Aug
12
2011

Clinically, Who Should We Call “Doctor?”

Introduction

Photo c/o Ambro

Occasionally I see a patient I took care of a while back wandering around the hospital. This particular patient consistently refers to me as “She-Won’t-Let-Me-Call-Her-Doctor,” it cracks me up every time, but I’m well aware of where I got the nickname.

“Hello, Dr. Jones” is a phrase I’ve begun to hear more and more in the past few weeks. While it is interesting to hear myself referred to as “doctor,” a doctor I am not and, as such, with each reference I correct the person doing the name calling. I’ve corrected attendings and residents, but mostly I’ve corrected patients. I don’t do it out of disrespect or because I don’t appreciate the politeness of an attempt to reference me with an “official title”, I do it because I want it to be very clear to my patients what my role is on their healthcare team is.

I always introduce myself as “Danielle, the medical student on this team” and follow-up with a little information about my role. Some of my classmates choose to use “Student Doctor,” which is fine, but I prefer to avoid the confusion all together and never leave it up to interpretation. I think some people simply get thrown off trying to address us due to the fact that there really is no “proper” way to address the med student on the team.

It appears medical students are not the only ones with Lack-Of-Title Syndrome. The disease is epidemic among Nurse Practioners, Physician Assistants and other mid-level care providers…how do we introduce ourselves? How do our patients address us?

I stumbled on a blog* that discussed the title problem with DNPs – nurse practitioners who have their doctorate degree in nursing. Should they introduce themselves to patients as “doctor?” I mean, after all - they are doctors in the educational sense of the word.

My personal take on this is that, no, they should absolutely not represent themselves to patients clinically as “doctor.”

In one’s personal life there is not room for my opinion, Nurse Practioners who have a doctorate degree are doctors of nursing practice and if they’d like to introduce themselves socially and educationally as “doctor” then that is their choice. However, in the clinical sense of the word they are not doctors and should not misrepresent themselves as such to patients. When it comes to patient care in the hospital this practice is simply unfair. I have classmates who got their PhD before coming to medical school. Would it be honest of them to introduce themselves as “Doctor” to their patients? They are, in the educational sense, doctors, aren’t they? This would, of course, distract from the fact that they are not licensed physicians and are, realistically, the lowest on the healthcare totem pole.

The argument one person gave to the opposite of my opinion is this JAMA article indicating that primary care outcomes do not differ between patients treated by Nurse Practitioners and patients treated by Physicians.

While I think this is excellent news for the primary care front and recognize that Nurse Practitioners have an extremely important role to play in the healthcare field, I don’t think it justifies the practice in any regard.

It’s particularly harmful when you live somewhere serving large populations of people who either do not speak English or do not speak English very well, which is the case in my area of the country. It may be next to impossible to communicate to someone the difference between “Doctor of Medicine, “Doctor of Nursing” and “Doctor of Anthropology, but also current medical student” when translating between languages and I fail to see the benefit of this in the way of patient interaction.

In historical and dictionary definitions the word “doctor” simply refers to anyone with a doctorate level degree, but it’s no secret that, to the general public in a clinical setting, “doctor” means something very specific.

Whether it should be this way or not is not the issue. The fact is, when a patient is in a clinic or hospital and someone introduces themselves as “Doctor” a vast majority of patients will assume this person is a physician. I know I would and I’m completely literate in the major players of a health care team – most of our patients are not…they may not know the fundamental differences between a NP, RN, LVN, CNA, and PA, but they do have a pre-constructed idea about the training of the person being called doctor.

I don’t see what any non-physician can gain by calling themselves “doctor” clinically, but I do see what a patient can lose – confidence that the information being presented to them is being done so in the most clear, simple and accurate manner possible. Our number one concern should be patient care and, if there is potential confusion to the patient, what are we really trying to achieve? Should one of our main goals not be to make sure the patient is fully aware of their healthcare team?

Obviously, this doesn’t solve the issue of how everyone should introduce themselves clinically, that I don’t have an answer for. There is a serious need for an official title for those with PA, NP and other upper-level, non-MD/DO degrees. What are you thoughts on the issue? Am I being ridiculous, should it simply be a non-issue? If you don’t think “doctor” is appropriate clinically for non-physician practitioners, what are the other options for these people? Most importantly, as a patient would this be confusing to you?

 

*I’m so sorry I can’t remember your blog URL…if you read this please tell me so I can linkback to you!!

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52 Comments + Add Comment

  • I agree with you. The title Doctor may have its definition but as far as it’s connotative suggestion, it can be very misleading to patients, especially in a busy hospital atmosphere.

    Having to go to the hospital can be scary enough, but when you’re admitted to the ER you’re seen by a lot of people & it’s almost impossible to keep track. I consider myself to be a pretty smart person (not med student smart, that’s for sure!) and am fortunate enough to not have a language barrier, and still it is pretty impossible for me to identify the different professionals attending me at a given visit. My last hospital experience I had at least 6 people come and check on me before the “doctor” came to sign off on my charts and whatever else was needed at that point. No one else bothered with their job title when introducing themselves, just their name and why they were visiting me. In my opinion, that helped me keep things clear especially in regards to who I should address certain questions to.

    I understand those who have earned the title doctor through their degrees but when in a hospital setting, that title almost has a universal meaning and I feel that should be taken into consideration when being introduced that way.

    Those are my two cents. Hope that made sense. :)

    • Great points on identifying our reason for being there! I always try to make sure that patients understand my role by giving an abbreviated version of the blog I wrote about a med student’s role on the health care team…I hope others, whether med student, doctor or other, choose to do this as well.

    • I suppose my major concern is that American physicians who insist upon the exclusive
      use of the title Dr. to the total exclusion of other healthcare providers who have earned
      doctorates is a reflection of maintaining a type of social distance to insure that everyone
      knows who is in charge. A popular TV physician who was talking to an audience member
      who had a foot problem suggested that if it didn’t get better to see her podiatrist or doctor.
      More approxpriately he should have said “podiatrist or physician.” And, what of the case
      of England where upon being admitted to the College of Surgery your title becomes Mr.,
      Miss, or Mrs. depending upon gender. Enuf said.

  • My resident on neurosurgery introduces me as “Dr. (mylastname) , the medical student.I always just introduce myself as cate the medical student- because no way in he’ll am I qualified to be anyone’s doctor after 7 weeks of surgery. Interesting post!

    • Thanks for your thoughts, Cate! I totally agree – it makes me incredibly uncomfortable.

  • Happy Birthday!
    I love Yami’s point about describing what you are there to do rather than your title. Dr. Covers everyone from most junior to most senior… Surely we need to do just as much expelling about why we are talking to the patient? Maybe that is more important than the Dr. title?
    Thanks AM

    • Thank you! And yes, I definitely agree that role >> title.

  • ultimately, patients need to know WHAT we are, where we fit into their care and what even the title Dr means. there are vastly different levels of knowledge and experience within that name. an introduction is just the start of a conversation.

    • Excellent point, I whole-heartedly agree. Thanks for your thoughts.

  • Interesting to see that @ffloliet makes almost exactly same comment as me… although that might not be clear as somehow or other ipad autocorrect managed to get ‘expelling’ when I meant ‘explaining’ :)

  • I don’t like being addressed or introduced as doctor, either. At this point in my training I don’t want any of my patients to take anything I say as authoritative medical advice (not that I attempt to give any, lol). One of my attendings introduces me like this: “This is Dr. _____, she’s learning to be a doctor.” … uh, what? LOL. When she leaves I’m just like “Hi, I’m Brittany, the medical student working with Dr. [attending] today.”

    I do think it makes a difference. Many patients trust anything a doctor says, and whenever they perceive me as a doctor anyway and ask me, “What do you think would be best for me?” I always tell them we will discuss it with the resident or attending physician. In my opinion the only people who should be introduced as “doctor” to patients are physicians. That being said, someone needs to come up with titles or a way to address PAs and NPs because when it gets that confusing, sometimes they might introduce themselves as doctor just for simplicity’s sake.

    • Thanks for your thoughts, friend! :) Can’t wait to see you in a few weeks for our trip!!

  • Great post!! After a few months, I realized that a lot of patients don’t realize that “medical students” are training to be “doctors”, but as Yami said, the latter has sort of a universally accepted meaning in the hospital environment. I just introduce myself as “Rishi, a member of the *insert specialty here* treatment team.” :-)

    • I think that’s a great introduction. It is true many don’t realize we are training to be doctors, in fact I got called a “nursing student having fun playing doctor” just the other day. While this is frustrating, it’s not really that big of a deal in the long run and I’d still prefer to avoid any confusion. I don’t think your choice of introduction would cause confusion at all, I think it’s a good way to inform the patient of your role and who you are in a concise manner. Thanks for your thoughts.

  • Great post! I always introduce myself as a medical student but I secretly LOVE it when patients think I’m a doctor! Haha. I definitely think NPs, PAs, etc. should introduce themselves using exactly what their title is, not doctor. Some of my classmates have PhDs and they definitely do not introduce themselves as doctor. Putting myself into the patient’s perspective I would absolutely want to know who has an MD and who doesn’t.

    • While it’s always interesting to hear someone call me doctor and I appreciate that someone thinks I come off as knowing what I’m doing, it really makes me uncomfortable when a patient thinks I’m their physician. I just feel like it’s a breakdown in the system when someone doesn’t know who their real provider is…I don’t know, I’m sure I’m making it a bigger deal than it is, it just really makes me uncomfortable for some reason. I always get this awful feeling like they’ll take something I say as truth over what their actual, trained physician says and use that to make a decision that ends up negatively impacting their health. Even though I’m never giving advice like that anyway and nothing I tell a patient could ever lead to that (because I tend to avoid advice-giving like the plague…even when asked), it’s just what goes through my head. I know exactly what you mean, though – it’s always very exciting to think that someone could actually think that you’re a doctor, it makes all the hard work feel like it’s paying off. The first few times it happened I had to come home and let my husband know, because it finally felt like all of this training and school was starting to get me to my goal.

  • While I respect and appreciate doctoral level credentials in all disciplines, I agree it is confusing to patients to have providers other than MD/MO introducing themselves as doctors. The only exceptions I can think of off the top of my head are PhD Clinical Psychologists and Dentists, both of whom would likely be introducing themselves in context….

    • Those are great points! I didn’t even consider a PhD Clinical Psychologist, some of whom may occasionally be consulting in a hospital. Very interesting.

      You are right, though – dentists are kind of a non-issue. It goes along with the social situation to me – nobody should be interacting with a dentist without knowing that they are there for dental work. Dentists are traditionally called doctors and, although their setting IS clinical in some sense, they work in more unique settings. I don’t think that people mix up their physician’s role and their dentist’s role too often, because of the nature and location of the care settings. I could be wrong.

      Thanks so much for your input. I’d love to hear how others feel about PhD Clinical Psychologists, particularly ones who are interacting with patients outside of private practice – consulting in hospitals and stuff like that.

  • Yes, of course it is uncomfortable for those in the team who are not doctors to be called doctors, however, if you look from the patient’s point-of-view, many of whom are not sure what is going on anyway, it is reassuring to have doctors around you, because they feel they are being cared for by a lot of practitioners. Of course, it is wrong for non-doctor HCPs to call themselves doctors, but if there’s no harm in the patient calling you doctor – why not?

    • Unfortunately, I do feel like there could be potential harm in patients calling us (especially as students) doctor if we are not. If they misinterpret your position, and thus your education level, they could potentially take your word over the word of someone who more educated than you. I have the opportunity to sit down and talk with my patients a lot and, in such, build more steady relationships with inpatients than some of the physicians do. While I value this role as a medical student, I do not want my patients to mistakenly believe that my advice or information is more important than than their REAL doctors when factoring in the healthcare team’s advice for decision making purposes.

  • Hello, I am Dr. Kyle Ridgeway and I am a physical therapist. You can call me Kyle.

    I find this topic to be fascinating and think it has to be analyzed from the context of other non-physician doctoral holding healthcare providers as well as in the context of other clinical settings.

    I fully understand the physicians perspective that the title Dr. implies a certain level of training and education to a patient. And, I agree most of the time IN A HOSPITAL it is inappropriate for anyone except for a physician to refer to themselves as “Dr.” In fact, I NEVER refer to myself as Dr. Ridgeway when I am within the hospital setting (I practice approximately 24 hours a week at a large university/academic hospital).

    In academic settings, the title Dr. usually refers to someone who has research doctorate (PhD, DSc, etc). Is it thus inappropriate for those with clinical doctorates (MD, DO, DDS, DPT, DOT, DNP, etc) to refer to themselves as a Dr. in this setting? Just a thought.

    I think you need to be careful about projecting that only physicians can refer to themselves as “Dr.” as it becomes a rather slippery slope. About 10 years ago when the number of clinical doctoral degrees was growing (podiatrists, physical therapists, pharmacists, occupational therapists, nurses all now offer clinical doctoral degrees) physicians considered enacting legislation granting physicians, and only physicians, the right to utilize the term doctor. This was met with strong opposition by PhD degree holders. Remember, PhD holders outnumber physicians and the PhD was actually the first “doctoral” degree.

    As far as other clinical settings (which a few comments have brought), I believe it is absolutely appropriate to refer to yourself as “Dr.” if you have that degree. BUT, I also think it is an absolute must that you explain that you are not a physician, what your degree is in, and what the difference between yourself and a physician is. I practice in private outpatient clinic. I never introduce myself as Dr. Ridgeway, but my degree is hanging in our clinic and my business card says Kyle Ridgeway PT, DPT (underneath it says Doctor of Physical Therapy…..just a quick clarification point “PT” after your initials means you are licensed to practice physical therapy, have passed the boards, and have a license number….this is usually followed by your degree as the clinical degrees in PT have changed immensely over the years). I have seen this lie of ommision many times from chiropractors marketing very dubious treatments for various MEDICAL conditions, and only referring to themselves as “Dr.” In fact there was recently a news investigation in CO about a chiropractor running a “functional endocronology” center. None of the patients interviewed knew that person was chiro. Now, that is an abuse of the term used to mislead individuals.

    Patients routinely ask me what a DPT means and if I am “doctor.” My very first response is that I am NOT a physician. Then I explain that I am a physical therapist, and what the clinical doctoral degree means and represents. Most patients, even those who have low health literacy, can understand this distinction in the outpatient setting where there is time to explain it appropriately. Further, I think it does provide a benefit to the patient, professional, and profession. For example, I think knowing I hold a doctoral degree creates inherent and increased accountability for myself and the profession of PT. I also believe that it forces patients and society to hold us to a higher standard. Lastly, I think it conveys the high level of training and education the professions attains as well as the skill in the examination, evaluation, and treatment provided.

    My question for the physicians and future physicians is when (if ever) would you refer to ME or other health professionals with doctoral degrees as “Dr.”?
    Do you feel differently about those with PhD’s?
    Do believe that their is a heirarchy of doctoral degress or that an MD may/may not encompass the knowledge base/skill of other clinical doctorates?

    • Thanks for the input, Kyle.

      In academic settings I still feel it is appropriate for physicians, as well as others with doctorate level degrees, to refer to themselves as doctors. Many physicians work in academic settings and teach doctorate level medicine. There is no harm or misleading that goes on when my professors teach classes under the title “doctor,” no matter what their degree is. While patients in a hospital getting PhD and MD/DO mixed up could adversely affect their health, there is no potential for this in the academic setting.

      Thanks for your thought that I “need to be careful” projecting that only physicians should use doctor, but I don’t feel I said or implied that at all. I said socially or outside the clinical setting I don’t care who uses the term – if you earned it then by all means use it! To me it doesn’t matter who was the “first” doctorate level degree. If you’re in a hospital and someone says “Hi, I’m a doctor.” the general public interprets that as physician and, as such, those with non-MD/DO degrees introducing themselves as doctor clinically could be misleading and harmful to patients.

      In other clinical settings, such as small clinics, it’s much different. Patients come there on their own accord, pick you out from a list of providers and know what they are coming for. Nobody mixes up Dr. Smith the Dentist with Dr. Ridgeway the Physical Therapist. They come to the former for dental work and to you for Physicial Therapy. They do so on their own accord and likely have access to your degrees on the wall in your office at the same time. There isn’t confusion here and medical decisions outside of the scope of Physical Therapy don’t occur in your office.

      In the hospital patients are likely to see a huge mixture of all of these people. They are in a position where they cannot access your credentials or make judgements about your specific type of training and thus are much more likely to interpret “doctor” as “physician” purely based on their surroundings.

      Personally, I would (and do) absolutely refer to anyone with a doctorate level degree as “Doctor” no matter what the situation or location. Anyone who has earned a doctorate degree deserves this. Like I said, I am not in any way implying that you and others with degrees don’t deserve the title, “Doctor” if you want it….only that introducing yourselves as such in a setting where a patient could possible misinterpret is irresponsible.

      I don’t think there is a “hierarchy” per se, but everyone with a clinical doctorate is taught different things. Doctorates of Nursing have the highest level of nursing knowledge possible, but there is still inherent and large differences in the training of a DNP and MD. The knowledge base is different. Same with any other doctorate degree, they wouldn’t exist if there wasn’t a different level of knowledge.

    • I’ll call you doctor when you can actually crack someone’s chest open and massage there heart to keep them alive. I will call you doctor when you can handle someone hypoxic while on the vent and diagnosing a pneumothorax and placing a chest tube to save there life.
      Please don’t hold yourself or your “doctorate” degree as equal to that of a MD. Better yet next time you need a doctor or have a patient goes unresponsive ask for one of those phd doctors for help.

      • The issue here is simply a historical abuse by physicians of title (doctor) who says that physicians are doctors? and yet they start using that title from year one. When physicians graduate from the medical school the graduate with a degree equivalent to a bachelor degree of science just like any other graduate but for some reason and over the years they managed to use this title without any right mostly( some do have doctoral degrees and deserves it for sure)but the majority do not.
        Now what should happen is that the governing bodies, universities and governments must step in to correct this historical misconception.
        A medical school upon graduation must be called a physician and that is it until he/she earns their Master followed by PhD medicine.
        The effort should be directed towards the education of the general public in order to correct this issue once and for all.
        By the way I am PHYSICIAN.

  • Very thoughtful and insightful post by you, Dr. Ridgeway.

    I understand and agree with you on all the examples and situations you mentioned. I, too, am curious to the answers of your final questions for the physicians and/or medical students engaged in this discussion.

    I think you eloquently stated that given the correct situations, anyone with a doctoral degree should be entitled to use the term “doctor”. I don’t see it as a problem one bit, except in cases such as a hospital where it can become confusing for patients without proper education.

    Another point I would like to make is that we are talking about using the term “doctor”, but what about those professional who are not MD/DO but still wear a white coat in the clinical setting? I have seen very often a nurse practitioner, chiropractor, etc wearing white coats while providing services.

    Is this any different than using the term doctor? What if they are wearing white coats AND referring to themselves as doctor?

    • Ohh the white coat debate, enough for an entirely new post, I’m sure!

      I don’t personally have any strong opinions on this, I would love to hear what others have to say! I’m not a big fan of wearing a white coat in the first place, since they are uncomfortable, germy and frightening to about 60% of the population (especially young kids)…so I really just wish they’d kinda disappear lol.

  • Preston, I have recently heard that there are physical therapy programs doing the white coat ceremony, similar to the MD/DO programs. I am curious to know what people say/ask when they see this in a clinical setting? What settings do these PT’s wear their white coats??

  • If you’re going to steal a blog idea at least give the other blogger some credit.

    • If you’re going to comment on a blog at least read the post in it’s entirety.

      I read that person’s blog and didn’t think anything of it until I had an experience in clinic that prompted me to want to write a response. Unfortunately, at that point it had been several days, possibly weeks, since I had read it via a link from who knows where and despite my best efforts I could not find it. Hence, the footnote on this post which is clearly marked by an asterisk in the body. Replies to blog posts stating the author’s opinion are not “stolen ideas,” they are opinion responses and without them the blogging world would be very boring.

  • As someone who has been a patient, but never a med student/doctor/anything in the medical field, I would whole heartedly agree with you. If I was in a hospital setting and was introduced to someone called Dr. Smith, I am going to assume they are a physician. Period. I agree with you, Kyle, in that you have earned the Dr. title and think you should absolutely use it at your own practice, in the supermarket, etc etc. But I think it may be difficult for those in your shoes to look at it simply from a patient point of view. In a hospital setting, it would absolutely be misleading, unless you took the time to explain the difference. Which I think was the point all along.

    Oh, and “D”- learn how to read :)

  • I had read this a while back but also didn’t think anything of it until recently. Thanks for leading me here!

    For my own personal comfort I think, in regards to my situation, I will speak to the patients ahead of time to explain that Dr Soandso is not a MD/DO but a PA-C who is equally qualified to provide the same type of care that they would otherwise receive from a MD/DO. This is partly because, all the malpractice stuff aside, if something goes wrong the patients will think that I had lied to them as an interpreter. I’d rather not jeopardize the trust that I’ve built with the patients because of a misunderstanding in titles and roles. As a potential/future/hopeful MD, it wouldn’t sit well with me to have a patient lose trust in me for any reason.

  • A really interesting debate but I thought I’d throw in a UK perspective. In the UK a MD degree is a higher degree I.e a PhD in medicine for research. The qualification we get after 5 or 6 years of medical school is MB ChB or MB BS (bachelor of medicine and bachelor of surgery). We are then allowed to use the title Dr as a MB ChB is the equivalent of a USA/canada MD. Try explaining that one to patients especially if a UK doctor moves to the USA to work!!

    Interestingly physicians in the US used to be awarded MBChB and it was only when Scotland reverted to the English system the Americans took on the old Scottish MD as the Primary medical qualification. I think all medical degree holders should have the right to use the term doctor considering 6 years is the length of study required to Obtain a bachelor degree followed by a PhD so academically the length of study is the same. Further to this I agree it can cause confusion to patients if everyone bands the term dr around.

    Interestingly though surgeons in the UK once they have pAssed the royal college exams. Or boars exams for the Americans amongst us drop the prefix Dr in the UK and revert to mr in the hospital setting which causes even more confusion amongst patients they do this out of respect for the first surgeons who didn’t go to medical school in the 17-1800′s instead did an apprenticeship like a butcher hence the term butcher surgeons. But because they hold a medical degree usually call themselves doctor outside of the hospital to Add more confusion to the mix. Personally I think they UK should revert All current MBChb etc to MD and do away and make surgeons call themselves dr in hospital to prevent confusion Within the general public in the UK

  • Wow, that’s awesome you have the integrity and will to repeatedly correct all your patients. In a big public hospital where 85% of my patients don’t speak English, I’ve all but given up trying to convince my patients I’m not their doctor after I introduce myself as the med student. I even had one patient smile and assert, “No, no, you are my son’s doctor,” after I reinforced multiple times that I was just the med student rotating through pediatrics. Later, I had an attending who introduced all her med students as Dr. So-and-so. At first I thought it was rather deceptive (and still do, to an extent). But she made the point that we know our patients better than anyone on the team and in the setting of an perpetually overcrowded public hospital, we were- for better or worse- forced into the role of primary caretaker, or doctor (scary, I know!). I’m still trying to figure out how I feel about the value of these professional titles in regards to patient care, but I enjoyed your post.

    • I’m not sure I’d call it integrity so much as fear of being held in some kind of position I haven’t earned. I mostly don’t want my patients thinking I’m their doctor because I’m afraid they may take to heart something I say over something someone more knowledgeable and qualified says.

      Many of our patients are Spanish-speaking only and that does present a bit of a problem, but as with any language barrier we all just do our best.

      I think it is absolutely unprofessional and misleading for attendings to introduce students as “Doctor.” Student Doctor is okay, but pretending they are doctors is not. I don’t care how well we know our patients, we are not doctors and we should not mislead people to think that (just as anyone else who is not a doctor shouldn’t introduce themselves as such).

      If I were at a doctor’s office I would want to know if the person taking care of me was a doctor or not and I think my patients deserve at least that much from me.

  • This reminds me of a joke! The Germans are rather fond of the title of ‘Doctor’ as a prefix to their names.On a ‘Luftahansa’ commercial flight on route to Berlin an elderly male passenger had collapsed during the flight.The chief cabin stewart annnounced on the cabin PA system ”Is there a doctor on board? Please contact the flight attendant nearest you to identify yourself”.3 people responded and came forward to offer help.The first one said he is a doctor of philosophy and would like to help in any way he could.Then there was the second one who identified himself as a doctor of Chemistry and obligingly offered his service.Then the 3rd passenger stood up annnouncing that he is a doctor of divinity and said he was more than happy to help the sick passenger.The flight attendant in exasperation announced again “Is there a real doctor on board”?After a few moments of silene, a trained nurse stood up apolizing that she was not a doctor but was quite willing to help in the medical emergency in any way she could.She saw the sick passenger and quickly administered the CPR and stabilized him medically.The captain after learning what had happened asked the flight attendant to promote the nurse from cattle class to 1st class.The plain landed safely without further incidence.

  • I think doctor is appropriate. Physicians and non-physician practitioners can avoid confusing patient by introducing themselves as Dr. so and so then their clinical title. For example “Hi I am Dr. Ratchet I am a physician; hi I am Dr. Slim I am a Family Nurse Practitioner; hi I am Dr. know-it-all I am a Nurse researcher”. I don’t think we should confuse patients by solely using the title Doctor you should tell them your clinical title as well. Letting a patient aware of your level of education reinforces their level of confidence in your ability to care for them. I am not sure why physicians took ownership of the title doctor but I think it is insulting to those individuals who have received a terminal degree in their discipline. I am not a physician. I am a RN who plans on applying to medical school in the near future. On a side note I have heard people say things to people who are Doctorate prepared professionals outside the health care arena say “he is not a real doctor”. What does that mean? A vast majority of the public are ignorant to the difference between the titles doctor and physician. In many countries Physicians hold a bachelor degree in medicine and still call themselves doctor. I think this is a miss representation of a person’s title and is insulting to those physicians who hold a Doctorate of medicine (MD/DO).

  • Can’t we all just get along? (R.I.P. Rodney King) Listen, we need to all respect each other and our level of education. I can only speak for my profession. The Doctor of Physical Therapy is a terminal clinical doctorate, not an educational doctorate. In the outpatient setting we are the autonomous provider. However, in the acute care setting the physician is the primary provider and everyone else is there in an ancillary role. When I see a patient in the acute care setting I start with, “Hi I’m Chris. I’m with physical therapy. Your physician wanted me to come by and do an evaluation on you to see if you need our services while you are here or if you need services after discharge.” The patient is almost always compliant. This is probably due to the fact that I am a 6’5″, 245lb well nourished male. No explanation of education needed. All kidding aside, the key words here are “physician” and “physical therapy”. We need to refer to ourselves as what we are and not our education level. This eliminates the “Doctor” problem. Unless I am referring to a specific person I make it a point to use the term physician. From our point of view, we do not want to be confused with physicians or any other profession that we are not trained to provide. We too think it is irresponsible. At the same time we deserve the respect of our fellow colleagues for our specific and unique skill sets. Thanks for reading, and thanks for what you do. MD/DO, DNP, DPT, etc… are all noble professions and require a lot of personal sacrifice at times. #2cents

  • I think nurses with the DNP degree should not introduce themselves as “Doctor”. The title of Doctor has always garnered a level of respect and trust from the general public. People confide their deepest concerns to Doctors (MD/DO) and misrepresenting DNPs as Doctors will definitely cause much confusion. DNPs most certainly don’t even go through near the same intensity of training comparing to the MD and that would just cause every other Doctorate out there to call themselves Doctor. The DPT, PharmD, and so on would start calling themselves Doctor. The MD is an old degree that the public recognizes very well and confusing them is uncalled for, especially when many of these DNPs are just craving the title of “Doctor”. I appreciate the need for DNPs and I’m fine with RNs wanting to continue their educations to earn more etc..but not at the expense of the MD. The MD/DO is and will always be the overseer of everything medicine. DNPs should call themselves what they are..a nurse practitioner. Just like a DPT calls him/herself a physical therapist and a PharmD calls himself a pharmacist. Mixing these things up will only cause frustration and confusion.

  • This is a very interesting topic and thread. I will preface my remarks by disclaiming that I am a realist, so some of this may seem a bit blunt to those whose egos or personalities are damaged (inferiority complexes, etc.). I am also speaking solely for the US.

    The US allopathic medical school degree (MD) is the most prestigious and difficult to attain degree in the country, based on the intellectual (IQ – as assessed by the MCAT, which, you may not be aware, is designed to weed out those who are not in the top 1% of IQ level), academic, and extracurricular credential-set required to be accepted to a US allopathic school. The US osteopathic schools and Caribbean/foreign MD schools allow a lower standard of requirements for admission and are therefore excluded from this distinction. Even the most rigorous PhD program entrance requirements pale in comparison (again, nothing against PhD’s at all, I’m just presenting the facts/reality as can be accessed online by anyone willing to look up the statistics). I write this only because some on here/elsewhere feel that the title of doctor insinuates a level of prestige, which is not necessarily untrue. If this is important to you, then you need to go to a US allopathic school. If you cannot get accepted, but are prestige-hungry, then you may need to see a therapist, or settle for something less prestigious.

    In the case of the hospital setting, the following should be observed (on the basis of minimizing patient confusion, which in my opinion is the most important factor):
    Medical students: the appropriate title is: Mr., Ms., or first name
    MD, DO, clinical psychologist (PsyD, PhD), DDS, DMD, DPM, OD: the appropriate title is Dr.
    All others (DPT, DNP, PharmD, academic PhD, DC, etc.): the appropriate title is Mr., Ms., (or simply first name); addressing themselves as Dr. is ABSOLUTELY unacceptable and potentially illegal depending on the context
    (Clarifiers after name [medical student, physical therapist, etc.] are appropriate as well)

    In the case of the general public/social setting, the following should be observed:
    MD, DO, clinical psychologist (PsyD, PhD), DDS, DMD, DPM, OD: the appropriate title is Dr.
    All others (DPT, DNP, PharmD, academic PhD, DC, etc.): depends on the social context, but most often the appropriate title is: Mr. or Ms.
    For example, the correct way to address an MD on a postal envelope is Dr. (always), where as an academic PhD is Mr. / Ms. UNLESS the sender is addressing the academician as an academician (and not a random individual).

    In the case of the academic setting or a personal office, the following should be observed:
    MD, DO, clinical psychologist (PsyD, PhD), DDS, DMD, DPM, OD, DPT, DNP, PharmD, academic PhD, etc.: the appropriate title is Dr. or Professor

    The etymology and history of the word “doctor,” while interesting, is mostly irrelevant from a realist’s perspective living in this day and age (vernacularism and tradition take precedence). Hate to break this to some of you, but no one in the general public considers, or ever will consider, a DPT, DNP, PharmD, PhD, etc. as a “doctor.” If you obtained one of these degrees hoping to be seen as such, you made a mistake. sorry.

    Hope this helps with minimizing patient confusion. I certainly am confused when anyone but my physician labels themselves as Dr. while I am in the hospital, and I find it quite offensive (if not amusing) to be honest. But, I certainly do hope that all fields can work together as a cohesive unit regardless of degree type or level.

    • I was getting ready to write a comment. Then I stopped to read a few, one of which was yours, and I decided not to write mine, because it would be the exact same thing, lol. Agreed, 100%. It’s blunt, honest, and more importantly, the truth.

    • This is gold. Great reply.

    • Anybody who has graduated from university with a doctorate, whether it be PhD, MD, PharmD etc is a “doctor”, a learned man, and has every right to be addressed by this title. In the UK all doctorates are academic/research degrees, including the MD, whereas the equivalent of the American MD is actually MBChB/MBBS, a bachelor, and holders of this degree are given the honorary title of doctor. Yes, Scotland used to confer the MD many many years ago but even at the University of St Andrews, the oldest university in the country, the degree is conferred as MBChB. If you go to India holders of MBChBs refer to themselves as physicians, not doctors. Whether you hold a professional degree in medicine or an academic doctorate you are a pompous twat if you introduce yourself to people as Dr John Blah Blah Blah outside the context of your work.

      And as for MCAT, yes it is there to weed out the other 99% but that doesn’t mean that a holder of a PhD isn’t also in the top 1%. There are universities out there which don’t use MCAT/UKCAT yet their students graduate with degrees in medicine and are called doctors and may only be in the top 2%… or God forbid, even lower. Similarly, there are plenty of PhDs who aren’t the brightest tools in the box. There is the funny story about the person who did a PhD on the use of the comma… whether it’s true or not, academics are judged on their work. If you can publish in high standing peer reviewed journals, develop ideas, file patents etc then your PhD was worthwhile. If not, then you wasted a lot of your life for nothing apart from a redundant title.

      Someone obtaining a degree in one field and masquerading as a practitioner of another is totally unacceptable. But holders of doctorates are “doctors”, end of story. If the general public don’t know the meaning of the word then who’s fault is that? The doctors? I first studied for a BEng, then MBChB, then PhD. Why engineering, medicine/surgery and philosophy? I work in a hospital. I study the mechanics of soft biological tissue and links with the underlying microstructure, mechanisms of ageing and chronic disease. I need the combination of anatomy and human biology, engineering and the skills developed during my research degree to do what I do in the best way possible. I work with a large team of people, mostly academics, who design new and optimise current medical devices. Concept development, design optimisation, clinical trials, patient feedback, CE marking… it can take many many years to bring a device to market. The only thing we use doctors (in your sense of the word) for is to oversee the clinical trials. The majority of staff in the department (clinical and medical engineering) hold bachelor degrees in engineering, masters degrees in science and doctorates of philosophy. Since we are in a hospital should I run down the hallway and tell them all that they cannot have the title of Dr on the door of their office because we are in a hospital? If they were running around the hospital trying to prescribe medication to patients and advising someone suffering from a combination of chronic open angle glaucoma and sclerocornea to go out and drive a formula 1 car down the motorway then there would be a problem. But they don’t. Yet they are still doctors. However, I always introduce myself by my first name, never by doctor, not even at work (apart from some emails). If someone asks what I do for a living I say I’m a biomedical engineer as that best describes what I do… just like how the word physician best describes the work of an MBChB. The only people who seem to have inferiority complexes about the title are those who have studied medicine.

      • And of course, MBChB’s also have every right to be called doctor… but that still doesn’t mean they are a pompous twat if they go around introducing themselves a Dr in social settings. Introduce yourself using your name. If a woman introduces herself as “miss” she’s probably trying to tell you something. If someone introduces themselves as “doctor” they are also telling you something… that they are an ass!

  • Can I just add in here it IS acceptable for Physicians and surgeons with a MBCHB (Bachelor of medicine Bachelor of surgery) to use the Title Dr.

    An MB ChB is exactly same as MD or DO as per the world health organisation I know I have worked in the USA and the UK.

    In fact the USA used to use the MBCHB degree instead of MD/DO

    Finally a MD in the UK as I said is a degree you do after the MBChB or US MD or US DO it is a Research higher doctorate given to Physicians/surgeons/psychiatrists etc. instead of a PhD…

  • I’m in school to become a nurse practitioner. I agree that it’s better for us to say, “I’m your nurse practitioner, so and so” than “I’m Dr. so and so” when you are introducing yourself to a patient directly. That is what I plan to do when I finish (my NP program is a Masters’ not Doctoral one, as most currently are – though I may go back to get a DNP someday). However, I think that your comparison to med students that have a PhD not calling themselves doctor is really different than DPTs or DNPs claiming the term doctor and it’s pretty misleading and inaccurate to set up that analogy. Your PhD classmates have a doctoral degree in whatever it is they studied – microbiology, anthropology, public health, whatever. They don’t have doctoral level training in a clinical field, and not in the field they are currently working in as a student. DPTs and DNPs have doctoral level training in a clinical field, doctoral training to do exactly the job they are currently doing.

    Also, your post and definitely those of some of the other commenters here have a tone of superiority about physicians that is not the most respectful or collaborative with all the healthcare colleagues you’ll be working with. It also sounds like you don’t understand the role and scope of NPs and PAs very well. Yes, we are NOT physicians and have different training. But in terms of what we are trained to work in – we do perform the same role as primary care physicians in many cases. If the JAMA article about primary care outcomes is a surprise to you, then don’t understand (or don’t respect) the roles we play. Some job positions are even designated to have either an NP or a family practice MD, etiher one, in the role. The work of most NPs is much more similar to MDs than to RNs (who are super important and often highly skilled, just different ones than an NP). And your point that most don’t know the difference between NPs, RNs, CNAs, etc. – so it’s better to keep that whole group separate – actually undermines your point that helping the patient understand your role is the important goal.

    The language thing is a hard one – I don’t know what the solution is. Provider (or healthcare provider, primary care provider) is a word we use alot, but that term can seem vague to people not in the field. Even if we come up with some better name for NPs, PAs, etc., linguistic change in the general population (or even the healthcare field) takes a long time and probably most patients still wouldn’t know what we were talking about. Even currently, I know several nurse practitioners who always introduce themselves as an NP, never as “Dr,” whose patients call them doctor all the time. Even with wearing a pin that says “I’m a nurse practitioner” and sometimes even correcting them verbally. Their patients see that they are acting in the role of being their primary care provider and that is the word that comes to their mind. I don’t think this means we should introduce ourselves as doctors – just shows the language dilemma here.

    Another thing about the language – you mention people that speak English as a second language (or don’t speak it). In Spanish there is no word for nurse practitioner – partly because it’s a role that’s specific to a few countries like the U.S., UK, Canada, etc. The direct translation is really inaccurate because because it makes it sound like you are a nursing student (not even a nurse) rather than a nurse practitioner. Made slightly more complicated by the fact that in many Latin American countries, nurses are not as highly respected as they are in the U.S. and don’t receive the same level of training – so it can make patients unfamiliar with the role feel extra uneasy about who is taking care of them as their primary care provider.

  • When I have a med student with me I always introduce them as Dr. They know they’re not a doctor but I want them to get used to the title. The journey from med school to residency to attending is one of gradual change and increasing responsibility and I want students to get used to being a doctor because it is a position that has great responsibility.

    As for NPs referring to themselves as doctor – complete misrepresentation – so many courses can be done online which makes it even more farcical – there’s no substitute for a sleepless and stressful year as an intern followed by residency.

  • Very interesting question about titles. I was awarded a PhD (doing molecular biology type things with liver cells) from the Faculty of Medicine at the University of Southampton in the UK. I’ve since acquired an MSc in Health Informatics from the same university. Oh and I guess I’m on the other end of life’s curve to you although I’m still hoping for quite a few good years yet.

    I don’t use my title much in everyday life preferring to be simply Neil Turner. If anyone insists on using titles I will always use Dr rather than Mr.

    I would always use Dr professionally. The areas in which I work are on the borders of medicine and I contribute a slightly different skillset to the medics.I think this is healthy and, frankly, I’m entitled to my professional respect.

    In fact I’ve always found my medical colleagues to be very supportive. Where I have encountered a negative reaction it has tended to be from colleagues who have not been doctored in any way. Even then they are very much in a minority.

    I would never try to pass myself off as medically qualified. It could be illegal and you would look pretty stupid whenb you were found out.

    If anyone asks my advice socially I might say “you should see your doctor about that” or “I don’t think it’s serious and if it were mine, I’d keep an eye on it for a few weeks..BUT if you are at all worried go and see your doctor and see what he (she) says”

    (A wise GP once told me that an important part of his job was to keep the patient occupied while the illness got better in it’s own time!

    Happy New Year,

    Neil

  • I greatly appreciate this bog….I am a RN currently in school for my DNP. I work with a gentleman who is a physical therapist and received his doctorate and insists we call him Dr. ____. While I don’t want to seem like he didn’t work hard on his degree, it can become very confusing to patients on what his role in the healthcare setting is. It already becomes difficult when a patient calls me into the room when he leaves and says the Dr just left. I am for higher education, but not for a title, but rather to better myself. In a hospital setting, we forget there are many who don’t understand “medical lingo” and this is already confusing let alone try to keep up with what degrees mean. People should only be referred to as Dr’s in a medical setting if they are physicians. I also feel this will become a problem as NP’s and being encouraged and soon forced to obtain a DNP vs MNP. There is a difference in what responsibility and the amount of schooling it takes to be a physician vs a NP/PA/etc. I feel credit is due where it is earned, but not at the extent of confusing our community.

  • Roxanne

    I think you are the one who misinterpreted the patient who was calling a DPT a doctor because the same patient new that the doctor who was treating him or her is a physiotherapist. but you assumed that the patient meant physician.

  • “I’ll call you doctor when you can actually crack someone’s chest open and massage there heart to keep them alive. I will call you doctor when you can handle someone hypoxic while on the vent and diagnosing a pneumothorax and placing a chest tube to save there life.
    Please don’t hold yourself or your “doctorate” degree as equal to that of a MD. Better yet next time you need a doctor or have a patient goes unresponsive ask for one of those phd doctors for help.”

    I don’t get the above statement at all!!!! There is all this intellegent conversation around about who gets to call themselves Dr and where…… and then this crap. What does it even mean? Somehow Dr should only apply to medical practitioners because they are involved in particularly important work? Uttlery absurd. You could just as easily say only people with PhDs in geological science should be called Drs because medical practitioners have no idea how to predict an eathquake and subsequently save 1000s of lives.

    Personally I find that a burning desire to be called Dr goes along with a basic lack of confidence and desire for status. I know several medical practitioners and people with PhDs and neither group call themselves Dr in a social setting. Who would???!!!! “Hi Jane, nice to meet you my name is Dr Jones”. Really, I have heard people say things like that.

    I am a health professional and not a Dr in any sense. I meet frequently with General Practitioners and I almost always call them the generic name “Doctor”. That is, no surname after it. Honestly, they often have surnames that are difficult to pronounce and it is easier to just call them “Doctor”. For the ones who don’t care, well they don’t care, and for the ones who need the status boost it goes down well. That is a clinical setting with the patient there.

    I agree it can be confusing for patients in a clinical setting and in particular a hospital setting, to discerne who does what, when the titles are not specific and for the sake of the patient it is probably better to stick to the traditional medical practitioner = Dr. Many patients would need quite a bit of education to understand the various nuances of the term Dr and what benefit is there in that for the patient?

    I believe the term Doctor should be phased out as it is too imprecise. Medical Practioners could be called Physicians or Medicos. Physios can be physios, chiropractors can be chiropractors, dentists can be dentists, people with PhDs can have PhD after their name. Revolutionary? Maybe.

  • I am a UK consultant with a Master of Science degree and 10 years research experience, so see things from both sides of the fence as it were. Sadly, we medics tend to have a rather overblown image of our own self-importance, particularly junior medics who have no qualifications other than the taught MBBCh degree, which is basically just rote-learning and an extension of school-life. In contrast, the PhD is only gained through thorough, independent research activity by someone who has already gained a primary science degree. Who, then, is more entitiled to term themselves “doctor”, if the strict scientific meaning of the term is appllied? In Germany, the distinction between “doctor” and “medical practioner” is very stringent. There, holders of the MBBCh equvalent are not allowed to use a Dr title on leaving medical school until they have acquired a doctorate-level research qualification. Food for thought, perhaps?

  • I’ve worked in health care since 1988, and I think it was silly in the first place for “Doctor” to be so misused, but part of that is because I am married to an anthropologist who loves to explore language and it’s usage and history.

    I think that not all patients know or care much about the intricate details of who went to school for how many years, and just want to know “are you qualified to help me”. So when I refer to myself I say I’m an NP student, and when I refer to the psychiatrist on the team I’m with, I call him a psychiatrist and when I refer to the person’s primary medical provider, I call them a physician (well. .. if they are one). I try to start with the simplest titles (ideally one to three words) that convey area of expertise and imply training/education.

    Education-wise the NP I’m doing a rotation with had four master’s degrees before she decided to pursue her doctoral degree in nursing practice. On the other hand one of the PA’s I work with had a master’s in business, switched tracks and now works in health care. Another “Nurse” is a talented surgeon from another country who needed to get a degree that would allow him to support his family while he re-attends medical school here (not everyone falls through the cracks like that – it was bad luck and bad timing). A nursing student I work with has a 2-year degree in holistic health, is a licensed massage therapist, a Reiki master (for over 10 years) but technically is “only a student nurse”.

    The clinicians I have the most respect for are the ones who can collaborate well – they are the ones that end up participating in the best care and the best patient outcomes.

    Diane Inda, BSN, RN, PHN (and student in a doctoral psych/mental health NP program)

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I’m a Medical Student (that means I'm in school to become a doctor). My life story can be viewed here. I started this blog in hopes of landing a role in a Lifetime movie so I could quit school and move to Hollywood, so if you wouldn't take medical advice from Angelina Jolie, you shouldn't take it from me. I may not even be a real person. In fact I'm probably a spambot. Or a 15 yo boy blogging from a dingy basement. If you're really interested you can read more about me here. If you have any questions or want to guest post contact me.

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