[n_g]

What do people think when they see this?

http://www.getsmoothskin.com/index.shtml

It says Dr. Kimberly Ho. She must be a physician or maybe even DNP? Nope. It's Dr. Kimberly Ho, PharmD.

Do people understand now why patients will be confused?

[fluphenazine]

Originally Posted by yellow finch

Honestly? A PhD is a terminal degree. MD isn't. The DNP would be a terminal degree. Terminal degrees have every right to be addressed as 'Dr'. Physicians have done an immense job of promoting themselves with the title of 'Dr' from the turn of the last century. They devised the best possible publicity stunt in history by creating the white coat image and title to earn (well-deserved, I might say) respect.

However, they cannot fully expect to hold onto that title of 'Dr' when there are people working hard at their PhD or equivalent degrees. These folks have every right to request others to address them as 'Dr'... kinda like the respect chefs have for one another by addressing one another as 'Chef James'. They have earned their right to be called that and differentiate themselves from the rest of the cooking staff.

I don't have a PhD or DNP, but if I did... well, then I would most likely want to use that title in a professional setting while at the same time remain clear about who I am and that I'm a mid-level provider, not a physician.

What do you mean an MD is not a terminal degree? What degree comes after it?

Certainly, all holders of doctoral degrees should be afforded the title of "Doctor." I would venture to say that outside of the hospital, the general public understands that "Doctor" is a salutation applicable to PhDs, MDs, etc. But in the history of our language, we have conflated a title with an occupation. In the clinical setting, the title "Doctor" has been historically and functionally equivalent to the role of "physician." In commonwealth countries -- and indeed in almost every other country -- physicians do not actually have a doctoral degree per se but rather an MBBS, a bachelor of medicine, bachelor of surgery degree. In these countries, the MD is in fact a particularly rare research distinction.

Nevertheless, despite the lack of doctoral level education, physicians have been addressed with the title of doctor not, as you say, since the turn of the century, but actually since the 1700s. My point, which I suppose I am making in a very long winded way, is that in the hospital, "doctor" is not just an educational distinction, it is a synonym for a physician. That is why some institutions have restrictions on the title of "doctor" while in the clinical setting. In my hospital, PharmDs cannot introduce themselves as "doctors." I suppose that dentists are afforded the title in a clinical setting because they are technically surgeons (DDS), though it is interesting to note that in the UK, surgeons relinquish the title of "doctor" for "Mister" or "Miss."

If we follow the logic that everyone is entitled to use the title of doctor in the hospital based solely on educational degree, then we should be completely egalitarian. PhDs and the occasional JD hired by the hospital should be able to demand that they be called doctor as well -- as long as they follow with the qualification that they are not "that type of doctor."

[Hopefull2009]

Originally Posted by fluphenazine

What do you mean an MD is not a terminal degree? What degree comes after it?

Certainly, all holders of doctoral degrees should be afforded the title of "Doctor." I would venture to say that outside of the hospital, the general public understands that "Doctor" is a salutation applicable to PhDs, MDs, etc. But in the history of our language, we have conflated a title with an occupation. In the clinical setting, the title "Doctor" has been historically and functionally equivalent to the role of "physician." In commonwealth countries -- and indeed in almost every other country -- physicians do not actually have a doctoral degree per se but rather an MBBS, a bachelor of medicine, bachelor of surgery degree. In these countries, the MD is in fact a particularly rare research distinction.

Nevertheless, despite the lack of doctoral level education, physicians have been addressed with the title of doctor not, as you say, since the turn of the century, but actually since the 1700s. My point, which I suppose I am making in a very long winded way, is that in the hospital, "doctor" is not just an educational distinction, it is a synonym for a physician. That is why some institutions have restrictions on the title of "doctor" while in the clinical setting. In my hospital, PharmDs cannot introduce themselves as "doctors." I suppose that dentists are afforded the title in a clinical setting because they are technically surgeons (DDS), though it is interesting to note that in the UK, surgeons relinquish the title of "doctor" for "Mister" or "Miss."

If we follow the logic that everyone is entitled to use the title of doctor in the hospital based solely on educational degree, then we should be completely egalitarian. PhDs and the occasional JD hired by the hospital should be able to demand that they be called doctor as well -- as long as they follow with the qualification that they are not "that type of doctor."

Whether someone is called 'doctor' or not depends on what is appropriate in THIS country.

An MD is a doctorate degree, hence the "Medical Doctor" distinction, the PhD, which is a "Doctor of Philosphy", a DDS is a "Doctor of Dental Science".

The PharmD's, all of them in this area (we have a pharmacy school nearby) all refer to themselves as "Doctor" because that is appropraite, because it's a "Doctor of Pharmacy" degree.

Places like Walgreens, Walmart, etc...I hear all of the employees refer to the Pharmacist as "Dr _____" and the same for the hospital pharmacists.

I believe that anyone that has earned the degree has the legal right to be named appropriately, and in fact, think it should be illegal for a hospital to do differently.

[yellow finch]

Originally Posted by n_g

What do people think when they see this?

http://www.getsmoothskin.com/index.shtml

It says Dr. Kimberly Ho. She must be a physician or maybe even DNP? Nope. It's Dr. Kimberly Ho, PharmD.

Do people understand now why patients will be confused?

Pharmacists don't typically see patients. The only interactions they have would be inside of a pharmacy. There shouldn't be any confusion there.

This Kimberly Ho seems to be taking advantage of the definition of her title until you read her "about us" page. That should never be done in any setting.

[yellow finch]

I misspoke about the terminal degree thingy and didn't explain that part too well. That's what I get for staying up late doing homework after a 12 hour shift.

[llg]

Originally Posted by n_g

What do people think when they see this?

http://www.getsmoothskin.com/index.shtml

It says Dr. Kimberly Ho. She must be a physician or maybe even DNP? Nope. It's Dr. Kimberly Ho, PharmD.

Do people understand now why patients will be confused?

I'm sure we have all understood why a patient might be confused -- particularly if someone isn't clear in how they introduce themselves. We just feel that difficulty can be overcome with proper communication and a little public education.

If I were to say, "Hi, I'm Dr. llg, an expert in health care and you should do what I say." -- that's confusing.

If I were to say, "Hi, I'm Dr. llg, one of the nurses responsible for overseeing your care ..." and be open to answering any questions about my role, the patient would not be confused.

My nametag does not say "Dr. llg." It says, "llg, PhD, RN." I make it clear that I am an RN -- as everyone should make it clear as to what discipline they are experts in.

[n_g]

Originally Posted by yellow finch

This Kimberly Ho seems to be taking advantage of the definition of her title until you read her "about us" page. That should never be done in any setting.

That's the point of why the only people who should introduce themselves in a clinical setting as doctor should be physicians.

It confuses the patients.

Pharms want to get into primary care as well. Patients are having physicians, nurses, pharms, PT's introduce themselves as doctors. After a while, the term doctor loses its value.

Ultimately, what separates the attending from every other doctor. He/she is in charge. By how the person talks, carries themselves, and how other staff follow his/her orders, the patient knows who's in charge. So the DNP does not really help all that much. I think that anyone getting the DNP thinking that they will be equivalent to physicians, especially in the inpatient setting, is in denial.

[core0]

Originally Posted by llg

I'm sure we have all understood why a patient might be confused -- particularly if someone isn't clear in how they introduce themselves. We just feel that difficulty can be overcome with proper communication and a little public education.

If I were to say, "Hi, I'm Dr. llg, an expert in health care and you should do what I say." -- that's confusing.

If I were to say, "Hi, I'm Dr. llg, one of the nurses responsible for overseeing your care ..." and be open to answering any questions about my role, the patient would not be confused.

My nametag does not say "Dr. llg." It says, "llg, PhD, RN." I make it clear that I am an RN -- as everyone should make it clear as to what discipline they are experts in.

This is again where the confusion come in. Oversight implies managing the performance of a person or a group. Who are you responsible for? Do you oversee the other nurses? Do you oversee the physicians? Are you responsible for directing their care? This is the prime problem with the title.

The patient population equates doctor with physician. However, there is are bunch of studies by the drug companies that show that the patients generally equate doctor with provider. Once you add non providers into the mix it becomes very confused.

Ultimately (at least in the inpatient population) there is one person who has ultimate medical decision making capacity. That person is a physician. Given the way the state medical acts are written there is no chance in the near future that any non-physician will be able to direct how a physician makes medical decisions. For example you would not be able to tell a physician how to treat a patient. Similarly the hospital CEO (if not a physician) could not tell the physician how to treat a patient.

In the end the proliferation of "doctors" can lead the patient to become confused over who is ultimately in charge of their care.

Realistically physicians are ultimately responsible for using doctor when more properly they should have been using physician. However, its a little late to put that genie back in the bottle. There is also an element of ego here.

Ultimately the unlike the other titles, the doctor in physician is both an academic title and by common usage a professional title. While it is illegal to state that you are a nurse without an active RN license, the use of Doctor in most states is not protected leading to the current confusion.

David Carpenter, PA-C

[pinoyNP]

Originally Posted by n_g

Pharms want to get into primary care as well

Do you have any data regarding this...just curious, 'cause that's the first time I am reading this.

[pinoyNP]

Originally Posted by n_g

What do people think when they see this?

http://www.getsmoothskin.com/index.shtml

It says Dr. Kimberly Ho. She must be a physician or maybe even DNP? Nope. It's Dr. Kimberly Ho, PharmD.

Do people understand now why patients will be confused?

If this is a concern...maybe she should be brought to the attention of the Pharmacist Licensing Board.