Friday, June 19, 2009

Titles and letters after your name

The dose reduction of oxaliplatin has left me less befuddled this time and perhaps the cold-induced parasthesiae are less. I have gone back to the steroids this time with heavy doses of lanzoprazole to avoid the indigestion. This means that I wake at 3am and start to compose a blog. This time I started thinking about titles.

In America President Clinton is still called President even though he is no longer the President. Senator is a prized title and I suppose there are many others. Every country has its own traditions. In Germany the wife of a University Professor who has a medical degree and a PhD is formally called "Frau Professor Doctor Doctor Schmidt". In America even a schoolteacher is known as Professor and most medical academics prefer to be called Doctor except in Europe where Professor is the more revered title.

Medical degrees is the UK are officially Bachelor of Medicine and Bachelor of Surgery (some Universities also add Master of Midwifery) yet everyone is called Doctor. In most other countries the qualifying degree is MD, though in some countries it is simply a license to practise. In the UK many people with a PhD do not call themselves Doctor for fear of being asked to officiate at an emergency. I notice that theologians like to call themselves the Reverend Doctor but musicians prefer Maestro to Dr. In the UK physicians look more to post-graduate diplomas to define their status. Thus MRCP or FRCS are more coveted than than MD or MB,BS. There used to be a qualifying degree called Licentiate of the College of Physicians and Membership of the College of Surgeons (LRCP, MRCS) which those who couldn't pass their University finals took, and for the really hopeless there was the Licentiate of the Society of Apothecaries of Cork which was parodied in the movie 'Doctor at Large' where dear old Cyril Cusack examines Donald Sinden in a ride on a pony and trap and the most difficult question is "What can you tell me about urea?" and Sinden's reply is "Do you mean the thing you hear with of the chemical substance?".

It used to be that when you passed the Diploma exams (which are rather like the Boards exams in the US) you were a Member for a few years and then were automatically promoted to a Fellow when they increased your annual subscription. That's why I have FRCP and FRCPath after my name. To become a hematologist in the UK you have to be doubly qualified in Pathology and Internal Medicine. Oxford and Southampton degrees are a bit different to everybody else's. Instead of having MDs and PhDs they have DMs and DPhils. Which is why my letters are DM (though I often write MD to avoid confusion). In the UK the MD is a research degree like a PhD (though it is usually on a clinical subject rather than a laboratory one. It can be awarded for a period of study in a time out from training or as a result of published works on a particular subject as mine was - 13 years of studying CLL.

Of course all these letters after someone's name can be very confusing. I remember being with Reg Clift in a line for refreshments at a meeting. Together with Don Thomas he pioneered the development of bone marrow transplantation in Seattle. Someone came up to Reg and asked what the letters FIMLS after his name meant. Reg wasn't a doctor (though he practised like one). Before Reg could answer, the then Editor of the Lancet who was an Immunologist piped up, "It stands for Fellow of the Institute of Medical-Laboratory Scientists. I've got twenty of those working for me back in England." To which Reg responded, "That's a coincidence, I've got 20 MDs working for me."

Not all letters after the name are what they seem. FRSM simply means that you belong to an expensive Gentleman's Club in central London. It does have a superb Library and a wonderful restaurant as well as cheap lodging so it is worth the annual subscription, but FRSH is a simply a vanity purchase to fool the customers. Buying letters after your name is a common practise; Oxford and Cambridge BAs can upgrade their degrees to MAs after a year for only 10 quid. In the past the only MD degrees awarded were to Oxford and Cambridge graduates who had to take examinations in Latin, Greek and Physic. Edward Jenner, one of the greatest physicians ever, (he invented smallpox vaccination) trained as an apprentice surgeon and qualified as an Apothecary. He couldn't get an MD because he had no Latin or Greek, for the same reason he could not become a member of the Royal College of Physicians. Eventually he bought an MD from Glasgow University for £100; even then the Scots were canny with money. It should be remembered that at the time Jenner was already a Fellow of the Royal Society (the highest Scientific Accolade), not for smallpox, but for discovering how the fledgling cuckoo removed the other eggs and birds from the nest.

Not many medics make FRS and to compensate for that a few years ago a few senior academic doctors set up a new Society, the Academy of Medical Scientists. Leading medical academics were invited to become FMedSci. They guard their doors assiduously against anyone who has not achieved very much yet.

Nowadays it seems that everyone wants to be called Doctor; Dentists, back manipulators, acupuncturists, and even podiatrists. In Russia doctors are called "vrach" I believe, which being translated means "leech". Surgeons in the UK are offended by being called Doctor. Once they have their FRCS they insist on being called Mister. This dates from their origin as barber-surgeons (like Sweeney Todd).

In the church there are many titles, as I illustrated in a previous blog. But it is Bishops I want to attack. The Greek word 'episcopos' which is translated 'bishop' literally means overseer and it is used interchangeably in the New Testament with 'presbutos' which is often translated as 'priest' but actually means 'elder'. The NT only recognises two clerical offices in the church: elder and deacon (which could also be translated as 'minister' or 'servant'. The problem arose when bishops got too big for their mitres ans started assuming and authoritative power. The Bible assumes a plurality of elders in a local church, all of whom should be apt to teach (a quality missing from the list of requirements for deacons). Some elders (but not all) are to be set aside for the preaching of the word and the elders as a whole are to be given the governance of the church, but the NT specifically warns against getting involved in the affairs of the world. It is therefore a nonsense that certain Bishops are guaranteed seats in the British House of Lords, that hangover from feudal times.

Permit this small digression. I watched the Trooping of the Color last week on the Queen's birthday. It was a colorful pageant with clever marching and martial music. I would not want to see it lost, but all the various ranks: knights, baronets, marquises, viscounts, barons, earls and dukes seem to be an affectation too far. The House of Lords as a chamber for refining and modifying legislation seems a sensible organisation, though it is largely a resting place for retired politicians, many of whom remain the crooks they were in the House of Commons.

Anyway, back to Bishops. They quickly became secular authorities in the Roman Catholic Church. Bishop Odo fought with William the Conqueror. Others in England became Lord Chancellors of effectively Prime Ministers. Even in the Church Bishops sought to lord it over people, specifically against the instructions given in the New Testament.

The Quakers have it right, I think. Everyone there is plain John Smith or Jane Baker. If a qualifier is needed it could be Jane Baker, secretary, or John Smith, businessman. I would be happy to be Terry Hamblin, with the physician only added if someone needed one.


Chonette said...

Thanks for a very interesting description of all the letters and titles on the medical profession.
Over the last couple of years the words 'registrar' and 'internist',referring to younger doctors has been mentioned in hospital.
One of the young training nurses offered to make a list for me of all the titles and different type of nurses they had on the Oncology/haematology wards including the doctors (registrars, consultants, etc.) however never had time and I am still ignorant of all the titles they have written on their names.
It must be many different ones as I noticed some new ones at The Royal Free like 'transplant expert clinical nurse'.
If you have the time and motivation to add a few of these I would be very grateful.
I hope you are doing well.
Thinking of you

Paul said...

Terry's comments about Germany are all too true.
I was staying with my sister-in-law in a small town in Germany. She was living in an apartment house that belonged to a pharma firm.
In the communial cellat I saw a wheelie bin with its owner's name painted on - Professor Dr Dr Hofer.