Beyond the Physician
At this point, we leave the world of “medical doctors” but still find the label “doctor” available to some members of the medical profession. Specifically, there are a few non-physicians who have earned the title “doctor.” These are those in the medical community who have earned a doctorate in nursing. It is worth noting that these senior-level nurses are usually not called “Doctor.” They may have acquired major power in a hospital system, but not the status awarded to those called “Doctor.”
We then come to the many professions in medicine that do not require an earned doctorate. These professions include Physician Assistants and Nurse Practitioners. Originally, many of these women and men had provided important medical services to those wounded in war (Vietnam). It was not unusual for these armed forces veterans to be more experienced and gifted in treating major injuries and accompanying trauma than their civilian counterparts (with “doctor” attached to their name plate).
Close on the hierarchy are the registered nurses (and then those assigned other nursing titles). There are then the “orderlies” and other members of the medical community who are allowed to touch patients. This “touching” restriction seems to be central to the assignment of status in a medical community. For example, medical technicians come to medicine with significant (and critical) knowledge and skills in specific areas (such as radiation and phlebotomy). They might even have a doctorate in their field. However, they are lower on the medical totem pole.
What do we do with those engaged in the “soft” stuff of medical treatment? There are social workers and psychologists (who may have a “Doctorate”). They certainly “do not deserve” to be called “doctor” – but often are allowed to use this title as a way to “reassure” their patients/clients that they are receiving “legitimate” treatment from these practitioners. Recently, a new term has emerged that appears to be bridging the gap between the “soft” and “hard” domains of medicine. This term is “behavioral medicine” and is provided by practitioners who are specially certified in behavior-oriented psychological services to patients/clients. These services range from nutrition and health-related habits to stress management and even the treatment of trauma. There are no white coats for these folks, and currently not much status in the healthcare community.
While the services offered by those engaged in behavioral medicine have proven to be quite valuable in the reduction of recovery time and reduction in occurrence of certain illnesses (thus resulting in cost saving), behavioral medicine is still considered an adjunct service in most health care systems and is likely to “come and go” depending on the proclivity of those in charge of the health care system. Reimbursement for these behavioral medicine services is also not assured, leading to an even more vulnerable position (and lower status) for those providing these services.
It is finally time to identify those at the bottom of the medical hierarchy. They are engaged in nontraditional medical practices. Those whom the authors of the Flexner Report tried to put out of business as “quacks”. These engaged in chiropractic, naturopathy, Asian medical practices (such as the use of acupuncture), and certain physical therapy practices (such as those offered by the Feldenkrais practitioners). Funding for these services is controversial in many countries, even though evidence-based medical studies often find these services to be effective. The reticent acceptance of these nontraditional practices is often evident in the assignment of a specific term to these valuable services. This term is “complementary medicine.” It suggests that these nontraditional services should stand alongside (“complement”) traditional medical services rather than operate on their own as adequate (and successful) sources of medical treatment.
