Should medical students be introduced as Doctor?

I recently saw a post in Yahoo questions entitled, “Is it illegal for a medical student to introduce themselves as ‘Doctor’ before they have received their MD?”

One of the answers that was rated highly was “I think it is more unethical than illegal.” Clearly, if a student is deliberately misrepresenting themselves as a ‘doctor’, it is grounds for disciplinary action.  More often than not, this misrepresentation is not deliberate on the part of the student.  For example, some of our prior work demonstrates that medical students often report that they were introduced by other physicians as a doctor to a patient and that to a lesser extent, students may not correct someone who mistakes them to be a doctor.

Complicating matters is the propagation of the term “student doctor” at some institutions which is especially problematic.  After all, how many patients will be quickly discern that ‘student doctor’ actually refers to ‘medical student’ and not a ‘doctor’?  Unfortunately, patients who hear the term ‘student doctor’ may not hear the term ‘student’ and just zero in on the ‘doctor’ part, as they often wait patiently for their doctors to see them in the hospital.   This brings us to the problems of how doctors are named in teaching hospitals.  The system could not be more confusing.

  • Interns. This is probably one of the most confusing terms in a teaching hospital.  Interns are doctors who have graduated medical school and are in their first year of a residency training program.  Of course, ‘intern’ is also the universal term for all those college students trying to get a short term experience on their resume by ‘interning’ there first.  So, why would a patient think an intern is a doctor?   After all, you would never put your faith in the legal ‘intern’ at the law firm to defend you in a lawsuit.   To make matters worse, there is the opposite problem.  Intern is often mistaken for ‘internist’, who is actually a doctor who has completed their internal medicine residency and otherwise a ‘doctor for adults.’  (Patients are more familiar with their “PCP” or ‘primary care physician,’ which could refer to either an internist or a family physician).
  • Residents. Residents can refer to any doctor who has graduated from medical school and is in a residency training program (including interns). The term “residents” originates from William Osler’s era when residents did live in the hospital.  Of course, they don’t live there anymore  which would violate worker’s rights not to mention their regulated duty hours… but we still call them residents.  The other name residents are often referred to is as “PGY1” (post graduate year) which is certainly not an improvement.
  • Housestaff. One of our premed college students just asked me what this term was this week.  I explained that while this does sound like the butler, maid, or cook a fancy estate, this term actually refers to the hospital as the “house” that the residents live in as the staff.  So all residents (including interns) are part of the ‘housestaff’.
  • Fellow. This is perhaps one of the most disconcerting names for a physician as it may sound like it refers only to male doctors (and conjure up images of young man from England with excellent manners i.e. he’s a fine ‘fellow’).  In fact, a fellow is a doctor who has completed residency and is getting advanced training in a certain subspecialty.
  • Attending. Attending to what you may wonder?  The attending physician is actually the doctor who has completed training and is legally responsible for the care provided by residents.  In other words, this is the ‘boss’ doctor as my residents sometimes introduce me to the patients on our team.

A few years ago, we tried to improve the situation for our patients by having doctors introduce themselves with baseball cards with their pictures on the front and the roles of the doctors were displayed on the back.  While we were able to increase the percentage of patients who knew who their doctor was, we were surprised to discover that fewer patients stated they understood the roles of the doctors.   How did we make it worse?  Perhaps ignorance is bliss.  By trying to unlock the secrets of these names, patients realized the names we use in teaching hospitals are confusing.

However, this confusion is more than just a name, it is also a patient safety issue.  After 18 year old Lewis Blackman died in a South Carolina teaching hospital without an attending evaluation when his family kept asking to see the doctor, a new law in his honor aims to address the issue.  It requires that patients receive written materials describing the roles of the trainees on their team and also how to contact the attending if they have a concern.  More recently, the ACGME, which accredits US residency programs, has included a mandate in its now infamous policy restricting resident work hours that states “residents and faculty members should inform patients of their respective roles in each patient’s care.”  While it is not certain how this will be implemented at every teaching hospital across the land, it’s certainly time to make our naming system easier and more transparent for patients to understand.

Vineet Arora is an internal medicine physician who blogs at FutureDocs.

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  • http://twitter.com/insidercoach Jocelyn Clarke

    The baseball cards are a great idea! Being in the hospital is quite stressful, and many families are confused by the internal organization of hospital staff. It’s great that you are concerned with clarity of communication of roles–shows quite a bit of respect for patients.

  • http://pulse.yahoo.com/_6HESRKK73LGQRCOWNS2XXWYOYQ Georgia England

    I
    had simple outpatient surgery last year and they had to move it to a
    teaching hospital vs an outpatient clinic. I was very clear that I
    didn’t want anyone other then my attending gyn present if at all
    possible as a result of an error with an ER intern a few years ago. My
    GYn asked me just prior to going into pre-op if it would be okay if a
    “fellow” she worked with was there and I agreed but I wrote on my
    admission and surgery authorization forms “no students” thinking that
    would cover me from residents or interns or medical students. (and I
    know the difference)

    I spoke to the “fellow” in pre-op for 30 minutes and only later
    discovered she was an ER fellow not a gyn one. I also later I learned
    that 2 residents were not only present for my surgery but did the pre-op
    and discharge orders which included over-riding my agreed on anesthesia
    plan for a spinal. When I questioned what had happened and why – the
    Hospital responded that they weren’t “students” and they needed to learn
    and since I was unconscious (as the result of the unplanned general
    that one of the residents ordered as she felt it would be less stressful
    then a spinal) why did I care?

    The surgery itself was fine but I felt so betrayed I terminated a 6 year
    relationship with my gyn provider as a result of not knowing who I was
    talking to and their ability to change my care.  I would suggest that
    they wear different colored coats or badges White for a board
    certified doctor but no one else (lab techs, nurses and others are also
    confusing). I also feel like I should be given a staff list of who is involved in my care and what their role is and how to escalate questions and concerns. It is sooo frustrating to tell your entire history to the wrong person

     

  • http://abnormalfacies.wordpress.com/ Jim

    I believe in keeping it simple for the patient’s sake – we are medical students, and that’s the only term we should use to describe ourselves. 

    Many attendings will use “student doctor” or “young doctor” to refer to us, and I suppose that’s fine when they’re in the room and our respective roles are clear (based on who is taking instruction from who).

    When we’re beyond the earshot of patients (lectures, conferences, rounds, etc.) I really don’t care what terms we use to refer to one another.  I think more senior physicians call students “doctor” to be encouraging while questioning us, as well as to remind us that we need to start thinking like physicians.

  • Anonymous

    I think it depends if they stay at a Holiday Inn Express.

  • http://www.facebook.com/profile.php?id=1172033608 Gary Trunk

    No! Not as long as I’m  the attending physician. Once they obtain their M.D./D.O. degree, then they can be addressed as “Doctor” but not beforehand.

  • http://twitter.com/sarasteinmd Sara Stein MD

    I introduce and refer to all of my med students as “Student Doctor”. No misunderstandings on either end.

    • http://westcoastglaucoma.com Rob Schertzer, MD, MEd, FRCSC

      I stick with Medical Student for the introductions; I think that ‘Student Doctor’ is what many patients think includes interns, residents and fellows.

  • http://drinkingfromthefirehose.wordpress.com Thirsty Scholar

    As a student, I introduce myself to every patient as a “third year medical student” or “medical student at University Medical School”. I am particularly careful to do this when I am introduced by someone as a “doctor” or “student doctor”, which happens at least once every day. I think it is incumbent upon the student to make sure they are properly introduced and to correct any slips of the tongue that might be made. Besides, the core issue in my mind isn’t whether students/trainees are around, but whether they are appropriately supervised and whether they know and respect the limits of their abilities and knowledge.

    As a patient in a teaching hospital, you will be cared for by all kinds
    of students and trainees in many different facets of the hospital’s
    operations no matter what you say or do. Anyone who tells you otherwise
    is being less than honest.
    For instance, in Ms. England’s story, she felt that she was lied to and that her preferences for a specific type of anaesthesia were not followed. I would send my mother to a teaching hospital. I have been a patient at several teaching hospitals. However, I understand Ms. England’s frustration, and I feel badly for her.

  • Anonymous

    The residents in Ms. England’s case should have provided her with information about the change of recommended anesthesia.  So much for informed consent.

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