing were labeled followers of Sheik Abdel-Rahman for that very reason.

According to those standards, I could be labeled a follower as well since the sheik has spoken at the mosque I regularly attend.

We all have our own ideas of how we think our nation should be governed and the direction it should pursue.

Agreement with a compatriot's opinions doesn't make you a follower of that individual, either.

Whenever there is some incident, why is it that the media insist on calling the alleged offender a "Muslim extremist" or an "Islamic fundamentalist?"

Never once in all the incidents of murder and mayhem carried out by my fellow Americans does anyone refer to the antagonist as a Baptist or Lutheran militant or Catholic extremist or fundamentalist.

We Muslims, one billion strong and growing faster than any other religion on the planet, are human beings first and foremost.

History has shown us repeatedly how it is never fair to assess an entire group by the actions of few.

Islam is a subject about which the West is all too anxious to make unfounded generalizations and accusations.

We would appreciate the same tolerance, reverence and respect due to any of the earth's inhabitants and would like the witch hunt to cease.

Soraya Abdallah

Baltimore

Schaefer's Vision

Once again, The Baltimore Sun is attacking Gov. William Donald Schaefer, his cabinet and C & P Telephone Co.

In five full columns, there is only one apparent statement that is close to reality and that a description of our governor as a man "who sees himself as a visionary."

He is a visionary and all you have to do is consider the All-Star game.

We should all remember that if not for his vision, the whole Camden Yards experience would be missing from a city and state that desperately need the income and recognition associated with this success. The Sun wrote many negative articles about this vision.

Whenever our state leaders look to the future and create public and private partnerships, you immediately attack them as being something wrong. All of us in private industry want less %o government and more business involvement.

Dr. Nancy S. Grasmick is working hard to make our state school system much better.

This fiber-optic network appears to be a significant advancement for education that is in desperate need of change. How can you criticize that?

The writers and editors The Sun should learn from Governor Schaefer how to be more positive and visionary.

Blase Cooke

Silver Spring

War in the Ballpark

So the hometown crowd embarrassed Dale Bandy's delicatsensibilities (letter, July 15)? So the Toronto fans act with "more class and dignity?"

Gee, too bad. I, for one, was thrilled by the terrific display of true baseball spirit our wonderful Oriole fans showed at the All-Star Game.

I am the typical grumbling working-class baseball fan who yearns for the old days of spontaneous trips to Memorial Stadium.

Yeah, this new place is great, if you like Disneyland. But I liked smelly old Memorial Stadium, where my father took me as a kid, where your nose was assaulted by cigar smoke. Camden Yards seems a little too gentrified. The fans a little too polite.

So the high point of the All-Star Game for me was to see that the real fans were actually there, actually booing those bad old Blue Jays like crazy.

It's a pennant race. The Blue Jays are the enemy. Their manager is the evil enemy general.

I'm a bleeding-heart liberal in politics -- anti-war, anti-nuke, all the rest. Baseball is lovely and poetic. But also primitive. May peace and civility reign throughout the world. But let it be war in the ballpark.

Thanks, Mike Mussina, for firing up the crowd! I hope I'm there for the next bench-clearing brawl.

0$ And I'm proud to be an American.

Christina Johnson

Bel Air

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I'm afraid I must agree with Dale Bandy's letter July 15 about the behavior of the fans at the All-Star Game.

Baltimoreans used to have the reputation, still quoted, as being "Baseball's Best Fans," a title we earned not only by our enthusiasm for the Orioles, but the willingness to cheer for opposing players as well.

A great play by an Oriole in another ballpark might be greeted by silence, but visitors here would receive a nice round of applause.

That spirit has faded over the last few years. Opposing players do not get many cheers any more, and we seem to be headed from respect through indifference to disrespect at full speed.

Not only was the booing of the Toronto players unfortunate (our dislike of manager Cito Gaston's pettiness should not have extended beyond him), but so was the mocking of Atlanta's John Smoltz, a good pitcher whose two wild pitches should have elicited sympathy rather than jeers.

Coupling actions like these with our willingness to boo any Oriole who goes into a slump, I don't think we can lay claim to being "Baseball's Best Fans" any longer.

Jeffrey D. Smith

Baltimore

Separate Maryland Colleges

Any value in Dave Walcher's letter (July 11) advocating for the Baltimore area public universities and colleges may be lost because of his misunderstanding of the missions of the institutions.

Probably not even Towson State (Mr. Walcher's alma mater) would accept his picture of it.

What he described are caricatures of the schools. For example, his narrow vision of the University of Baltimore is to train lawyers.

He ignores its excellent record (and stated mission) of offering accredited business and public administration programs and the applied liberal arts at both the graduate and undergraduate levels, as well as law.

His point, however, of urging the institutions to "excel in its own way" is indeed the philosophy that the Board of Regents espouses. Building up the strengths of each while avoiding duplication is exactly what is happening.

Mark Freedman

Baltimore

The writer is president of the University of Baltimore Alumni

Association.

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Unfortunately, rather than simply making the case for supporting Towson State, Mr. Walcher chose to make several claims about the University of Maryland College Park that just aren't true.

For example, contrary to his assertion, no Towson State student fees go directly to College Park. Neither is it true that budget savings from Towson State academic program reduction will be used to build an academic performing arts building at College Park.

The fact is that operating budgets and capital building budgets are legally separate items and funding for one cannot be used for the other.

Mr. Walcher left out that budget reductions at College Park forced it to reduce its academic programs more than any other university in the state. The budget reduction at College Park have been among the largest reductions at any university in the country.

But Mr. Walcher misses the most important point. Recognizing finite state resources, the governor and General Assembly in 1988 created a system of higher education in Maryland built on distinctive missions.

The Board of Regents is given the responsibility and authority to determine the appropriateness of academic programs and to allocate state financial resources among the 11 state colleges and universities in the system. Maryland colleges and universities were not to compete so much among themselves as much as with peer groups of colleges and universities across the country.

How is College Park meeting its mission as a national research university mission? College Park is the only Maryland public university classified by the Carnegie Commission as a Research-1 University and is a member of the Association of American Universities, the association of the 56 most prestigious public and private research universities in North America.

College Park's peers as determined by the Maryland Higher Education Commission include the universities of Michigan, Wisconsin and North Carolina. College Park's student profile is the highest in the university system, attracting students from all 50 states, and it is the only public school in Maryland with a chapter of Phi Beta Kappa.

A little-noticed recent evaluation of graduate liberal arts programs by U.S. News and World Report showed that College Park and Johns Hopkins had nationally ranked graduate programs, and that these two institutions had the strongest overall academic programs of any public or private institutions in the Washington-Baltimore region.

These evaluations were consistent with earlier National Academy Sciences rankings on the strengths of College Park's programs in the physical sciences and engineering.

Maryland is fortunate to have a variety of state-supported institutions serving different roles. Both Towson State University and University of Maryland College Park are examples of strong, effective institutions within that system. No college or university

is well-served by undeserved public criticism.

David E. Raderman

Ellicott City

The writer is president-elect of the University of Maryland at College Park Alumni Association.

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