WhiteCoat

Dr. Nurse

I really don’t like it when people call me “doctor.”

The only time that I ever refer to myself as “Dr. WhiteCoat” is when I first enter a room and introduce myself to a patient. That way they know that I’m not some schmuck off of the street who wandered into the wrong room. Patients came to the emergency department to be evaluated by a doctor and, like it or not, I’m that guy.
However, almost all of the staff that I work with call me “Whitey” and many patients call me by that nickname. The rest call me “Dr. Whitey” apparently because they feel uncomfortable addressing me without the “Doctor” moniker.

Personally, it annoys me to no end when people correct others and demand to be called “Doctor”.
I met a child’s parent at a football game and introduced myself.
“Hi, Mr. Smith, I’m Thaddeus WhiteCoat. Nice to meet you.”
“It’s Doctor Smith. Dr. Mark Smith.”
“Oh. My apologies. What’s you’re specialty?”
“I have a PhD in psychology.”
“Oh. Nice.”
In the back of my mind I was thinking about saying something like “Unfortunately, we’re in football stands so I can’t genuflect in front of you. Please forgive me.”

Enough rambling.

In the NY Times a couple of weeks ago, there was an article about nurses who want to be called “doctor.” Actually, the nurses in the article earned the title. They have doctorates in nursing or other PhD degrees.

Is it good public policy to allow a non-physician to use the title “doctor” in a medical setting without having a medical degree?

Personally, I don’t care what people want to call themselves. If your ego is that fragile, call yourself Grand Exalted Supreme Poobah Doctor Nightingale for all I care. Introduce yourself that way at dinner parties. Command people to address you that way. Knock yourself out.

When someone introduces themselves as “doctor” in a medical setting, it evokes a specific and consistent response from just about any patient: The person in front of me is a physician.

Whether the patient thinks the “doctor” is intelligent or a quack depends upon multiple other issues, but the presumption is that “doctors” have gone through a lot of medical training and are capable of independently evaluating, diagnosing, and treating the medical condition for which the patient is seeking care.

In my view, calling oneself “doctor” when one is not a physician is misleading. Think about it. What if you bought a “hybrid” car, then opened up the hood to find a regular engine with a “hybrid” soybean growing in a crevice. Hey, it is a hybrid, isn’t it ? Or what if you bought a “Big Mac” and unwrapped a sandwich with two buns and a piece of cheese that was made by some guy named “Big Mac”?

States tend to frown upon nurses and physicians assistants referring to themselves as “doctor” as well. Many state Medical Practice¬† Acts, Nursing Practice Acts, and Physician Assistant Practice Acts prohibit non-physicians from leading a patient to believe that they are capable of independently providing medical care. There have also been lawsuits against physician assistants who have not disclosed their credentials.

Maybe the increasing number of non-physicians who refer to themselves as “doctor” will create a “caveat emptor” environment where consumers will inquire about the credentials of a health care provider before seeking care. I see that as a good thing.
Maybe hospitals will use the idea to enhance their advertising: “This hospital emergency department is staffed exclusively by board certified emergency department physicians.”
We haven’t reached that tipping point, yet, though.

Given the current medical practice environment where providers are attempting to cut costs by employing non-physicians, I don’t think it is appropriate for non-physicians to refer to themselves in a medical setting as “doctor,” even if they have earned some other doctorate degree.

If non-physicians want to demand that others call them “Doctor” at dinner parties, go through the explanation about how they are not a physician but have completed a doctorate in some other course of study, garner the eye rolls that go along with the explanation, and then deal with the whispers about how he or she is not a “real” doctor, hey … be my guest.

What do you think?

40 Responses to “Dr. Nurse”

  1. I agree and used a slightly different line of reasoning. Medical students who have doctoral degrees never introduce themselves as “Doctor” when seeing patients. So why should a DNP?

    My post on the article:
    http://thereflexhammer.blogspot.com/2011/10/who-is-doctor-anyway.html

  2. Antigonos says:

    This reminds me of the way many medical institutions dress just about everyone above the rank of cleaner in the same, or almost same, uniforms as the nurses, so it looks as if there is plenty of staff, when in fact, there are far too few nurses on the wards. I worked in one L&D unit where the nurses’ aides were dressed in exactly the same scrubs as the midwives, except that the auxiliaries had a blue edging on the pockets. Prospective parents on tours were told to note that the “Patient-staff* ratio” was “one to one”. In reality, one midwife covered three delivery rooms.
    *Note the cunning use of “staff” to avoid actually lying. Nurses’ aides are indeed “staff”. They just aren’t able to give any real care.

  3. Corey says:

    I think that people can do whatever they want, but I am also free to judge them however I want!

    I’m not trying to diminish the amount of effort required to earn a Ph.D, but if you insist that I call you by any title — especially in a social situation outside your place of specialty — I’m gonna think you’re a bit insecure and/or pompous.

    That said, when at their office, I call my medical doctors “Doctor” out of respect. After all, I am asking them for their help. I’ll also call professors “Doctor” in the context of the classroom or their office.

    But if I see you at the coffee shop, I’m probably going with first name. If you feel the need to correct me, I may either concede or try to wind you up, depending on my mood. But either way, I’ll think you’re a prick.

    Thanks for the blog, Whitey. It’s one of my daily pleasures.

  4. steve says:

    So do you also do the “Mister” thing over there for the surgeons? See

    http://en.wikipedia.org/wiki/Fellowship_of_the_Royal_College_of_Surgeons

    It can be confusing, “Can I book an appointment with Dr…no sorry Mr hacknslash”

  5. Dybbuk Klezmer says:

    I think you missed an important point in your rant. I have a Ph.D. In general, I would prefer to be called by my first name. I would never ask someone to call me Dr. Klezmer instead of Dybbuk. However, if someone uses Ms. or, worse yet, Mrs. for me, they are using the wrong title. If they want to call me Dybbuk, that’s fine, but if they want to use a title, they should use the correct one.

    • Alice says:

      Meh. I get called “Mrs. Husbandname” all the time especially when at my kids’ school, when in fact the accurate address would be “Dr. Myname” since I am a physician and I didn’t change my name. But to correct the person making the assumption based on knowing that I’m my kids’ mother would make me an ass.

      • Corey says:

        ^ Winner.

        Plus, I don’t understand what people have to gain by communicating a title as soon as one meets another socially.

        If you’re trying to show that you’re awesome, it does just the opposite. If you’re trying to establish your place in a hierarchy, all you do for me is help me determine your level of douchiness.

        I love it when I meet people, and I get to know them and I’m like, “Hey, you’re cool as hell. What do you do?” And they say something super impressive like “Doctor” or “Rocket Scientist”.

        And then you know they’re both humble and talented.

    • Gene says:

      I tend to agree with this. My spouse has a PhD in Biochem and uses Dr in professional settings. We have different last names. But we both use our first names regularly (if a nurse, tech, or med student calls me “Doctor”, I always ask that they call me Gene). Sometimes people will call me “Mrs HisLast” and I only correct if it is appropriate (“Oh, my last name is XXX” or “Hi! I’m Dr. MyLast”). My spouse is the same way. It’s all about the way you say it. Though we both hate it when someone tells my spouse, “Oh, you mean you’re not a REAL doctor!” His response (again, with a winning smile) is usually, “You mean YOU are not a REAL scientist!”

      I do, however, tend to introduce myself to patients as “Doctor” because if I don’t, I am invariably referred to as a nurse. Even after I call myself Dr. Gene, parents will tell their kids “Let the nurse look in your mouth”, etc. Hazard of the gender, I suppose. Again, correction always with a smile.

      • NurseBeth says:

        When folks at work ask what my husband does, I reply, “he’s a scientist”. Often I get ooohs and aahs, or better yet, they laugh and say “no, really, what does he do?”

        I worry that it may sound snooty, but that really is what he does, in a laboratory, at a Nat’l Lab.

        But my favorite is reminding my Dr. Pal in the ER that after all, *my* husband is a scientist, and medicine is an *art*, so that makes him …….
        :D

  6. jillian says:

    Doctors should be called that only when actually practicing the thing they have a doctorate in — professors are called that by their students, MD’s by their patients, etc. If you’re a PROFESSOR of nursing, then your students should call you doctor. Anybody, MD, PhD, whatever, who uses the Dr outside that context is being a d-bag. That includes tickets, reservations, social situations, whatever.

    I definitely agree that when your health care provider introduces him/herself as Dr Whatever, you assume MD or DO, and if they aren’t one of those, they’re being disingenuous.

  7. Bruce says:

    As a medical student, I cannot tell you have confused I get with titles and introducing myself and my team. I would never introduce myself as “doctor,” as Im not one yet. My ego is fragile, but that’s because my clinical skills and knowledge base are green… and I am secretly flattered when someone “slips up” and calls me “doc.”

    Regardless, medicine is one of the most hierarchical fields and I think that the titles completely reflect that. In fact, doctors are addressed “Dr” outside of the profession all the time – on invitations, solicitations, and even friends.

  8. LTC NP says:

    On the flip side, as an NP (no doctorate), I frequently have to remind my patients that I am NOT a doctor, I am their Nurse Practitioner. The usual response “You’re MY doctor, regardless”. They seem to attach the title to the behaviors, not the degree/initials behind the name.

  9. EM Resident says:

    I’ve seen numerous NP/PAs introduce themselves as “Hi my name is ___, I’m with the ___ team” without actually stating their credentials. The patients naturally just assume they’re being treated by a doctor. Just today I had an NP get frustrated when I had her elucidate who she actually was while we were both in a patient’s room. What’s ironic is that most nurses get irate when they see techs confused for nurses.

    In the end I think everyone just yearns to be one step higher on the totem pole, even if it means misleading the patients.

  10. Sue Denyhm says:

    Similar to Steve above, after moving to Australia and working in a hospital, I found it difficult to get used to the idea that surgeons use the title ‘Mister’ instead of ‘Doctor’.

  11. Patrick says:

    I prefer “Your Royal Highness”, but Patrick is fine for my friends. Of which there are none…

  12. Bill Alexander says:

    All this discussion has created a question in my mind. If nurses can get a PhD in nursing, is there such a thing as a PhD in medicine, or is the regular Dr. degree a PhD? Excuse my ignorance, I normally work around PhDs in physics, and know little of medicine.

  13. cardioNP says:

    I agree 100% with your post. I do not have a doctorate in anything and will never get one. Don’t see the value at this stage in my career.
    During my NP training we had one professor who did have a doctorate (I think it may have been an education doctorate, not sure of the exact degree). As a visiting faculty member at a hospital where she was not on staff she wore a white lab coat with her name embroidered as:
    “Dr. Firstname Lastname, RN”. I thought it was entirely inappropriate, but didn’t say anything to her directly. My classmates and I did snicker about it and thought she was way too pompous. One day one of the staff ICU nurses where I was doing my rotation asked her if she was a physician as well as a nurse. I literally had to turn around and act busy because I thought I was going to burst out laughing. I’m not sure this Doctor RN individual got the not so subtle hint.

    I introduce myself to pts as Firstname Lastname, cardiology nurse practitioner. Many want to know what to call me, I tell them to call me Firstname. But as LTC mentions, some pts refer to me as doctor despite being told I’m an NP and not an MD. I think that some of that stems from their wanting to show respect and the NP role not having a title which confers that respect.

  14. Tarl says:

    On the overall issue of titles, there are cultures outside the U.S. where it is imperative to refer to someone as [title] [lastname]. The title is tremendously important, it essentially defines the social class of the individual. Getting it wrong is a big mistake.

    In many such cultures, the use of a person’s first name is insulting, it presumes an intimacy which is not welcomed. And the use of the default title equivalent of “Mister” can also be even more insulting as it demeans the individual to a lower social class.

    Many people influenced by such cultures will insist on their academic or work title even in the U.S. – the informality we use in this country is somewhat the exception worldwide.

  15. J says:

    About 6 months ago I walk into a room in our clinic (Ophthalmology). Guy in the back stands up and says Dr. J it is nice to meet you, I am Dr. NeedtotellyouIamadoctor, thank you for seeing my wife (sitting in exam chair) Dr. Needtotellyousheisadoctor. Yes, a guy introduced himself as a doctor and referred to his wife as doctor. Both are Phds in psych. Do they do that at the dinner table when dining alone? Was there some secret handshake I was supposed to give?

  16. Tex says:

    Works for “Dr.” Phil….

  17. ThorMD says:

    Patient’s should know who is involved in their care and in what capacity. I don’t think the “average” person can understand that a Nurse, PhD who calls herself Dr. has a different education than an MD or DO. I tried explaining it to my intelligent elderly mother, and she couldn’t grasp the concept.

    People understand the difference between physician doctors and PhD doctors, but they don’t expect a PhD nurse to take care of their health.

    I have been a patient numerous times as has my spouse. I never introduce myself as Dr. Douche. OTOH, my brother is a PhD and he never misses an opportunity to introduce himself as Dr. He even has it on his return address label. Seriously dude. Then again, he reads WebMD on the internet and thinks he knows more than his physicians, because he is a doctor.

  18. AC says:

    funny, i had a friend who has a PharmD who got very nasty at the hospital when she was refered to by her first name, she did the “Excuse me, I am Dr. LASTNAME”… I looked at her and said, “Yea, and you are a pharmacist just like me and the other 5 standing here, although we got BS and not PharmDs we all are pharmacists. Get over it”

  19. RE says:

    I’m not a physician or otherwise involved in the medical world any more, but I am a lawyer. As a lawyer, I possess a Juris Doctor degree and can refer to myself as “Doctor.” However, I do not and I have never heard a lawyer refer to themselves as Doctor – in my opinion, to do so would be the ultimate in douchiness. I don’t even use the old term of Esq. as I think it is pompous. I do, however, address any physician, dentist or Ph.D as “Doctor” out of respect, even in social settings, and continue to do so unless asked otherwise. I also address a sitting or retired judge as “Judge” in the same circumstances. It is a matter of respect.

  20. Paul says:

    I was at an orthopedist with my girlfriend and her son, who had a buildup of blood on his knee from a distal femur fracture (motorcycle accident). After drawing off one syringe, he needed a second, which he asked me to hand him. I did so, opening the package in the usual sterile manner. He then said I had a bright future as a medical technician. I laughed at that, but didn’t say anything until my girlfriend made me explain that I was already a physician. The look on his face was priceless. Even now, I think it was funny.

    It’s much better to be humble and impress, than to be pompous and disgust.

  21. Right. In a medical setting in this country, Doctor means physician to the vast majority of the population. Unless you are a physician, don’t call yourself doctor in that setting. Now, in a college lecture hall as a PhD, of course you can call yourself doctor because you are obviously not in a clinical setting.

  22. Anonymous says:

    Personally I think the only people who should really use the “Doctor” title are actual doctors by profession. Engineers with doctorates will usually say First Name Last Name, PhD. But I’ve never heard of an engineer calling themselves “Dr.”

    The people who get their doctorates in useless stuff like english or whatever always seem to be the ones that insist on using the Dr. title. Maybe they’re compensating for the fact that their doctorate is easy to obtain and hence worthless.

    • we'reallgonnadie says:

      Ouch. I’m one of those holders of a “worthless” doctorate in psychology. It took several years to earn it, but perhaps that’s because I’m stupid.

      • Melissa says:

        “Doctor” has never been used exclusively to refer to medical doctors. My dad has a PhD in forestry and is called “Doctor” in professional settings. Some folks are getting a little carried away here. In a professional setting I would call you Doctor out of respect for your training and status. I would never believe or imply that you did not deserve the title.

        But if you introduced yourself to me as Dr. Freud at the carwash I would probably snicker a little :-)

  23. throckmorton says:

    A recent CMS report seemed to hint that they would accept inpatients to be cared for by Nurse Practicioners as opposed to physicians as a way to decrease cost. I am very concerned about this. In our facilities, there are nurse practioners who work with the hospitalists under thier direct supervision. There are also nurse practicioners who work with some of the specialists also under their supervision. If one of my patients needs a cardiologist, I dont mind if a ARNP is the one doing all the paperwork to comply with all the govt mandated EMR junk but I sure what the physician to be the one who takes care of their post-operative stemi!

  24. Emily says:

    I’m an RN & will likely have a doctorate before I’m finished.

    However, I’m not a “doctor”-doctor, and I don’t need to be called Dr. NursePerson. In my experience, most NPs/PAs introduce themselves with their first/last names and note their licensure.

    I haven’t seen anyone yet insist on the use of term ‘doctor’, despite the PhD/DNP/whathaveyou.
    I imagine they’re out there …. but I think they’re probably more vocal than the quiet majority who just want to chill out about the honorary title and provide good care.

    Also, I would like to commend you for writing a solid piece about this without the usual refrain of “If they want to be a doctor, they can go to medical school” so many physicians have. ;) It’s nice when we can speak with one another respectfully.

  25. whitecap nurse says:

    I think it is perfectly acceptable to say “actually, it’s Doctor So & So, I just earned my degree yesterday!” After that first flush of excitement, if they don’t know you’re a doctor socially – then you don’t need to tell them. I have more patients that want to be called Dr.Theirlastname which I always do, once corrected, but they still go into the pompous, needy category.

  26. ohwendyis says:

    I have an MS. For some reason I can’t get my friends and family to refer to me as “Master”

  27. Kat says:

    I am *not* a doctor, nor related to one, however, I have always felt strongly about this subject in that only an M.D. should be allowed to carry the title of “Dr.” in their name. M.D. = Medical DOCTOR – Medical Degree are somewhat synonymous terms in my eyes. The social-phobe college professors and other useless “Ph.D”‘s that have zero clue about medicine and not even the ability to write an Rx or treat a hangnail do not deserve the title. Dean, or perhaps some other title for the egocentric types who insist on a title for their Ph.D might be appropriate, but doctor for a non “doctor”, uhm no. The poster above, “RE” who is a lawyer – that’s the humble type of person who has rightfully earned their degree, but also has a clue.
    I always prefer humble people like Dr. Whitecoat here who are ok with the title, but just being called ‘Whitey’ is fine in his eyes.
    Whenever I hear of a-non MD referred to “Dr.” ___ I can’t help but roll my eyes more often than not.

    • MV says:

      On the other hand, why exactly should an MD be referred to as a doctor? After all, they have not met the qualifications for a PhD. If MD’s don’t like the confusion then they should refer to themselves as a physician (or some other term) rather than usurp the benefits of the title of doctor.

  28. Mimi says:

    Sometimes, I refer to my cat as “Dr. Tinycat”, because she’s little and cute…wonder how offended some of these “Doctors” would be.
    Also, had to deal with some lady at work, who was an architect, and insisted on being called “Dr.” She even sent an email calling us out on it. Needless to say, she’s not very pleasant to deal with.

  29. Melissa says:

    This is such a sticky issue, and I have really enjoyed reading this debate. I am an RN and here is my perspective:

    I think LTC made a very astute comment that patients often consider the person who is providing treatment, rounding on them, ordering their medications, etc. to be their “doctor,” even if that person is an NP or PA. This is the person who is primarily responsible for the patient’s diagnosis and treatment. If that person is a nurse practitioner with a doctorate, what is the objection to calling him or her “doctor?” If the NP introduces him/herself as “Dr. Nightengale, a nurse practitioner who will be taking care of you,” is that acceptable?

    I also have some thoughts on the idea that staffing with doctors is always better than staffing with nurse practitioners or PAs. I work in a small ER that is occasionally covered overnight by moonlighting physicians. Most of these folks are excellent, but sometimes they are inexperienced when it comes to complex emergencies (there is a particular Infectious Disease Fellow I am thinking of here- I don’t care about the patient’s sed rate if he’s coding). In that context, I would rather work with a Critical Care NP, who has been specifically trained to work in that setting. Most NPs had years of nursing experience prior to earning their masters or doctorates, and they possess instincts that the medical interns and fellows have not had time to develop. In that context, I would take a Dr. Nurse over a Dr. Doctor all day.
    (I don’t mean to exclude PAs from this discussion, my hospital doesn’t have very many so I don’t know as much about their training etc)

    In general, how should NPs and PAs appropriately distinguish themselves from the registered nurses? Many comments have pointed out that the general public does know how to distinguish between CNAs, LPNs, RTs, RNs, ARNPs, PAs, and MDs. When you add in nurses who are doctors, physical therapists and pharmacists who have doctorates, the whole thing gets very sticky. Maybe the hospital should provided a brochure to explain it?

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