The Title Is About The Power

When I was young and worked at Sticksville General Emerg, we had exactly one dental surgeon on call. I secretly called him Dr. Fabulous, because in his esteemed and respected opinion, he was fabulous. He was fabulously good-looking, and lived in a fabulous house with fabulous wife and children; his practice was fabulous, and of course, his ego was fabulously huge.

As I’ve mentioned before, Sticksville Gen was somewhat reactionary in attitude: the physicians were all men and the real leaders and heroes, and the nurses followed them like meek lost puppies. We had one nurse — Suzanne — however, who didn’t quite fit the mold: she was, truth be told, dangerously mouthy.

One day, Dr. Fabulous made his triumphal entrance, all pomp and self-regard, into the emergency department to look at the smashed mandible of an 18 year-old hockey player.

“Jim,” said Suzanne, “Your patient is in Minor Trauma.”

Dr. Fabulous screwed up his eyes and made a great show of looking at Suzanne’s name tag.

“Suzie,” he said, “You will please address me as Dr. Fabulous!”

Without missing a beat Suzanne screwed up her eyes and looked at Dr. Fabulous’s name tag.

“In that case, Jimmy,” she said, “You may call me Nurse Assertive or Mrs. Assertive. Only the people I like get to call me Suzie!”

I was reminded of this story when I saw this article: Doctorate in nursing causes confusion, resentment.

Shirato, a nurse practitioner, just got her doctor of nursing practice degree at Thomas Jefferson University.

[snip]

Most newly graduating physical therapists now have doctorates, too. Pharmacists and psychologists already made that move. Audiologists, physician assistants, and occupational therapists can also get doctorates.

As nonphysicians with doctorates proliferate, the potential for confusion has grown, and physicians aren’t happy about it. A 2008 survey by the American Medical Association found that 38 percent of patients believed that nurses with doctorates were medical doctors.

The American Medial Association has produced model “truth in advertising” legislation that requires health professionals, including physicians, to wear badges that clearly spell out their credentials.

Yeah, well, yawn. Just do normal practice and identify yourself when you meet the patient. In any case, I’ve come around to the opinion that titles of any sort are antiquated expressions of professional authority. Physicians acquired the title “doctor” — and remember it was originally, and still is, an academic title — over the course of the 18th Century to establish their credentials on par with the traditional professions (and gain entrance to the middle-class). They then spent a good part 19th Century trying to deny the same title to surgeons who were, in their opinion, “mere barbers.”

Titles, in short, are about establishing status and power. Why else worry about them? They are utterly irrelevant to actual patient care and one’s ability to do the job. Insisting on their use can create an atmosphere of professional intimidation that suppresses the free exchange of information. Health care professionals expressing power over patients is definitely not a good way to create therapeutic relationships. Implicitly saying (or believing) the title makes you a better person or supplies you with definitive or superior knowledge about patient care is dangerous as well as destructive to collaborative relationships with other health care professionals. In the end, it results in bad care of our patients, and of each other.

Some physicians really resent the loss of power. Don’t believe me? Check out why the defensiveness of this physician.

James Goodyear, a Lansdale, Pa., general surgeon and president of the Pennsylvania Medical Society, said health care workers who are not physicians should immediately tell patients what they do.

“I am a physician. They are not,” he said. “They trained for hundreds of hours. We trained for thousands of hours.”

And, he said, physicians should still be in charge. “We think that those in the allied health fields that get a doctorate such as in nursing are a very, very important component of a physician-directed … team,” he said. [Emphasis mine.]

Not about power and status? Fer sure. When this guy says, “I am physician” you can almost hear the sub-vocal “I am God”.

Oh, and thanks for the condescension too.