Saturday, October 29, 2011

What is in a Name?

‘That which we call a rose by any other name would smell as sweet.’

William Shakespeare’s Juliet in the play ‘Romeo and Juliet’ knew that it is not what things are called that matters; what is important is what they are or what they do.

In the world of healthcare in general and medicine in particular, the names of professionals has caused disquiet as far back as the 16th century, when only two educational establishments were allowed to grant licences to men (and only men) qualified in medicine. The first, the Royal College of Physicians of London was founded by King Henry VIII in 1518. The second was not a college but the Archbishop of Canterbury, under the Peter’s Pence Act 1533. Physicians took the title of ‘Dr’ as a reflection on their learned status and their possession of a degree in medicine.

Working within the same environment as the physicians were barber surgeons. As their name implies, these were men who earned their living cutting hair, shaving men, letting blood, setting bones, amputating limbs, extracting stones from bladders, and other similar surgical delights. They were tradesmen who learned the tricks of their trade by apprenticeship or simply raw experience. They did not have a degree in medicine and therefore were not entitled to call themselves ‘Dr’.

The third category of 16th century healthcare workers was that of the apothecary. Apothecaries made up the medicines prescribed by the physicians. Today, they would be called pharmacists. However, in the 16th century, apothecaries would often be asked for advice by the poor, who could not afford the fees of physicians. This unlawful practice of medicine was legalised by the Apothecaries Act of 1815. As a result, apothecaries became what we now know as general medical practitioners (or GPs).

Today, all medical practitioners (regardless as to whether they end up as hospital doctors or GPs) qualify in the same way and hence have the right to the honorary title of ‘Dr’. Those taking postgraduate qualifications in surgery, enabling them to become specialist surgeons, then often forsake this hard-earned title and revert to calling themselves ‘Mr’ as a historic reflection to the time of the barber surgeons. So in hospitals, consultants are usually ‘Dr’ if they are physicians or ‘Mr’ if they are surgeons.

I called the title ‘Dr’ an ‘honorary title as all medical practitioners qualify with two bachelor degrees in medicine and surgery (e.g. MBBS). In academia, the title ‘Dr’ is usually retained for those obtaining higher degrees (a doctorate), such as an MD (Doctor of Medicine) or PhD (Doctor of Philosophy); the latter meaning that not every ‘Dr’ is medically qualified.

If that isn’t confusing enough for members of the public, there is a growing trend for dentists to call themselves ‘Dr’. A similar situation is found with chiropractors. Some senior nurses take a PhD degree and hence rightly adopt the title ‘Dr’. Then there is the growing list of non-doctor job titles such as ‘nurse consultant’, ‘nurse practitioner’, ‘consultant podiatric surgeons’ and ‘operating department practitioner’ (neither of the last two being medically qualified surgeons).

Over the twenty-seven years since I became medically qualified I have been called by many names, some of which cannot be repeated here. However, I am still amused by one chap who, from a crowded waiting room and with a cheeky grin, usually forgoes the pomposity of titles and greets me with a loud ‘Morning, Robert’. As he has often said to his daughter, ‘they all have to wipe their bottom the same as us’. He is quite right, of course. Ultimately, it is not the title that matters; but professional honesty and transparency most definitely do matter. Clarification of health professionals’ titles and roles is urgently required if the public is going to understand the educational background of the person treating them in an increasingly complex health arena.

(First published in the Scunthorpe Telegraph, Thursday 13th October 2011)

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