Phil Hammond MD

When I was a house officer, we did the curing and killing and nurses did the caring. Now, shock horror, there are nurses who can prescribe paracetamol

As I get older, I find it hard to tell where a nurse ends and a doctor begins. When I was a house officer, we did the curing and killing and nurses did the caring. If you were lucky, they'd make you a nice cup of tea. If you were desperate, you'd make them one. And if you were a tosser, they'd phone you up at 3am and ask you to write up paracetamol for a patient who was asleep.

Now, shock horror, there are nurses who can prescribe paracetamol without first clearing it with a doctor. There aren't many of them, mind, but the very notion that experienced professionals can dish out a tablet sold in thousands of corner shops across the land represents a giant leap forward for the nursing establishment.

This, of course, is only the tip of the iceberg. There are also nurses who sew wounds in casualty, plaster broken limbs, incubate tiny babies, manage intensive care units, certify death, set drips up for cancer sufferers, give intravenous injections, run asthma and diabetic clinics and do all manner of things that were traditionally the domain of doctors. The only way to tell the difference between the two these days is not by the job description but by the silly hat and the flammable J-cloth dress. Last week I drove past a hospital that had "Warning - Guard Dogs Operating On This Site" plastered across the entrance. I can only assume they'd run out of nurses.

The doctoring of nurses has led many to call for their expansion at the expense of junior doctors and GPs. Eighty per cent of the problems that surface in your average surgery are self-limiting or psychosocial, so why not let the nurses take the strain and take the doctor away from his form filling only when something unusual crops up?

Indeed, is there anything a GP does that a good nurse couldn't do just as well - and for less? To minimise any sexual bias, I asked a female GP who works with lots of practice nurses. "In theory," she said, "the answer's no. In practice, nurses are a lot slower than doctors, they're not as good at handling uncertainty and they don't like the buck stopping with them. These problems might be ironed out with training, but then they'd be doing essentially the same job as us and, quite rightly, they'd demand the same pay. So where's the saving?"

Some academics have called for a merger of medical and nursing training, not just because of the job similarities, but so that we could iron out prejudices at an early stage and learn from each other's roles. It could be a disaster. We'd end up with nurses who drink ten pints, drop their trousers and urinate in people's flowerbeds. And doctors who have to go on a three-week course to get a shiny badge before they can so much as fart on the ward. These cultural stereotypes of hard-drinking, gung-ho doctors doing operations they've never heard of with the book open on the table, and timid nurses who aren't allowed to breathe until another nurse checks it first, are very deep-rooted. Hence many doctors are still using their arrogant incompetence on patients, and many nurses still haven't crossed the paracetamol barrier.

Some, however, have gone way beyond it. When Sister Valerie Tomlinson whipped out a Cornish appendix, we all got in a terrible froth; but nurses have been dabbling illicitly with the instruments for years, usually to rescue cack-handed junior doctors. Nurses often cite problems in getting insurance, and fear of litigation, as the reasons for not openly challenging surgeons for a place in the hospital league table, but in America, the most litigious country of all, they give anaesthetics, cut chests open and play God as much as the next doctor. Can you tell who's a doctor and who's a nurse in ER?

In the less hi-tech world of geriatric medicine (i.e. most of medicine), nurses are clear winners. An experiment in Oxford revealed that patients on a geriatric ward staffed entirely by nurses did better than on wards where doctors poked their noses in. Other studies have since substantiated this. Quite why it should be so is unclear - I've taught both nursing and medical students and you'd be hard pressed to tell the difference when they start their courses, especially since 70 per cent of medical students are now women. Are nurses trained to appeal to the elderly, or is it just the dress? White coats frighten people, J-cloths reassure them. Would doctors in blue checks be more empathic? Would nurses in white coats take more responsibility? And who would end up making the tea? I think we should be told.