Wednesday, 16 December 2009

Who is a doctor?

Beep Beep… Beep Beep…

My mobile phone shrills and I casually reach over and pick it up to read the incoming text message.

You have an appointment with Dr Kavelidis at 16:00 on 17/12/09. Please allow time for parking.

I furrow my brow in confusion. I haven’t made an appointment with my G.P. in fact I haven’t needed to see him in over a year. Besides, I don’t have a clue who “Dr Kavelidis” is, perhaps he’s a new G.P. at the practice. But it still doesn’t make sense I’m sure the GPs at my surgery are busy enough without having to randomly text people on their practice lists to trawl for business. Was this some sort of new QOF thing? Seems unlikely, I’m a healthy young man. Maybe FashionGirl has the answer.

“Darling,” I say and she looks up at me from the magazine that she’s engrossed in. “Did you make me an appointment at the doctors? I’ve just had a text telling me I’ve got an appointment in a couple of days and I never made one.”

She shakes her head at me and says, “No, I didn’t. Let me see that.” She has a look at my phone and says, “It’s odd isn’t it? Especially as there’s no “from” number.”

None the wiser, I delete the message and continue watching the telly. Last time I went to the GP, I did get a reminder text beforehand, so I assumed there’s been a mix up and I’ve go the text by mistake.

Two hours later, it hits me. I do have an appointment on Thursday, but not with the doctor, with the dentist.

I go over to the fridge where I’ve stuck the appointment card and have a look at the names. Sure enough Dr. Kavelidis’ name is on the card, just below "Dr. Chang" and just above, ironically enough, “Dr Anderson.”

So, it does beg the question, “Are dentists ‘doctors?’” On this evidence, apparently they are. It just seems a bit odd to me. Dentistry is incredibly competitive to get into. Like medicine, you need straight As at A-level and then you have to spend five years studying at dental school before you’ve earned the right to call yourself a “dentist.” So why on earth, after all that, would you want to call yourself “doctor”?

It’s not just dentists that are “doctors.” Apparently, these days psychologists are “doctors,” chiropractors are “doctors”, and even nutritionists are “doctors.”

Slag me off if you want, but I spent five years at doctor school to earn the right to call myself “doctor” when I treat patients and I find it rather annoying (and inappropriate) that people with no medical qualifications get to call themselves “doctor” when treating patients.

I know there’s a feeling in the modern NHS that “anyone can do a doctor’s job,” but it’s simply not true. The way I see it, if you think you can be a real doctor, go to medical school and graduate. That way, you’ll see for yourself how “easy” it is.

Now, I totally agree that a PhD is hardly a walk in the park either, and neither is a dentistry degree and I can see that people who’ve worked hard for years at these should have a title to show their achievement.

The solution, I think is to use a system like the do in the USA whereby medical doctors have the suffix MD after their names. I know that MD means something different in the UK, but now dentists, nurses, psychologists, chiropractors and nutritionists are “doctors,” sooner or later, every man jack is going to be a “doctor” and the term will be meaningless.

Dr. Michael Anderson MD

I like the sound of that.


Anonymous said...

I'd consider a dentist to be a doctor. They spend the first 2 years of university (in Belfast anyway) with the medical students doing the same physiology, and they then go off and specialise in dentistry for the next 3. I'd say dentistry is just a speciality of medicine and that to be a dentist you need to know head and neck anatomy very well, as well as a bit of radiology, anaesthesiology, pharmacology and physiology. This is coming from a medical student, so there is bias away from admitting this even (I want doctor to be a title that not everyone has as well) but I'll accept dentists being called doctor.

Harry said...

On the subject of "everyone becoming a doctor", my dad (a GP for 40+ years now) freely admits that a medical doctor is just a doctor by publicly granted title alone, and that PhD holders are still the "real" doctors.

Definitely pushing it if they have no postgrad qualification (ie PhD) and just call themselves "doctor" to look / sound better, hasn't that been blogged about before?

As for dentists, maybe they need their own suffix / prefix ;)

GrumpyRN said...

Oh for god's sake, get over yourself! Doctor is an educational title granted to people who have put the work in and done the studying to that level. You are a doctor who happens to doctor. As opposed to, for example, my brother in law who is a doctor because he has a PhD in physics and works in IT.

brokenangel said...

you have letters after your name just like MD ie

Dr. Michael Anderson MBBS

Tho i do agree that nutritionalist calling themselves doctor is pushing it

Anonymous said...

My friend can take out the parts of a machine for example a car and put it back together in good working order, that is because he has a PhD in Engineering and a good sense of humour. He is a 'doctor' in his own right of his chosen speciality.


Oliver Smith said...

The title "Dr" never has been the exclusive preserve of the medical profession.

Anonymous said...

Almost every language except English can make this distinction properly... for example Arzt/Doktor in German, 医生/博士 in Chinese etc.

Dr Michael Anderson said...

Thank you all for your comments, just to add a couple more points.

Back when I was an A&E SHO, I frequently had to tell patients that there was not a great deal I could do about their toothache because I’m a doctor, not a dentist and that they should go and see a dentist for their problem. If dentists are now calling themselves “doctor,” surely this just adds to the confusion.

GrumpyRN, you need to RTFP, I said that a person who is SEEING PATIENTS and calling themselves “doctor” should have qualified from medical school. I’m not talking about scientists working in IT or engineers or anyone else. Do you see the difference? Anyone who is seeing a “doctor” for a computer problem is unlikely to start asking about their hernia, if they were seeing a “doctor” in a clinic or surgery, the story is different.

Also, it’s a bit rich to be told to “get over myself” by a nurse when the word “nurse” is legally protected by the Nurses, Midwives and Health Visitors Act 1997. That is, it’s illegal to call yourself a “nurse” without the suitable qualifications and registration. All I’m asking for is something similar to apply to medical doctors, much like the “RN” part of GrumpyRN. Am I being ridiculous?

Brokenangel, you’re right about the MB BS (Bachelor of Medicine & Bachelor of Surgery). Annoyingly though, the exact letters that doctors get after their name varies depending on which university they graduated from. So, you can have MB BS, MB ChB, MB BChir etc… etc… and they all mean the same thing, so using my degree letters is likely to just add to the confusion until the time when all UK universities agree on the same letters to use.

Oli Smith, I am well aware of this, which is why I think we need a title that is exclusive to the medical profession to stop all this confusion

GrumpyRN said...

"I spent five years at doctor school to earn the right to call myself “doctor”"
No, you didn't. You spent 5 years training to BE a doctor.

"All I’m asking for is something similar to apply to medical doctors, much like the “RN” part of GrumpyRN. Am I being ridiculous?"
Well.... to a certain extent, it is only medical doctors who worry about this.
I don't go around calling myself Nurse Grumpy, (yes I know about the dinosaurs who call(ed) themself nurse ***** - but they should have retired or died out by now) if I use a title it is Mr., although I still think people mean my dad when they call me that.
I take your point about patients being seen in clinics etc. but if you are seeing the right person does it matter?

In passing, I would prefer to call my dentist Mr. because he is a dental surgeon.

Dr Michael Anderson said...

No, you didn't. You spent 5 years training to BE a doctor.

I'm not sure what you mean by this, are you saying I can BE a doctor but shouldn't CALL myself "doctor?" I don't understand.

Anyway, pedantry aside, regarding your main point:

I don't go around calling myself Nurse Grumpy

But you do (or at least I hope you do). Do you not introduce yourself to patients as a nurse? Something like, "Hello I'm Grumpy, I'm the nurse who'll be looking after you." I hope you do.

Now the question I'd like to ask you GrumpyRN is: if you had a PhD and are working as a nurse, would you introduce yourself to your patients as "Dr Grumpy?"

If so (as is your right), then do you not agree we need some other way of distinguishing medical and non-medical "doctors"?

it is only medical doctors who worry about this

Well, that's because this issue only really affects medical doctors.

As I mentioned, the term "RN" is legally protected, but the term "Dr" is not.

Personally, I'd be quite happy to be known as "Michael Anderson MD" if it was well understood that MD means "medical doctor." I think the American way is better.

bored urology sho said...

surely in the case of GrumpyRN it should be Murse anyway

Dr Aust - that's PhD, NOT MD, MBChB etc said...

I'm always amused by this one...

I am one of those PhD types so I NEVER EVER call myself "Dr" in setting where I could be plausibly mistaken for a medical person. The exception, I guess, is in the blogosphere, but I picked "Dr Aust" as an alias in about two minutes five yrs ago and I can't be bothered changing it. I have a prominent disclaimer on my website:

"I am NOT a medical doctor! I'm a PhD!"

- and on Twitter I am now "Dr Aust PhD" precisely to clarify things.

Anyway, my point was that PhDs in the UK almost never call themselves "Dr" Strangelove (or whatever) in non-academic settings, since it makes people think, erroneously, that they are medics. For better or for worse, "Dr" in the UK means, in common usage, medical doctor, and that is how almost all the public see it.

So I'm with Michael on this one. It is deeply and unnecessarily confusing for Dentists, Psychologists, embryologists, Nurses w PhDs etc in the NHS to call themselves "Dr".

I know other countries have different solutions to the problem - indeed, Mrs Dr Aust, who IS a medic, found it deeply disconcerting to be called "Dr" when she arrived in the UK rather than "Artzt" (physician). But unless we can find a different amd better systems - like changing all UK medical degrees to "MD" - AND get everyone to sign up to it, we are stuck with what we have.

GrumpyRN said...

Bored Urology SHO - Murse?? No such word, neologisms are sometimes a sign of mental illness, I know a good CPN if you are interested.

"Do you not introduce yourself to patients as a nurse?"
Yes, I introduce myself by my first name and say I am an Emergency NURSE Practitioner.

"Now the question I'd like to ask you GrumpyRN is: if you had a PhD and are working as a nurse, would you introduce yourself to your patients as "Dr Grumpy?""
Yes, if that was the title I was entitled to use AND if it was in context.

"As I mentioned, the term "RN" is legally protected, but the term "Dr" is not."
You will be jailed if you pretend to be a medical doctor when you do not have the qualifications to support it, so in practice the title is protected. Plus why would you protect a title for medics when it belongs to PhD's?

Anonymous said...

I call my dentist 'Doctor', I can't see the problem with it.

I never understand why medical doctors get so arsey about other people holding the title 'doctor'. Yes, if it's some shyster/quack then fair enough. But what's the big deal about a dentist? And if they've got a doctorate they've got more right to the title than you have.

Dr Michael Anderson said...

You two, as much I enjoy having a discussion and debate, it seems that you are both totally missing the point of what I'm trying to say. I've never said I think that nobody else should use the title "Dr."

Let me say it again so it's clear. Non-doctors calling themselves "doctor" in a clinical setting causes confusion, so medical doctors should have a separate title to avoid this.

I've said this quite clearly

"The solution, I think is to use a system like the do in the USA whereby medical doctors have the suffix MD after their names. "

"Personally, I'd be quite happy to be known as "Michael Anderson MD" (that is, to drop the Dr title altogther) if it was well understood that MD means "medical doctor." I think the American way is better."

Michael said...

I studied medicine as a graduate student. Several of the other students in my year had PhDs. If they were seeing a patient on a ward, they could introduce themselves as 'Dr so-and-so'.

No-one (to the best of my knowledge) did, and we all agreed that it would be grossly unprofessional to do so. Does anyone think that they should have done differently?

Anonymous said...

It's basically a crock of balls to call yourself "Dr" int he hospital setting when you're not a medical doctor. Same with "consultant". Even the pharmacists are starting to call their juniors "pharmacy interns".
If people weren't trying to massage their own egos, it would be so so easy to pick simpler names for everyone to avoid confusion.

I'm sorry, but a nurse with a PhD has no place in caling herself "Dr" in the hospital environment. We can debate the minutiae all we like, but we all know it will confuse patients.

I call myself by my first name and say "I'm the doctor looking after you today". It always seems to me in hospitals that the people who are carrying these other "consultant" and "Dr" tags are just insecure, and know what clinical staff really think of them. So, they try and get kudos from the patients instead.

I know the above seems harsh. BUt it's not about titles. It's about so many plonkers doing jobs with so many stupid titles in them nowadays, just for the ego erection.

What's wrong with "I'm your doctor", "I'm your nurse". Only real time I can see a reason to stray outside that is "I'm the consultant" as patients do like to know they're seeing a consultant. Do they care if you're an emergency nurse practitioner/consultant dietician/pharmacy intern? They do in their balls.

Kind regards,

Dr. Thunder

Almost a Doctor said...

I did medicine as a second degree and many of my colleagues starting the course had PhDs, but weren't allowed to use the title "Dr" in the hospital or on their ID badges as it would be confusing. On the other hand the Tissue Viability nurse at the same hospital has a PhD in pressure ulcer management and so uses the title "Dr" in the hospital. Not sure which side of the argument I'm on but these are just points of info.

Charley Burright said...

I like your point, Dr. Anderson. I think it takes a lot before anyone in the industry can call himself a "doctor". A dentist who performs complicated procedures like implants and other dental care are still dentists. It still depends on their forte. I prefer calling my teeth doctor in Chattanooga a "dentist". It's easier.

Anonymous said...

Hmm...interesting debate.

I hope you guys know that the word "Doctor" comes from Latin meaning "a teacher".

Just be aware that, strictly speaking, people who earned a PhD degree are the proper "doctors", and medical doctors are honourary doctors. It's only through time (hundreds of years) that the word doctor has slowly changed to mean a medical doctor.

I do know the confusion it can cause - I know of someone who as a medical student did use "Dr." on the accommodation form (but never used it on the ward). The administrator came back and declared that no medical student should have a title Dr, on the form! Now there are PLENTY of graduate students who have PhDs, so it was good that administrator was educated in the finer points in life. Silly cow (she still works at Lincoln Hospital!).

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Laurentius said...

In my opinion, unless you have a doctoral degree in any subject you have no right to call yourself doctor.

You may call yourself a phsyician and realise that is a noble calling, but to call yourself doctor if you understand anything about the meaning of the word and where it comes from is just fraud.

A doctor (from latin docere, to teach) is one who is qualified to teach at a higher academic level, it is about time that the medical profession stopped this rather bizarre notion that there field of knowlege trumped all others.

Theirs's is only an honorary title, and by that token there is no reason why they should be so jealous if Dentists want to ape that honorific.

spac18 said...

@laurentius Actully, from the get go the term doctor was associated with medicine, law and theology education. Physicians were always allowed to use the title doctor because their job is to treat patients and TEACH them about maintaining their health. So physicians are using the title doctor even before there was a thing called phd. Plus outside of a very narrow subject matter, phd as no relevancy. A person with a phd in perticle physics can not rightfully.use the title doctor during a lecture on thermal physics because his phd has nothing to do with the current discussion. Their msc degree is the relevant one in that instance. On the other hand a mbbs degree is relevant everywhere, from a church to a brothel. That's the resion why a physician can use the title doctor everywhere but a phd and a dentist should not use the title doctor outside their specific department.

Anonymous said...

Its a bit ironic for a physician to be complaining about it when most of them haven't earned it either, rather 'Dr' is only a courtesy title that their profession adopted years ago to give themselves some status. Medical school is a 5 year undergrad course in the UK, it doesn't finish with an MD degree but a double bachelors.
You can't really complain if other professions such as dentistry then start to do the same thing that your profession has done over time. The only people with real grounds for complaint are people who hold actual doctorates - they are technically the real 'doctors'.

Anonymous said...

The reason "doctor" is not a protected title like "nurse", "pharmacist" or "dentist" is because it's not a title with an specific meaning; graduating with a medical degree does not make you a doctor but a PHYSICIAN. The term doctor is a courtesy title given to PHYSICIANS a few hundred years ago by medical schools who wanted their graduates to have a special status. Is it not rank hyposcrisy for the author to complain about said "misuse" of the title when those responsible for his profession did the same thing in the past? Or maybe the medical profession need to have a couple of letters to make them feel more important than us mere plebs...

Anonymous said...

In the US (and most of the rest of the world), MD is a postgraduate qualification and given that the recipient has done an undergraduate bachelor's or master's degree first, takes a darn sight longer than the double ordinary undergrad degree done in the UK. The average holder of a Ph.D. in the UK will have spent at least 6, but more likely 7 or 8 years completing their studies (took me 7 - 4 years B.Sc. and 3 years Ph.D.). Putting these facts together, I can't help regarding the MB ChB "doctors" as fakes. As others have pointed out, the title 'doctor' means teacher, rather than physician (Latin docere). It only took on the meaning of medical practitioner in the 18th century: and not long after, started to be used in the context of 'to falsify'. Is there a connection?

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President said...

As a Doctor in Engineering i get annoyed at junior Doctors with just an undergraduate medical degree calling themselves Doctor as their experience within their profession is far below what is accredited to the title of Doctor. I feel that the title should only be used by medical professionals with higher degrees or qualifications or those with several additional years practice under their belt !

Anonymous said...

Physicians exerted hegemonic control over the general populace by virtue of state recognition of occupational privilege. Physicians use the title doctor as a courtesy. The general public have fallen for the availability heuristic of constant repetition and now understand the term doctor to mean physician when it actually means teacher. Any confusion is the doing of physicians and the collaboration of their patients.

A true doctor has spent years doing original research, making a unique contribution to advance human knowledge and has defended his/her thesis before a panel of experts. Physicians have spent several years at OJT which is nevertheless useful and they make a useful contribution to the human condition however, they should stop getting so far up themselves and introduce themselves by saying I'm a physician NOT I'm a Doctor. That would redress the issue. Anyone with a terminal degree is entitled to the title of doctor irrespective of their occupational title.

Anonymous said...

Dr Anderson, to pursue your argument to its logical conclusion, I presume you call yourself Mr Anderson when you are outside the medical environment.

Wendy Emberson said...

The reason dentists can call themselves Doctor is because they are regulated by the General Dental Council (since the 1960s) in the same way that medical doctors are regulated by the General Medical Council. This is the legal requirement that allows you to call yourself a Medical Practitioner ie medicine with a large M and not a medical practitioner with a small m.
I looked into this re physiotherapy and unless we have a General Physiotherapy Council as a regulatory body, then we cannot call ourselves doctor despite any PhDs or extensive undergrad and post grad education etc etc.
This came up as we are NOT considered to be sufficiently "medical" to carry out acupuncture outside of the NHS or GP surgery for local authorities to lump us together with tattooists and ear piercers for licensing purposes! Physiotherapy is the 4th largest medical profession after doctors, nurse and midwives, and we have Consultant Physiotherapists.... and you think you have problems!!!!!

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