Any other name

Med Twitter, the community of medical professionals on Twitter, is a fascinating place. Stories and threads range from inspiring patient encounters to tongue-in-cheek comments about the differences between specialties. It’s also a place of toxicity, where older medical professionals can talk down on medical students who “have it easy” now with a thousand iterations of complaints beginning with “back in my day…” It’s interesting, from the perspective of a physician in a Third World country, to see that the tiny arguments, aggressions and differences of opinion that we see locally are reflected even in the medical fields of so-called developed nations.

A recent hot topic is the way that we address Filipino doctors, especially within health care institutions. For those from my (public) mother hospital, it’s a point of pride that physicians, whether junior or senior, are called “Ma’am” or “Sir.” It’s said to be a great equalizer that recognizes that members of a health care team, from nurses to doctors to ancillary staff, are equally important. In contrast there is “Doc”: on the one hand, it’s a clear designation of roles, and is also conveniently gender neutral. On the other hand, some perceive that it enforces a sort of hierarchy which distinguishes, and perhaps unintentionally elevates, the doctor from the rest of the team. (“Dockie,” I am told, is a designation universally despised.)

Some people feel strongly about the terminology and whatever culture it fosters, and for some, myself included, it’s mostly a nonissue; a culture of respect among medical professionals isn’t a byproduct of naming conventions, but is something alive and evolving that requires constant effort in the face of exhaustion, administrative demands, intellectual stress and patient concerns. Still, it’s interesting to see how we call our physicians and what this reflects. It’s a curious tidbit of history that surgeons are addressed as “Mr.” and “Ms.” in the United Kingdom and the Republic of Ireland: Before 1800, physicians were doctors who obtained a university medical degree while surgeons often had different, less formal training, and were thus not called “Doctor.” Later, after the founding of the Royal College of Surgeons which then bestowed a formal qualification on surgeons, it had become a badge of honor for surgeons to be distinguished from other physicians, so that the designation “Mr.” (and later “Ms.”) became a point of pride. Thus the difference in nomenclature eventually became yet another way for one set of physicians to assert their perceived superiority over another.

It’s amusing that, much like the gentleman doctors of the 1800s squabbling over titles, we can put so much stock into how we’re addressed. It’s 2019 and doctors, while briefly the victims of doctor shaming and similar mindless assaults, are still treated with much pomp and circumstance. Our relatives call us “doc.” Security guards in malls don’t check our bags as long as we wear white coats. Demands and whims of bigwig “docs” are met with the same fear and sycophancy usually reserved for minor nobility. The attitudes of people on the phone, on service counters, in retail and in the hospital can do a 180-degree turn when people introduce themselves as physicians. We can still find ourselves on the receiving end of disrespect like any other kind of health professional, but nowhere near the same degree.

And one wonders why that is; why we should persist in cultivating this pretense of hierarchy, as though a medical degree should have earned one a degree of minor celebrity, a free pass not just against color coding, but against a hundred other inconveniences. It bears remembering that medicine, while a noble calling, is just a profession like any other, practiced by those who studied a little longer. We’re not above enjoying these minor privileges, but whether we’re called Sir, Ma’am or Doc, the exaggerated respect given to physicians — especially when contrasted with others in the medical field — should be a thing of the past.

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