Wednesday, November 15, 2006

Is there a Doctor in the House?

Where Dr. Dino left off (on January 15th):

I work with MDs, PhDs and MD/PhDs (and others) on a daily basis. All of them use the title "Doctor".

Let me focus for a moment.

MDs or MD/PhDs are able to engage in clinical practise, teach medical students and/or engage in research. That is, MDs and MD/PhDs can be physicians, teachers and/or scholars. PhDs can obviously do all of the same things except for clinical practise. So, PhDs can be teachers and/or scholars.

Now here is where this little story gets interesting.

Derived from the Latin verb docere, meaning "to teach," the word doctor means "teacher" or, by extension, "scholar." It does not mean "physician." Does that mean that an MD should not use the title "Doctor" unless they are also teachers or scholars?

From Roman times through the Middle Ages until well into the 18th century, the honorific doctor applied only to eminent scholars - e.g., the Four Doctors of the Western Church in the 5th and 6th centuries (Saints Ambrose, Augustine of Hippo, Jerome, and Gregory); and Martin Luther, known to his supporters and detractors in the 16th century as Doctor Luther.

Moving forward in history a little, the primary designation of the title of "Doctor" (and when used as a prefix — abbreviated "Dr.") was intended for a person who has obtained a doctoral degree (doctorate), the highest rank of academic degree awardable. Doctoral degrees may be "research doctorates," awarded on the basis of competency in research, or "taught doctorates" (also called "professional doctorates," because they are invariably awarded in professional subjects), awarded on the basis of coursework and adjunct requirements (if any) successfully completed by the conferee.

All of that said, from the 19th century onward, the title "Doctor" has been commonly (incorrectly) used as a synonym for "physician" in many countries and the term is commonly used as a title of address for physicians, whether or not they hold a doctorate degree.

How did this occur? The story goes something like this: jealous of the respect shown to scholars by the title "Doctor", medical schools in the 18th century (particularly Edinburgh in Scotland) began the practise of addressing their graduates as "Doctor." The schools argued that since their graduates generally earned bachelor's degrees before admission to medical studies, they were entitled to the honorific in the same manner as university scholars.

In the UK (and many Commonwealth countries) the primary medical qualifications are the Bachelor of Medicine and Bachelor of Surgery degrees (MB BS, MB BCh, MB ChB, BM BCh or MB BChir). The final qualification for the title "Dr." is conferred by the General Medical Council when graduates' names appear on the list of 'Registered medical practitioners'.

In the United States and Canada, however, the degrees Medicinae Doctor (Latin, "Doctor of Medicine") and Doctor of Osteopathy (D.O.) are the qualifications for the title "Doctor". The term may also apply to other fields of healthcare, in which the degrees "M.D." and "D.O." are not required. For example, doctors of Chiropractic (D.C.), doctors of Pharmacy (Pharm.D.), doctors of Optometry (O.D.) and so on.

Oh, and of course in all of the above countries the PhD degree also confers the title "Doctor", even if it's not a medical PhD.

Perhaps the most interesting case is Germany. There, a doctoral degree and the title of "Doktor" is only awarded to students if they complete both their medical studies and a separate research thesis (the equivalent of the MD/PhD combination). A German physician who is licensed to practise medicine needs to have passed his/her medical exams but if they did not complete a research thesis then it is inappropriate to use the title "Dr.". In this case they would list their qualifications in this format: "State Med Exam (state) (year)" rather than writing "MD" or "MBCHB" as seen in Anglophone countries.

So now you know.

Isn't that interesting? Does it even matter? *shrug* I just like knowing the history.
(Thanks to many internet sites for some dates and details.)


CharleyBrowne said...

I like history as well. And apparently, this is a touchy subject for some. I had a similar post back in october or september and innocently made a joke about the acronyms MD and PhD. It turn into a whole debate!

Cathy said...

Interesting! I love learning about all this. I get very confused when folks have about 6-8 letter's after their name. I can't tell for sure who they are.

Dr. K said...

Very interesting, charleybrowne. Thanks for directing me to your blog. Touchy indeed.

Cathy: I always laugh when people list their degrees after their names. Really, get over yourself and tell me what you really do.

Pieces of Mind said...

Your post made me think of a rather interesting side note: Through Victorian times, the British made a distinction between "physicians" and "surgeons." Surgeons were the ones who actually set broken bones and did hands-on medicine. They were considered lower in the social scale because they - gasp! - worked with their hands, like tradesmen. Physicians had more cachet because they mostly prescribed pills, gave out advice and presumably were more qualified to be viewed as gentlemen.