"Doctor" vs. "Physician"

[Guest Kirsteen]

Hi there,

 

Just an interesting wee bit...

 

It was a half a year ago or so that someone who was not a medic brought it to my attention that the titles "doctor" and "physician" are quite distinct, heavy with quite different meanings. At the time I was using the terms fairly interchangeably, however, their exact defintions were clarified: "doctor" can refer to a medical doctor or a doctor of philosophy, whereas "physician" refers to a medical doctor solely. The issue was clear to me until this week.

 

I was writing a paper about doctors/physicians this past week with my boss (a surgeon). Obviously, given the topic of the paper, in the body of this paper I had to refer to those who are medically trained, who hold MD degrees. Using the above logic, I used "physician" throughout the paper. He promptly brought an interesting point to my attention: apparently, and especially among the old school "boys", if they are addressed as "physician" and they are "doctors" (non-surgical specialists) or "surgeons" then they may take a wide degree of offense. This is especially exacerbated: 1) if the "physician" is a surgeon; 2) if they are from the UK or any country with colonial history. His advice was to always use the term "doctor" since most parties will not take offense to this term, and even less so than if "physician" is used.

 

So much tacit stuff to learn.

 

Cheers,

Kirsteen

[Guest moo]

Interesting. But what would you say to those who say that doctors should refer to not only MDs/DOs and PhDs but also DCs, DDS/DMDs, OD, PharmD, PsyDs, etc. Are they "doctors" too?

[Guest therealcrackers]

Surgeons in the UK follow the old tradition of being called "Mr." or "Miss". About 200 years ago, barbers were also surgeons, called in to do blood-lettings for a whole lot of different ailments. The "physicians" refused to let their surgical colleagues be called doctors; this practice was also in place in France. This was also at a time when doctors attended only the rich, except in very rare circumstances; and the patient told the doctor what they had, and the doctor complied and followed suit. It was actually a fairly menial profession, but the doctors vigourously separated themselves from their "surgical" counterparts. This was also at a time when they thought similar symptoms caused different diseases in different people.

 

The big change to the whole establishment came from two things around the time of the French revolution. First, Georges Couvier worked out the science of pathological anatomy, describing 21 types of tissue; he decided disease processes hit specific tissues, rather than whole people, and that basis of treatment should follow that principle rather than the aristocratic rubbish of the time. Second, France and England were at war, with millions of men in the field. With high casualty rates, and lots of injured men to practice on, the surgeon types discovered things like water vs. ointment for wounds, appropriate hemostasis for amputations, methods of surgical extraction of projectiles, etc. For all of this, they were awarded the status of "doctor", and began to run the significant hospitals like "les Invalides" that were built. The British surgeons, now in the presently familiar position of having patients do what the doctor ordered (since they were often officers having been promoted for their skill, and the patients were mostly former soldiers), still scorned the title of "doctor" and go by Mr. or Miss. The degrees are different: a surgeon in the UK can get a ChB (Chirurgien is surgeon in French is the closest I can come).

 

There are five disciplines involved in human patient care that can call themselves doctors, and prescribe medications and interventional treatments, according to legislation in the US: MD (allopathic medicine), DO (osteopathic medicine), DC (Chiropractic medicine), ND (naturopathic medicine), and DDS (dental surgery). DVM, PhD, PharmD and other doctorates can call themselves doctor, but don't meet the human patient care and pharmaceutical criteria...

[Guest UWOMED2005]

Hmm. . . I'd argue surgery didn't really get going until the days of Lister and Ether in the mid 19th century.

 

And in terms of the development of medicine in North America, I'd argue the key step towards the development of the current medical system was the founding of the American Medical Association (AMA) in 1846 to counter the rise of Homeopathy (1), which at one point in the mid 19th century looked like Homeopathy might become the norm. What ensued was as much a political struggle for the support of patients as it was a rational development of modern medicine. It was in this context allopathic medicine began to claim it was "scientific" and superior to homeopathy.

 

The mid 19th century was an era of scientific innovation, remarkable inventions, and new ideas that were changing how we lived and - railroads, steamships, the telegraph, Darwin's theory of evolution. It was the era Jules Verne was writing about how scientific innovations could take use under the sea, to the stars, and to the center of the earth. Scientific popularizers such Herman von Helmholtz (2) in Germany claimed there was no limit to what science could do.

 

It was in this context the AMA set out to establish itself as a "scientifically superior" to its competitors. It began to adopt symbols of sciences such as the white lab coat and microscope as its own (3). The ironic thing was, in 1846 allopathic medicine wasn't scientific at all - many docs were still in the era of bloodletting and some allopaths were clinging to miasma theory. While science had led to the development of steam engines and air balloons, it really had yet to make an impact on medicine. It was also a time of great conflict. Did you know the "great physiologist/physician Virchow," oftens claimed as the father of scientic medicine/physiology and whom I'm sure you've had profs refer to with adoration, actually rejected Pasteur's theories of infectious causes for disease? In fact, in the mid 19th century, science was doing more to DISPROVE anything allopathic medicine did than to advance it. Most of the advances in life expectancy in the west came not from surgical or medical innovations, but from changes to public health policy. And I'd argue that in 1846 homeopathic medicine was probably MORE scientific than allopathic medicine - it used a scientific approach to experimental pharmacology in deciding which drugs to use, (1)rather than the age-old allopathic strategy of bloodletting for everything from GI bleed to folate deficiency.*

 

That's why you'll never see me in a white lab coat. It's a controversial topic in medicine, and there are a lot of arguments for (ie look more traditional, patients may look up to the lab coat, more pockets, prevent spills of samples on your clothes) and against (ie barrier to patient-doctor relationship, white coat hypertension, frightens little kids.) But for me, donning the white coat reminds me of the history of how and why it was adopted by the medical profession in an era of unscientific medicine, and it makes me feel like one of those 1950s ads for soap where a guy in a white coat would claim "our soap is scientifically proven to be better than the competition."

 

*Note, I am not saying homeopathic medicine is more scientific today in 2004, just that it was in 1846. There's a reason I chose to go to allopathic med school rather than naturopathic!

 

1) Kauffman, Martin. "Homeopathy in America: The Rise and Fall and Persistence of a Medical Heresy." in Other Healers ed Norman Gertz. Baltimore: John Hopkins UP, 1988.

2) von Helmholtz, Herman. "The Aim and Progress of Physical Science. [1869]" from Selected writings of Herman von Helmholtz, Russell Kahl, ed. Middletown, Conn: Wesleyan UP, 1971.

3) "The White Coat: Why not Follow Suit?" Valerie A. Jones JAMA. 1999;281:478.

[Guest coastal79]

Those are some great posts!

 

My humble contribution pales in the shadow of such posts. Anyways, my girlfriend learned in a lecture the other day (she's an education student) that "Doctor" comes from the Latin word for "teacher". Don't know if that's true or not, just thought I'd toss it out there.

[Guest Steve U of T]

I can see how surgeons would be offended by being called physicians. They spent 5 or more years in residency training to earn the FRCS (Fellow of the Royal College of Surgeons, I believe) after their name, while a medical specialist earns FRCP (...College of Physicians).

 

It's interesting that this division of titles still exists despite the Royal College of Physicians & Surgeons of Canada being a unified governing body.

[Guest cptn med]

This is a really interesting discussion. I really like hearing the historical bits and ideas. So I cant resist throwing my $.02 in.

Though to the society of physicians, surgeons, or whoever it may seem insulting or belittling to be referred to as a simple "doctor" we should remember a bit about the people who are using these words most freely.

Patients really don't care about what the preferential name is for one type of "doctor" or another. I think the point of the people who use the term 'doctor' is simply that they trust you and that they are depending on you to make the best of their situation. I am sure they would call you 'Betty Boop' if it meant you could fix their child's heart defect, or change the fate of a dying loved one.

Around the world, the word doctor means great things...I believe that to many it symbolizes hope, ease of mind and trust. Thats not such a bad category to be lumped into.

[Curious P]

bump!

 

I found this thread informative and hope others will too!

[a41]

Those are some great posts!

 

My humble contribution pales in the shadow of such posts. Anyways, my girlfriend learned in a lecture the other day (she's an education student) that "Doctor" comes from the Latin word for "teacher". Don't know if that's true or not, just thought I'd toss it out there.

 

Yes this is true, literally it means "one who teaches", stemming from the verb, docere, "to teach". It is like the word "actor", which means "one who does, or acts".

 

Hooray for first year Latin.