Why Mary, Kylie and I may prefer to be known as Doctor….

As Croakey recalls (perhaps hazily), it was the former Federal Health Minister Dr Neal Blewett who started a debate some years ago about who are the real doctors in health. His suggestion, as I remember, was that “real doctors” have doctorates.

More recently, The Power Index (a sister publication of Crikey) ran an article querying whether it was appropriate for Mary Foley, director-general of the NSW Health Ministry, to call herself “Doctor” after being awarded an Honorary Doctor of Letters by the University of Western Sydney.

In the article below, Dr Enrico Brik, the pseudonym of a self-employed consultant and sometime writer and blogger who has worked for over a decade in various roles in health services policy and planning, reflects upon some of the history surrounding the use of the term “doctor”.

And in a spot of impeccable timing, The Power Index has just published a profile of AMA president, Dr Steve Hambleton, which includes this memorable line: “What’s good for doctors is actually good for health care.”

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Kylie, Mary and Me: Among the Deserving Many

“It is better to deserve honours and not have them than to have them and not deserve them.” Mark Twain

Enrico Brik writes:

Obviously Mr Twain did not work in the health system; an industry most Croakey readers will know is replete with honours and the honoured, merited or otherwise.

Indeed I find myself writing having recently returned from Boggabri – one of the lesser known gems of inland northern NSW – as the proud recipient of an honorary doctorate in Health Politics. The polyester bonnet now hangs in my office next to the plastic stethoscope given me by grateful staff to mark my departure from a senior health consulting role in NSW in 2009.

But why Boggabri, you ask? Because, interested reader, this little town hosts the southern hemisphere’s sole outreach campus for that citadel of Slovak tertiary education and research – the Scientific University of Bratislava. Like the universe, globalisation may be bounded, but it is infinite in its reach.

Having a few hours to mull over the import of this elevation while wheeling my azure 1987 Maserati Biturbo back home down the New England Highway, my mind turned to those other worthies I know of connected in some way to the health system who have been similarly honoured for their selfless dedication and years of quiet achievement. And to why there appear to be so many people in health in particular with doctorates or the like.

Much of this can of course be attributed to the title, Doctor: it holds a long-esteemed place in the western (and not only western) socio-cultural landscape. Those with a penchant for etymology will know that the term can be traced back to the middle English of about 1300, when the noun meant ‘church father’, coming from the old French, doctour, and before that from the medieval Latin, doctor, meaning ‘religious teacher, advisor, scholar’. That use came in turn from the classical Latin verb, docere, meaning ‘to show, teach’ and, originally, ‘make to appear right’.

Later in the 14th century the term acquired the meaning, ‘holder of the highest degree in (a) university’, the sense in which we are interested today. About the same time, it also began to be used as a title for medical professionals; eventually deposing in the late 16th century the previous epithet, leech. I wonder why such a change occurred? Along the way, the verb ‘to doctor’ acquired in the early 18th century the meaning ‘to treat medically’, and from the late 18th century the sense of ‘to alter, disguise, falsify’.

So there we have a potted history of the term, doctor. But what has this to do with Kylie, Mary and me?

Well, many of you would have been overjoyed, as I was, to hear in October 2011 of the award made to the then Ms Kylie Minogue of an honorary Doctor of Health Sciences by Anglia Ruskin University in Chelmsford, Essex (in southern England), for her work in raising awareness of breast cancer – a hitherto little-understood condition experienced by thirty-something pop singers and other female celebrities.

The singer, who was diagnosed with the disease in 2005, underwent chemotherapy and surgery before resuming the career that has made her a star in Britain, Australia and elsewhere. The university noted that her well-publicised diagnosis has been credited with encouraging young women to undergo breast screening: the so-called ‘Kylie Effect’. So, she received her honorary doctorate for being famous, ill and prepared to self-publicise in the interests of others.

By contrast, Mary Foley is one of the nation’s pre-eminent professionals with a distinguished career in Australian health care in both the public and private sectors. She is now the Director-General of the NSW Ministry of Health. Immediately before taking up that appointment, she was the National Health Practice Leader for Pricewaterhouse Coopers. She is I understand also the longest serving member of the Board of Trustees of the University of Western Sydney (UWS).

UWS tells us that the then Ms Foley was the Telstra Business Woman of the Year in 1998 and received a Centenary Medal in 2003 for service to Australian society in business leadership. She has also served as director on a number of prestigious boards, including the Garvan Institute of Medical Research, the Victor Chang Cardiac Research Institute, and the St Vincent’s Research and Biotechnology Precinct. She was awarded an Honorary Doctorate of Letters honoris causa by UWS in 2010.

Thus, each of us is now a proper doctor – that is, have had conferred upon us an (admittedly honorary) doctorate. We are not to be confused with one of those doctor doctors, who hold just a couple of bachelor degrees (typically MB,BS – no better really than BA,LLB; or BEc,BBus; or BSc,BEng). While I do not know if the popette is yet referring to herself as Dr Minogue, I have been aware for a while that Dr Foley has decided, as I have, to embrace the title (no matter how modest she may otherwise be).

Imagine then my consternation when I found out only a day or so ago that a certain Matthew Knott, writing in some scarcely-known web journal called The Power Index*, had produced a piece in October 2011 chiding the aforementioned Dr Foley for employing the honorific as her preferred title.

Really! Doesn’t he understand how important it is to be able to face the doctor doctors on equal terms?

Mr Knott – who evidently grasps little of the highly competitive, status-driven environment and the atmosphere of pomposity that pervades the health landscape – quotes the churlish views of an anonymous informant that there is ‘increasing discomfort among senior clinicians and public servants about her use of the honorific’. Well, Mary, I can tell you we policy consultants are absolutely fine about it. Especially those of us who hold honorary doctorates from obscure Eastern European universities.

The petulant health system gossip adds that ‘there is also a view that Foley’s ego trip could lead people to wrongly assume that the country’s biggest public health service actually has a qualified medical practitioner at the helm’.

Hell no! NSW couldn’t be that silly, could it?

Well, no and yes. Dr Foley isn’t a medical practitioner (thankfully); but she has been mistaken for one – by her own organisation, no less, which continues to cite her thus in the list of members of the NSW Mental Health Taskforce. (Indeed, here is a link.)

But, apart from this bureaucratic misstep, how could Dr Foley’s use of the title be possibly considered an ego trip, when it clearly reveals a deep insecurity about one’s status and doubts about one’s intellectual credentials. Oh. Hold on…

Look, OK. There could be something in that. But be fair. We in the health industry have to put up with some people who don’t have just one actual, wrote-the-thesis-and-got-the-hat doctorate, but occasionally two or more. And a few of them are even medical practitioners as well! While one real PhD is meritorious, having two doctorates is a bit obsessive; and three is just plain showing off.

Little wonder Mary and I (and maybe Kylie, too) are determined to use the honorific, Doctor.

At least we are in good company. Just look at all those clinicians with a couple of bachelor degrees who are doctors qua medical practitioners, but insist on the title ‘Doctor’. And, infamously, these days not only medical practitioners, but also vets, dentists, and even osteopaths (quelle horreur!) call themselves ‘Doctor’. Where will it end? Podiatrists? Speech pathologists? Surely not nurses…!?

There are very few professions these days whose name also confers a title. Once, in medieval England, a commonplace – Farmer Smith, Goodwife Jones – it is a quirk now limited principally to the military and the church. We do not, for example, call solicitors, Lawyer Pellegrini. Nor do we abbreviate an architect’s title as At Seidler. Yet doctors are called ‘Doctor’ as captains are called ‘Captain’. (Interestingly, however, the obverse is not the case: Holders of a doctorate are given the title ‘Doctor’ even though they usually are not, and are not called, doctors as a professional description.)

So, being a doctor (qua medical practitioner) does not itself entail or justify use of the title ‘Doctor’: that use is an honorific. And, as noted above, it is an honorific no more merited than the use of the same honorific when one has received (only) an honorary doctorate.  With such abundant and deserving company, Mary and I should be feeling much more comfortable about calling ourselves ‘Doctor’.

Now, I wonder how the Scientific University of Bratislava is about the use of the title, ‘Professor’?

• Dr Enrico Brik is the pseudonym of a self-employed consultant and sometime writer and blogger who has worked for over a decade in various roles in health services policy and planning. Dr Brik currently resides outside Sydney in NSW. He is not a clinician. His blog is at http://enricobrik.blogspot.com/.

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His previous posts at Croakey include:

• The role of doctors in health services planning and management

• Opportunities for the cunning health bureaucrat in the proposed NSW Mental Health Commission