Titles have always been important in healthcare. A title is supposed to address someone's capability of taking care of us. An MD has a certain level of expertise, a nurse has a certain level of expertise.... "Doctor John Brown" would presumably have more knowledge about diagnosing and treating than "Nurse Nancy Green" - and so forth....
Or... maybe not?
Why is it we call a doctor, "doctor" and we call a nurse by his or her first name? Why do we call a nurse practitioner who has been practicing for 20 years by her first name - vs - calling a new medical resident "doctor" because she has, by virtue of the fact that she has completed four years of medical school, earned the title?
And now a relatively new phenomenon, as the New York Times pointed out, what do we call the nurse who has earned a PhD, and has, according to the academic pecking order, therefore earned the title "doctor"? Is she Dr. Green? Or is she Nurse Nancy, or just plain Nancy?
As I read the NYT article, I had to think about it. What IS in a name? And who really cares?
It struck me that the people who care are the people concerned with that pecking order. I believe it's mostly the professionals themselves who are concerned with it - not us patients. Why is that so important to them?
If this fellow named Jeffrey Smith is a board certified neurologist, will I get better care from him because he is Dr. Smith as opposed to Jeffrey? If he just earned that board certification last week, will I get better care from him than from a nurse named Nancy Green, who is called Nancy, and who has been a neurology nurse practitioner for twenty years? If she earns a PhD, will I get better care from her just because I can call her Dr. Green?
What IS in a title? We may think a title by itself provides some knowledge about the capability of the person who holds the title. It may hold some, but just by the questions above, clearly it may not hold what we think it does.
Further, even within the titles we know and hear, there are many additional levels of expertise - doctors may also be attendings, residents and fellows. Nurses may also be nurse practitioners or PhD-type doctors. Assistants to physicians or medical assistants - or physician assistants?
HUH?
Most of us patients are clueless about the differences among those titles. And the truth is - for myself, I don't care what you call the person, I just want to know that person can help me with the aspects of care I need help with.
If you believe that's true as well, then you may want to begin double checking on the capabilities of your providers and not rely just on their titles.
How? If it's someone you already have a satisfactory relationship with - then ask. What is their level of education? How do they describe their expertise? You may find out that the person you thought was a doctor is really a nurse Practitioner PhD - or not.
If you are in the process of choosing a new doctor, then make sure you are well aware of the important aspects of choosing the right doctor for you, including a review of his or her credentials and some detective work to uncover malpractice.
OK - time for a snack. Think I'll go find a Dr. Pepper. (With that more important name, it's bound to quench my thirst better than a coke, right?)
• How to Review a Doctor's Credentials
• Learn more about Nurse Practitioners and Physician Assistants
• Uncover a Doctor's Malpractice Record
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Good points, Trisha.
What’s often not discussed is what I consider to be the deprofessionalization of bedside care. It used to be done mostly
by nurses. Now we have all kinds of titles for that job — nurse asst., cna (and various versions of cna), patient techs, medical assts. etc. Some of these caregivers are coming right out of high school, or only have a GED, spend maybe 8 weeks in training, and then begin the bedside care. In some states, they are permitted to do some very invasive procedures. Most doctor offices are now staffed by medical assistants, not nurses. And it’s my understanding that they are not licensed, but work under the doctor’s license — which means they may do procedures that even LPN’s and RN’s don’t do. As long as the doctor takes on the responsibility.
Now don’t misunderstand. I’m not saying that all these jobs don’t have a place in medicine. They do. But it seems to me that they’re often outside their scope of practice. Why? Well, you’ve said it many times before. Follow the money. They’re cheaper to train and cheaper to hire.
I consider this to be what I’ve called the deprofessionalization of patient care, especially bedside care.
In UK NHS Direct is run by admin & health professionals who are not over seen or directed by a Doctor . This is happening with every doctor contracted in to LAs & hospital directed by accountants protecting their interest . Have been told GP surgeries are rationing & don’t have to use medical oath nowdays ? Surely this can’t be true . I have had so many tests with no specialist on site or follow up including taking off a 24 hr heart monitor at bowel hospital then having to drive on motorways getting lost an hour later cardiac arrest .two years prior Specialist findings and private tests ignored no referrals. I have tried to get so many to address this health & safety risk . Nobody wants to know especially since Government deregulated. Who is in charge ???