By Jason Ford, via Flickr.
. . . and the PhD turns to her and says . . . (Sorry. That’s copyeditor humor—dangling modifiers and all that.)
My question for you is, should that nurse (let’s call her Beverly Smythe) be called Dr. Smythe? It’s an intriguing question, if only because it seems that some people think the answer is no. Diana Mason (PhD, RN, FAAN) mentioned this in her editorial last August.
I am sometimes referred to as an arbiter of style questions at AJN, and although I did write (or rewrite) the style guide we use here, I inherited quite a few of the little style quirks and ticks that make AJN what it is (and I’ve installed quite a few myself). One of the tidbits I inherited was that we never use the word “doctor” when we’re talking about a physician.
For a long time, I couldn’t figure out why that was. I thought (I confess), “Man, these nurses are touchy about the weirdest things!” That is, until the AMA began calling for a ban on the use of the word “doctor” in hospitals unless it refers to a physician, on the grounds that it might confuse patients. Now I find myself thinking, “Man, these physicians are touchy about the weirdest things!”
There are a lot of other people in the world who can claim the title “doctor.” Anyone with an academic PhD (honorary degrees don’t count) or a doctorate in education (EdD), podiatrists, chiropractors, veterinarians, dentists, some physical therapists, some pharmacists—the list goes on, I’m sure. The point is that physicians get nervous about all those other doctors out there.
What I want to know is how this is playing out in the real world. Are you a hospital nurse with a PhD or do you know hospital nurses with PhDs? And do physicians—or other hospital employees (even nurses)—hesitate to call you Doctor? I’d love to know. I always followed the rule here at AJN, but now I know why I do, and I’m all for it.
Now, if you’re one of those physicians who think the title should be banned for everyone but you, I say this to you: Physician, hush thyself.
—The Word Curmudgeon (Doug Brandt, AJN associate editor) provides occasional and crusty contemplations for the writing nurse, from a copyeditor’s perspective.
I have a question for Dr. Brubeck, and it’s not rhetorical. I’m really curious.
If you are conducting rounds and one of the nurses on staff has a PhD, how do you address her in front of patients? Is she Dr. So and So? Nurse So and So? Do you refer to her by her first name, even as she’s addressing you as Dr Brubeck?
This is where the thing gets a little complicated.
The word doctor is also a verb, meaning “To give medical treatment” or “restore to good condition.” Although physicians are the ones providing “medical” treatment, and the nurses are providing “nursing care,” all are trying to restore their patients to good condition.
There’s another aspect here. The title “Doctor” means teacher, right? So, if you are introduced as “Dr Smith” and your PhD is in counseling for example, and another person wants you to prescribe something for their verrucae, it’s a perfect time to be a “teacher” and teach the person what your title actually stands for, what it means, and therefore you are effectively validating your title.
Right?
Should an individual with a PhD in nursing use the title “doctor?” In an academic setting, absolutely. In a clinical setting? Absolutely not.
“Doctor” is an academic title, anyone earning a PhD should feel entitled to use it in an academic setting.
“Doctor” is also a noun. In that usage, it refers to a medical doctor (M.D. or D.O.). In clinical settings it is synonymous with “physician.” Not because of a deliberate decades-long conspiracy by the AMA, that’s just the way the term evolved in our society.
If you ask someone who holds a PhD in biochemistry what she does for a living, she will reply “I’m a biochemist” not “I’m a doctor.” If you ask an M.D. the same question you would expect her to reply “I’m a doctor.”
In a clinical setting, a patient assumes anyone who introduces themselves as “doctor” is a medical doctor. Expanding that term to include nurses is inherently deceptive: you are using the adjective academic title in a setting where the patient assumes you’re using “doctor” as a noun.
Fair disclosure: I’m an M.D. I expect fellow members of the clinical team (nurses, techs, other docs, etc.) to call me “Dave” when we’re working. They only call me “Dr. Brubeck” in front of patients. One exception, I make medical students call me “doctor.”
Why call me doctor in front of patients? Most of my patients don’t want to be on a first-name basis with me, they find it more reassuring to think of me as a medical doctor worthy of trust rather than as a friend with which they’d like to split a pitcher of beer. In turn, I treat my patients with the utmost respect and call them Mr. or Ms. If they ask me to call them by their first name I ask them to call me by mine.
I don’t understand why anyone would deliberately use the term “doctor” in a setting where patients might be misled. I agree with Dr. Schoenly’s nametag format.
This is a great discussion topic!
I have been a nurse with a doctorate for over a decade. Although I refer to myself simple by my given name to patients I deal with, I have a peer standard when dealing with medical staff. If they call me by my first name, I do the same in referring to them. If they expect to be called Dr. Smith, then I expect to be called Dr. Schoenly. I like to have a reference to Dr. Schoenly at least once during a formal introduction at, say, a podium presentation as it establishes credibility.
As to nametag, I like full name with credential rather than a title.
OK, it’s a bit of stir. Maybe silly, but it got me to dust off the ol’ Oxford English Dictionary and look it up. So let’s see: “Doctor” comes from the Latin “docere,” meaning “to teach.” In the beginning, “doctor” was a title bestowed upon those who had risen to the level at which they were considered esteemed teachers, in any field of study. But then somehow those in one field of study–Medicine–had the term bestowed upon their profession (physicians = doctors). I was surprised to see that “doctor” was used that way as early as the 16th Century.
So I’m thinking now that it’s appropriate to address a nurse who has risen to the level of Ph.D. as “Doctor” when he or she is acting as teacher, or as a title of honor in the public forum. But as far as the patient is concerned, a nurse with the Ph.D. is still a “nurse.” And thank goodness for that!
But wait–That doesn’t solve the problem of the nametag, does it . . . Did I just stir up a hole and fall into it?
Yes, the DNP is causing a stir in the nursing community, too! Gasp, indeed.
There is a great thread on the student doctor network addressing this very thing. Doctors and med students are in a tizzy because nurses can now get a DNP. The med students/doctors are crying foul because nurses are not only being trained to provide primary care, but also *gasp* call themselves doctor. They think nurses aren’t adequately trained to do this, nor have the right to have Dr. as a title.I will be a DNP someday, and will call myself doctor.
I think the argument is absurd, to tell you the truth, but I can see how it can be confusing to the patient. Especially pts who are unfamiliar with all the different types of doctors. They hear the title “Dr” before a name, and they will probably assume that it is a medical doctor, and not the physical therapist with a phD, or the phD nurse, or social worker, pharmacist, etc.
So I can see that point, from the viewpoint of the patient. Some patients assume everyone in scrubs in a doctor as well, or that anyone wearing white is a nurse, etc.
That’s a great point. In fact, if anyone from a Planetree hospital (where care is viewed “from the patient’s perspective”) has experience with this, I’d love to hear it. Do clinicians at Planetree facilities use titles or are they on a first-name basis?
Would it be blasphemy if everyone was on a first name basis? Doesn’t that help build trust and relationships? Perish the thought of not calling a PhD “DR” but last I checked we all age, we all die, we all poop, and we all put our pants on one at a time, except when we’re being pants on head stupid.
Good article.