Online Outrage After We Suggest Doctors Drop the Dr. Title

Physician feedback to the MedPage Today video was intense, with the primary objection being a potential loss of status

In this edition of “The Wired Practice,” Ron Harman King CEO of Vanguard Communications, responds to online comments from his previous video: A Huge Step Toward Improving the Doctor-Patient Relationship.

Watch the video on MedPage Today

Video transcript

In my previous installment of The Wired Practice video blogs, I raised an unconventional idea for addressing a big healthcare problem and asked for comments from you, MedPage Today readers. And wow, did I get them – more than 120, roughly 10 times the number of comments my videos typically get.

Being a former engineer and numbers guy, my response was to classify the comments by category. While there weren’t enough to yield a scientific sample, there was a sufficient number to provide a few insights.

My idea sprang from a recent study published in the Journal of the American Medical Association. The study reported a shocking majority of healthcare consumers consciously withholding medically relevant information from clinicians – specifically, in one poll of patients, 61%admitted to being less than fully transparent with their caregivers, and in a second poll, 81% said they withheld information.

Only God can judge me, doctor

The reasons the survey participants gave for withholding information were as follows:

  1. They didn’t want to be judged or lectured.
  2. They didn’t want to hear how harmful their behavior is.
  3. They feared embarrassment.
  4. They didn’t want the clinician to think they’re difficult patients.
  5. And they didn’t want to take up more of the clinician’s time.

Does this sound like intimidated patients? It sure does to me, which is why I floated a trial balloon – a hypothesis, not an evidence-backed theory – one that I knew might well draw objections. The question I posed was, If patients were on a first-name basis with all clinicians including physicians, would this decrease their intimidation and increase their candor?

The notion clearly touched a raw nerve. By my count, more than four dozen of the online comments on the blog expressed robust, vehement opposition. Another dozen indicated earnest skepticism. The strongest dissenters categorized the idea variously as ridiculous, shallow, superficial, naïve, BS, very biased, deeply flawed, utter nonsense, a lot of baloney, the most absurd thing I’ve read on your site, plus my favorite, snowflaky.

One even went so far as to condemn me as – brace yourself for this – “a businessman who can’t do much else so you stand at a podium and point fingers.” Hmmm. Maybe I need an image overhaul. It must be my jacket and tie. Perhaps I should take on a more humble, down-to-earth appearance. Or maybe something more pious. Oh, wait. Won’t work. I’m married.

Yes, it’s true that like nearly half of all physicians in the U.S., I am a self-employed services provider with a staff and a payroll to meet twice a month – although I’m not sure how that corrupts my thinking any more than that of any other boss.

Physicians’ responses to having no doctor title

By far the most common objection to the idea of dropping the Doctor title was about status: Nearly half the protestors said something to the effect of, I earned the right, I deserve the respect, We physicians know more than patients, and We are not patients’ equals.

Let’s see. Doctor says, “We are not equals,” and patient says, “Doctor unnerves me too much for me to tell him or her everything.” Does no one else see a possible connection? Well, at least one reader did – a commenter who did not self-identify as a physician remarked, “That ‘you are not my equal’ viewpoint is likely picked up easily by patients.”

The second most common protest focused on academic credentials – mine. Ten years of post-secondary education and three university degrees have amounted to my going no further than a paltry Master of Science diploma. On this basis, quite a few readers opined that an M.S. degree disqualifies the holder from credibly discussing this topic. This constitutes an ad hominem attack: a criticism not of an idea itself but the person putting forth the idea.

The third most common response was a perceived erosion of public respect for physicians. This perception is discredited by survey after survey, which for years have shown that doctors rank consistently in the top five of the most respected and trusted professions nationally and worldwide, along with – you guessed it – nurses.

The fourth most common response was to blame electronic health records for discouraging patients from sharing sensitive information that others might access – echoing the speculation of physicians interviewed for a related MedPage Today article, although in neither case did anyone cite any studies. A couple of commenters insisted that the authority conveyed by the Doctor title encourages patient compliance with medication and lifestyle and rehabilitation instructions – again, without citing scientific evidence.

Thinking outside the $3.5 trillion healthcare cost box

So why dwell on this issue? For this reason: American healthcare spending tops $3.5 trillion each year, an estimated trillion dollars more than the U.S. spent in the first 15 years of the wars in Iraq and Afghanistan. That number is 35 plus 11 zeroes.

Let’s say for argument’s sake that if we found a way to lessen patients’ fear of disclosure, would that not most likely increase earlier detection and more affordable treatment of certain diseases and health conditions? And if it did, hypothetically speaking, let’s conjecture that this would lead to, say, a 1% reduction in our annual national healthcare cost, or $35 billion a year. For perspective, $35 billion is more than 6 times what the federal government now spends on cancer research each year.

Is such potentially gargantuan savings not worth some heavy duty thinking outside the proverbial box? Think of the conceivable gains not only in improved healthcare outcomes in general but also in shifting those resources to escalating the fight against humankind’s second deadliest disease by a multiple of 6.

Alright, maybe going to a first-name basis isn’t THE solution. It’s certainly not the only POSSIBLE solution. I only proposed it as a hypothesis, not a proven theory. To be sure, there are counter arguments. For example, one emergency room physician commented that early in his career, he introduced himself to patients by first name but later changed this habit, he said, when it became clear patients come to the ED to see a doctor and were noticeably comforted when hearing the Doctor title.

And two female physicians of color reported struggling for acceptance and recognition by patients who sometimes addressed them as “honey” and “dear.” Without a doubt, their experiences support a defensible argument against first name usage at least in certain individual circumstances.

But for the rest, not one commenter offered any alternative idea other than the obvious and rather vague suggestion of developing better listening skills. Meanwhile, one physician supported the notion of dropping the formal title; another reported that giving her patients the choice of how to address her yields significant benefits in relationship and trust building. And of a half-dozen nurses and mid-level providers weighing in, only one expressed opposition to elimination of the Doctor title, while two of the other five said that in their observations, patients generally volunteer less information to physicians than to nurses and mid-levels, who don’t bear the professional designation.

Outraged feedback aside, why not drop the Dr. title?

So I say, let’s go another round on this larger issue of patient silence, shall we? Right here on MedPage Today. But this time, I ask you to include in your comments replies to one or both of two questions:

First, what’s your idea? If patient shyness is conceivably wasting billions in healthcare costs every year, what do you, the experts with the most education and training in healthcare, and professionals with some of the highest public respect, propose to do about it?

Second, for those who commented that no reliable evidence exists in favor of dropping the Doctor title, can you find the scientific evidence against it? If there is none to date, and if instead someone launched a randomized, long-term study in which a number of physicians directed half their patients to call them by first name and the other half to continue using the Doctorappellation, and those patients’ health was monitored over time, would you be willing to participate? Would you be willing to risk a bit of your most-trusted-and-respected status to get to the truth and a possible improvement in healthcare outcomes? Which would take precedence: prestige or patients?

I again eagerly await your reaction, doctor.

References

  1. Levi, A.G. et al, “Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to Clinicians,” Journal of the American Medical Association, 2018; 1(7):e185293. doi:10.1001/jamanetworkopen.2018.5293.
  2. https://www.ama-assn.org/practice-management/economics/first-time-physician-practice-owners-are-not-majority.
  3. “Worldwide Ranking: Trust in Professions,” Nuremberg Institute for Market Decisions, March 2016, https://www.nim.org/en/compact/focustopics/worldwide-ranking-trust-professions.
  4. Dolton P. et al, “Global Teacher Status Index,” the Varkey Foundation, London, ISBN 9781-5272-3293-8, p. 14.
  5. “Honesty/Ethics in Professions,” Gallup, Inc., https://news.gallup.com/poll/1654/honesty-ethics-professions.aspx.
  6. https://www.cancer.gov/about-nci/budget/fact-book/data/research-funding.