Monday, January 17, 2011

Family Medicine: Please Call Us "Doctor"

Doctor Jennifer Middleton (MD, MPH) writes a blog called "The Singing Pen of Dr Jen" which focuses on her career as an academic Family Physician.  Her January 13 blog post expresses her desire for the physicians she trains to refer to themselves as "Doctor" when interacting with patients.  Her blog post is here. I responded to it with the following comments.  A lot more could be said: Good topic, Doctor. In the late 70's, we also had resident physicians who didn't want to be called "Doctor". It seemed that the "denial" of doctor "status" was one way to "power down" and not be threatening or aloof from patient "status". I found some clarification about this position in The Healer's Power by Howard Brody, MD, PhD (1992, Yale University Press). I still refer to Dr. Brody's insightful commentary frequently to refresh my insights about power and compassion. While the White Coat Ceremony in medical school serves to help students understand the obligations and potential separateness of our profession, the virtue of compassion (as demonstrated by countless Family Physicians) "is integrally linked to the ethical use of power in the physician-patient relationship. Surely, being with the sufferer and helping him find his own story to attach meaning to his experience is a prime example of shared power. Few things that the physician can do have the capacity to empower the patient to a similar degree.... To be compassionate in response to the suffering of the patient is therefore one of the most powerful things a physician can do: but this is possible only to the extent that the physician is willing to adopt a position of relative powerlessness, to acknowledge that the patient's suffering has incredible power over him and that he cannot remain unchanged in the face of it. This is a major irony of the physician-patient relationship, in which a sense both of one's own healing power and of one's necessary humility forms a synthesis of the apparent contradiction of power and powerlessness." Some physicians may not feel ready for this type of struggle for professional development and don't want to fully accept the title of Doctor.

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