The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and
pubs.asahq.org
“About half of my classmates at Stanford Medical School had PhD degrees. These med school classmates wanted training in the practice of medicine to supplement their training in a separate discipline. When we started our clinical rotations, everyone was introduced to patients as “Mr.” or “Ms.” It would have been inconceivable for a medical school classmate to introduce himself or herself to a patient as “Doctor Jones” on the basis of a PhD in biochemistry. Had any of my PhD classmates introduced themselves to a patient as “Doctor Jones,” he or she likely would receive an immediate sanction. Had the practice continued, I expect the student would have been expelled.
The reason for the expulsion would have been dishonesty. To patients, the word “doctor” unambiguously implies a physician with either an MD degree, a DO degree, or an equivalent degree from abroad. It implies undergraduate training in chemistry, biology, physics, mathematics, and statistics. It implies sufficient academic accomplishment to gain admission to medical school, among the most competitive admissions processes in academia. It implies years of study in medical school to gain basic knowledge of physiology, pharmacology, anatomy, medical ethics, and medical procedures. It implies additional years of caring for patients under the direct supervision of physicians to complete medical training. It implies passing numerous standardized tests to verify successful acquisition of that knowledge. In contemporary medicine, “doctor” usually implies subspecialty training in a medical, surgical, or psychiatric discipline. Finally, and perhaps of greatest importance, the word “doctor” implies the individual representing himself or herself can be trusted with the most personal and intimate details about a patient's life and body.
Given the profound implications of the title “doctor” to a patient, any introduction of a non-physician to a patient as “Doctor Jones” is beyond comprehension. It is inconceivable that a Doctor of Biochemistry would put on a white coat, drape a stethoscope around his or her neck, and introduce himself or herself to a patient as “Doctor Jones.” Patients have an absolute right to know who is interviewing them, who is examining them, and who is caring for them. If it is “Doctor Jones,” then Doctor Jones better be a physician.
Outside of clinical care, a person with a doctoral degree is appropriately referred to as “Dr.” The first lady, Dr. Jill Biden, has a doctoral degree in education (Ed.D). She is properly introduced to others as “Dr. Biden,” unless it is to a patient in a clinical setting. In a clinical setting, “doctor” is synonymous with “physician.” If Dr. Biden ever tours Stanford Hospital, she will be introduced to patients as “First Lady Biden.” If she is invited to give our commencement address, she will be introduced as “Dr. Biden.”
Many schools of nursing offer doctoral degrees, typically a “Doctor of Nursing Practice.” Nursing is every bit as worthy of study and advanced training as medicine, biology, or any intellectual discipline. With proper accreditation, nurses should have every opportunity to receive advanced training to further their discipline. However, possessing a doctoral degree requires nuance in the clinical setting. Just as my medical school classmates would never introduce themselves to a patient as “Doctor Jones” based on a doctoral degree in biochemistry, a Doctor of Nursing Practice must never introduce himself or herself to a patient as “Doctor Jones.” This is not to disparage either the individual or the training. Rather, it is because when you tell a patient you are a “doctor,” you are unambiguously implying that you are a physician. You are defining for the patient your training and skills. You are respecting the patient's right to know. You are establishing the doctor-patient relationship, enshrined decades of law, and centuries of medical practice. Of course, I expect to see “DNP” on the name badge, just as many badges list “MD, PhD.” Education is to be celebrated!
My usual introduction to a patient is “Hello, I'm Steve Shafer. I am the anesthesiologist who will be caring for you today.” I use my first name, and not “Doctor Shafer,” because “anesthesiologist” implies that I am a physician with subspecialty training in anesthesiology. When I say “anesthesiologist,” I am introducing every aspect implied by the word “doctor.” As succinctly stated in the Merriam-Webster Dictionary, an anesthesiologist is “a physician specializing in anesthesiology.”
I matriculated at Stanford Medical School in 1978. It took 10 years to complete my medical training, my training in anesthesiology, and my training in clinical pharmacology. By today's standards, that is relatively fast. Most Stanford anesthesiology residents have more than 10 years of training after medical school matriculation. With more than a decade of training, our residency graduates have earned the title of “anesthesiologist” and all that title implies.
It is inconceivable that some of our CRNA colleagues are advocating to use the word “anesthesiologist” to describe their medical role to patients. They are not physicians. They may or may not have undergraduate training in science, mathematics, and statistics. They have not completed medical school. They have not passed the numerous tests required of physicians. They have not successfully competed for highly selective anesthesiology residency positions. They have not had the exceptional training in complex case management that we provide for anesthesiology residents. They are not physicians. They are not anesthesiologists. Full stop.
Patient deception is unacceptable. For a non-physician, a non-anesthesiologist, to misrepresent his or her clinical training as an “anesthesiologist” is deception, pure and simple. Deception is incompatible with the responsibility of every health care provider to be completely honest with patients. Deception is incompatible with a patient's right to know the qualifications of every caregiver.
This is completely orthogonal to my own experience with CRNAs at Stanford. All I can say is “Wow!” They are exceptional clinicians. We work together as a team. I recognize their expertise and appreciate their clinical skills. I always look forward to the days that I am paired with our CRNAs.
However, just as I can't envision my PhD medical school classmates claiming to be a “doctor” to a patient prior to receiving an MD degree, I can't envision any of my Stanford CRNA colleagues claiming to be an anesthesiologist. They are proud of being Certified Registered Nurse Anesthetists, just as I'm proud to be an anesthesiologist. We are proud of who we are and we are proud of what we do.
Nursing has always been a highly respected profession. That is especially true now, given the daily news reports on the risks and personal sacrifices of nurses during the COVID-19 pandemic. Out of respect for our nursing colleagues, their training, their skills, and their exceptional dedication to patient care, I simply ask that we be careful. Patients have a right to understand the role of every health care provider. Health care providers have a duty to honestly represent their roles to patients. Because “doctor” unambiguously means “physician” to patients, only physicians should introduce themselves to patients as “doctor.” Because “anesthesiologist” implies “physician,” only residency-trained physicians should adopt the term “anesthesiologist.”
This is not about jockeying for money, power, or turf. Proper use of the term “doctor” and “anesthesiologist” with patients reflects the duty of every health care provider to be honest with our patients, while fully respecting their rights and autonomy.”
www.medpagetoday.com
www.asahq.org
