S03E65 Who Should Call Themselves Doctor?

Who are we calling Doctor? You'll be amazed to learn how an age-old title has sparked contemporary controversy. We're unearthing the historical roots and evolution of the term and the current legal ruckus brewing in California about whether nurses with doctoral degrees have the right to the title.

We'll navigate this contentious issue, delving into the reasons some feel they have earned the right to the honorific and why it's crucial to respect personal title preferences. We'll also probe into the practicalities of how this applies in healthcare settings.

After that weighty discussion, this week's thankful is something lighter and more melodious - the magic of music in your car!

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S03E65 Who Should Call Themselves Doctor?

[00:00:00] Sam Rhee: Who should call themselves doctor?

Do you remember the episode of Friends? The one where Ross and Rachel are in the hospital to see Rachel's father and Ross, who has a PhD, introduces himself to a nurse saying... "I'm Dr. Ross Geller," And Rachel says, "Ross, please, this is a hospital, okay? That actually means something here."

Or in the movie The Hangover, where the crew is checking into Caesar's Palace, and Stu says, "We have a reservation under Dr. Price," and Phil says, "Dr. Price, Stu, you're a dentist, okay? Don't try and get fancy." Then he tells the receptionist, "Hey, he's a dentist. Don't get too excited. And uh, if someone has a heart attack, you should still call 911."

And then even later in the hospital, the physician reading off the charts says, "Patient name Phil Wenick, 2:45am arrival. Minor concussion. Some bruising, pretty standard." And Stu says, "Hey, do you mind if I take a look? I'm actually a doctor." And the guy replies, "Yeah, you said that several times last night, but really, you're just a dentist."

Hangover is one of my favorite movies. The best line the doctor has, though, is when Phil asks, "Hey, Best Little Chapel, do you know where that is? And the doctor says, "I do. It's at the corner of Get a Map and Fuck Off. I'm a doctor, not a tour guide. Figure it out yourself, okay? You're big boys."

These lines kill me every time, but I digress.

The topic of this podcast is who should be called doctor? And this question has raised a lot of hackles over the years and even more litigation in the past few months. Under California law only physicians and surgeons can use the word doctor in titles online and in business communications. In fact, last year a nurse practitioner paid $20,000 in a civil settlement with the state for allegedly describing themselves as a doctor on professional websites and social media.

And several months ago, three nurses with doctorate of nursing practice degrees, or DNPs, sued the California Attorney General and the California Medical and Nursing Boards, arguing they have the right to call themselves doctors.

In a recent Washington Post article, Jacqueline Palmer, one of the plaintiffs, said that after 14 years in the classroom, she has earned the right to call herself Doctor. "It's not an ego trip, it's not a power trip," Palmer said. "It's just validation that I worked hard to get to where I am today."

So with this controversy about who should be called Doctor in the United States, let's dig into a couple things. Where did this calling people Doctor come from in the first place? What do most people think of when you use the title Doctor, and does it even matter these days anyway?

So according to Wikipedia, the title Doctor started in medieval times in Europe when doctoral degrees were first awarded to graduates who were then allowed to teach others.

Back in the 13th century, doctorates were awarded in three fields, Theology, Law, and Medicine. But then gradually, other humanities and science fields began awarding doctoral degrees in their own specific fields. These humanity and science degrees were known as doctorates in philosophy, or PhDs. Back then, philosophy was used as a general term for all academic studies.

And then in the United States, universities began awarding these Ph.Ds in the late 1800s as they began building their own graduate programs. And then these Ph. D. graduates began using the title doctor.

Now on the medical side, the common use of the title doctor by physicians, even if medical degrees were technically professional degrees, not graduate level degrees, became popular starting around Shakespeare's time and then continued into the United States once medical degrees were awarded starting in the 1700s.

Debate about who could use the term doctor and how it should be used has raged for a long time. In the past hundred years, The US has had many professions which now call themselves doctors. Not only are PhD graduates using the title doctor, dentists, podiatrists, veterinarians, chiropractors, physical therapists, occupational therapists, audiologists, pharmacists, optometrists, speech pathologists, psychologists, and even some doctors with a Juris Doctor degree. All of these professionals are using the title. So should they all be called doctor? Sure, why not? A lot of people believe that being called doctor is a sign of respect. I've heard people say when they call themselves Dr. So and so, they get better treatment than saying Ms. or Mr. So and so.

I mean, my own policy, and Miss Manner's official policy by the way, is that in social situations, everyone should be addressed according to their wishes. Makes total sense to me. I'm happy to call anyone Doctor, and I mean that sincerely.

But personally, I honestly avoid using the title Doctor for myself if possible.

Because 1. It's pretentious and egotistical. And 2. I hate when people use the title Doctor to make themselves seem more important in some way. Whether it's doctor license plates on the car to try to avoid speeding tickets, or standing at airline ticket counters trying to get rebooked and dropping the title doctor, and I've actually seen this, it speaks to entitlement and a false sense of superiority.

I remember someone I knew, the wife of a podiatrist, she would constantly insist that her husband be called Dr. So and so, even when just hanging out with friends. It's just like the jokes I mentioned earlier, it's all super fake to me.

There's someone at the gym who always calls me doc, and while that may be a sign of respect, I half suspect the guy's just breaking my balls. Like, what am I supposed to do, break out my prescription pad or start doing chest compressions or something? It feels jarring and weird when someone calls me doc and I'm not actually working as a physician.

But the biggest issue these days isn't really whether people call themselves Doctor over drinks and appetizers or using the title doctor to score a reservation on a crowded Friday night. The recent litigation is all about what people are allowed to call themselves in a clinical setting.

If you're a patient and you see someone in the hospital, the clinic, or the ER, and they introduce themselves as Dr. So and so, what is the expectation that you should have as a patient? The American Medical Association calls for non physicians, those not holding an MD or DO degree, who use the title doctor and are in direct contact with patients, to clarify that they are not physicians and to define the nature of their doctorate degree.

The American Osteopathic Association opposes the use of the title doctor by non physicians in clinical settings absolutely, because in their view such use deceives the public.

The Emergency Nurses Association has adopted the position statement that nurses are entitled to have their educational degrees acknowledged in the same manner as other professions and when being addressed or introduced as doctor in the clinical environment, it is the responsible practice for any healthcare provider to clarify their professional role.

Now, right now, different states have different laws. California and some other states only permit MDs and DOs to use the term doctor. But in Texas and Kentucky, they allow the use of doctor in advertising if the practitioner also lists the specific type of doctoral degree held.

Illinois allows all health care practitioners to refer to themselves as doctor in interactions with patients, as long as these practitioners clarify their specific role.

Again, Jacqueline Palmer, one of the plaintiffs in this lawsuit against California, said "The word doctor doesn't belong to physicians. We need to educate everybody and patients are very intelligent. They can understand the difference."

But do we really understand the difference? One of the problems is that most people, including me, get confused with all the degrees out there.

Quick question, is someone with a Doctor of Medical Science degree a doctor? 61 percent of people surveyed by the AMA believe so. However, a DMS degree is actually a doctoral degree for a physician assistant.

How about someone who has a DNP degree, Doctorate of Nursing Practice, like the three plaintiffs suing the state of California? 40 percent of people surveyed by the AMA already believe that a DNP degree is the same as an MD or a DO.

And some of these issues over titles is that there's an increased push by nurse practitioners and physician assistants to be able to practice medicine without the oversight of a physician.

And that scope of practice conflict will continue to grow. There were less than 100 DNP programs back in 2008. Currently there are nearly 400 DNP training programs today.

Now, most physicians that I know do not agree that DNPs should be called doctors. Now, is that in their own self-interest? Of course. But is it justified?

The AMA argues that the training is not the same for DNPs as it is for physicians. DNPs can get their doctoral degrees in three to four years after getting their Bachelor's in Nursing, while medical school plus residency is usually at least seven.

And the accreditation and certification process is more extensive for MDs and DOs than DNPs. Personally, I've never taken a nursing exam, but those USMLE and board exams I took to become a certified and practicing physician, were no joke.

So I don't blame physicians for arguing that they didn't spend six years in evil medical school to be called mister, thank you very much. Classic line from one of the great movies, Austin Powers.

But for DNPs, the argument is that the right to be able to use the title doctor reflects the time and effort invested to pursue the degree and the greater expertise graduates have gained from it.

So personally, what do I think about this debate? Well, as an aesthetic plastic surgeon, I don't really worry about being called doctor. Except... When they announce overhead for medical help on an airplane flight. And then I sink into my seat and wait for anyone more capable than I am in emergency care to ring the bell.

But, if someone has a medical crisis needing liposuction, I'll be the first to jump up.

I don't know, call me doctor, physician, surgeon, plastic surgeon, doorknob, whatever. I know who I am and what I do, and at this point in my career, I'm very comfortable regardless of what you call me. I believe actions speak louder than words. Titles are meaningless. What are you actually responsible for? That's what matters.

And everyone's calling themselves doctor these days anyway. The prestige associated with being a doctor is less now than it was 30 years ago. And in 30 years it will mean even less. Or maybe it will even become... an insult at that point.

So, if you, as a medical provider, are truly not wanting to be designated doctor just to take advantage of the slowly dying professional and cultural concepts associated with being a doctor, then go right ahead.

Call yourself doctor in the hospital, in your medical office, in the ER. But be mindful of the saying, Everybody wants to be a beast until it's time to do what real beasts do.

You want to be treated as a doctor? Are you acting like a real doctor? How about accepting real doctor responsibility? Are you willing to be solely responsible for your patient's care where the buck stops here, like physicians are?

Are you willing to legally sign off on your own records, charts, and clinical care like physicians do? Are you willing to accept the same standards of care and evaluation and certifications to which physicians are held? Are you willing to accept the malpractice risk that physicians take? Are you willing to pay the malpractice insurance that physicians pay? Are you willing to risk being sued the way physicians are?

If you are, welcome to the club. Our country could use more qualified medical providers. We need them desperately. Please step on up. But if you want to pose and use the doctor title without actually working as a doctor, then maybe you need to look at yourself and see what is lacking within you where you need that ego boost in your professional life.

Finally, a shout out to the most famous doctors in the world who aren't really doctors. but truly deserve the doctor title. They include Dr. Dre, Dr. J, Dr. Strangelove, Dr. Evil, Dr. Doom, Dr. Pepper, Dr. Bunsen Honeydew, Dr. Who, Doc Martens, and one of the best doctors of them all, Dr. Seuss. You're the real doctors heroes out there.

Thank you.

My weekly thankful is listening to music in the car. When I'm driving by myself, the car is the one place I can play whatever music I want, as loud as I want, I can sing along, shake my head, no interruptions. Maybe I feel like listening to 80s New Wave, maybe it's 90s rock, maybe it's the Barbie soundtrack over and over again.

No judgment, complete freedom. The only problem right now is that there's a leak in my car, there's been a ton of rain, and the water shorted out my speaker system. So right now, I am driving in complete silence.

But whenever I can get my car stereo fixed, I will be appreciating music in my car even more, and I will be rocking out sometime soon.

What kind of music do you like listening to in the car when you're alone? Sure, sometimes it's podcasts or talk radio or whatever, but what music gets you in the mood when you get into the car after a long day? Let me know.

As always DM me @BotoxAndBurpeesPodcast on Instagram or leave a comment on YouTube.com/@BotoxAndBurpees. Thank you.