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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 08-August-2008, Vol 121 No 1279

Abuse of the title ‘Dr’
In a recent article on the use of the title ‘doctor’ by complementary and alternative medicine (CAM) practitioners, Andrew Gilbey makes the following recommendation: “that CAM practitioners who are not medically registered practitioners must accept that in New Zealand they are not entitled to use the courtesy title ‘Doctor’ and cease to do so at the earliest available opportunity”.1
In an editorial commenting on this, David Colquhoun states that the title of doctor is “widely abused”, and later states that “You can still be held to have misled the public into thinking you are a medical practitioner, even if you have a real doctorate”.2
As such, a real doctor is in danger of being prosecuted in order to protect the professional turf of those who use the title as a ‘courtesy’. Perhaps it is time that we left this topsy turvy Wonderland world and brought in regulations so that only those who have ‘real’ doctorates should be allowed the title of doctor. It is clear that the medical profession itself has been abusing the title for some centuries.
Professor Kevin Dew
School of Social and Cultural Studies
Victoria University of Wellington
Wellington
References:
  1. Gilbey A. Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. New Zealand Medical Journal. 2008;121(1278). http://www.nzma.org.nz/journal/121-1278/3160
  2. Colquhoun D. Doctor Who? Inappropriate use of titles by some alternative “medicine” practitioners. New Zealand Medical Journal. 2008;121(1278). http://www.nzma.org.nz/journal/121-1278/3158
Response from Andrew Gilbey
In principle, Professor Dew’s reflection on who is truly entitled to use the title doctor is correct. Only those conferred doctorates from recognised universities do not mislead if they use the title of doctor. (Obviously, this precludes those who have bought, rather than earned, their ‘doctorates’, as identified by Professor Colquhoun.)1
In practice, however, the title ‘doctor’ is synonymous with ‘registered medical practitioner’. To argue its use should be discontinued, on the grounds that it is wrong in principle, would divert attention from where its use is abused. Indeed, I suspect that registered medical practitioners gain little by using the title doctor, whereas prospective clients gain much by being helped to identify who is a registered medical practitioner and who is a complementary and alternative medicine (CAM) practitioner.
Conversely, CAM practitioners, who are not registered medical practitioners, gain much by using the title doctor (e.g. competitive advantage, social-status, credibility). And herein lays the problem identified in my recent article.2 When used by CAM practitioners, the title doctor may mislead prospective clients by making it harder for them to differentiate between providers of mainstream medicine (which is evidence-based and theory-driven) and CAM (which is often supported by anecdotal evidence and has little or no theoretical rationale).
Ever the pragmatist, I suggest that New Zealand’s legislation, as interpreted in the Medical Council News, is pitched sensibly.3 But, like the equally sensible 20 km/h speed limit for driving past New Zealand school buses as they unload, such legislation is of little use if it neither adopted nor enforced. I therefore reiterate that current legislation should be enforced. That is, registered medical practitioners call themselves doctor and all other health practitioners refrain from using the title doctor unless they have doctorates directly relevant to their area of practice. Those with doctorates should make clear the area of their doctorate if it is not in medicine or their area of CAM practice.
Andrew Gilbey
Lecturer
College of Business
Massey University
Palmerston North, NZ
References:
  1. Colquhoun D. Doctor Who? Inappropriate use of titles by some alternative “medicine” practitioners. New Zealand Medical Journal. 2008;121(1278). http://www.nzma.org.nz/journal/121-1278/3158
  2. Gilbey, A. Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. New Zealand Medical Journal. 2008;121(1278). http://www.nzma.org.nz/journal/121-1278/3160
  3. Medical Council News; The right to the title ‘doctor’; Wellington, NZ Medical Council of New Zealand. 2006;42(5).
Response from David Colquhoun
While sympathising with Professor Dew, I fear he is too late. There are two reasons for this. The first is that the popular use of the word 'doctor' to mean a medical practitioner, that one can't imagine it ever being replaced. As consequence its use by people with real doctorates in a medical context can easily be misleading and therefore wrong. Most PhDs that I know use their titles only in an academic environment (or to impress a bank manager).
A more important reason is that as an academic title "doctor" has been made almost worthless, by things like awarding 'doctor of chiropractic' as first degrees (I'm told that 'doctor of physiotherapy' is also being considered in New Zealand). These involve no research at all.
If we were to follow Professor Dew's advice, the effect that chiropractors with one of these degrees could call themselves 'doctor' quite legitimately. Still worse, it would give a boost to the mail-order doctorates like that of "Doctor" Gillian Mckeith.
The blame for this absurd situation lies squarely with university vice chancellors and principals, and with government officials (with the HR-mindset) who seem happy to prostitute intellectual standards by handing out doctorates to almost anyone for fees.
David Colquhoun
Research Fellow
Dept of Pharmacology
University College London, UK
     
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