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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 22-August-2008, Vol 121 No 1280

Who is confused by courtesy titles?
At the risk of being tiresome I think there is some value in pursuing the recent debate facilitated by Andrew Gibley’s article on the issue of the use of the title “doctor” by complementary and alternative medicine (CAM) practitioners.1
In his response to my mildly chiding letter Andrew clearly demonstrates his limited knowledge in the area. To quote, he states that CAM “has little or no theoretical rationale”. Even a cursory reading of the educational materials of chiropractic, osteopathy, acupuncture and homeopathy would demonstrate very clearly that theoretical rationales are central to the therapeutic system. Of course there is disagreement about the validity of the theory—but that is a completely different matter from having no theory at all. By contrast, one could, if one was to continue in such a provocative vein, draw on the views of Michel Foucault who suggested that medical discourse reconciles the extreme scantiness of medical theory with the overwhelming complexity of its object—the human body.2
But this level of debate is surely not of great import to day-to-day therapeutic practices. Similarly, it is not clear that the use of the title doctor is an important one. As David Colquhoun so aptly puts it in his response to my letter—it is “too late” to appropriately reserve the use of the word doctor for those who have doctorates.
So the issue should be—is this a problem? To determine that we should go beyond conjecture and speculation (or mere theory) and provide some empirical evidence. As such I suggest that the following research questions need to be answered.
Are CAM therapists deceiving people into thinking that they have the same scope of practice as medical practitioners? It appears that the term doctor is so widely used as a ‘courtesy’ title and in other ways that it is unlikely to be a problem for patients. A real concern would be the use of the term “medical practitioner” by CAM therapists, particularly where this might suggest that the CAM therapists have the same scope of practice as medical practitioners. If the concern is clinical safety then any CAM therapists deliberately deceiving in this matter should indeed be identified.
Using Andrew Gibley’s rigorous methodology of looking at the yellow pages I was able to provide some evidence to answer this question. My research suggests that this is not a problem. In fact, there are examples of chiropractic advertisements that state “we offer a non-drug and non-surgical way to help”—which appears to be explicitly distancing chiropractic from the scope of practice of a medical practitioner. This should go some way in allaying any concerns that Gibley and Colquhoun have on this matter.
Another research question should address patients. In cases where CAM practitioners are using the title “doctor”—does this confuse the patients? Do they think they are going to someone who has the scope of practice of a medical practitioner? That is – do they believe that they may be offered medications that can only be obtained on prescription or that they may get referred into the hospital system?
To answer this would require, in the first instance, a qualitative research approach whereby data is collected from new patients attending a CAM practitioner who also uses the title of doctor.
If we find from this research that the term doctor does indeed “mislead prospective clients” then there is a problem to be addressed. As it stands—there is no clear problem here.
So I suggest we move beyond the bluster, continue to cope with the Wonderland world where real doctorates may be prosecuted but those with the courtesy title may not, and find out if there is anything of clinical significance in this issue by doing some actual research. I wonder if we should broaden the debate further to determine if the title “Mister” is confusing for patients in that they think anyone with this title is a surgeon?
Professor Kevin Dew
School of Social and Cultural Studies
Victoria University of Wellington
Wellington
References:
  1. Gibley A. Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy. N Z Med J. 2008;121(1278). http://www.nzma.org.nz/journal/121-1278/3160
  2. Racevskis K. Michel Foucault and the Subversion of Intellect. Ithaca: Cornell University Press, 1983.
     
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