In a recent issue of Annals of Internal Medicine, a female resident relates her early morning interaction with Mr. B., an elderly patient. Nauseated and cold from fatigue at the end of a two-week rotation of 14-hour shifts, she approaches the patient, who immediately takes her for a nurse and asks for a glass of water. Infuriated by his assumption that she is the nurse, she tries to calm herself. "Deep breath in and out," she tells herself. After collecting herself she informs Mr. B. that she is the physician and goes on to question him regarding his symptoms and medical history.

Before examining Mr. B., she apologizes for her frigid hands and tries in vain to warm them. As she proceeds, Mr. B. slowly reaches out toward her. She thinks he might want to touch her hair, but instead he takes her hands, one at a time, and rubs them-"to warm you up, Doctor," he says. Moved by his kindness, the resident feels her "impatience and haste" dissipate. She realizes that it had been "the patient rather than the doctor who had the healing touch." 1

As a nurse practitioner working with female obstetrics-gynecology residents, I hear complaints about mistaken identity all the time. Often, when a female resident walks into a patient's room, the patient calls her "nurse" or asks her to perform a menial task. This makes the resident furious. One resident told me, "I've had it. I'm sick and tired of being called a nurse."

This mistake-a common one in a world that still might equate "doctor" with man and "nurse" with woman-evokes hostility and sometimes, when the residents are very tired, even tears. "Why does being mistaken for a nurse upset you so much?" I've asked. Most residents say it has to do with education, authority, responsibility, and identification. They've studied long and hard. The buck stops with them. They want to be recognized for their achievements.

Oddly enough, I have the opposite problem. When I walk into a patient's room wearing my white coat, a stethoscope in my pocket and a chart in my hand, most patients assume I'm the physician. Even when I tell them that I'm a nurse practitioner, once I begin to elicit a history or perform an examination, patients persist in calling me "Doctor."

Maybe it's because I'm older than most residents and dressed in street clothes, not scrubs. My husband, who's a physician, thinks it may be because I display the traits patients take for granted in their nurses but applaud in their physicians: listening more than talking; responding to the emotional tone in the room, not just to the patient's words; giving patients glasses of water and helping them dress after an examination; explaining complicated information in plain language; celebrating or mourning with families; cleaning up when, in the course of caregiving, I make a mess. Once patients get to know me, they understand that although I may perform some of the procedures a physician does, what I'm really doing is nursing.

In a scene in the play Wit, by Margaret Edson, Jason, a brilliant clinical fellow with no bedside manner, chats with Susie, the nurse. Their dying patient, Dr. Vivian Bearing, lies unconscious before them. Talking over Vivian's body, Jason disparages what he calls "that meaning-of-life garbage." When Susie replies that she does believe life has a meaning, he snaps at her. "What do they teach you in nursing school?" he asks, and leaves the room.

Susie lingers. As if to answer Jason's question, she picks up a bottle of lotion, pours some into her palm, then takes her dying patient's hands, one at a time, and massages them-the same simple act of caring Mr. B. offered his tired, cold resident.

When patients mistake physicians for nurses (or nurses for physicians), they must be seeing in one the best qualities of the other: nurses can be smart and decisive; physicians can be gentle and nurturing. Maybe patients would be better served if such confusion was, well, appreciated. After all, while our duties as nurses and physicians may differ, our goals are the same: to give undivided attention to one patient at a time; to help that patient through the process of illness toward recovery; and if recovery isn't possible, to stay with a patient as death approaches.

Whether physicians or nurses, we are not so different from the patients we tend. All of us, at one time or another, will be in great need of comforting and kindness. The resident who balked at being called a nurse, for example, ended up being nursed by her patient; his attempt to warm her hands made her irritation vanish.

So maybe the next time a patient calls a physician "nurse," or a nurse "doctor," the best response, along with a gentle correction, would be "Thank you."

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