I was speaking to a CMO the other day who informed me of the following issue that occurred in the hospital: A nurse practitioner had just received his Doctorate in Nursing and wanted patients and staff from now on to refer to him as “Doctor”. Several of the physicians objected to that term feeling that the patient or staff could confuse that person with being a “Physician”. One sarcastic physician even said, “That person is a NURSE, not a DOCTOR!”. The CMO asked me whether their hospital should develop a policy that would specifically delineate who could be referred to as “Doctor” in the patient care setting.

Historically, by tradition, a person who has earned a doctorate degree in academia and research, regardless of the field, is referred to as “Doctor” in the professional workplace and as a social title. Thus, a history professor with a PhD in History would be called “Doctor” by the students. A pastor who has received a Doctor of Divinity could appropriately be addressed as “Doctor” by the congregation. The term “Doctor” is also associated with a great deal of regard and respect by society. The recipient typically has worked very hard for many years to achieve that status and by all means deserves to be addressed by that title. It is definitely an esteemed title. In theory, the same should be true in medicine.

Unfortunately, this tradition breaks down in the medical setting and has the potential to cause ambiguity of roles. On the one hand, there are more and more health care professionals who are getting their doctorate degrees in administration, nursing, psychology, dietary sciences, Pharm. D, etc.,. Through their diligence and hard work, they have appropriately earned the title of “Doctor” in their professional settings. But on the other hand, in medicine, and particularly in the hospital setting, the term “Doctor” has historically implied “Physician”. Both of these realities need to be acknowledged. Not only can be very confusing to patients, family and staff, but it can also put the individual provider, the patient, and the hospital at substantial risk if these roles are confused and adverse events occur.

Given this ambiguity, what steps should a hospital or clinic take to clarify the term “Doctor” in the patient care setting?

In many hospitals there is often a practice that no one holding a doctoral degree except the physicians (medical doctors, dentists, osteopaths, podiatrists, veterinarians … ) can be addressed as “Doctor” in the care settings. This is out of consideration for the patients who want to know who are the doctors and who are nurses, support staff and allied professionals.

But let’s address the underlying issues:

First and foremost, regardless of any policy or title designation, every health care team member’s role must be absolutely clear to the patients and staff. Every professional has an obligation to make sure that the patient clearly understands that person’s particular role and responsibilities in that patient’s care. This is especially challenging the acute medical situations such as a busy Emergency Department where there are multiple professionals coming and going, or when dealing with a critically ill patient who may not be cognitively aware of the situation.

Secondly, a professional who has attained an advanced degree such as a Doctorate has truly earned and deserves all of the privileges associated with that degree. Therefore, not allowing a person who has achieved a Doctorate of Nursing to be referred to as “Doctor” would not be fair to that person.

For Nurse Practitioners who have achieved a doctorate (DNP’s) there is legislation in several states to address the issue. In Arizona, Illinois, Pennsylvania, Texas, and Virginia, for example, doctorally educated NP’s can be addressed as “Doctor” as long as they clarify that they are nurse practitioners. Other states such as Georgia, Maine, Missouri, Ohio and Oregon have statutory restrictions against these NP’s addressing themselves as “Doctor”. As laws can change, please verify the current status in your state.

Bottom line, it is essential that every team member make their role and function completely transparent to the patients and staff. There must be NO ambiguity of function, either directly or assumed. To do so would be an absolute set-up for something to go wrong. It can initially sound a bit cumbersome, but a very appropriate response from the nurse practitioner in the example above to the patient, if not statutorily prohibited would be: ” Hello, my name is Doctor Smith and I am your nurse practitioner.”

The word “Doctor” should be avoided as part of the title on name-tags or uniforms, as a general principle. A physician would be John Jones, MD or John Jones, DO… NOT Doctor Jones. A chiropractor would be John Jones, DC. Likewise a nurse with a doctorate would be John Jones, RN, DNP, etc.,.

The best term for the “Medical Doctor” is either “Physician” or “Clinician”. Whenever possible, in official communications and in day-to-day discussions, those terms should be used instead of “Doctor”.

Some hospitals have developed color-coded scrubs to delineate the specific role of the health care providers. Of course, patients and staff have to learn the color-code. It is extreme, but does work.

We must keep in mind that the end game for best patient care requires absolute clarity of roles and responsibilities of each team member. There is no intent to either step on egos or deny a person their earned title. The term “Doctor” is particularly ambiguous in the medical setting and must be used with extreme caution. Alternative, more specific titles simply make more sense.
Does it require an official policy? For some hospitals it may, but if each health care individual completely clarifies their role, except where legislated otherwise, the situation can be managed on a case by case basis.

Is there a “Doctor” in the house? That’s not a simple question anymore.

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