Clinically, Who Should We Call “Doctor?”

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!!