Journal of the Royal Society of Medicine Volume 85 November 1992

13 Tyler RS, Davis JM, Lansing CR. Cochlear implants in young children. American Speech-Language-Hearing Association 1987;29:41-9 14 Staller SJ, Dowell RC, Beiter AL, et aL Perceptual abilities of children with the nucleus 22-channel cochlear implant. Ear Hear 1991:12(suppl):34-47

What's in a title - Mr or Dr? The British like doing things their own way. They always have done, and probably always will. However as we approach 1992 and closer links with out European neighbours develop, will there be less scope for individuality? 1992 represents the start of a universal general 'jobs and goods' market amongst Member States ofthe European Community. This has already been the situation for the medical professions for some time. Since the 'Free Circulation Directive' of December 1976, migration of members of the profession has been possible, there being mutual recognition of different Member States' relevant diplomas. However, as has been pointed out', there has been no standardization oi medical training, duration of training within a specific specialty, nor even what represents a- medical specialty. The trend towards uniformity of training within the Community poses interesting questions as to what should be the accepted 'titles' of different members of the medical and allied professions. The word doctor has its origins in Latin where it means teacher, and even in more modern languages it retains the same meaning. Chambers Twentieth Century Dictionary defines doctor as: 'teacher (arch.) originally implying competency to teach'2, and Butterworth's medical dictionary pits the teachitig definition before the medical definition3.,It is nowadays generally accepted that a 'doctor' is one who provides medical care and advice (along with the other duties pertaining to their practice). These people are given the title 'Dr'; yet in our midst there is a group of doctors who do not use this title - the surgeons; who prefer to be known as 'Mister' or 'r. In almost every other country that we can think of, with the possible exception of Australia, where many surgeons have an FRCS, as well as FACS, this is not the case and all medics are known as 'doctor'. The title 'Doctor' is in fact a courtesy title to members of the medical profession, and only those, who have achieved certain academic qualifications are allowed to use such a title by right, namely an MD, PhD, DSc, DDS. Many of the. holders of these degrees remain within the academic community undertaking not only further research but also actively teaching their subjects, and could therefore be said to be even more worthy of the title 'Doctor'. However, in the minds of many people a doctor is gtill, a doctor! This can lead to a small amount of confusion in,the general public. Those who are or who have -been involved in hospital life do not. appear to have a problem when addressing medical staff. There are few

15 Osberger MJ, Robbins AM, Miyamoto RT.. Speech perception abilities of children with cochlear implants, tpcile aids, or heanug aide. Am 4 Otol 1991;12(suppl): 105-15 16 Qiittner AL, Steck JT. Predictors of cocJ4lear implant use in children. Am J Otol 1991;12(suppl):89-94

surgeons who have not been incorrectly addressed by their patients at one time or another as 'doctor', and in these circumstances has to decide whether to correct that person. Yet in another situation, when the call goes out 'Is there a-doctor in-the house?' there is seldom a rush of PhDs' to uassist the needyl Where does this anomaly come from?-The history ofthe title 'Mister' for surgeons, is a little uncertain. In his paper Eibel4 reviewed some of -the likely origins. He suggests that after the decline of Rome, surgery was largely the domain of monks assisted by barbers. In the 12th century, however, the Pope decreed that monks must no longer shed blood, the result of which was to give great heart to the barbers who began more advanced surgery such -s bloodletting, fracture treatment, and tooth-pulling. Hence this group became known as the barber-surgeons (although the monksdid continue to act in an advisory or consultant capacity). At the same time, there was another group of 'surgeons' who were apprenticed, and since unqualified, not titled 'doctor'. These groups .joined in 1493 to better define their respective job desrpin King Henry VYII formalized this arrangement in 1-540, and the -affiliation became, known as 'Masters, Governors, ofthe Mystery and Commonalty of Barbers and Surgery of London'. Any miber of this- group was now allowed to -be aded as 'Master', which in time became 'Mister'. The union with the barbers lasted until 1745 when the surgeons lobbied Parliament to effect-a separation, and thus ended this partnership4 Nowadays, with increasing international meetings and cooperation, uniformity of -title may seem to be a otep forward amongst -colleagues, who seek to advance their common knowledge for the common good. Yetthere is also t-he opinion -that there is little con^sion currently and that there is no need for change, anid that the traditional British way should be; maintained, since the attainment- of higher surgical qualifications bringswith it the 'higher' title

of 'Misier'. There is also currently much debate in the -dental

press that dentists should be allowed to use the courtesy title 'Doctor'. Currently this is illegal (unlees the individual holds a doctorate or medical degree). European dentists are addressed as 'Doctor?, until they; decide to practice in the UK. Herethey must be addressed as 'Mister' even;if tbeir degree is, for itance, a French doctor of dental ;surger-y. The current moves to the use of such a title in dealings with patients is being supported- by, the Biritish Dlental Association, the- General -Dental Practitioners Association and the Women in Dentistry group.

These organizations h&ve, following little consultation with their grass-roots members, decided to

Journal of the Royal Society of Medicine Volume 85 November 1992

address their members as doctor on all communications, who can, if they wish, decline by contacting the relevant organization, ie an opt out rather than opt in situation. In a recent article5 one of the prime movers for this change explains why he feels that it should come about. He writes that the undergraduate training of doctors and dentists is comparable; that modern dentistry is no longer harsh and invasive (quite true); that young graduates see themselves more as caring and prevention orientated. He has also tried to rally support, numerical and financial, for parliamentary lobbying, through the columns of the dental press6-8. In another article9, Pike suggests that if British dentists flout the law, a test case will be required, and in such a case a wider European view will be needed - which is just what he wants! However, since the role of the dentist is changing from one of dental surgeon to one of dental physician, that is to say, there is an increased emphasis on patient education, a teaching role, should the title not change to reflect this? The title of 'Mister' for dentists also seems to have somewhat confused origins. Some say that since the first licences were issued, by the Royal College of Surgeons, in 1860, the title 'Mister' is by right ofthe surgical nature of the diploma and that when the universities granted degrees they assumed that odontology was a branch of surgery, just as ophthalmology and otology are branches of that art'0, coupled with the equally close ties that dentistry has with the Barber-Surgeons. However, others believe that the title is more likely to be comparable to the 'Mister' given to any gentleman, eg Mr Bun the baker or Mr Pullem the dentist. The point has also been raised that a change in title will avoid confusion in dental surgeries where dental hygienists and female dentists, often similarly uniformed, have been wrongly identified. It is interesting to note that such a change in title recently took place in Australia and New Zealand with apparently little problem, although we are led to believe that there was a simultaneous move for dentists to perform simple health screening tests, eg blood pressure monitoring, since many patients attend for dental examination twice a year, which is more frequently than many attend their medical practitioner. There are those who feel that this issue is nothing more than a group of professionals trying to raise

The portrayal of the physician in non-medical literature -the physician and religion '(Even) the best among physicians is destined for Gehenna'.1

Garcia-Marquez2 describes a devout physician who attends mass regularly, who does not visit his patients on days of obligation and who kneels in the street

their public image, and their own collective morale in the light of recent changes to the NHS contract, although this question has been with us since the beginning of the century6. Ultimately it will require an amendment to the law by parliament to allow this change to occur for dentists. However there has been little if any discussion with one of the other interested parties, namely the doctors or more particularly, the surgeons, since it is not beyond the realms of possibility that such a change could be imposed on them by our neighbours who seek such pan-European conformity. It would be interesting to hear the views of the groups with whom dentists have much in common, except, some feel, a title. J M Lever Department of Prosthetic Dentistry Institute of Dental Surgery, London

P Hornick Department of Cardiothoracic Surgery Harefield Hospital, Middlesex

L C H John Department of Cardiothoracic Surgery & Thrombosis St Bartholomew's Hospital, London References 1 John LCH. Surgical training and the European Community. Scalpel (supplement to Surgery) 1991; 89:1-2 2 Chambers Twentieth Century Dictionary. W&R Chambers, 1972 3 Butterworth Medical Dictionary, 2nd edn. 1978 4 Eibel P. Doctor or Mister (the correct appellation of British surgeons). Can J Surg 1988;31:452-3 5 Pike D. Why dentists want to be called 'doctor'. BMA News March 1991:21 6 Pike D. The General Dental Practitioner April 1990:15 7 Pike D. The General Dental Practitioner May 1990: 14-15 8 Pike D. The General Dental Practitioner September 1990:3 9 Pike D. BDA says 'yes' to the title 'doctor'. The General Dental Practitioner Jan/Feb 1991:25 10 The question of title. Br Dent J 1917;38:104-6

(Correspondence to: Mr J M Lever, 93 Haverstock Hill, London NW3 4RL)

when the archbishop's carriage drives past. Indeed, when he has a disagreement with his wife he suggests to her that they go to the archbishop for arbitration. The physician, Juvenal Urbino, is rewarded for his piety by being made a Knight of the Holy Sepulchre. Such individuals obviously exist but they are relatively uncommon in fictional literature. Moreover, Urbino is depicted as a somewhat anachronistic Don Quixote whose knowledge of medicine is thoroughly out-of-date and who spends his time playing chess and training his parrot to recite passages out of St Matthew's gospel (in Latin)2.


What's in a title--Mr or Dr?

658 Journal of the Royal Society of Medicine Volume 85 November 1992 13 Tyler RS, Davis JM, Lansing CR. Cochlear implants in young children. America...
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