Why Are Doctors Called ‘Dr’?

Not a book review but I thought it best to put my words down regarding this subject.  A difficult one to get across I think and I apologise if the post doesn’t flow very well or the argument is a little over-egged.

I have been a medical ‘doctor’ for over 6 years now and have never really thought about how I am addressed.  Mostly, I introduce myself with my first name and have never really wanted to be referred to as ‘Dr So-and-So’ but I know plenty of medics who do use the title and pretty much insist on being referred to by it.  But what’s even in a title?

Having recently embarked on a PhD and putting my clinical work to one side, I have had the opportunity to reflect upon this curious enigma.  For those who may not be aware, in the UK, a medical degree is an undergraduate degree which results in the award of a Bachelor in Medicine and Surgery.  This is usually abbreviated to MBChB, MBBS, MBBCh, BMBCh, BMBS, or MBBChir depending on the conferring institution however they all mean the same thing and allow registration with the General Medical Council.  In the US however, medicine is a postgraduate degree which results in the conferring of MD or Doctor of Medicine.  The title ‘Dr’ is given to all graduates of a doctoral programme no matter the specialism such as PhD, DSc and DPhil.  This is earned after 3-4 years of hard study at the postgraduate level similar to how the MD is earner after such postgraduate training in the US.  So why, in the UK and other countries, do medical doctors with essentially a Bachelor’s degree get the right to call themselves ‘Dr’? The MD degree does exist in the UK but is a postgraduate doctorate in medicine so an undergraduate degree is already a pre-requisite.

The word ‘Doctor’ derives from the Latin “Docere” which means ‘teacher’ hence its original meaning was a person of great knowledge who had spent a significant amount of time imparting this into others.  Prior to the birth of the earliest universities in 13^th century, the term was bestowed upon religious preachers who taught and interpreted the Bible.  It is fairly easy to see how this could translate to an academic but less so for medicine.  There were several terms for medical practitioners before ‘doctor’ my favourite being ‘leecher’ which must stem from their preoccupation with using leeches as treatment.

The story of British surgeons and their appellations is interesting and well documented.  Every wondered why the surgeon who took your appendix out was “Mr So-and-So” rather than ‘Dr’ event though they have a medical degree?  Surgeons and physicians (i.e. doctors) never used to have the same training.  In fact, the art of surgery was developed by Barber Surgeons who were, you guessed it, barbers.  They had all the sharp implements necessary to, not only cut your hair, but also remain a wart or a limb.  Barber Surgeons were officially recognised in the UK in 1540 when the Fellowship of Surgeons merged with the Company of Barbers.  It wasn’t until 1745 that surgeons became a recognised separate profession from barbers but they still did not train medically. It wasn’t until 1830 that a medical degree became a requirement and this was mandated by the Royal College of Surgeons (RCS) and pretty much forced upon them by the Royal College of Physicians (RCP), who saw surgeons as untrained charlatans.  As an ode to the RCP for making them become ‘doctors’ before they can become surgeons, when a surgeon gains membership of the RCS (i.e., MRCS post-nominals by examination) they revert to ‘Mr’, ‘Ms’ or ‘Mrs’.

I have read that the barber’s pole (white pole with red ribboning) has some historical link to Barber Surgeons.  This reflected blood dripping down the pole as the Barber Surgeon performed some barbaric procedures.  I have no idea if this is correct but makes for good reading.

Surgeons don’t pretend to have doctorates and, indeed, I know many who have doctorates but still insist on being called ‘Mr’ and ‘Mrs’ so why do physicians still use it? My research hasn’t led me to a definitive answer but has brought up some interesting suggestions:

1. The title ‘Dr’ is given to reflect the profession.  The verb ‘doctoring’ describes treating maladies in patients, however, can also mean falsifying.  I’m not sure I am fully persuaded by this as there is a chicken-and-egg paradox.  What came first?  The noun or the verb.  It would seem to be the noun would come first and verb would follow.
2. Given that medical doctors have a responsibility to teach their juniors, the title has been given to reflect this.  Traditionally, doctors never needed degrees and would apprentice themselves to a local physician, surgeon or apothecary.  It may surprise you that it wasn’t until 2007 that the United Examination Board was dissolved.  This allowed the award of a ‘licence’ to practice medicine or surgery (i.e. LRCS and LRCP) to those without medical degrees.  It was usually sat by final year medical students before their degree exams as it allowed them to start working earlier and earn some money.  Most would go on to get their degree too but some would spend their whole careers working purely on the basis of LRCS LRCP.  Interestingly, those with the licence but no degree were forbidden to use the title ‘Dr’ until 1905 when the RCP reversed this with the knowledge that the general public often used the term for all medical practitioners.
3. The original degree for medicine was, in fact, a doctorate of medicine (MD).  This was indeed the case in Scotland and followed over to America where the first medical schools there opened under the auspices of Scottish physicians and surgeons. When and why the degree was converted to a Bachelors, I cannot seem to find.  In this case, the title is bestowed in an honorary fashion keeping up with the cultural norm.

The short answer is that it is a cultural gesture and the title is not protected (which means anyone can call themselves ‘Dr’ if they like – although deliberately pretending to be a medical doctor resulting in harm to patients is, of course, a criminal offence).  Still, I have a medical degree but no doctorate (yet) and I certainly feel the title is somewhat honorary.  The other argument is the use of the title by Dentists and Veterinary Surgeons.  This may be a post in its own right but given both professions as surgeons by nature, do we not think that they would follow the same practice as other surgeons using the usual pronouns? 

Anyway, what’s in a title?  Who really cares?  If you do, what do you think medical doctors should call themselves?