Jarrod Shapiro, DPM
Practice Perfect Editor
Mountain View
Medical &
Surgical Associates,
Madras, Oregon
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Or Should I Call You Doctor?
One of those uncomfortable milestones we all reach—usually after graduation from residency—is the point where we start calling other doctors by their first names. This was an especially uncomfortable moment for me. I can remember my residency director, who I became very close with but still called “Dr”, asking me to call him by his first name. His first name sounded very foreign to me, and I imagined myself sounding like Don Corleone from The Godfather with cotton in my mouth. As time went by, though, I became more comfortable with the use of physicians’ first names.
As I’ve been increasingly involved in the medical community, I’ve noticed that the use of the first name, especially in reference to a physician, holds a certain level of significance. I’ve observed this phenomenon manifesting itself in two primary ways: indicating familiarity and emphasizing respect.
Indicating Familiarity
What do I mean by “indicating familiarity?” Let me provide an example from my first two years in practice, where I worked for—and observed the interaction of—an older, well respected podiatrist. The vast majority of his patients referred to him as “doctor,” but a few—especially those who were trying to obtain something extra from him—would refer to him by his first name. What I found most striking about this was they never referred to him by first name when in his presence. It was always when he was out of the room and they were talking to his staff, that these patients would refer to him by first name. The obvious explanation is they were trying to elevate themselves in the eyes of the staff by indicating their familiarity with the doctor. They would say things like, “I’m sure John can fit me into his schedule at the last minute.” or “I know John will reschedule my surgery without any hassle.” Unfortunately for them, this ploy never worked. In fact, the staff was also aware of this false familiarity and would laughingly make fun of these people.
Emphasizing Respect
How does using a doctor’s first name emphasize respect? First, from the patient standpoint, using “Doctor” communicates that they understand—and agree to—a certain level of authority. Not authority from the dictatorial standpoint, but rather from the expert point of view. Our patients are implicitly stating that they understand we are the expert in what they’re seeking treatment for and agree to create the doctor-patient relationship.
From the peer-to-peer standpoint, the opposite seems to hold true. The use of “Doctor” between physicians creates a significant level of formality that maintains a distance between the interactors. I find myself at this level most often when I’m introducing myself to another doctor or I’m speaking with a new physician on the telephone. On the flip side of this coin, I use first names with my regular physician colleagues. For example, if I pass by a physician I know, I’ll stop, say hello using their first name, and have a short discussion about a mutual patient or social issue. In this situation, by using our first names, we implicitly establish respect and equality. If I used the formal “Doctor” in this instance, I would be implying a level of superiority that doesn’t exist.
All that from the simple use or omission of the word “Doctor.” To many of us, this may sound insignificant—its just part of being a doctor. What I find fascinating is that all of these social interactions are guided implicitly, tacitly, without much coaching. Our use of these terms seem to, for the most part, fall into place as naturally as any other social contact. It’s amazing the power our language imbues into our collective social mind.
The converse of this entire argument is the use of first names for our patients. Do you call patients Mr, Miss, or Mrs? Do you use first names with your patients? Where does age fit into this? Somehow this situation seems less clear to me than the Dr designation. Best wishes all you Johns, Janes, Harrys, and Samanthas. Or should I call you Doctor?
Please scroll down and take a moment to read a few letters from your colleagues, responding to a couple of topics recently covered in Practice Perfect. I encourage you to read them and see what your colleagues are thinking. Keep writing in with your thoughts and comments, or better yet, post them in the eTalk forum on PRESENT Podiatry where you can get in on the discussion or start one of your own. Best wishes.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
Letters to the Editor
***Fellowships***
This is why the local podiatric social networking is so important en lieu of the amount of training that one receives. We need to get back to the basics of giving our established practitioners the opportunity to rekindle, refresh, or hone the skills that may just allow them to have the ability to improve their bottom line.
More knowledge equals an ability to put to those skills into practice. Why is the fellowship just for the newly graduated? Why can't it also be for those who are in practice and want to learn and do more either because they never had the opportunity years ago or are just wanting to be able to do more?
CME opportunities with surgical workshops are fine to get the necessary hours to maintain a license, but a 2 hour workshop does nothing to allow the foot surgeon to have the necessary confidence to either perform the newer procedures or even think about doing them. CPME needs to start thinking about those DPM's who have been lost in the shuffle of deciding to maintain an independent solo practice and mostly do not have the contact with their colleagues who are more well trained or have the modern surgical skill that is necessary to compete in the current health care market.
The viability of a podiatric surgical practice and hospital surgical privilege credentialing now an into the future will depend on the competency of the DPM. As newer DPM 3+ year surgically trained resident enter the podiatric field, the competency bar will be raised to a point where the long-time DPM practitioner will be blocked from maintaining surgical privileges at a hospital.
Hence, the creation of the emergency resolution that I wrote with the IPMA which will hopefully be presented to the APMA HOD for passage in the coming weeks which brings to light the consulting bodies like the Greely Medical Staff Institute who are authoring podiatric surgical credentialing without our input.
We need to do something with the help of the APMA and other national podiatric surgical organizations to help those who have fought so hard for this profession and have continued to do so. What sort of remedial training will be made available for those that will seemingly have been left behind stop the inevitable from happening?
Joseph Borreggine,DPM
President, Illinois Podiatric Medical Association (2009-10)
Podiatric Physician
2111 18th Street,
Charleston,IL 61920
(217)348-0888
***Podiatric Parity***
I always enjoy reading your materials, and once again am in agreement pretty much with what you say. In 1983, after being in the profession only four years, I was ready to apply to medical school because of my frustration with being a 2nd class citizen in the medical world. I had toiled to become board eligible by ABPS, though I had not had a formal residency program, yet the city hospital would not let me even order an X-ray at their facility. I look at the training today and also the opportunities of our young practitioners, saying, “We’ve come a long way.” Yet it still isn’t as far as we want to go. I work in the VA system, and while our podiatry team is very well accepted by the other primary care and specialists, and we have an extremely close relationship with orthopaedics, yet there are still institutional discriminations that need to be overcome. For example MDs and DOs receive twice the CME allotment that podiatrists receive. MDs and DOs receive performance pay while podiatrists do not. So we are still clawing against some archaic remnants of the past, but the cracks continue to appear one small crevice at a time.
One of the things, though, we need to ask ourselves seriously, what would happen if the DPM degree went away, and podiatry became a 4-5 year residency open to all MD or DO graduates? Right now we have a couple of MDs in our institution that would love to be podiatrists. One is currently in Europe getting more training on the feet. Our institution last year opened up an optional rotation for the family practice residents from a nearby hospital, of a podiatry-wound care rotation. I am the chief mentor in that rotation. This year we had 3 residents sign up for the rotation. Next year 8 have signed up. I believe it’s the harbinger of better times coming. I am more than willing to admit that I will soon become a dinosaur in the medical community, however in becoming such, I am still very satisfied that my life’s work has been of worth in advancing the cause of foot health and preservation of ambulation.
While I have not been a part of the 2015 project, I hope that those who are, are thinking outside the box – not in the terms of trying to maintain the status quo – but instead thinking to the year 2115.
Thank you again for your thoughts.
Best wishes,
Robert D. Phillips, D.P.M.
[email protected]
***Podiatric Parity***
Just to clarify a point of my understanding...the initial concept of Vision 2015 as originally conceived here in Ohio was more closely related to the "objectives" that you listed. Although you may desire to be an MD/DO that was not the intention. That is why the objective lists "comparable" education not equal. Here in Ohio we initially felt that artificial restrictions placed on our profession by State legislation and Insurance regulations with deceased access and reimbursement levels should be addressed by our national leadership. All of the objectives within the APMA Vision 2015 statement can and should be achieved without "equal" training. I apparently am in the minority feeling just fine about my scope and responsibilities as a DPM. (This probably because I practice in Ohio where we work extremely hard at the OPMA to maintain the rights and access of Podiatrists)
I personally am of a belief that keeping the DPM and achieving the stated objectives is more important than receiving an MD/DO degree. If those degrees are desired, then a student should pursue that at the beginning of their medical education. With the changes in healthcare we should continue to direct our attention to the objectives of the Vision 2015 with maintaining our access to patients and receiving equal pay for our services. It is naive to think that in the coming years that when patient will be directed to PA and NP under the supervision of the practicing MD, or even as independent primary care providers, that our education is that far off. In that case with potential salaries approaching that of DPMs, we might as well go back to school to obtain those certifications!
Peter Wiggin, DPM
[email protected]
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