Mark Speechley is a Professor of Epidemiology at Western University
The age-old debate over who should be addressed as ‘doctor’ lives again in recent letters to CMAJ. Of course, it is important not to confuse the public. Since more people get sick than get university educated, members of the public are more likely to have met a physician-doctor than a professor-doctor. As a PhD epidemiologist, ‘the population is my patient’. Consequently, when I meet my medical colleagues in the hospital, I do not expect to be addressed as ‘Doctor’, but should the whole population be in the hospital, and the crowding in the corridors be so acute that I would have the statistical power to practice my profession by expertly assembling the massed throngs of gurneys into long rows of cases and controls, or exposed and unexposed, as appropriate, I would most certainly expect to be addressed as such.
We do not restrict professional titles for power or status or tribalism or – please! – to salve our fragile egos. Rather, we do so to avoid confusing patients, because if there is one thing the typical hospital patient does not want or need, it is more confusion. But what might Cindy tell her Grade 5 ‘Intro to Logic and Critical Thinking’ class about how well it’s working?
“Hello Cindy. I am Dr. Blaggs. I am a medical doctor, like your family doctor, except I work in a hospital and make twice as much money, as compensation for seeing the same type of patient day after day. This is Dr. Bleggs, who is a dentist. Like me, she can prescribe drugs and order a ton of x-rays, but she is supposed to restrict her treatments to your mouth area, although of course I know a thing or two about mouths because as a medical student I had to memorize the same body parts she did, plus all the others. And this is Dr. Bliggs, a psychologist, who has pretty much the same knowledge of mental illness as a medical doctor called a psychiatrist, except with more sophisticated research skills and without the legal authority to prescribe a single dram of placebo. This is Ms. Bloggs, a Doctor of Audiology, meaning she treats hearing disorders, which Dr. Bluggs, an ear, nose and throat doctor does too, except we don’t call Ms. Bloggs a doctor to avoid confusing you. Same with Mr. Blyggs, an advanced practice nurse who, even though he can prescribe some drugs, isn’t called ‘doctor’, which is kind of funny because ‘doctor’ in Latin means ‘teacher’, and many patients say they learn more from their nurses than from their physicians. And this is your surgeon, Dr. Blaaggs, who came from England, where he was addressed as Mr. Blaaggs, to differentiate himself from medical doctors who don’t cut into your body, at least not as often or as deeply. Any questions about what members of your care team do or how to address us, Cindy?”
And as we ponder more deeply this crucially important issue in health care, consider this: if a parrot got loose in a hospital, and addressed the veterinarian sent to capture it as ‘doctor’, and a therapy dog who wasn’t feeling well overheard the parrot, would that be so bad?