December 26, 2007

How to make patients think of the nurse as a doctor?

Have the nursing program give doctorate degrees and start calling the nurses "doctor"?
[O]pponents... say a plethora of professional doctorates will confuse patients and cheapen the prestige of academic doctorates, or Ph.D.s. Universities should not be forced to dole out doctorates to students doing master's level work, as is happening with nursing...
I agree with the opponents. A master's degree is not a doctorate. And I include the J.D. degree and note that no one goes around calling lawyers "doctor." Sometimes I get letters addressing me as "Dr. Althouse," and I invariably regard it as a mistake.


christopher said...

Ann said:

Sometimes I get letters addressing me as "Dr. Althouse," and I invariably regard it as a mistake.

So do we all, sweetie. So do we all...

Mr. Forward said...

"Call me the doctor
Makes you feel good
Make it feel better now
Everybody should
It’s my own opinion
It’s my point of view
If you really need it now
Call me the doctor
doctor feel good"

Cheap Trick

Meade said...

My doctor is The Doctor.

Trooper York said...

When I was single guy I was a real romantic. Flowers, fancy dinners, attentive and solicitous treatment to the max. So much so that the ladies often called me the "Doctor of Love." Right up to the time they got to see the tongue depressor.

ricpic said...

The question should be: how to make patients think of the doctor as a doctor?
Judging from my own experience it's getting to be more and more of a crap shoot.

PatCA said...

The new degree will include "classes about information technology, health policy and leadership."

This is true of most of the new doctorates, whether in education or nursing. It's make-work. It's pretty much of no scholarly value whatsoever. The university does gain tuition payers though and enthusiastically develops even more "doctorates."

And "leadership" is a code word for leftist advocacy taught by Howard Zinnian-type activists.

The Drill SGT said...

Is UW on quarters or semesters?

cause the article says that the MSN program is 2 years and DNS program will be 3 years, yet says:

May said the master's program in nursing has about 50 credits, nearly double the requirement of most master's programs on campus. The doctorate shift will add about 12 credits, she said.

what is a full load? My MBA at UC was 24 clases (qtr system) or 96 quarter units over 6 quarters.

These nurses seem to have a 25 credit hour load each year, then add another BS year with 1 class each in IT, Policy and leadership?

sounds bogus to me.

rhhardin said...

I'd hold out for Your Honor.

Paddy O. said...

This seems to be a failure of language to keep up with education inflation.

Soon advanced degrees will be expected for everyone, like an undergraduate degree is now.

Maybe Hillary will wrap up Doctorates for Everyone in her 2011 Christmas commercial.

MarkW said...

This was done in my wife's field (who is also in medicine but is not a physician). It hasn't worked out well. The new glorified master's degree 'doctorates' are having the effect of destroying many of the PhD programs in the field and, as a consequence, are harming the overall professionalism and prestige -- previously 'doctors' in her field were PhDs who did original scientific research, whereas now they're just people who've been forced to go through extended-length, extra cost Master's degrees.

christopher said...

Well, I've been banned, but since Ann hasn't deleted my comments, I can only assume she's otherwise occupied.

I figure she's alone in her room, a mouldering wedding cake off to her side, waiting for Glenn Reynolds to link to her. It's so wonderfully Dickensian....

Steven Taylor said...

PatCA pretty much hits the nail on the head--these programs tend be simply piling on more Master-level courses and calling that a "doctorate"--no original research, no dissertation.

I would quibble with this:

And "leadership" is a code word for leftist advocacy taught by Howard Zinnian-type activists.

In my experience, "Leadership" tens to be largely devoid of much of any real content. It just sounds good.

john said...

Years ago, in the ER of our local hospital, a nurse practioner had to come in and finish cleaning and stitching up of my lacerated foot, after the resident MD forgot that sewing comes after cleaning. Always trust an NP (not a LPN, who is only 1 step up from a candy striper) over an MD. Never trust an old RN either, assuming you are conscious and can make decisions.

Never trust a PhD in a trade practice. Keep them in academia where they can do less physical harm.

john said...

Hi Christopher.
Merry Christmas!
Bye Christopher.

john said...

Oops, I forgot to mention above that the hospital is a university "teaching" hospital. Maybe that MD did have a PhD.

jeff said...

I'm sure when Chris gets his GED it will be comparable with anyone's JD. Then we will have to call him "GED Chris" rather than the more common "Is that asshole living in his mother's basement STILL have nothing better to do that haunt a site that he contributes nothing to and has been asked a number of times to go away"? So you can see where "GED Chris" would be much easier. Good luck with the test. Try to remember: Hole in the ground=depression in the earth, like a cave, or where a prairie dog builds his home, and ass=that place you store your head. You get those right, and you're well on your way.

mcg said...

Very interesting!. Certainly, holders of non-medical doctorates should only be referred to as "Dr." in an appropriate academic or professional context. As a holder of a Ph.D. in engineering I regularly correct people who refer to me as "Dr." casually or socially.

But these other medical "Dr.'s" pose an interesting problem. Seems to me that the protocol is going to have to be defined very sharply in order to avoid confusion.

Beth said...

John's comment of 11:59 isn't an atypical story. This faux-PhD arrangement could ruin nursing, and that's a far worse outcome than diluting the MD degree. My brother, and RN, says his main responsibility is to keep doctors from killing patients. He's not saying doctors are incompetent in their medical knowledge, but that they don't have the moment-to-moment responsibility over patients' treatment, and create errors in their rush to finish rounds and move on to another patient.

The Drill SGT said...

Beth (take all of this in the joking spirit it was intended :)

All of this of course is fallout from women's liberation. Before that, the best and brightest women went into nursing and teaching, those being the only 2 "professional" fields wide open for women. Ever since we started letting women do just any old jobs they wanted, instead of 2 of the 3 God intended for them, things have been going down hill. Both fields seem to be attempting to upgrade their appeal to post-feminist women by creating make-work faux-professional degrees.

althouse too said...

Perhaps we need a means of distinguishing between "professional degree doctors" and "academic degree doctors". Then the various fields could sort out the proliferating "doctors" within their fields.
Since my wife is an advanced practice nurse with a masters, I know that she would still consider herself an advanced practice nurse with a doctor degree of some sort. All the pharmacy programs are now two year Pharm D. degrees after college. These folks do not tend to call themselves "Doctor" either. Optometrists are "doctors" but not equivalent to opthamologists. Most people in health care know their role.
Lastly, I am a Dr. Althouse, no relation as far as I know, but as a dentist, I do not feel Dr. is my first name as some of my medical colleagues do, and always introduce myself by first and last name, even to patients. The Dr. will get you by gatekeeper administrative assistants and allow you to talk with many people directly! Otherwise you were just in school for a long time.

Meade said...

Dr. Science

Beth said...

Drill Sgt., you think maybe they're trying to appeal to men? Dude, yes, you'll be a nurse, but you'll be DR. NURSE. Cool, huh?

My brother did 8 years in the Army, knocked around at a bunch of little jobs for 10 years, then became an RN in 1978. He took a bit of ribbing about the "cap and pin" ceremony but he's a feminist so he laughed that off. It's a great job for men, though; the upper body strength is useful, and there's adreneline-pumping excitement.

Sigivald said...

mcg: Remember that "who gets called Doctor" isn't so universal.

Germans expect to be referred to as "Herr Doktor" if they have any doctorate; the practice is, as far as I know, universal in Germany.

It might well only be the English-speaking world that reserves "Doctor" (or the local equivalent) for a subset of medical degree holders. Anyone know how the French, Scandis, Russians, and Japanese do it?

I'm almost more sympathetic with the Krauts on this one; a real doctorate isn't easy to get, and I see nothing wrong with calling someone with a PhD in physics "Doctor" - though I'd only call an MD or DDS "Doc".

Mortimer Brezny said...


My doctor is The Doctor.

JimM47 said...

People doing academic work on serious topics in a scholarly setting will often be addressed as Doctor. I have seen other bloggers comment on this as well.

Some people assume professors all have PhDs or forget that people working on a doctorate write the same sort of things as people who have doctorates.

My personal theory is that "Dr." is easier to spell than "professor." I mean, how many f's does it have? How many s's? Easier to just type three characters and be done with it.

The Drill SGT said...

Germans expect to be referred to as "Herr Doktor" if they have any doctorate; the practice is, as far as I know, universal in Germany.

The Germans are title crazy though.

The wife of a Doktor is Frau Doktor, and don't you forget it.

and they concatenate titles as well. One can be Herr Professor Oberst Doktor if one is both an Army Officer and hold a doctorate, and one can certainly be a Herr Generalmajor Graf (Count), though I have never heard of linking a military, professional and aristocratic rank in the same sentence, nor do I know how the wife is handled.
My perception is they string them from least to greatist, but I don't know that for a fact.

Ann Althouse said...

1. Americans don't use "Dr." unless you're a medical doctor. (But there's an odd race-based exception for Martin Luther King, Jr., Condoleezza Rice, etc.) I think if clinics started addressing the nurses as "doctor" because they had doctorate degrees, patients would feel deceived.

2. I think "Professor" is a wonderful title. I remember the first time I was called that, by an editor, before I got my teaching job, and I launched into a reflexive I'm-not-worthy-routine. I'd much rather be called Professor Althouse than Dr. Althouse. After more than 20 years, I still feel thrilled and honored to be called "Professor."

Bruce Hayden said...

Yes, the Germans are a bit overboard. One friend is addressed as Professor Doctor Doctor Lt. Col.

As a patent attorney, I have cause to communicate routinely outside our country, and I am addressed in such cases more often than not as "Doctor".

Here, it is rare. But I mave a male bonding ski group that includes MDs, a PhD, PharmDs and (formerly) a DC. So, I now have them addressing me as "Doctor" when we start doing the doctor thing.

There has long been a problem between MDs (and associated medical doctors like DDS, DC, DO, etc.) and PhDs. Indeed, in one situation I know well, the father was an MD, and that title was reserved for him, as long as he lived. But then, after he died, his kids with PhDs started using the title (outside business). Of course though, there has always been an exception for ministers (e.g. Dr. MLK, Jr.)

Also, the nurses may be following the lead of the pharmacists. When I was an undergraduate, pharmacists got a BS degree after five years of schooling. Now, most of them are graduating with a PharmD with maybe seven years of schooling.

There are a lot of reasons behind this, but one of the big ones seems to be to put themselves on a more even footing with MDs in the medical field, with the argument that they really typically have forgotten more about their specialty, drugs, than most MDs know.
And I really can't fault them, as there are a lot of people who die every year from that lack of understanding of the drugs they prescribe by physicians. It is much harder to tell a superior than a peer that they are endangering a patient with this lack of knowledge. So, part of the goal is to integrate pharmacists into the practice of medicine at a higher level of the medical hierarchy.

Which gets us to the nursing doctors. I would think that their rationale is similar to that of the pharmacists. Physicians do what they are trained to do well. The problem is that medicine is getting ever more complex, and it is arguably becoming harder and harder for them to do what they are responsible for well. And, thus, a lot of people die every year due to this difference between their training and their responsibilities.

I do suspect though that these nursing doctors are going to have a harder time than the pharmacists pulling this off, because their expertise comes closer to a physicians core responsibilities.

Kev said...

Americans don't use "Dr." unless you're a medical doctor

I've found this to be true in most cases, assuming one is off-campus. Growing up, I had a college-professor neighbor who was there for years before I ever knew he was Dr. Jones, because he never used it socially.

On the other hand, I had a friend whose scientist dad actually answered his home phone "Dr. Smith." It always seemed pretentious to us...

I think "Professor" is a wonderful title.

Agreed, even if our college jazz department is so informal that the title hardly ever gets used. The first time I was called Professor was a bit premature--I had just received my graduate teaching fellowship, and my dad greeted me that way the first time we saw each other after that--but it was still a proud moment.

Pogo said...

I used to be opposed to the expansion of medical care beyond the traditional MD degree. No longer.

MDs, like JDs, are a guild system that, under the guise of "the best interest of the patient" uses the power of the regulatory state to limit competition. But PAs and NPs have been around for many years, and have their niches. Now optometrists and pharmacists want to prescribe, too. I cannot say that would be a bad thing.

Each group seems to think the other is composed of idiots and charlatans, and each has stories of saving some patient from disaster caused by the incompetence of the other. It was ever thus, in every field.

The Nurse-Doctorate is unlikely to be used in any actual direct medical care, however. The nurses have realized that we are drifting into a fully nationalized health care system, and want a piece of the administrative pie. In national heath care, patient care is for chumps. The real money is in government, and nurses are taking a page from the teacher's union playbook here, and elevating themselves over other potential administrators.

Basically, they want to tell you what to do.

Pogo said...

What we could use is a modernization of the 1910 Flexner Report to provide a useful signal to patients what the various levels of medical practice actually means, expertise-wise, because things are slowly returning to the haphazard way medicine used to be taught.

"Medical education in the United States today is strikingly standardized and demanding. It was not always so. Prior to the widespread implementation of educational reforms, medical training was highly variable and frequently inadequate. It was not until the early decades of the 20th century that a "uniformly arduous and expensive" system of medical education was instituted nationally.

In the 19th century, most medical education in the United States was administered through 1 of 3 basic systems: an apprenticeship system, in which students received hands-on instruction from a local practitioner; a proprietary school system, in which groups of students attended a course of lectures from physicians who owned the medical college; or a university system, in which students received some combination of didactic and clinical training at university-affiliated lecture halls and hospitals."