Personal views: Drop the “Dear Doctor” here
Authors: Des Spence
Journal: BMJ (2002)

I became a doctor when I was 23 after an enjoyable five years at university. I had travelled, met lots of interesting people, met lots of dull people, been to many wild parties, had great summer jobs, lived in dreadful flats, had stupid hair cuts, worn awful clothes, listened to depressing, angst ridden music, and generally had a bloody fantastic time. I had also worked hard on my studies. I was happy and proud. Like most of my friends I wrote to my bank to change the title on my bank card from Mr to Dr. I also began to use my title when making bookings over the phone and in certain other social situations.

At first it was quite fun and people thought “you're so young to be a doctor.” This lasted to about the end of my residency when I had lost most of my hair and aged about 10 years. People treated me differently socially. They made certain assumptions about my background, my education, my views on politics, which newspapers I read, and what sort of music I listened to. So after about a year I began to think that calling myself “Dr” outside work was bordering on the ridiculous and it really irritated me how differently I was treated. I realised that I was the same prat I had always been and being a doctor wasn't going to change that.

I have since this time never introduced myself as a doctor or used my title in social situations. I find this much more appropriate and natural. It frees me from all the appalling social preconceptions that people often make and I find that I don't have to live the role of “a doctor.”


Work was different, however, and I began to notice that when doctors entered meetings the whole dynamic would change and other professionals seemed reluctant to express opinions and generally deferred to the doctors. Senior doctors had an even more inhibiting effect on discussions and could frequently be poorly informed and make inappropriate decisions, but no one was prepared to tackle them. This deferential culture was an impenetrable wall for most patients, who seemed to have little or no opportunity to be involved in the decisions about their own care. The hierarchy is justified as the only way to maintain control and standards but in fact the reverse seems to be true. This is in stark contrast to other service industries that have flat management structures and a partnership approach at their core. The titles of “doctor,” “consultant,” and “professor” are often used as a barrier to prevent change and challenges from other members of the healthcare organisation. The medical profession seems to think that medicine is fundamentally different from other professions, but we all know that doctors have the same failings as the rest of humanity. We are not made of a higher moral fibre. 




We need to recognise the problems of our profession and one first step may be to stop using the title of doctor. We need to reduce the status of doctors—respect is an individual perspective and those who demand it rarely deserve it. Qualifications, position, and money do little to address low self esteem or sense of self worth, and many doctors remain unhappy and dissatisfied. If we were to view our profession differently and accept that we are merely part of a large organisation working for the benefit of patients then perhaps the public might view us more kindly and not have unrealistic expectations of what we can do. Consequently, perhaps our own expectations of medicine would be different and we might stop working so hard, spend more time with our families, stop getting divorced so frequently, drink less, and stop killing ourselves.

I believe that the use of the title “Dr” is an anachronism. “Doctor” should become merely a job description, so let's drop the “Dear Doctor” here.