New Rules for the Game: Interdisciplinary Education for Health Professionals Elaine L. Larson, RN, PhD, CIC, FAAN To enhance interdisciplinary collaboration among medicine and nursing, and to better respond to societal health care needs, we must take a serious look at the educational systems that socialize young health professionals into their respective roles. I n 1967 the term "doctor-nurse game" was coined by Stein 1 in the Archives of General Psychiatry. The term caught on and has appeared intermittently in the literature over the past three de- cades. 24 The object of the game is to preserve the interactive roles tradition- ally held by the physician and nurse in clinical practice, with the physician seemingly the sole decision maker and team leader, and the nurse "allowed" to make recommendations as long as she appeared passive. Open disagreement was to be avoided at all costs. Rewards for playing the game well included re- spect for the nurse (a "damn good nurse") and smooth facilitation of work for the physician. The genesis of the game was attrib- uted to differences in the education of medical and nursing professionals. It was suggested that medical students, inun- dated with facts vital to life and death and often trained in a confrontational interview style, developed a phobia of NURS OUTLOOK 1995;43:180-5. Copyright o 1995 by Mosby-Year Book, Inc. 0029-6554/95155.00+ 0 3511151728 making a mistake. As a protective mechanism, physicians adopted a defen- sive posture in which they attempted to be perceived as omniscient and all pow- erful. The game was thought to be learned during graduate training, when the physician felt pulled between the need to give patients the best care pos- sible, which sometimes meant seeking advice from the nurse, and the need to protect the facade of omnipotence. Nursing students began their social- ization to the game during school, in programs that were disciplined and in- flexible. Their time was carefully, even militantly, controlled, and virtues such as duty, discipline, self-control, and obe- dience were extolled. Nursing students learned to be wary of independent deci- sion making. A nurse writing in 1917 expressed the prevailing belief of that time: In my estimation obedience is the first law and the very cornerstone of good nursing .... No matter how gifted she may be, she will never become a reliable nurse until she can obey without ques- tion. 5 In the mid-1960s, at about the time when "The Doctor-Nurse Game" was published, an experiment was conducted in which 22 nurses were given a tele- phone order by a physician for an obvi- ous overdose of a drug. Twenty-one of the nurses said that they would have given the drug without question. 6 While nurses were socialized to a de- pendent role, they were also told that their skills were vital to the welfare of the patient and an invaluable asset to the physician. Thus the nurse and the physician were caught in a paradox, and the doctor-nurse game allowed a reason- able mechanism for maintaining the in- tegrity of their respective perceived roles, while also facilitating patient care delivery. In 1990 Stein proposed that the game had changed as a result of changes in public perceptions of the physician, in- creasing numbers of women entering medicine, a shortage of nurses, the in- creasing responsibilities and authority of nurses, and changes in nursing educa- tion away from hospital-based training to the academic setting. 2 The game did not work any more because one of the players (the nurse) had decided to stop playing, expressing a desire for more autonomy and a more collaborative role as a partner in the health care team. At this point nurses' reactions to the game sometimes became defensive, overdetermined, assertive, and even hostile as they sought recognition. Phy- sicians' reactions ranged from tentative support to puzzlement to feelings of be- trayal and anger. They perceived that nurses were abandoning their focus on patient care and bemoaned the fact that 180 Larson VOLUME 43 * NUMBER 4 NURSING OUTLOOK