Strike While the Iron is Hot: Defining Doctor
So, we’ve all seen the news story Families sound the alarm on medical transparency after deaths of their children. I just wrote about it in my last blog “Sophia the Worst. Well, turns out, other news stations caught on and aired the headline as well. Referenced in Reddit is a story about this story from WPTV News Channel 5, West Palm Beach Florida Defining Doctor. It focuses on the two cases highlighted in the original story but also speaks to the topic of using the title “Doctor” in a clinical setting. This video also highlights the training difference between physicians and NPs in addition to speaking about a pending law in Florida to make it illegal to use the term doctor in a clinical setting for NPs. The video also highlights how “online diploma mills” have low admission criteria and can be completed in a short period of time. Of course, the story interviews those that feel entitled to be able to use the term “doctor” in a clinical setting. One says, “my degree title says doctor of nursing practice.” But what she fails to realize is that the same could be said about Ross from the Friends TV show who had a Ph.D. Doctor of Philosophy, but we all have seen the meme whereby Rachel hushes him and says for him to be quiet as that means something different in a hospital. What she also fails to realize is that the curriculum of the DNP is less than rigorous and lax for doctoral level work when compared to actual PhDs or MD/DO. The story also speaks to that patients often don’t know who is treating them especially if the patient only hears the word “doctor.” The story references Florida Senate Bill 612, which initially appeared in 2013 but will soon be up for debate again.
Sophia the Worst says in the video that “Doctor is an academic title.” She says, “doctor doesn’t mean physician.” She says, “the physician world doesn’t own the term doctor.” Which of course in an academic setting that is true. For example, on college campuses, professors often use the “Doctor” title. But in a heath care setting, the most common connotation is that doctor means physician. The story highlights this lack of transparency seen in healthcare today. It seems that everyone in healthcare wants to be seen as important, which is fine. Everyone does have a role from the CNA, to the unit secretary, to the lab tech, to the RN etc., and everybody is important. However, the character of heath care players is starting to wane such that everyone is now entitled to wear the white coat, park in physician parking, eat in the physician lounge etc. These are just a few of my pet peeves, but bigger than these small items, I think they represent a bigger systemic problem in health care today. This being the out-of-control expansion of scope of practice and encroachment on the physician scope of practice and nomenclature by those that call themselves Advance Practice Providers (APPs). Now, many have just skipped that and end up calling themselves and advertise themselves as “Doctors.” The story referenced the Alexis Ochoa case that the NP introduced herself as the “attending physician” to the patient’s mother. I mean come on, attending physician?? Advanced compared to what anyway? Being a former NP, this terminology irks me as well as. I will state emphatically that I was not more advanced than a physician in terms of medical education and training so what the heck is the word advanced all about if not to simply confuse the public? But I digress, back to the video, this video and topic seems to be catching on and the truth will come out. And speaking of truth………..
The AMA has a Truth in Advertising statement that reads:
“The AMA Truth in Advertising Campaign is designed to ensure health care providers clearly and honestly state their level of training, education and licensing. Patients deserve to have this information when in face-to-face encounters as well as when they read health care providers’ advertising, marketing and other communications materials.
Patients are confused about the qualifications of different health care professionals. Many non-physicians earn advanced degrees, and many of those degree programs now confer the title “doctor.” As a result, patients often mistakenly believe they are meeting with physicians (medical doctors or doctors of osteopathic medicine) when they are not.”
The AAEM has a position statement titled Updated Position Statement on Non-Physician Practitioners:
Every practitioner in an ED has a moral duty to clearly inform the patient of his/her training and qualifications to provide emergency care. In the interest of transparency, NPPs must not be called “doctor” in the clinical setting.
I don’t know where the following quote comes from, but it’s almost proverb like in quality, and I’m too tired to search, but it goes something like this: “They’re going to try every way they know to put lipstick on this pig, but you know when you put lipstick on a pig, at the end of the day, it’s still a pig.” I just wish the lies and BS would stop.
In Washington State, statute quoted below. You cannot use the term “psychologist”, “psychology”, “psychological” in any representation to the public, unless you are licensed as a psychologist in the State of Washington.
This came to my attention when I had a patient who insisted he was seeing a psychiatrist, bave me her name. Searched all over, I could find no psychiatrist by the name he gave me. Turns out, mental health nurse practitioner. Stopped by the nearby office and got a business card.
Sure enough, signage read “Psychiatric Services”. Business card read her name and “PSYCHIATRY”, with “nurse practitioner” in microprint hidden in a corner.
I complained to the Medical Board. The Board said no jurisdiction as she was not a licensed physician. I replied that means if my brother the accountant held himself out to the public as a neurosurgeon, it would be OK with the Board ’cause he wasn’t a licensed physician? And the Accounting Board would onle care about his accounting credentials, not about any other credentials he represented. Perfect loophole.
They referred to Nursing Board, which of course felt all this was OK. “Patient was just confused”. Damn right he was confused, the nurse was creating the confusion.
So if she used the term “psychology” she would have violated the law, but using the term “psychiatry” was OK.
I wonder if perhaps medicine cannot control the term “doctor”, alternative approaches would be to control the term “physician and surgeon”. Many states the chiros can use the term “physician”, but not “physician and surgeon”. Perhaps the same could be done with the various specialties, even famiy medicine.Restrict those terms to those holding medical degrees.
If the psychologists can do it in my state, surely there is a way for physicians (physicians and surgeons) to do the same.
RCW 18.83.020
License required—Use of “psychology” or similar terms.
(1) To safeguard the people of the state of Washington from the dangers of unqualified and improper practice of psychology, it is unlawful for any person to whom this chapter applies to represent himself or herself to be a psychologist without first obtaining a license as provided in this chapter.
(2) A person represents himself or herself to be a psychologist when the person adopts or uses any title or any description of services which incorporates one or more of the following terms: “psychology,” “psychological,” “psychologist,” or any term of like import.
[ 1986 c 27 § 1; 1965 c 70 § 2; 1955 c 305 § 2.]
The thing is that many doctors – physicians with an MD or DO – are not surgeons. Most general practitioners – family physicians – are not surgeons anymore. If a patient appears to need surgery, that doctor has to refer to a general surgeon, or a specialist surgeon such as an orthopedic surgeon, gynecological surgeon, cardiac surgeon, etc.
I agree though that a nurse practitioner – even one with a doctorate degree – is not the same credential or equivalent to the medical doctorates above.
Actually my state license says specifically “physician and surgeon”. In my state, the Board does not care if I’m a psychiatrist and don’t keep sharp objects in the office, I’m still “physician and surgeon”.
Wait, what? FLORIDA is doing something that makes sense?!?!
I googled it. That exact quote can be attributed to John Edwards in 2004.
About 30 years ago, the attorney general of Texas ruled that chiropractors were allowed to advertise themselves as physicians.