What’s in a title?

As the BMA calls for the Government to change the name of physician associates, Dr David Salkin reflects on the importance of having clear titles in medicine

I’ve rarely been mistaken for anyone else, or anything else. But it has happened.

A patient once said that I could pass for the Irish singer-songwriter Gilbert O’Sullivan, although that was when I had a full head of curly hair, and before the patient had heard me sing.

And earlier this summer, when weeding in the front garden, albeit in very tatty jeans, a passer-by briefly enquired what my rates were and whether I had any Thursday afternoon sessions free.

So the news this summer that a physician associate had been mistaken for a doctor had me thinking. Is there an imposter syndrome in medicine? And in some cases, could it be deliberate? Do titles matter?

The dictionary says the word ‘associate’ could imply association, subordination, or partner. It can mean different things to different people, and therein lies confusion where clarity is needed. As a physician associate, you could be a colleague of equal standing, a junior in the first year of training, or a member of the same golf club. It’s really not clear, and while the physician associate – who is undoubtedly a valued member of the team – may in rare cases be quite happy to hide behind such ambiguity, a patient with complex medical needs may not be so impressed, or indeed informed.

Meanwhile, the word ‘assistant’ is much clearer, as it denotes a hierarchy. But the concern expressed to me by several GP colleagues is that some non-GPs may not want to associate with such clarity. Or, as they suggest, ‘pecking order’. Could this ambiguity come home to roost?

I don’t believe that I’m being a hypocrite either. For 10 years, I worked as a clinical assistant in cardiology at our local DGH. I wasn’t a ‘cardiology associate’, that would have been far too grand, not to mention misleading. However, I did invest in a rather expensive stethoscope and learned a few things about ECGs, some of which I still remember to this day. But as far as I can recall, I always introduced myself as a ‘local GP, helping out in the clinic today’. I knew – and hopefully still know – my place in the pecking order.

But at least for now, the title ‘Dr’ still has some meaning. How did you react when the title first appeared on your chequebook, a few months after qualifying? How did the sober excitement of that title merge with the very great clinical responsibility about to be thrust upon those young shoulders? And today, years or even decades later, do you ever correct someone who calls you ‘Mr’ or ‘Mrs’ when you’re getting a quote or booking a reservation? Or does that reek of pomposity?

If you were looking for someone to clean your carpets and came across an online business named ’Carpet Doctor’, would that description floor you? How would you feel if the GMC stripped you of using the title ‘Dr’, unless somewhere along the way you’d managed to get a PhD under your belt?

Whatever we call ourselves, our patients may have different ideas. A few call me ‘Doc’ (quite endearing). Some South Asian patients refer to me as ‘Uncle’ when talking to their children (especially endearing). Then there was the patient who insisted on always calling me ‘Mr Salkin’, despite a self-professed lack of evidence for having a surgical qualification (not at all endearing).

Titles really do matter. They don’t signify superiority, or inferiority. But they do inform people of experience, of qualification, of expertise. Patients have a right to know. And quite often, patients themselves will have their own professional titles missing from the computer record, despite several attempts to have them corrected. We’re clearly in this name game together.

Don’t mind me, though. If this all seems rather precious, please be reassured that one day, when I get rid of the tatty old jeans, and I am knighted or admitted to the House of Lords, and you don’t know what to call me, plain old Gilbert will suit me just fine.

Dr David Salkin is a GP in Leicester