Is there a Doctor in the House?

by
  • Zakowski, Mark, MD
| Oct 17, 2011

Is there a doctor in the house? We are all familiar with the question and its intent, but many nurses, pharmacists, physical therapists, and alternative health care providers like acupuncturists and chiropractors are increasingly claiming the title to be their own. Certainly anyone earning a Ph.D. (doctorate of philosophy), D.C. (doctorate of chiropractor), D.D.S. (doctor of dental surgery), even an attorney J.D. (doctorate of jurisprudence) can call themselves “doctor” – after all, they earned the post-graduate degree! However, what is totally lacking is the context for the title within a conversation. Implicit in the question, “Is there a doctor in the house?” is the understanding that someone has fallen ill and needs the attention of a physician. For hundreds of years, the almost exclusive use of “doctor” in the common language has been to refer to a physician (medical doctor). That usage is what the public expects when they are seeking medical care or are approached by someone in health care uniform who introduces him or herself as a “doctor.” Currently, there is a growing trend for non-physicians to obtain advanced degrees—a laudable goal—but what is the purpose of these same non-physicians introducing themselves with the title “doctor” to patients?

Gertrude Stein in 1913 wrote, “Rose is a rose is a rose is a rose.” Does it really matter what a health care professional calls him or herself? After all, a non-physician with an advanced degree has earned the right to use the title “doctor,” and certainly his or her parents are very proud. However, non-physicians introducing themselves to patients as “doctor” when the patient expectation is that only a physician (medical doctor) will use that term is not only misleading, but also potentially deceptive and unethical. Is this result simply the inconvenient consequence of an earned credential or an intentional and direct assault on physicians? Possibly either or both, but I would argue that questioning the root cause is irrelevant, because what matters most is that the result of the obfuscation is an intentional and direct assault on patients.

A recent New York Times article by Gardiner Harris entitled, When The Nurse Wants To Be Called “Doctor”, addresses just this issue. Nurses, pharmacists and physical therapists are increasingly calling themselves “doctor,” after earning an advanced degree in their field. Harris states that patients may have “confusion over who is responsible for their care and what sort of training they have.” Exactly! One option to avoid the confusion might be having those non-physician health care providers introduce themselves with an alternative title to denote their extra learning, such as “Advanced Practice Nurse” or “Advanced Practice Pharmacist.” Some states have already implemented an alternative solution by passing laws preventing the usage of the title “doctor,” unless qualified by the profession, such as “Doctor of Nursing” or “Doctor of Pharmacy.” Although technically accurate, these phrases are still confusing to the public. A legislative bill pending in New York would prohibit nurses using “doctor” in advertisements.

A recent survey found that over 40% of patients find it hard to tell who is a physician and who is not. Don’t we all believe in truth in advertising? In January of this year, Rep. John Sullivan (R-OK) and Rep. David Scott (D-GA) introduced H.R. 451, the “Healthcare Truth and Transparency Act of 2011,” to address this grievous problem. Patients can only make an educated, informed choice about their health care when they can clearly understand with whom they are speaking. Representatives Sullivan and Scott, in a letter to their colleagues, state, “The goal of this legislation is to hold health care providers to the same truth in advertising standard as every other provider of a good or service in the United States.” Many state and national medical societies (including the CSA and ASA) have supported the Healthcare Truth and Transparency Act.

Modern healthcare involves complex decisions with both individuals and teams of doctors, nurses, pharmacists, physical therapists, and other health care professionals taking care of seriously ill patients. It is in the best interests of the patients to clearly know who is taking care of them and what their training and expertise is, so patients may better be able to understand and make decisions. America owes the public the clarity offered in the Healthcare Truth and Transparency Act, H.R. 451. The next time John and Jane Public ask for a doctor, we can help ensure they get what they are asking for – a physician.

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