What's in a title?

One good thing about being a doctor is that you deal with both rich and poor. Many middle class types do not interact with the dregs of society and confine themselves to sanitised interactions with the well-to-do. Dr Grumble has looked after lords and tramps on the same ward round. He considers this a great privilege. It’s not dealing with the rich that he likes but the reality of dealing with a whole cross section of society together. And it is a particular privilege to be working in the UK and offering both groups the same quality of care. Can this be true? Yes it is. Few patients have a private GP and private provision for acute medicine in the UK is woefully lacking. When the chips are down, in an emergency we all go to the same place and get the same emergency treatment.

A lord in his lord's outfit.

So what’s in a title? Quite a lot it seems. Certainly those with money seem to be prepared to spend quite a lot on trying to get one. If you’re in the position to sell titles, this is quite a good way to extract money from the rich. The very rich are used to getting whatever they want but money does not buy everything. This leaves the unfortunate rich ruminating over the things they cannot buy. The most important of these is good health. Titles are not so important. Actually they are not important at all but the rich do not have this sort of insight. Like children they want what they cannot have. So it is no surprise if the unscrupulous exploit them. The unscrupulous bit is selling what is not your to sell. But that doesn’t bother the rich. But it should bother the sellers.

Doctors, of course, have titles. Of a sort anyway. Grumble is Dr Grumble. He would, in many circumstances, like to be incognito as plain Mr Grumble or, better still, John Grumble. The reason he has chosen to be Dr Grumble here is because his being a doctor is an important aspect of this blog. Chosen is the right word for most UK doctors who do not actually have a doctorate. Some of the people Dr Grumble works with have doctorates but are not doctors. Many doctors in the UK call themselves Mr, something which perplexes patients and foreigners alike. Dentists in some parts of the world call themselves Dr and, in recent times, Dr Grumble has been getting letters from UK dental surgeons, without an obvious doctorate, calling themselves Dr. This is puzzling because medically qualified doctors, who are surgeons, generally call themselves Mr or Mrs or Miss or that terrible but rather useful title, Ms. In many hospitals, to add to the confusion, you will also find a few Professors.

Does any of this matter? Dr Grumble thinks it does. Patients need to know whether the person they consult is a doctor or not. They know what a doctor is. They don’t really know what a Mr or Mrs or Ms or Professor is. There are lots of people in hospitals with these titles who are not doctors. And quite a few that are. Unfortunately, there are also a good few Drs that are not what patients consider to be a doctor. It’s all very difficult. If ideas about doctorates in nursing practice take off it may get even more difficult.

Dr Grumble has always wondered what the public mean when they refer to a ‘qualified doctor’ as in ‘John Grumble is a qualified doctor’. What, for goodness sake, is an unqualified doctor? Perhaps an ‘unqualified doctor’ is one of the new breed of practitioners that are being brought in to do doctors’ work. Do the public want to be treated by an unqualified doctor? If the person doing the job can do it to a high standard then it really doesn’t matter though how can this square with the Blair concept of choice? Certainly patients have the right to know if they are being treated by unqualified doctors and it’s time all this was clarified for them. Perhaps they should even be given some choice in the matter. In the headlong rush for an efficiency, which is proving elusive, nobody seems to have given this any thought. Except, of course, doctors. But nobody listens to them in today's NHS. Dr Grumble is worried.