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Use of titles appropriate or not

Discussion in 'United Kingdom' started by DAVOhorn, Aug 2, 2012.

  1. DAVOhorn

    DAVOhorn Well-Known Member


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    Dear All,

    while enjoying a cup of tea at the gym this morning i overheard a group of mature members discussing treatment for a painful spine.

    The chap was saying he went to a back place for a massage to his spine. His friend asked was it a physio or osteopath.

    He said no they were a choro thingummy proctor.

    He then added that they were DOCTORS.

    So i enjoyed this as he had no idea what the professional title was but gave great credence to the fact that they are DOCTORS.

    SO we have a Chiropractic Practice using a self appointed title of DOCTOR which i believe the profession agrees is Honourary.

    Years ago there was a chiropodist who used the title Doctor and justified this by saying that Chiropractors and Dentists used the title.

    As today there are many Allied health Professionals who do have PhD's and rightly use the title Doctor should the HPC look at professions using the title Doctor for its practitioners when they have no PHd or Medical degree.

    regards David
     
  2. W J Liggins

    W J Liggins Well-Known Member

    As I understand it, the HCPC does not hold osteopaths or chiropractors amongst its ranks. It most certainly does not have dental surgeons in its purview so it would not be in its power to make official comment. It has been stated often on this site that many doctors in the UK are not MDs. they are Batchelors of medicine and surgery and thus use the title 'Doctor' in an honorary fashion as do those other professions that you mention. There is nothing to stop anyone calling themselves anything at all, as long as they do not hold themselves out to be something that they are not.

    There is a good deal of interesting posting on the subject under the Australian section.

    All the best

    Bill Liggins
     
  3. Catfoot

    Catfoot Well-Known Member

    This is an interesting topic.

    The SCP Code of Ethics used to say that a practitioner was not allowed to use, in their advertising/promotional literature, any designatory letters that related anything other than Chiropody/Podiatry.

    So a holder of a DPodM - Diploma in Podiatric Medicine who was also a BSc in Physics was not allowed to put BSc on their business cards.

    The reasoning behind this was not to mislead the public into thinking that the person had chiropody/podiatry qualifications at a higher level.

    I can't speak for any other professional organisations.

    What does concern me is practitioners, both regulated and unregulated putting RN or RGN (both nursing qualifications) in their advertising. This confuses the public as to what their scope of practice actually is. This could cause untold problems in the case of litigation.

    regards

    Catfoot
     
  4. Do you really think the public are aware or even care about what goes on your business card, Heather? What concerns them is how good a job you do and how much you charge for doing it. Period. It's only some areas of the profession that has its knickers in a twist over titles and qualifications and territorial encroachment. If more energy and time was devoted to looking forward instead of constantly glancing over their shoulders to see if anyone is snapping at their heels - the world would take on an altogether different view.....
     
  5. Catfoot

    Catfoot Well-Known Member

    Mark, or should I call you "bluebell" ?

    We were talking about marketing strategies, as per ASA maxim "honest, legal, decent"

    You of course are entitled to your opinion, but that is all it is, you cannot back your assertion up with evidence.

    In my opinion you are wrong on this occasion, even your order of priorities is wrong.

    I’m pleased you spend all of your time looking forward, after all who would want to sully their beliefs with experience?

    regards Catfoot AKA "holly"
     
  6. rosherville

    rosherville Active Member

    If you doctor people (change them for the better), you are perfectly entitled to call yourseld a doctor.

    If you do so to mislead people to believe you're a 'registered medical practitioner', you can`t.
     
  7. Catfoot

    Catfoot Well-Known Member

    Rosherville,
    Does that go for Tom cats as well ? :D

    regards

    CF
     
  8. David Wedemeyer

    David Wedemeyer Well-Known Member

    David,

    I believe the title doctor is viewed differently in the UK than in the US? In the US a doctor of chiropractic degree (DC) is a first professional degree conferred on those completing the chiropractic curriculum and 4 national board exams. DC's are portal of entry, primary care providers in that they do not require a referral to evaluate, diagnose and provide treatment within their scope of practice (in the US where the profession was conceived). It is the same with podiatrists in the US as well and it wouldn't occur to me to refer to my DPM in his office as anything other than Dr. *****. Perhaps in the UK it is different? I refer to my friend with PhD's as doctor, they've earned the title I feel and I am well aware that they are not physicians.

    So yes in the context that DC's are "doctors" of chiropractic, they are doctors and enjoy the title and many of the same rights as physicians (MD's), but our scope is limited as are all healthcare professionals who are not MD's or DO's. To my knowledge the non MD/DO professions cannot advertise the title doctor without specifying their professional designation (DC, DPM etc.) in their advertising.

    I agree much with Mark's sentiment and many of my patients refer to me by my first name. I'm not offended by this, I'm more concerned that they respect my abilities to help them and to know when to refer them to another "doctor" when I cannot.

    Semantic and professional, territorial schisms aside, a title means very little unless your patients laud your for your abilities. What should you call the "doctor" who diagnosed and resolved your L5 radiculopathy conservatively (manipulation) when injections, physical therapy and medication failed to resolve your complaint (or through training and evaluation decided he cannot and referred you to the appropriate physician); David? ;)

    Regards,
     
  9. Catfoot

    Catfoot Well-Known Member

    David,

    Yes you are correct when you describe the difference between the US and UK use of doctor.

    We are nations joined by an arguable common language, but have very little reciprocity when it comes to education and professional qualifications.

    Just out of interest is a British qualified chiropractor able to work in the US without further qualifications? Certainly a Pod cannot.

    My impression is that the laws in the US are more strictly enforced than in the UK where abuse of title and exaggerated claims of competence is common.

    It would be nice if Mark’s sentiments held true but at point of first contact what else does a client have but what is "on your business card"- unless of course they are coming from personal recommendation? I have had many clients arrive with their feet in an atrocious state, having had long term inadequate treatment but not knowing things could be better. I questioned one patient as to why she had allowed this to happen and the response was "it says she's a nurse so I thought it was alright".

    I’m not totally convinced that how a patient addresses a practitioner is anything to do with the practitioner, more the social norms of the client.

    Unfortunately David, this thread is about semantics and professional territorial schism, subjects of great concern in the UK.

    regards

    Catfoot
     
    Last edited: Aug 4, 2012
  10. George Brandy

    George Brandy Active Member

    Good thread and one I hope does not deteriorate.

    Mark, I don't see many of my professional colleagues glancing over their shoulders to see if anyone is snapping at their heels. I am more inclined to witness sadness, a shaking of heads as professionalism and standards are eroded further by the what we commonly refer to as the "lower end of the market place" which has been thrown open to all providers of service, competence unchallenged.

    Catfoot raises a potentially interesting point where they have stated "My impression is that the laws in the US are more strictly enforced than in the UK where abuse of title and exaggerated claims of competence is common." Our US colleagues may enlighten us?

    Again Catfoot makes another good point about the RGN qualification. Only yesterday I treated a lovely ex-client who had opted for NHS treatment since 1996. Yesterday the client returned to the fold after suffering atrocious footcare at the hands of "someone" only 3 days previously. This client was also suffering "neuropathic" changes in both feet - she had recently suffered a back injury, shingles affecting the sciatic region and had raised blood glucose levels. On asking who this client had last seen at our local "health centre", the response was " I don't really know. She was wearing a white coat and looked like she knew what she was doing." My client had not met this service provider before. Could it have been a nurse employed as provider of footcare? I really don't know and made no comment to the patient on the changing scene of UK podiatry service provision. My duty of care was to support this patient in relieving the immediate foot problems, helping understand the causes of sensory changes and referring onwards for appropriate diagnosis.

    I give this example to support Catfoots point, that many in the UK put such a level of trust in our NHS and it is undisputable that the older client will see RGN, Nurse or Doctor in an advertisement whether it be on a professional card or elsewhere and immediately assume a level of competence no matter what the cost of that particular service is. As has been said previously it is often by chance that a client finds something better. In the case I describe, the client knew there was better and on this occasion chose to afford my services.

    So how should level of competence in the care of the foot be addressed within the UK? Legislation has failed in its entirety.

    GB
     
  11. Catfoot

    Catfoot Well-Known Member

    The use, by a practitioner, of multiple unrelated titles blurs the boundaries of professional liability and only serves to obfuscate the service user. The failure to understand and keep to professional boundaries can lead to any practitioner making serious mistakes.

    When areas of professional responsibility are not clearly defined and adhered to the patient is always the loser if litigation occurs. There is often confusion in the mind of the practitioner as to which "hat" they are wearing and inappropriate advice and treatment (albeit well-meaning) can be dispensed.

    I am rather concerned when practitioners trade under dual titles in a regulated/unregulated footcare dichotomy.

    However, I know of practitioners who use two Regulated Titles and practice successfully as Podiatrist/Physiotherapist and Podiatrist/Chiropractor without problems.

    regards

    Catfoot
     
  12. I don't disagree with any of that. The problem is quite simple - the current legislation is inadequate and needs ammendment. If the legislation was framed to address the primary weaknesses - there would be no issue of a free-for-all at the footcare end of the market. Grandparenting has been visited on the profession twice in the past 50 years - I have no desire to see it happen again.

    The primary issue with just having protection of title as the underlying framework for the legislation is that it can only apply to those who use the title. It's what you do rather than what you are that's really important hence the imperative for clarity of function for the protected titles. It is vital for two reasons; to inhibit the circumvention of the legislation by either members of the public who sell their skills as footcare providers and to prevent those who have been struck off from continuing in practice under another misleading title. It is not a difficult issue - and does not encroach on people attending to their own or some relative or friend's footcare - providing they do not gain their livliehood - in part or in full - from those activities. With respect to my position re the HPC and use of a protected title, I've made clear my reason for doing so. Partly this is out of frustration over the failure of the podiatry profession through its representatives to secure an ammendment - and there is even less enthusiam from politicians who have their hands and heads full of other matters presently. Nothing has really changed for the better for our profession - only the State Registered has disappeared. The problem was that the HPO was devised for several allied health professions and was ambiguous rather than specific. The best the profesion could hope for was influencing the consultative process prior to enactment but I suspect the weaknesses were not as apparent or perhaps they were given assurances at the time - but the outcome was still the same. There is an unregulated sector with all its attendant problems for society and the profession. This is fed by people coming through the unregulated training and correspondence routes - from other professions eg RGNs - and from our own registered sector. The latter is the primary source of concern. This was from a recent FtP hearing.
    A serious offence and a real danger to the public where the registrant has access to vulnerable members of the public - including children. I would not want to be associated with this individual in any way, nor would I expect would most of you. Yet there is nothing to prevent this offender setting up in practice immediately - in any part of the country - and practising, to all intents and purposes what everyone would consider 'podiatry' - but under any of the many unregulated titles - and now without any regulation framework whatsoever. Would you like your child or your mother to be in a room on their own with this man? This is where a dedicated registrar like a General Podiatry Council may have been advantageous but only if it had the supporting legislation, of course. You compare the Uk and US professions - the difference is that the US legislation specifies function and the role of the podiatrist much clearer than our own - it is much tighter and the public is more aware and reassured of the services they enjoy from Board Certified clinicians.

    We have all had experience of inadequate and unprofessional care - from all ends of the profesional spectrum and I would very much like to see the professional bar raised across the board to improve standards - see my previous comments on practice establishment and training, but whatever system of podiatric practice we build - it needs to be supported and protected by legislation - so that really is the first goal we need to achieve.

    Many years ago when I was at school we had a hillwalking group (in the days when teachers did extra-curricular activities) and would head off to the highlands most weekends. The assistant rector - Norrie Clark - was an extremely inspirational figure in the school and used to organise the Duke of Edinburgh scheme. One weekend we were off to Glencoe and as usual I was off like a whippet as soon as the doors were open - I was much fitter and less obese then! As per - I was at the top of the hill first and passed the group going up on my way down - and was back at the minibus an hour before the group arrived. On the way home, Norrie asked what I was going to write as the headline for the school journal that week and after I thought for a bit - suggested something like "Buachaille beaten by Beath in under three hours!" Buachaille being the hill and Beath the school.

    "Not quite" was his reply - "You did it in under three hours - but always remember the success or otherwise of the party is measured by the pace of the slowest member." It's a lesson a few could do with taking on board - and not just within podiatry either.

    All the best.
     
  13. antipodean

    antipodean Active Member

    I don't care if chiros can call themselves professors I find pods reputations are higher in the eyes of both the public and other health professionals. Be it mechanics, IT services or any other service I steer clear of those who put titles and testimonials in prominent places.
     
  14. Tomato and Cock-a-leekie ;)
     
  15. W J Liggins

    W J Liggins Well-Known Member

    Well, I frequently find myself in the soap!

    (For those who are unaware 'Batchelors' is the name of a well known soup producer in the UK, and I'm generally pretty fussy about spelling and grammar.)

    Sorry about that Mark and thanks for the 'heads up'; 5/10 'can do better'.

    Bill
     
  16. Catfoot

    Catfoot Well-Known Member

    Mark,

    I’m now doubly confused on the one hand you say the public do not care about what is on the business card, then give us all a long lecture on why the profession should have ‘functional closure’. :confused:

    Some of us, usually accused of being Trolls, :rolleyes: have never moved away from our belief in Functional Closure, others skirt around pretending to agree to it, then claiming ‘foul’ for the now unregulated.

    Lets face it, the ‘profession’ however you define it, is a mess, as is all UK regulation, neither the representative bodies nor the government are going to change that.

    The HPC are now to regulate the Social Workers, and in doing so become the HCPC :rolleyes: what the f*** do they know about Social Work? Nothing, but they are ‘jolly good regulators’, arguably!

    (In the meantime those of us in the private sector have to do yet another reprint of our practice stationary.)

    While I have no great love for our friends across the pond, their habit of pulling a gun when you disagree with their orders does seem to work.

    regards

    Catfoot
     
  17. rosherville

    rosherville Active Member

    Catfoot

    'Does that go for Tom Cats as well ?

    Sadly yes, the 'unkindest cut of all'

    Regards

    Rosherville aka John Mason
     
  18. David Wedemeyer

    David Wedemeyer Well-Known Member

    Gentlemen,

    The main reason that I responded to this thread was that I found David’s comment “He said no they were a choro thingummy proctor.” very offensive and unprofessional. I don’t feel that it is productive to disparage other licensed health care providers to make your point. I see this enough over here often as I do a fair amount of work for orthopaedic foot & ankle specialists and their views on podiatrists are often voiced with disdain and the same level of vitriol (and by the way quite a few refer their patients for chiropractic care as well).

    The second reason that I responded was to hopefully provide some understanding of the use of the title doctor by DC’s in the US; this is after all an international forum. Being in the minority as a DC who also dispenses and provides foot orthoses on referral from allied professions as a Pedorthist, I do not feel that patients are confused as to my role(s). As well, I do not hold myself out as providing anything other than quality chiropractic care and foot orthoses.

    If that ruffles some feathers or the fact that my signs, website and business cards simply state my name, followed by my professional designation and the words “doctor of chiropractic” and “certified pedorthist” give you pause or a chuckle so be it. I wouldn’t think of deriding a UK pod because they cannot perform proper surgery or call them “toe clippers”, especially on an international forum. Obviously there are differing levels of training in chiropody outside the US but here where “their habit of pulling a gun when you disagree with their orders does seem to work” we call our DPM’s and DC’s doctor and rightly so.

    The UK and US have very different educational systems, scopes of practice and regulations regarding use of title apparently. We have similar turf wars here and you’ll notice a number of your own profession represented here are keen on manipulation, although it was not taught at the university level. I find that ironic because everyone knows them “choro thingummy proctors.” Aren’t “real doctors”

    I’ll leave you to your discussion now, best wishes and Godspeed sorting this all out ;)
     
  19. George Brandy

    George Brandy Active Member

    David,

    Please accept my sincere apologies if the debate between my colleagues has caused you offence. It was not intended to do so. I suspect our humour, our issues with title and even our ability to say "sorry" is an example of the divide between the UK and the USA.

    The other David, the original poster, was simply using this example to highlight the fact that in the UK the most important part of the discussion he was overhearing was not the competency of the practitioner treating the person with a sore back, but the fact he was a Doctor.

    I admit I do not entirely understand David's last paragraph. Bill Liggins pointed out the HCPC, our regulator, does not regulate the professions who tend to use Doctor in an "honorary fashion" but Catfoot astutely picked up on the inappropriate use of title in advertising and I thought this could be a reasonable debate.

    Mark now seems to think so too.

    I don't tend to use big words when I am debating so semantics and schisms may be umbrella terms others choose to describe the UK situation but I don't. I am a little more down to earth and understand the lay persons view point that doctors and nurses are instantly recognisable, allegedly trustworthy and the ones to choose when deciding on which chiropractor, podiatrist, physio or osteopath if the words "doctor" or "nurse" feature in promotional material. The use of these honorary titles, or in some instances earned, is likely to be misleading in the UK as it does not necessarily indicate competence in their profession. I realise the situation in the US is very different.

    But David, thank you, this statement (much cut) of yours highlights the difference between our countries...
    In my opinion the educational systems leading to the various qualifications in foot health in the UK needs a massive overhaul, consistency and agreement before we can even contemplate levels of competency of foot care suppliers and professional closure.

    GB
     
  20. W J Liggins

    W J Liggins Well-Known Member

    Hello David

    I'd join George in sensing that the OP did not intend any disrespect to you or your colleagues whether in the USA or over the pond here in the UK but was illustrating his point. However, can I just gently point out that there are clear misunderstandings internationally. For example, you state that you 'would not deride a UK pod because they cannot perform proper surgery'. You are falling headfirst into your own trap since podiatric surgeons in the UK do indeed perform 'proper surgery' and there are many who are, or have been consultants within the National Health Service, which is the highest clinical post that one can achieve over here.
    It is certainly the case that pods on qualifying from the universities are limited to certain levels of skin surgery but, having attended a number of courses in the USA, I understand that there is a similar (although not identical) situation in 'board certification' over there.

    On an international forum where there is frequently a lack of understanding concerning health systems and the education of those who provide services, indeed, as George points out, a difference in humour, philosophy and outlook. It behoves us all therefore to be a little sensitive to contributors from different countries - even if, as we have seen, insensitive to those in our own.

    All the best

    Bill
     
  21. Catfoot

    Catfoot Well-Known Member

    As ever a well balanced post from GB.

    To expand the debate beyond ‘titles’ I think should we also include designatory letters.

    It was once said that these were meaningless, however they still exist and are meant to impress, but also to describe a code of practice to which the user subscribes.

    I suggest it is the rigour with which these codes are enforced that adds legitimacy to the letters.

    However daily we see in advertising members of some bodies breaching the code.

    While it is OK to report these breaches to the HPC, should they also be notified to the appropriate body and what would be the outcome?

    regards

    Catfoot
     
  22. DAVOhorn

    DAVOhorn Well-Known Member

    Dear David Wedemeyer,

    I think you have misread my statement.

    It was the patient of the Chiropractor who had no idea what the title was and how to pronounce the title.

    The patient was impressed that they were Doctors and thus Medical Practitioners who specialised in the Spine.

    So it was the patient who surmised this not me.

    It was not me making the insulting remark.

    I have asked a Chiropractor in the past why they use the Title Doctor when they do not have a Medical degree or a PHd.

    They replied that it reassures the Public. I asked was that not unfair, they replied anybody can use the title Doctor.

    So i would ask that you reread my post and reflect upon what i was trying to say.

    regards David Cooper:drinks
     
  23. David Wedemeyer

    David Wedemeyer Well-Known Member

    David,

    I did understand that the comment was made by the patient. I didn’t feel that it warranted repeating and that it was derogatory as I read it. That said, perhaps my own comments were too harshly critical of you and I apologize for that.

    While I understand the point of the thread, I believe the title doctor is seen very differently in our respective countries as is obvious in this post. I surmise from reading this that your issue is that of regulation in advertising and that they differ between the US and UK.

    To answer some of the questions posed by Catfoot (Holly?), I know of at least one college in the UK with full reciprocal rights with the US (Anglo-European College of Chiropractic).

    Here, the use of the title doctor s not the sacred territory of allopathic physicians and yet those who are not are typically bound by state board regulations to divulge their specific designation (DC or the word chiropractor) following the use of the title doctor in advertising. Yes, this is more tightly regulated in the US. I agree that no DC (or any other non-MD practitioner) should hold themselves out as being anything other than a DC or otherwise in their advertising. Likewise, DPM’s are specialist doctors and I assume must adhere to similar rules?

    So what makes a “doctor” a doctor? I would say that any provider who enjoys first point of contact, portal of entry care status and must form a diagnosis, treatment plan and can provide independent care for that patient is a doctor. We are physician specialists in the Medicare system (limited to scope) and enjoy broad private health insurance privileges as well, without a referral from an MD/DO.

    I would add that by virtue of higher learning and training to provide the above that any program beyond a master’s (US) in healthcare is a doctorate level program. When you compare the classroom hours, basic and hard science training of MD’s vs DC’s a better understanding of the level of chiropractic training emerges:

    http://www.ncbi.nlm.nih.gov/pubmed/9737032

    So are chiropractors “doctors”? Yes they are doctors of chiropractic, the third largest, healing profession here in the US. Are chiropractors medical doctors, no. I don’t have first hand knowledge of how the profession is viewed in the UK but here when a patient calls to make an appointment I assure you that no one is confused as to the title, role and nature of the chiropractic doctor’s care they are seeking. Perhaps it is different in the UK but the UK colleges follow US educational guidelines (Council on Chiropractic Education) to my knowledge. It is not an honorary title, it is earned.

    So yes, it is a semantic argument I believe but not one without the implications and consideration that you have suggested to protect the public. On that we agree.

    Best regards,
     
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