The Third Standpoint: What Medicine Could Know If It Knew Nursing

I ask the nurse first.

Before I lay eyes on the patient — after I've precharted, after I know the vitals and the labs and the overnight events — I stop and ask the nurse what they think is happening. Not as a courtesy. Not as a performance for the residents watching from the doorway. Because I learned — in a classroom that most physicians have never sat in — that the nurse in that room has already synthesized something that isn't in any chart. Something that only exists in the standpoint of the person who has been there.

Most of my colleagues don't do this. Not because they're bad physicians. Because no one ever taught them there was something worth asking.

I am in a position to change that. And I have chosen to.

That choice — and the body of knowledge behind it — is why this publication exists.

Two Educations

I have been formally trained in two healthcare professions. I hold a BSN, a Master of Science with an emphasis in nursing, and a PhD in nursing from Emory University, where I was also trained in the pedagogy of teaching through their TAtto program. I hold an MD from the Medical College of Wisconsin and completed a three-year residency in family medicine. I am now an Assistant Professor of Medicine and Associate Program Director of the Community Health Center Family Medicine Residency Program at the University of Nebraska Medical Center. I practice at Winnebago Comprehensive Health System, OneWorld Community Health Center, and Nebraska Medicine, where I serve some of the most underserved patients in this country.

I am telling you this not to establish credentials but to establish position. Because what I have come to understand — and what this publication is built around — is that where you stand determines what you can see.

I am also telling you this because I am one of the people who decides what residents learn. And what I have decided — based on everything I am about to describe — is that what we are not teaching them is costing our patients.

The nursing education system and the medical education system are two of the most sophisticated professional training pipelines in the world. They share a subject — the human patient — and almost nothing else.

In nursing school, we talked constantly about the theory-practice gap. It is everywhere in graduate nursing education. Grand nursing theorists — Sister Callista Roy, Jean Watson, Dorothea Orem — built entire frameworks specifically to bridge the distance between what is taught and what is practiced. Nursing education takes seriously the idea that theory and practice are in tension, that this tension is real and consequential, and that the clinician must actively navigate it.

In medical school, no one mentioned it once.

This is not a criticism of medical education. It is an observation about epistemological difference — about two professions that have developed entirely different frameworks for understanding how knowledge becomes care. And because the two systems exist in almost complete isolation from each other, neither knows what the other has built.

Most nursing schools are not at academic medical centers. Most nursing clinical rotations happen in community hospitals, outpatient clinics, and long-term care facilities where the physician presence is peripheral. I can tell you from experience that in nursing school, we had almost no idea what residents were. We knew there were doctors. We didn't know they were also learning, also uncertain, also being supervised, also navigating the gap between what they had been taught and what the patient in front of them actually needed.

The resident who dismisses the nurse doesn't know that the nurse has a college education, formal theory training, and a clinical framework built around exactly the kind of observation they're dismissing. The nurse who resents the resident doesn't know that the resident is three months out of medical school, terrified, and has never once been taught to ask what the nurse thinks.

They were trained in silos that never acknowledged the other existed. And then we put them in the same room and expect them to save lives together.

As a residency program director, I see this collision every year. New residents arrive with extraordinary clinical preparation and almost no framework for understanding the professional standing, the clinical knowledge, or the epistemic position of the nurses they will work alongside for the rest of their careers. We have never formally taught them otherwise. That is a curriculum failure — and it is one I am working to correct.

Risjord and the Standpoint

In my doctoral program at Emory, I encountered the work of philosopher Mark Risjord, whose writing on nursing epistemology shaped how I understand what nurses know and how they know it.

Risjord drew on the tradition of standpoint epistemology — the philosophical argument, developed most fully by feminist theorists, that knowledge is not neutral. That what you can know is shaped by where you stand within social and institutional structures. That the view from the margin is not a lesser view — it is a different view, one that sees things the center cannot.

Applied to nursing, this argument is powerful. Nurses occupy a distinctive position in the clinical structure. They are present in ways physicians are not. They witness what happens between the formal clinical encounters — the patient at 3am, the family member who finally breaks down after the physician leaves, the subtle change in affect that precedes the deterioration no monitor has yet detected. This position generates knowledge. Not the same knowledge as medicine. Different knowledge. Knowledge that the clinical system cannot afford to ignore.

Risjord's argument was that nursing needed to take this standpoint seriously — to recognize it as a source of genuine clinical epistemology rather than merely ancillary observation.

He was right.

But there is something Risjord's framework did not fully address, because it could not. He was writing from a single standpoint. He was describing what nurses know from where nurses stand.

What happens when someone has stood in both places?

The Third Standpoint

I am not a better physician because I went to nursing school. I want to be careful about that claim. The relationship between nursing and medicine is not a hierarchy waiting to be corrected, and this essay is not an argument that one profession's knowledge is superior to the other's.

What I am arguing is this: there is a third epistemological position available to the dual-trained clinician that is categorically unavailable from either single standpoint alone. It is not a synthesis. It is not the average of two perspectives. It is a genuinely new way of seeing — one that emerges only from having been fully formed in both ways of knowing.

I see it on rounds every morning.

When I stop and ask the nurse what they think, I am not performing interprofessional respect. I am accessing a standpoint I was trained to value — not because someone told me to value it, but because I have inhabited it. I know what the nurse sees because I have seen through those eyes. I know the clinical weight of the observation they are about to offer because I understand the epistemological framework that produced it.

When I offer to help reposition a patient, I am not performing humility. I know what that work costs. I know what it means to be the person in the room at 3am who repositions a patient alone because the call light went off and no one else came. That knowledge lives in my body the way clinical knowledge does — not as information but as formation.

When I sit at the bedside and take time to learn one thing about a patient as a human being — not their chief complaint, not their med list, but one thing about who they are — I am practicing something that my nursing education named and my medical education did not. I am practicing presence as a clinical act.

Not all nurses do this. Not all physicians do either. I want to be honest about that. The professions are not monoliths and I am not romanticizing either. What I am saying is that the training that shaped me — both trainings — gave me access to a way of seeing the patient that neither training alone would have produced.

As an associate program director, I am in the unusual position of being able to change what residents learn. I have chosen to teach them to ask the nurse first. I have chosen to make interprofessional knowledge — not interprofessional courtesy, but genuine epistemological respect for what nurses know and how they know it — a formal part of what we do on rounds. That choice came directly from my nursing PhD. From a body of knowledge that most residency programs have never considered putting in a curriculum. From a standpoint that medicine, as a system, has never been trained to occupy.

I believe that needs to change. And I believe residency training is exactly where that change begins.

What Medicine Would Gain

My partner Lindsey is a physician with triple board certification in geriatrics, palliative care, and family medicine. She practices at the intersection of medicine's technical expertise and its deepest human obligations every single day. She reminds me — with a consistency that I have come to understand is not incidental but clinical — that sometimes all a patient wants is to be heard. To have a voice. To know that the person in the white coat sees them as a person and not a problem.

This is not soft knowledge. This is not the warm-and-fuzzy complement to the real work of medicine. In palliative care, in primary care, in every clinical encounter that matters, it is the work. The standpoint that produced it — the nursing standpoint, the human standpoint, the standpoint of the person who stays in the room after the physician leaves — is a source of genuine clinical knowledge that medicine has systematically undertrained itself to access.

What would medicine gain if it knew nursing?

It would gain the theory-practice gap conversation — the honest acknowledgment that what we teach and what we practice are in tension, and that this tension is worth naming and navigating rather than ignoring.

It would gain the epistemological humility to ask what the nurse thinks before laying eyes on the patient.

It would gain the clinical wisdom to understand that the person who has been in the room all night has synthesized something that the person who just walked in has not yet seen.

It would gain, in residency training specifically, a formal curriculum built around interprofessional epistemology — not teamwork exercises and communication modules, but a genuine philosophical grounding in what different clinical standpoints produce and why all of them matter.

It would gain, perhaps most importantly, the recognition that the patient in the bed is not primarily a clinical problem to be solved. They are a person who wants to be heard. Who wants a voice. Who wants to know that someone in that room — physician, nurse, resident, anyone — sees them.

That is what the nurse in me wants to give to every patient I care for.

That is what this publication is for.

About the author

Peter Schindler, MD, PhD is an Assistant Professor of Medicine and Associate Program Director of the Community Health Center Family Medicine Residency Program at the University of Nebraska Medical Center. He practices at Winnebago Comprehensive Health System, OneWorld Community Health Center, and Nebraska Medicine. He completed a Primary Care Research Fellowship at McGill University and holds a BSN from the University of Wisconsin-Oshkosh, an MS and PhD in nursing from Emory University's Laney Graduate School, a Diploma in Tropical Medicine from the Liverpool School of Tropical Medicine, and an MD from the Medical College of Wisconsin-Green Bay. He is board certified by the American Board of Family Medicine. The Interprofessional publishes new essays every week at the intersection of medicine, nursing, and the clinical knowledge that lives between them.

Disclaimer. The views in The Interprofessional are Peter Schindler's own and do not represent the official positions of the University of Nebraska Medical Center, Winnebago Comprehensive Health System, OneWorld Community Health Center, Nebraska Medicine, or any other affiliated institution.