Rebecca Hendren, for HealthLeaders Media, October 4, 2011
As a child addressing thank you notes for birthday gifts, I was perplexed by the one relative whose address began "Dr. and Mrs. John Doe." I knew he was not a Doctor and yet he was called doctor. My mother explained he was a doctor, but not a "Doctor," and you can imagine the emphasis on the second doctor.
This was my first introduction to the confusing world of honorifics and it hasn't become any simpler since.
We all know that the title "doctor" refers both to physicians with medical degrees and to people who have been awarded a doctorate in a certain subject. These days patients often visit "the doctor" and are seen by a nurse who has an advanced practice degree and whose title includes the right to use the honorific term doctor.
Physician groups have been voicing concerns that the growing numbers of nurses who are also doctors are confusing for patients. Nurses are concerned that advanced practice professionals who have received doctorates in their field are afforded the proper respect and receive the designation that advanced study and knowledge is usually afforded in other fields. The patients are left in the middle. Most patients grasp the differences between a physician and a nurse practitioner (or a physician assistant). Where many patients become confused is when the advanced practice nurse is referred to as doctor. As in, "hello Mr. Green, I'm Dr. Blue."
Nurse practitioners using the title with patients in care settings makes some physicians apoplectic. Their reaction leaves advanced practice nurses fuming. It leaves me perplexed. Why would any nurse want patients to think he or she was a medical doctor?
Nurses don't want to be doctors. Advanced practice nurses could have chosen medical school if they wanted to become doctors. Instead, they chose to expand their study of nursing through advanced practice programs such as anesthesia, nurse practitioners, or the rapidly expanding doctorate in nursing practice.
Choosing further study in the nursing profession is a commitment to the nursing model, which emphasizes holistic patient care. Nurses approach their profession in a very different manner than physicians approach theirs and both are valuable and necessary to the overall provision of care in this country. Indeed, given the physician shortage, particularly in rural areas, the only way to meet the country's needs for primary care is through advanced practice nurses.
So advanced practice nurses are necessary, vital, and supported by the public. Study after study has shown equal, or in some cases better, outcomes in patient care from advanced practice nurses. A study in the northwest last year revealed patients found nurse practitioner care just as good as physician care and the nurse practitioners were rated higher for listening, bedside manner, and spending time with patients.
Advanced practice nurses must be celebrated for their quality of care and for the ways they approach providing care. Calling them 'doctor' can take away from that perspective. I'm not a big fan of titles and don't see why using doctor is a benefit.
The controversy is a distraction from the wider issues of patient access, removing barriers to nurses practicing to the full extent of their training, and improving quality and outcomes. Physician groups have a tendency to use the topic of patient confusion as a smokescreen for their larger concerns over fears about increased advanced practice nurse autonomy and prescribing power and dwindling shares of the reimbursement pie.
Ultimately, patients don't care about titles as long as they see the right person, at the right time, who can provide the right care.
Source: HealthLeaders Media