Sunday, October 02, 2011
where context is key
The season that it is cool enough to wear sweaters and scarves, but not cold enough to have to wear those big poofy winter jackets. Since we live in Atlanta, weather like this will last until, oh, just around Thanksgiving, and resume probably by the end of January. Not a bad deal.
(Also, if you're thinking that the only reason to have kids is to dress them up in cute little clothes for the fall, you're 75% right. The other 25% is to legitimize buying a lot of Halloween candy. DO IT FOR THE CHILDREN.)
Anyway, this spawned a good amount of discussion on Twitter when I first posted it, but I just wanted to open it up here in the > 140 character arena. An article in The New York Times today detailed the growing trend of non-physician practitioners (such as, to give one example, nurse practitioners) introducing themselves as "doctors" to patients in a clinical setting. One argument is that, as someone with a doctoral degree, they deserve the honorific, and earning these doctoral degrees (I'll quote directly from the article here) "can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients."
My personal take is this: indeed, anyone who earns a doctoral degree has earned the right to be called "doctor." No one is disputing that, or taking respect or recognition from anyone who has earned that doctorate. But I would also point out that the term "doctor" has a very specific meaning in a clinical setting, and that the shades of grey ("I'm not a medical doctor but I do have a doctorate in nursing,") can be confusing or simply lost on a patient or their family, especially in the setting of an already complicated interaction in the hospital.
Some people argue that there is ego involved, and I don't doubt it--and might I point out there's likely a lot of ego on both sides, from the physician side for wanting to "defend" the title of doctor, and from the non-physician side in their desire to assert their own rich and well-deserved credentials. But like with most things in medicine, context is everything, and if we can all agree that the shades of differentiation of the term "doctor" are particularly fraught in the clinical milieu (and thus confusing to patients) perhaps ego can and should be put aside in the name of transparency.
There is also the issue of responsibility. In most situations in the hospital, the physician has the ultimate responsibility for the patient and what happens to them. As the physician, I am the bottom line, and whatever happens "under" me (someone misinterprets my order, a medical trainee under my supervision causes patient injury, a medication error occurs not directly because of me but under my watch)--in the end that's my responsibility and no one else's. When I introduce myself as "Doctor Au," that's part of the implicit understanding, and patients need to enter into that doctor-patient relationship where trust and the assumption of that ultimate responsibility go hand in hand. It may not seem like more than semantics to some people, but when you present yourself to a patient as their "doctor," in a hospital, that has to mean something very specific, for the understanding and ultimately the protection of the patients under all of our care.
In my mind, if someone calls themselves "doctor" during a professional interaction in the hospital, I assume that they are a physician, and I think I'm safe to say that most patients feel the same way. Just the same way that, if I'm in a college French class and the professor introduces him or herself "Doctor Webb," I assume that they have an academic doctoral degree and don't start, you know, taking off my clothes and showing them my rashes. In medicine, context is everything.
(Incidentally, on the flip side, if a patient asks me to call them "Doctor So-and-so," I will absolutely oblige them, no questions asked. But then again, I will pretty much call a patient whatever they ask me to call them, including the one patient I had who specifically requested that, when we woke up him up from anesthesia after surgery, we address him as "Big Poppa" because it was the only name he really responded to. No problem, uh, Mr. Poppa.)