Tag doctor

Should Nurse Practitioners Be Called Doctors?

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For this post, I am starting it off by copying and pasting an article by Art Caplan, who is from the Division of Medical Ethics at the NYU Grossman School of Medicine. In this transcript, he discusses a lawsuit which three nurse practitioners filed in California. For those of you who would like to see the original post as well as the video, please click here.

Three NP’s With Doctorates Sue to Use ‘Doctor’ Title”; Ethicist Disagrees

Arthur L. Caplan, PhD

August 08, 2023

Hi. I’m Art Caplan. I’m at the Division of Medical Ethics at the NYU Grossman School of Medicine. A lawsuit has been filed in California by three nurses. The nurses are arguing that because they have PhDs in clinically related fields of nursing and healthcare, they ought to be able to use the term “doctor” as a sign of respect for the work that they did to get a PhD.

That’s no insignificant amount of work. I have a PhD in a different area, but I know the kind of labor that it takes to complete that kind of a degree. I have no doubt that there are many advanced skills associated with having a PhD in one of those nursing areas that benefit patients.

The nurses say that California law, which currently restricts the use of the term “doctor” to MDs or DOs, ought to be expanded to recognize their PhD work. I don’t agree with this even though I certainly have nothing but respect for the work that nurses do, whether they have PhDs or not.

It seems to me that patients really come to hospitals, clinics, and healthcare settings distinguishing, if you will, between doctors (MDs and DOs) and nurses. They may have their ideas about what each of them do, and they may be wrong about what each of them do. I think the road to gaining respect for the work, the contributions, and even the importance of what nurses do is not to start to broaden the use of the term “doctor.”

Part of the reason I worry about that is that it’s a slippery slope. There may be others coming in who want to use that term. Some PhDs in bioethics may start to say, “Well, I’ve done a large amount of work in healthcare-related fields. Maybe I’d like to have that term used for me.” People in some of the more life science–oriented fields may do the same.

I don’t think heading down that road is the way to go. Instead, I would suggest that we try very hard to honor and recognize the work that all healthcare professionals do, including physical therapists, social workers, chaplains, doctors, nurses, lab technicians, and radiation technicians. When I have been in the hospital, I deeply respect all the work that those folks are trying to do to help me.

I don’t use the term “doctor” so much as the only person who’s worthy of respect or the only person who’s in charge. I use it just to distinguish between the set of skills, responsibilities, data collection, recommendation of therapy, and so on that, in my own head, correspond to different roles that people are doing.

Do nurses deserve more respect when they complete the difficult path to a PhD? Absolutely. My argument is simple. Let’s teach everyone who goes to the hospital. Let’s teach our students to respect everybody’s work, to respect the roles and professionalism that everybody tries to bring to the care of patients.

I don’t think having a battle over who really gets to use the word “doctor” is the best path forward because it still may lead to confusion. I think the path forward is learning to respect what all parties contribute in the care of patients.

I’m Art Caplan at the Division of Medical Ethics at NYU’s Grossman School of Medicine. Thanks for watching.

Now for my two cents…

I am in complete agreement with Art Caplan, and see absolutely no reason why these nurses who have PhD’s feel that they have the right to use the title of ‘doctor’ (due to the PhD designation and NOT MD or DO) and potentially confuse their patients. I firmly believe that unless someone who works in healthcare actually obtained an MD or a DO, that the individual has no right to insist on being referred to as ‘doctor’. If the title of ‘doctor’ is so important to someone who is interested in working in healthcare, then I suggest that the person attend and complete medical school and residency training just like I and countless others did. We put in the work, and we earned the doctor title.

Doctors Are Detectives

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Image ID : 14903561
Copyright : ostill

There is tremendous responsibility in being a physician, and I take it very seriously. Any time I walk into a medical facility and see patients, I know that the patients and staff are all counting on me to assess patients fully, make proper diagnoses, and provide appropriate treatments. Basically, I know that I MUST make the right decisions at all times and be at the top of my game. Talk about pressure! Nevertheless, the thrill of solving a problem is so rewarding that it quickly eradicates any feelings of anxiety.

I just read Atul Gawande’s excellent book, Being Mortal, and I love this passage in which he very aptly describes the satisfaction which can come from being a physician:

“You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. It is a deep satisfaction very much like the one that a carpenter experiences in restoring a fragile antique chest or that a science teacher experiences in bringing a fifth grader to that sudden, mind-shifting recognition of what atoms are. It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with problem you cannot solve.”

The truth is that pretty much every physician has come across a case which he or she could not solve, one which necessitated a discussion with a specialist, or a lengthy literature review to aid in diagnosing the zebra who walked into the office that day. Physicians are human, fallible, and though they usually have the answers to the puzzles which are constantly presented to them, they may find themselves stumped every now and then, and that is a dreadful feeling.

It is an honor to serve humankind as a problem-solver, and I will always strive to keep my clinical acumen as sharp as possible in order to provide the best medical care.

Consistency (Updated Post)

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As a physician, I am as much a therapist as I am a physical healer, and am well aware of the vital connection between mind, spirit and body. I have also seen how closely linked emotional stress is to development and exacerbation of physical ailments. What concerns me is when people abandon healthy habits during times of adversity, because it is at those times that some structure would provide balance to their lives.

A common question I hear from patients, clients, and strangers I meet is, “How can you maintain a regular exercise schedule and pack your food all the time with your busy careers?”, to which I respond, “I just do it.” Working out and eating right are as essential to me as sleeping and brushing my teeth. It never occurs to me to abandon healthy habits during stressful times. I recently went through a particularly difficult month during which I took a rigorous board certification exam, went through a residential move, and traveled to four destinations (two for my medical career, two for fitness and bodybuilding) over a two week period. Though I didn’t work out my usual six days per week, I did manage to train four to five days per week, every single week. The regular workouts gave me structure and balance which helped me to burn off some of the stress I was under, regulated my sleep cycle, and just plain felt good. In addition, I traveled with clean foods and lots of water, packing them and making sure I stayed on track.

Why would I push myself like this? Because I know that consistency is key to maintaining balance in one’s life. When I am consistent with my workouts and food, I maintain structure and focus and do not allow excuses of an insanely busy schedule to deter me from my mission to live an optimally healthy lifestyle. I know that if I were to deviate from a healthy lifestyle, I wouldn’t have the energy to push through my to-do list, and I certainly wouldn’t be very happy either. No matter whether I am traveling, working, or enjoying a rare free day for myself, I make sure to invest in myself every single day.

When I worked the Arnold Sports Festival Expo in Columbus, Ohio earlier this month, I made sure to drink plenty of water, filling up my one liter container 3 to 4 times each day. I also brought my Hot Logic Mini with me (https://youtu.be/GQltYTRLTC4) and had meals from Icon Meals with me, and I made sure to consume a meal every 3 hours to keep my energy levels up. If you are committed to living a healthy lifestyle, you will find ways to stay in line!

If you make an investment in yourself by being consistent with your exercise and meal habits, you will be rewarded with greater balance in your life and better health. Don’t you deserve that?

“Are You Sure You Broke It?”

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It’s amazing how much an injury to a small area can hurt like the dickens! I recently fractured my right great toe by dropping a 25 pound weight plate on it (oh, the hazards of being a gym rat…) and have been dealing with a tremendous amount of pain from the injury. I had done the exact same thing (albeit with a 10 pound weight plate) on the left great toe back in 2002 and experienced pain in my toe for a full year, so I am dreading having to endure the healing process again. Driving has become a major hassle, because pressing on the gas and brake pedals loads a pressure on the extremity which radiates to my poor broken digit. I am now limited to wearing flip flops and a couple of pairs of athletic shoes with larger toe boxes which accommodate the swelling somewhat. I say somewhat because the athletic shoes I have worn have created nasty blisters on the top of my toe, creating a completely different type of pain which is stacked upon the deep bone pain. Oh what fun.

When I shared the news that I had broken my toe, a couple of people had asked me if I knew it was broken, and one person kept yammering on about what to do to treat the fracture. I am a medical doctor who has seen more than my share of fractures, and I KNOW what a fracture looks like. What I don’t understand is how people can ask me if I know for sure, or how they can tell me I need to see a doctor for it. Rest assured, I am in excellent hands with my doctor: ME.

Here is a collage of images taken of my toe from 30 minutes post-injury to 36 hours post-injury. No X-ray will aid in the diagnosis, nor will it change the treatment course. Yes, it IS broken. This injury will definitely set me back with training and competing because I will not be able to perform plyometric exercises, treadmill work, calf work or lunges for a while. However, I will not be deterred from continuing to train around my injury, and will take this opportunity to develop a heightened awareness of pushing through the heel while performing exercises which target the glutes. Who knows, maybe this injury will be a blessing in disguise, a tool to help me round out a problem area?
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