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Like This - Do That
28th Feb 2006, 06:46
G'day PPRuNers

I grew up believing surgeons to be called 'Mister', not 'Doctor' (mum is a former nurse of the 'old school'). It seems that increasingly surgeons answer to 'Doctor' ..... when did this trend start?

For those of you shaking your heads wondering "who gives a sh1t" I agree - it doesn't matter very much. Just interested, that's all.

Cheers

acbus1
28th Feb 2006, 06:53
Sir.

:\

BlueDiamond
28th Feb 2006, 07:01
Well, the "Doctor" title that we give to our general practitioner or personal physician is a courtesy title only. Unless, of course they have a PhD in something, in which case they would be genuinely a "Doctor." The same would apply to a specialist; if he or she does not have a PhD, they are no more "entitled" to the term "Doctor" than anyone else.

Everyone seems to use the title these days though ... vets, dentists, chiropractors ... it does seem to be a growing trend, while the tendency to call a specialist "Mister" seems to be on the decline. What does one call a specialist who is a woman? Ms? Perhaps the term "Doctor" is being used to dispense with that awkwardness. As you say, who gives a rats what they're called ... that they do their job is the only thing that matters surely?

acbus1
28th Feb 2006, 07:09
What does one call a specialist who is a woman?
Depends upon what she specialises in.

"Mistress" is my favourite. :E

Fernando_Covas
28th Feb 2006, 08:29
At the end of the day a doctor is a doctor (Years of working for the NHS made me arrive at this). And female surgeons are called "miss".

BALIX
28th Feb 2006, 08:30
Well back here in Blighty surgeons cling desperately to their 'Mister' monicer. There has been recent debate about changing their title to 'Doctor' but there is a lot of resistance to it.

The reason they were called 'Mister' in the first place was because they were not medical doctors. They were butchers. After all, you didn't need an Oxbridge education to chop someone's leg off back in the 1700s. A set of sharp knives was the only prerequisite.

Today, of course, you have to go through just a little bit of rudimental medical training before you can perform open heart surgery but the title still remains. You still need the sharp knives, though.

tilewood
28th Feb 2006, 08:34
I'd call them what ever they wanted when they are standing
over me waving sharp pointed metal items around. "Sir, God, Christ!!" :eek:

lasernigel
28th Feb 2006, 08:54
In last job worked in hospitals around this country and abroad.In England once you're a consultant they want to be called Mr not Dr.However in Scotland most prefer to be called Dr's except when they have a 'chair' then most are Professor.

Jinkster
28th Feb 2006, 09:03
who cares as long as they call a captain, a captain:}

ORAC
28th Feb 2006, 09:09
I take it Bones is right out then.....

Capn Notarious
28th Feb 2006, 09:27
I take it Bones is right out then.....
Yes it is. MR or Miss for a surgeon
Dr for the others.
If it ain't broke why try and fix it. Unless the sands of time have worn yer down and yer need restoration.
Restaurentation could make yer fatter!

Re-Heat
28th Feb 2006, 09:37
Consultant surgeons are not known as Dr, since the medical business (in ages gone by) deemed surgery to be the most basic and unskilled of arts (hence the link to barbers whom were the most common original surgeons), therefore they were not deemed entitled to be known as Drs.

This is now a mark of pride to earn the elimination of "Dr" once one reaches consultant level.

The fact that UK doctors do not earn MDs is irrelevant - it is not dissimilar to Oxbridge graduates 'earning' their MA 7 years after matriculating. It is a sufficient enough convention to say that MBBS (or whatever the university's degree course is titled) entitles one to use Dr. upon graduation.

Conan the Librarian
28th Feb 2006, 10:26
Interesting... My understanding is that consultants can be either Mister of Doctor, but the general rule is that those that do the cutting are mister and those that don't, as in mental health for instance or non surgical neurology, are Doctors. It is maybe also why the health service accountants are known as Mister :}

Conan

Mac the Knife
28th Feb 2006, 10:32
As several people have pointed out, the Doctor vs. Mister bit comes from the Middle Ages, when most of the people doing the actual cutting did not have a medical qualification (though qualifications were a bit elastic at the time!). The operators were the often the local barber - he used to do the venesections for "bleeding" (a popular remedy for lots of things), so by extension, why not the cutting?

Some old woodcuts show the "physician" directing the "surgeon" what to do with a pointer (though I'm sure they didn't have any more idea than the operator!).

The transition from Doctor to Mister traditionally takes place when you pass your Fellowship exam from one of the Colleges of Surgeons -[I'm FRCS (England) myself (the best;) ), from back in the days when it really meant something] - I remember being very chuffed.

As for who calls themself Doctor, despite the point made about having a doctorate, I'm inclined to think that it should be confined to medical doctors - even as a courtesy title for those who have a mere MB, ChB. [I have an MD, so I can call myself Doctor].

The trend for everyone and his wife who has the least excuse to call themselves Doctor is I think a bit silly - look at Africa, where half the politician call themselves Doctor on the flimsiest of pretexts - it doesn't really fool anyone that they're any smarter and is often hilariously pretentious. Bit like someone in a rowboat donning a naval cap and stripes and insisting on being called Captain. But if you really have a Ph.D. then I guess it's OK.

The old Doctor vs Mister differentiation seems to be dying out worldwide (never existed in the States and in S.A. it only survives in Natal) and it seems a bit sad - another link with history and our traditions expires.

With the restructuring (read destruction:* ) of surgical training in the UK to bring it into line with huggy fluff ideas and the EEC, the old titles don't mean so much anymore, so perhaps it is for the better....

Mr. Mac

PS: It's a bit like "Professor" - in the old UK there were damn few full Professors (in a Chair) and the title truly meant something - now every greenhorn faculty member is an associate professor and insists on being called Prof! Pathetic...

It's all part of a worldwide trend by the ignorant and semieducated to try to cheapen everything and drag everyone down to their level of incompetence and/or mediocrity.

slim_slag
28th Feb 2006, 12:15
Turned up for my first ever outpatients clinic as a naieve medical student and the surgeon was over the moon that he was the first person to get to us in a clinical setting. So he spent the whole time telling us that surgeons are called mister as it's a promotion over doctor. This differentiation is important, he said, because "surgeons are physicians who operate". Took me some time to realise this is bollox, but the truth soon filtered in.

It's not when they start calling themselves mister after passing that trivial clinical exam called FRCS (a shadow of the MRCP where they make you sweat blood in the clinicals) that makes me laugh. (I understand the writtens are a bit more tricky, but they have to make FRCS slightly difficult or else we'd all have one:) ) It's when they get FRCS and then take their white coat off and start wearing a suit as a mere registrar. Nowadays it's all theatre kit, the old traditions were far more fun.

air pig
28th Feb 2006, 14:30
I recall a couple of years ago in the ICU were I work, all the junior surgeons came in for the morning ward round dressed in black suits, both male and female. My comment to them was that either they where on an awayday day for undertakers, or Mormons looking for converts. Exit one very p****d off bunch of surgeons with their pomposity punctured, but they were Cardiac surgeons.

welliewanger
28th Feb 2006, 14:42
In medicine, once they qualify, they're called Doctor. When they reach consultant level, they revert to being called Mister. Not sure why, but that's the way it is.

slim_slag
28th Feb 2006, 15:24
Nope, as mac said, it's after they get their FRCS. This is the surgical post grad qualification that lets you call yourself a surgeon proper, meaning Fellow of the Royal College of Surgeons. This induction consists of a really nasty written part where you will fail unless you have memorised Grays anatomy verbatim. Failure rate on this is high as learning Grays anatomy is a bitch. One understands that in the 70's they changed the rules to let you have six attempts as that was the number of times the then President of the college required to pass.

This is followed by a clinical examination where you are presented with a series of patients with assorted lumps, bumps and other physical abnormalities. After examining the patient, and finding said lump/bump/abnormality you are asked by the examiner what you would do about it. If your answer in all cases is 'Well Sir, I think I would hack it out' you will pass, and can call yourself 'mister'

:)

Bronx
28th Feb 2006, 16:14
Good post Mac the Knife.

air pig
Now let me guess.
You were looking up the foodchain not down?
Not difficult. Your chip's showing. ;)

I know, you coulda been a surgeon if you wanted to be. :)

Davaar
28th Feb 2006, 16:25
I see possibilities in this, a whole new practice of conflict resolution. When a patient is attended by two physicians, each an MB ChB MRCP; two of the same with MD MRCP; two surgeons each an MB ChB FRCS; two of the same with MD FRCS; and two nurses each with BSc PhD SRN; which has academic precedence? Which has professional precedence? How is each addressed? Which is given the key of the partners' washroom? Does your answer change if one of each class is male and the other female? Discuss. This is a beginning. Already I can conceive of variations. This "field" is where "Human Rights" were a generation ago, and I do believe will lead to my "obtaining", as they say these days, the PhD that has so far eluded me.

Mac the Knife
28th Feb 2006, 16:41
The big hurdle for the FRCS was the so-called Primary exam, that you had to get through first. Anatomy, Physiology and Pathology as I remember. First en masse the written, then if you were good enough, the vivas, in groups of 100 or so. A brute of an exam, with pass-rates between 20 and 30% - some people did it dozens of times, many gave up after the first few goes.

Used to be held in the old Examination Halls at Russell Square. Those walls must have been impregnated with 100 years of fear. Anyway, after the vivas, candidates would gather in a sort of underground cloak-room waiting for some magnificently uniformed beadle to appear at the top of the stairs and read out the numbers of the people who had passed that day.

One day he appeared and a deathly hush enveloped the waiting candidates. ""Gentlemen", he announced, "No one has passed today. Good day to you!"

I know, I was one of them.....

And Davaar, since you ask,

.....which has academic precedence? Which has professional precedence?

Why, the senior surgeon of course! All the rest are mere riff-raff.

Davaar
28th Feb 2006, 16:59
So when I tell you, Mac, that Frau Davaar observed the situation, assessed it as not good, summoned no less a Being than the heart surgeon, queried his bromide assurances, got him finally to admit that he had, No, not screwed up, exactly, of course, not at all, Goodness me, No, but Yes, did have to open me up again after the operation, and by the way and in addition did take venous tissue from my leg because his attempt to take it from an arm had failed, you will agree she can be one tough Prussian?

slim_slag
28th Feb 2006, 17:12
That would be the junior's fault, Davaar. It would be beneath the Great Man to remove the veins, or even open the chest. His SR would crack the sternum and expose the beating heart, his Reg (or if blessed his SHO) would remove the veins, and when all was prepared the Surgeon would enter to attach the veins to the heart. Quite a simple job actually, no idea what the fuss is all about, the anaesthetist is the one sweating (if awake).

It can be important to decide rank on occasions, for instance who is the boss of resucitation efforts when somebody has recently deceased. As surgeons are not generally invited to these parties there is no need to humiliate them by sending them to the back where they can watch the physicians at work, safely placed where they can do no harm behind the medical students.

con-pilot
28th Feb 2006, 17:34
In the US all Doctors (Medical) no matter their field of practice is address as 'Doctor'.

PHD holders can be entitled to be addressed as 'Doctor', however, the majority of PHDs are not addressed by the title of 'Doctor' except when associated with their work, as in casual conversation few use 'Doctor'.

At Los Alamos, New Mexico the birthplace of the Atomic Bomb there were so many PHD Doctors that it was finally agreed to that only Medical Doctors would be addressed as "Doctor".

air pig
28th Feb 2006, 20:14
Hi Bronx

Be a surgeon, you must be joking, I like having a normal life, not as well paid but I leave work at work not take it home 24/7.

Chips only served with brown sauce (English delicacy) or mayo.

Justiciar
28th Feb 2006, 20:38
Damned if I'd give up the title "Doctor" if I'd spent years on a tedious thesis to earn it.

Now in my line we can aspire to "Your Honour" (circuit judge) or "my Lord" (high court judge) or possibly "your worship (magistrates, but unqualified and don't really count). and all you have to do is bamboozle some officials in the Lord Chancellor's department that you can string words together with style:ok:

Unwell_Raptor
28th Feb 2006, 21:35
Reuben slaved for forty years in his grocery store, working seven days a week, fourteen hours a day. No detail missed his eye, no customer was ever left dissatisfied. He was too busy to marry, but he took good care of his old mother. Reuben built a fine business, and in the fullness of time he saw what he had created, and decided to accept a very satisfactory offer from a competitor that left him sitting on twenty million pounds cash.
He went to Camper and Nicholson and ordered their finest ninety-foot ocean-going yacht. The decks were teak, the equipment of the latest technology, the boat was the most beautiful creation on the water.
Next he went to Gieves and Hawkes in Savile Row. He was measured for a Captain's uniform, white trousers, jaunty cap, gold braid, two rows of buttons. He collected the uniform, tried it on and looked magnificent. He decided to surprise his mother who knew nothing of these plans. He was driven to her house, bounded up the steps, and strode into the sitting room.
"Momma" he cried "Look at your boy. Your boy is a captain!"
Momma put down her knitting and adjusted her spectacles. She looked up, and down, and she furrowed her brows.
"Son" she said, "By you you're a captain. By me you're a captain. But by a Captain you're a captain?

Davaar
28th Feb 2006, 21:52
Now in my line we can aspire to "Your Honour" (circuit judge) or "my Lord" (high court judge) or possibly "your worship (magistrates, but unqualified and don't really count). :ok:

We did quite a bit of work in New York state, so one of the partners qualified there (we all thought the QC looked neat on the certificate). Out of habit once he addressed the judge as "Milord".

"I beg your pardon, Your Honour". I should address you as 'Your Honour'".

"Not at all! You can call me 'My Lord' in this court any time you like".

Bronx
28th Feb 2006, 22:01
air pig

Be a surgeon, you must be joking, I like having a normal life

So like I said, you coulda been a surgeon if you wanted to be. You just didn't like the hours.


Yeah, course you could. ;)

slim_slag
1st Mar 2006, 10:24
At Los Alamos, New Mexico the birthplace of the Atomic Bomb there were so many PHD Doctors that it was finally agreed to that only Medical Doctors would be addressed as "Doctor".

Well that will be because US MD doctors consider themselves a class above the rest, which is strange because the phd is a higher degree. You should see how they look down on a mere MBBS which is what UK 'doctors' graduate with. That's quite peculiar too, because from what I've seen, a newly graduated UK MBBS (bachelor level) has more overall knowledge of medicine than a newly graduated US MD.

There used to be two other means of becoming a medical 'doctor' in the UK, neither of them awarded by universities. One was the old conjoint, LRCP MRCS, awarded by the London Royal Colleges. There will be quite a few UK doctors still practicing under that qualification. It was actually quite tough as the MRCS was issued by our old friend the Royal College of Surgeons - so you have to learn Grays anatomy and promise the examiner you would hack everything out :)

The other way was a licentiate from the Worshipful Society of Apothocaries, some ancient city of London body which could issue medical diplomas from the years of quackery. I considered getting that as a bit of a joke as I had heard rumours that as a member of such an ancient London body, you could then drive a flock of sheep across London Bridge, and if found drunk within the walls of the City of London the copper had to take you home. Probably a urban myth.

I also heard the Americans would accept the LRCP MRCS as acceptable to practice in the USA, but not the MBBS. Strange bunch.

Don't think you can get the conjoint/apothocaries now, 30 years ago it was possible, and I knew some who did.

FlyAnotherDay
1st Mar 2006, 10:52
In Britain, Doctor is an honorary title bestowed upon qualified medical practitioners by the community. A minority of these also have MDs or PhDs and so have another claim to the title Doctor. I understand that dentists have chosen to bestow the title Doctor upon themselves in recent years.

In days gone by, part of the Hippocratic oath was 'shall not cut for stone', as physicians were above such base practices. These practices became the province of the barber surgeons, as the barbers had the sharp tools. Physicians would look down their noses and speak haughtily of 'Mr Hyde the (barber) surgeon'. In time, the surgeons became qualified physicians too, but retained the title Mr in a form of inverted snobbery, so we can now look down our noses and refer to 'Dr Jekyl the physician'. Friends wondered why I spent five years at Med School earning the title Doctor only to spend another five loosing it again.

Around ¼ of newly qualified doctors want a surgical career. Only about ¼ of them make it. The pass rate at 2nd part FRCS when I sat it was 12%. Time was when the 2nd part FRCS was the final Fellowship examination. It was also when you became Mr.

From 1986, third part specialty exams were introduced, so I got to add five different letters after my FRCS tag - after more than twelve years of post med school surgical training. Now trainees sit an MRCS which isn't the same as the old 1st/2nd part FRCS, although they still get called Mr. They do however still go on to do the third part specialty exams when they too will hopefully become FRCS(specialty), where specialty denotes which of the nine surgical specilaties they've done the third part exam in.

Mac the Knife
1st Mar 2006, 11:06
Goodness me - I'd forgotten about the Apothecaries Hall

Looking at http://www.apothecaries.org/index.php?page=10 I see that "It continues to award its Licence as a member of the United Examining Board", now as the LMSSA rather than the LSA.

Not to be sneezed at

"John Keats, poet, qualified as a Licentiate of the Society (LSA) in July 1816; Elizabeth Garrett, later Garrett Anderson, became the first woman doctor to qualify in Britain when she obtained her Licence in 1865, and Ronald Ross, the second Nobel Prizewinner in Medicine or Physiology (1902), qualified LSA in 1881."

Ronald Ross was one of my malariologist father's heroes, so that's quite interesting - I never knew he was LSA.

Read about him at http://www.cdc.gov/malaria/history/ross.htm

"On 20 August 1897, in Secunderabad, Ross made his landmark discovery. While dissecting the stomach tissue of an anopheline mosquito fed four days previously on a malarious patient, he found the malaria parasite and went on to prove the role of Anopheles mosquitoes in the transmission of malaria parasites in humans."

"While Ross is remembered for his malaria work, this remarkable man was also a mathematician, epidemiologist, sanitarian, editor, novelist, dramatist, poet, amateur musician, composer, and artist. He died, after a long illness, at the Ross Institute on 16 September 1932.

"..With tears and toiling breath,
I find thy cunning seeds,
O million-murdering Death."

(fragment of poem by Ronald Ross, written in August 1897, following his discovery of malaria parasites in anopheline mosquitoes fed on malaria-infected patients)

So if people had been snobbier we might have been deprived of the life-saving work of a remarkable man.

BelfastChild
1st Mar 2006, 11:15
In Sydney (Down Under) most of the surgeons are called Doctor. Only the old wrinkly ones insist on being called Mister......

Mac the Knife
1st Mar 2006, 11:47
As FlyAnotherDay explains it's all changed a bit recently, at least on the surface.

In the old system after the Primary you got your old FRCS, which was the ticket to a Registrar job and higher surgical training (you'd probably have spent a couple of years cutting as a Senior House Officer before this).

After a year or so (sometimes several) as a general surgery Registrar, you either stayed on as a general surgeon or moved off into your speciality, where you'd spend anything from 5 to 15 years. After a while you'd start applying for Senior Registrar jobs - this was the golden point to get to (many never got an SR job and eventually quit to become GPs - not an option now).

As an SR you had a good life, admin was up to the Consultant, scut-work was for the Registrars and the SHOs, so you could choose what you wanted to cut and even do a bit of research if you were so minded. As an SR you could stay in post as long as you wanted (no termination date), got a reasonable salary, overtime (albeit at ludicrously low rates) which Consultants didn't - and in those days most SRs worked a 1:2 or 1:1 duty so it added up.

SRs were very wise, they seemed to know everything, have seen everything, done most things and were often more up to date than the Consultant!

But as an SR, to progress you needed accreditation in your speciality before you could apply for Consultant jobs. This depended on your boss to back you - if he didn't like you it could take many years. Some people were still SRs in their 50's!

So now:

old Primary=new Primary
old FRCS=new MRCS
old Accreditation=new FRCS(speciality)

Not much has changed really, except that the training is more streamlined so you get there much faster.

Also with far less cutting time and far less real experience (you'll have spent at least two years in a lab researching useful stuff like "d-hydrofolate deficiency in blind, immunocompromised white mice" for your CV)........

If I get sick gimme an old-time SR anyday!

BelfastChild
1st Mar 2006, 14:34
And now it is all going to change again. With these "foundation programs" we are going to have surgeons coming out the other side with even less experience. As for the juniors, instead of being PRHO and SHO, they will now be FY1 (foundation year 1) and FY2 (foundation year 2). However, anyone who has encountered this new breed of doctors knows that this really stands for FY1 (f :mad: k you 1) and FY2 (f :mad: k you 2) - it is impossible to get them to do anything....apparently it is not in their "job description".........:{ :{ :{

effortless
1st Mar 2006, 14:55
I quite liked working in Italy. When I first got there I was called Dotto. When I did a bit of teaching they called me proffesore. :cool: