What’s in a name? Shakespeare might have it that a rose by any other name would smell as sweet, but the Royal College of Surgeons of England doesn’t quite agree.
At the weekend, the college issued a call for the job title “surgeon” to be protected so that only those who have qualified as a medical doctor and undertaken post-graduate surgical training can use the name. “Public support for this is clear, with 92 per cent of respondents agreeing that the job title should be restricted by law,” the college says.
I must say that when I heard this story, I thought that the surgeons were getting snippy about use of the word “surgeon” generally – and for me, it was “tree surgeons” who first came to mind. Frankly, I thought it was a bit off that doctor surgeons were being snippy about this particular branch (no pun intended) of practice, as it’s absolutely clear – or should be – that tree surgeons and human surgeons are dealing in completely different areas.
Then I thought about dental surgeons, and veterinary surgeons, neither of whom are obliged to be “qualified as a medical doctor”, but have surely been using the name for long enough. (The RCS itself first started giving a Licence in Dental Surgery in 1860 and veterinary practice became a profession distinguished by the title “veterinary surgeon” in 1844, according to the Royal College of Veterinary Surgeons.)
A bit further down in the RCS press release, however, and it’s clear who is actually getting the surgeons’ goats. They’re upset that the NHS and private sectors are employing people called surgeons – specifically “podiatric surgeons” and “aesthetic surgeons”. “Podiatric surgeons have not completed a medical degree but have instead trained only in the surgical and non-surgical treatment of the foot which leaves them unable to treat the patients as a whole,” the college says. “An aesthetic surgeon may not have a medical degree and may not have undertaken specialist surgical training.” College president Norman Williams adds: “It is extremely worrying that in the health sector clarity regarding job titles is lacking.”
On this point, I couldn’t agree more. Trying to keep up with job titles in the NHS is a minefield, and doctors are among the worst offenders. Titles of junior doctors, or doctors in training (as some prefer to be called) are particularly confusing. A few years ago the terms “junior house officer” and “senior house officer”, usually shortened to JHO and SHO, were replaced when training was changed under the Modernising Medical Careers (MMC) initiative. The most junior of junior doctors are now called Foundation (Year) One or Two (FY1/FY2, or sometimes F1 and F2). Further up the scale, the doctors previously known as specialist registrars (SpRs) are now STs (Specialty Trainees) – although, even more confusingly, there are still some SpRs around who were on the old training scheme. Add to the mix various other titles (staff grade, associate specialist, specialty doctor, trust doctor and so on) and it’s easy to see where people can get muddled.
And health service staff themselves don’t help. A couple of years ago an otherwise very nice young lad (I know, I’m getting old) introduced himself to me (wearing my patient’s relative hat) as “I’m Tom, I’m the FY2”. As it happened, I did know what that meant, but I do write about these things a lot, so am a bit more exposed to it than most. On the other hand, a friend of mine (attending a rather stressful day of tests) was brusquely asked if she’d “seen the registrar”. She was nonplussed: as far as she knew a registrar was someone who worked in a registry office.
Surgeons too (the medical variety, the ones the college is trying to protect) arguably don’t help themselves. Once they pass their college membership exams (usually a few years after graduating with a medical degree), they stop calling themselves Dr and instead revert to Mr, Mrs, Miss etc. This dates back to the days when surgeons completed an apprenticeship, rather than medical training, before taking on the role – using the title is a sort of inverted snobbery which is often seen as a way of expressing superiority over mere physicians. Even more discombobulating, obstetricians and gynaecologists in England also go with Mrs/Mr/Miss, while those in Scotland stick with Dr.
If anything, surely this is even more confusing to patients. Some surgeons, particularly younger ones, actually call themselves Dr for that very reason, and there have been moves (notably in Australia) to get rid of the titular discrepancy in its entirety.
So what of podiatric and aesthetic surgeons (so-called); are they entitled to use the title? Etymology doesn’t help – “surgeon” (via old French, Latin and Greek) basically means someone who works with their hands. So that’s pretty much everyone then. Even in the narrower, more modern understanding of the word, yes, they do perform surgery, in that they are cutting into skin, flesh and even sometimes bone to try to improve the health, wellbeing or appearance of the patient. Certainly the Society of Chiropodists and Podiatrists is coming out fighting, pointing out that podiatric surgeons undergo some 11 years of “rigorous training”. “The issue of titles lies more with the understanding within the general public of roles within healthcare in general,” a spokesman adds.
Perhaps if medical surgeons want to help ease the confusion they could take steps themselves: first, stop calling themselves Mr/Mrs/Miss (okay, not usually all three at the same time) and stick with Dr (bearing in mind that it’s an honorary title anyway, unless they’ve actually gained a doctorate such as an MD or PhD on top of their MBChB, but that’s a whole other issue); second, lobby government and various other accreditation bodies to ask for a more simplified way of describing medics in their different stages of training; and third, if other professions insist on adopting the job title which was traditionally theirs, they could go for a new one of their own – one with just as venerable overtones, with an equally colourful history.
Yes, perhaps they should jettison “surgeon” and replace it with “sawbones”. Then we’d all know where we were. And the RCS wouldn’t even have to change its initials.