SHOULD A NURSE BE CALLED “DOCTOR”? (Just because they have a PhD?)
By Brandon Cohen, from WebMD
The value and meaning of the title doctor came into question during a recent discussion on Medscape’s Physician Connect, an all-physician discussion group.
A surgeon began the lively exchange with this question: “Many nurses, dieticians, etc. now have a PhD, and patients are beginning to call nurse-practitioners and physician assistants ‘doctor.’ Is this a good thing, and if so, how do we distinguish the various PhD categories from licensed MDs?”
A solid majority of responding physicians had a strong negative reaction.
“It pains me to see those who have not endured even the med school part (not to mention residency) become indistinguishable from me. It makes me wonder why I gave up such a big part of my life. I could have squeezed in through the backdoor for a lot less heartache…It just feels like it cheapens the degree,” wrote one general practitioner.
Another general practitioner went further: “If they call themselves doctor or allow patients to call them doctor in the clinical setting, they are lying and deceiving people…No. In clinical parlance, a nurse is not a doctor unless they have spent the time and money and work to obtain the MD, DO, or dentist DMD or DDS degree.”
An otolaryngologist agreed and added, “For the present, doctor in general denotes college, then medical school, then residency, etc. To do otherwise is pure deception and ego…[I] think that there should be clear identification made to patients (it is their right) as to who is a ‘real doctor’ and who is a ‘noctor.’”
Some physicians went to even greater extremes, coming out swinging and drawing the lines of battle. “The nurses…are a bloodthirsty bunch…What a mess. The AMA has proposed that only MD/DO, dentists, and podiatrists be called doctor in a medical setting; they finally got something right,” declared a general practitioner.
And a blunt vascular surgeon added, “I am sick of NPs. Give them nothing. Are lawyers called doctor? No. Never give the enemy a break.”
Even physicians who did not see nurses as the enemy did not think that they should use the title doctor. “There is nothing wrong with nurses,” wrote a general practitioner. “Nurses are comforting, nurses are helpful, nurses often save the day. But [they] should never be called doctor.”
There were some who disagreed. A live-and-let-live internist offered, “I personally don’t have any qualms about calling someone else with a doctorate doctor. So it’s OK if the nurse doctorates are called doctor. It’s only a word.”
An emergency room doctor was also permissive, with one significant condition: “I don’t really have a problem with them referring to themselves as doctor, as long as they are willing to accept full responsibility for their actions (including malpractice liability) if they want to act independently.”
Since most respondents considered this issue a problem, the discussion soon turned to solutions. As a general practitioner put it, “FNPs with a PhD technically are doctors and have earned the right to the title, just as your college professor did or a psychologist or a dentist. What they are not are physicians. For future reference, how do you differentiate between us with nomenclature so patients know the difference?”
A gastroenterologist started things off: “I think that the distinguishing title of doctor in medicine is the MD, and one should start to incorporate that specific title in communicating with patients: eg, MD Jones, MD Smith et al, or James Jones, MD; Bill Smith, MD. By default, patients will start asking what kind of doctor is treating them, and the doctors of nursing will have no option but to state that they are doctors of nursing.”
A surgeon suggested the use of clothing to distinguish doctors from nurses: “Have the med exec committee make rules about coats. Seems a lot of the trouble is there. Do like baseball uniforms — big letters on the back — doctor of pharmacy, or nurse doctor (non-MD) or whatever.”
A number of doctors advocated using a long-standing tradition among British surgeons. “British surgeons, once they pass their fellowship qualifying exam, revert to the title of Mr. and are proud of it,” wrote one surgeon. It is worth noting that a significant number of British surgeons prefer other titles, such as Ms.
An emergency room doctor offered another solution: “Let’s stop introducing ourselves as Dr. So-and-So. Instead of ‘Hello, Mr. Smith. I’m Dr. Jones,’ we could say, ‘Hello, Mr. Smith. I’m Chris Jones and I’m the ER doctor/physician.’ The bottom line: Emphasize our role and not our title.”
An optimistic internist offered the soothing suggestion, “I think if we provide a mutually respectful environment for all clinicians, then the DNPs would be okay with or without the doctor thing.”
One general practitioner blasted the title itself: “I don’t like the pretentious prefix doctor at all…Use of such prefixes encourages patients to put the physician on a pedestal, and the physicians, of course, love it since they then don’t have to say too much and [it] keeps their patients awed.”
But most colleagues disagreed and sought to preserve the title, when used in a clinical setting, for the exclusive use of medical doctors. One general practitioner went so far as to invoke the authority of Miss Manners, who wrote, “NPs should be called by their patients and colleagues “Nurse Johnson,” whether or not he/she has a doctorate.” For many this was a satisfying final word.
Dr. Pinna says:
My diploma issued by the University of Bologna, Italy, says in Italian: “Doctor of Medicine and Surgery.”
A person with a PhD is a “Doctor of Philosophy.” The degree which reads DDS means “Doctor of Dental Science.” There is even a JD degree, which means Doctor of Jurisprudence, and this refers to lawyers.
There are many “Doctor” degrees around the world, however, there is only one “Doctor of Medicine and Surgery” degree and that is reserved for doctors who have studied the science of medicine and the art of surgery.
The term “Doctor” is used in most countries to refer to a man or woman who has studied medicine and surgery and practices this art.
In the U.S.A. the title “Doctor” in a medical setting, was applied only to a Doctor of Medicine.
However, as more and more people began to help the doctor, and eventually to replace the doctor, they too wanted the respect that this title engendered in the mind of the public, even though they had not gone through the rigorous study and training of all medical doctors.
Today, we see nurses, and physician assistants and even technicians, drooping a stethoscope around their neck, and hoping that patients and other staff will think that they are Doctors of Medicine.
When they have a PhD they argue that the title “Doctor” should be theirs as well.
But, in America, the title Doctor refers to someone who has studied medicine and surgery and has trained years in a specialty, and, most importantly, has dedicated his or her life to serving patients.
In recent years, people who have not met these requirements, have decided to use the title in order to reap the reward of respect and even power.
This is very understandable.
The morality of the average person is generally limited to obeying written laws and not to following a moral code which has fairness as its central guiding value.
A truly ethical person would be ashamed to call himself or herself “doctor” without having the requirements listed above.
The fact that many people insist on the use of this title, in spite of the fact that they are not entitled to it, demonstrates how low the morality of the U.S. has dropped.
In Japan, for example, a person calling himself a Sushi Chef without the requisite training and experience would be shunned as a criminal.
After all, taking a title which is not yours is an act of stealing.
The doctors in their conversation above are awkward in their responses.
They know that the nurses who have stolen this title are amoral, but, as doctors are loyal to nurses, forgiveness is foremost in their minds.