The AMA has recently published a short article that – even though not addressing so-called alternative medicine (SCAM) directly – has considerable relevance for the field:

It’s increasingly common for patients to encounter nonphysician practitioners as members of their health care teams. Meanwhile, ever more nonphysician practitioners have received advanced training resulting in a doctorate degree, such as the doctor of nursing practice.

To help patients keep pace with these changes, physicians should make new strides to clarify their roles and credentials vis-a-vis other members of the health care team and also promote collaboration among all health professionals, according to an AMA Council on Ethical and Judicial Affairs report that was adopted at the 2022 AMA Interim Meeting.

The core issue is that “the skill sets and experience of nonphysician practitioners are not the same as those of physicians.” Thus, when nonphysician practitioners identify themselves as “doctors”—consistent with the doctoral-level degrees they earned—“it may create confusion and be misleading to patients and other practitioners,” says the report.

In fact, surveys (PDF) performed as part of the AMA Truth in Advertising Campaign have found that while patients strongly support physician-led health care teams, many are confused about the level of education and training of health professionals—and the confusion isn’t limited to nonphysician practitioners who hold doctorates. For example, roughly one-fifth of respondents think psychiatrists are not physicians, while a similar number think nurse practitioners are physicians.

The AMA Code of Medical Ethics touches on this issue in an opinion on collaborative care, which provides guidance on the roles of physicians in team-based settings where a mix of health professionals provide care.

In SCAM, we have the problem that practitioners often call themselves doctors or physicians without having a medical degree. This confuses patients who might consult and trust these practitioners assuming they have studied medicine. We recently discussed the case of a naturopath who called himself a doctor and failed to diagnose a rectal tumor of his patient. Much more dramatic was the case of a UK-based chiropractor who called herself a doctor, thus attracting a patient suffering from complex health issues contraindicating spinal manipulations. She nonetheless manipulated his neck and promptly killed him.

I know that patients are being misled every day by SCAM practitioners (ab)using the ‘Dr.’ title. Therefore, the AMA reminder is an important, timely, and necessary lesson for SCAM. I feel that the professional organizations of SCAM providers should issue similar reminders to their members and make sure they behave appropriately.

25 Responses to Patients deserve greater clarity on who is a physician—and who isn’t

  • since this is genuine care for the patients and not the gild just taking care of its member’s interests I suggest everyone should give up the title Doctor and Professor and identify themselves as Mr. Smith, MD etc. Otherwise, I suggest everyone clarify their role so there is no chance a patient may confuse an Orthopedic consult for a Chiropractor.

  • I can remember offering to find someone a doctor in my local pub but hat to admit one was a Ph.D in History and the other was a Ph.D in Philosophy. My offer was declined.

  • In Germany, you don’t even need a doctorate (although there are also providers of “health services” in this country with a doctorate in linguistics or alike …). It is enough to be allowed to call oneself a “Heilpraktiker”, which can be obtained without any reasonable medical training.

    These people, legally recognised as “practitioners of medicine without a license”, i.e. non-medical therapists, are often perceived by the general public as “small doctors”, often even as “very specialized doctors”. However, their portfolio consists mostly of CAM and sometimes the wildest evidence-free remedies and methods.

    Critics have been pointing out for many years that the state recognition and ennoblement of such a parallel medical world is logically completely nonsensical and represents a danger for patients. The legislator has failed for decades to take corrective action here. This has led to a certain stable legal position of “alternative practitioners”, whose number has more than doubled in the last two decades.

    Some time ago, the German Minister of Health commissioned a legal opinion to explore the possibilities and limits of regulating “Heilpraktiker”. This legal opinion has been available for some time, but it is so biased that it attempts to consolidate the profession of the “Heilpraktiker” even further and to legalize CAM as so-called “desirable medicine” and to place it among the “Heilpraktiker”. Insanity. Moreover, the legislator should only be authorized to impose restrictions if there is “empirical evidence” of harm caused by “alternative practitioners”.

    If this were true, many a protective law would have to be repealed. Nevertheless, another “expert opinion” was commissioned on just this point. One can imagine the future path.

    The fact that there is a fundamental problem of a systemic nature here, the core issue of which is patient safety and the avoidance of misleading those seeking help, seems to be completely pushed into the background.

    Really a nightmare.

    • Thank you very much Udo for your articulate and concise comments on this important topic. You tied it up and put a bow on what is of most importance.

      Getting to the “core” issue of the matter indeed… public safety!

    • In Australia, most physicians don’t hold a doctorate at all, they have a joint Bachelor of Medicine & Bachelor of Surgery (MBBS, or sometimes MBChB, depending where they graduated). They still use the title doctor, however.

      Here, generally only specialists hold doctorates.

      I thought that that was also the case in the UK.

      • Whence cometh the Australian system!
        And in UK, most surgeons remain humble enough to style themselves as ‘Mister.’

        For some reason, in recent years, UK dentists have taken to styling themselves as ‘Doctor’ – which, of course they are not (unless otherwise qualified as PhD or having a second degree in medicine).

        Why ‘Dentist Smith’ (‘Dn Smith’) does not suffice is beyond me.

        I guess it’s called ‘Ego.’
        But this practice misleads patients and the public.

  • The general public does indeed hold the Title of anyone who attaches the designate “Dr.” prefix to their name in high regard. This concept of trust with the medical profession is nothing new. The norm now for any faction or health group wanting false credibility. There are now Chiropractors “clinics” on just about very donut strip mall in Canada. Truly giving a sense of real security and false confidence, is the constant use of “Doctor of Chiropractic” on their business cards and documents.

    I fix furniture. I think I will change my name to Dr. Furniture Repair

    Unfortunately, my wife Sandra Nette placed way too much credence and validity into the level of care she would receive when visiting her Chiropractor (“Dr.”) in Edmonton, Alberta.

    Had she known this Chiropractor did not have the proper level of care, extensive medical training and understanding of the human body or the risks involved with rapid upper neck manipulation, she would never have placed her health care in his hands.

    Deep regrets that will now last a lifetime. Wish we could turn back the clock.

  • @David Nette

    I don’t know what happened with your wife’s neck, because you did not elaborate.
    That said, you or friends or family members have never suffered at the hand of an MD ? … count yourselves lucky then.

    • What happened to David’s wife is a matter of public record.
      What happened to your ‘friends’ or ‘family’ are unverifiable statements of a troll. A troll that has a history of making delusional claims

    • Fact:
      If it were not for the excellent care by the highly trained Doctors and Nurses at the University of Alberta Hospital and extensive rehabilitation at the Glenrose during Sandy’s one year hospital stay, she would not have survived.

      We owe these true medical professionals more than we could ever express. Thank goodness for these men and women who dedicate their lives and give us second chances.

      Yes….even Doctors can make mistakes, but our own personal experience was my young wife saw her Chiropractor believing these repeated neck manipulations were necessary in order to help her “maintain” her perfect health. She had no aliment, no disease, no drug use, youth on her side, and lived an incredibly clean lifestyle.

      We look forward to the day when all Chiropractors discontinue this needless rapid neck twisting. To those who have ceased this dangerous practice we commend you.

      When the risk of any procedure outweighs any real lasting benefit, why take the chance of destroying someone’s life?

      • “ discontinue this needless rapid neck twisting.”

        I will agree there should not be any “rapid neck twisting.”

        The proper way is to take the joint to lockout and a small but quick thrust is put into the joint. In the neck this is around 150N and gaps the Z joint a few mm.

        I see videos of people doing these rapid neck adjustments and it upsets me. That’s how people get hurt.

        • Highly qualified physical therapists do not see the need to “take the (neck) joint to lockout”, and, unfortunately. the thrust is also transmitted to the bend in the vertebral artery. No clear benefit, all risk. Just stop manipulating the neck.

          • Past attempts to have discussions with Sue on this topic have shown that she is unwilling, or unable, to defend her statements/claims with evidence or specifics. Thus, she is just expressing her general opinion/beliefs.

  • When a flight attendant asks over the loudspeaker if there is a ‘Doctor’ on board, how does the chiropractor respond?
    Perhaps like this brave fella’. ?

    To any (real) physician, this boastful account of alleged bravery is both frightening and hilarious. Activator and applied kinesiology…”listened to his heart with my ear”…sounds like a Leslie Nielsen movie.
    The chiropractor’s final declaration is particularly revealing:

    A chiropractor does not need an MRI — or a CAT-scan, an x-ray or an automatic processor. Even in an emergency, your hands, an Activator, a bed, a couch, a chair or a portable table are all you need to render care to 98% of the populace.

    Thinking back on my 44 years of practice and my varied experiences, I think maybe I should become a cruise-ship chiropractor in my retirement.

    Some of the most dangerous people around are those who do not know what they do not know.

  • IME, there can be other things at play too, such as assumptions made by patients and their families.

    I’m male, was a senior community MH nurse, i.e. an autonomous practitioner carrying my own caseload, who always, but always introduced myself as “nurse”.

    However, I lost count of the number of times I was referred to as “doctor”, as well as “psychologist” and, my favourite, “that gadgie” (that’s Teesside for you).

    This could not be out down to age, as I worked in CAMHS. And my own niece, the daughter of my sister the senior general nurse, at one time could not believe that Uncle Murmur was also a nurse…

    There remain some dodgily gendered assumptions out there.

  • To all, my anecdote

    I’ve never commented on Chiropractic therapy here previously, largely I try to stay out of the conversation.

    I had some previous chiropractic treatment many years ago (23) years ago for low back pain. One Chiro (the first) I visited a number of times employed much the same tactics that the second Chiro, some treatment differences…. nothing major. Both DC’s always began the treatment with a neck adjustment.

    I enrolled with the second Chiro with a regular treatment plan, three days a week for six months. From the beginning, when the DC would start out with the neck adjustment, he would always ask after, now how does that feel ? MY response every time was the very same. “I DON”T HAVE A NECK PROBLEM”. On about the 20th week, the adjustment did not go well, and the DC reapplied the technique. I left the office with some pain. I returned for another three consecutive days with no resolve to the pain. I ended the treatments short of completing the program.

    After about a week, the pain in my neck was beginning to feel somewhat better, however I got broadsided in a bad auto accident and it reaggravated the problem. From that point in time my neck has only gotten worse. I’ll never know if the problem today stems from the DC, the auto accident…. or both.

    I am convinced that this protocol is what DC’s have been taught in their schooling. However, my position now is that they should listen to their patients a bit more closely., that included MD’s.

    • Thanks for sharing RG!
      My young wife Sandy Nette went to Chiropractors for years. The neck adjustment was indeed the DC’s “go to” choice and very much a part of his advised “medical” treatment protocol. She didn’t even suffer from headaches and was only going regularly on the advice of the Chiropractor, to “maintain” her good health.

      On the day when Sandys vertebral arteries were ripped immediately following a rapid neck twisting by her Chiropractor in Edmonton, she felt dizzy but managed to exist the building and headed home.

      I distinctly recall thinking to myself, that had my wife not had the wherewithal to pull over to the side of the freeway, she very likely would have been in an accident. Anyway, she somehow made it about 20 minutes away from his clinic where I picked her up at the side of the road. Her vision was one of the first things affected by the Chiro “treatment”.

      I wonder what the number of people might be, who have been injured or even killed in road accidents or falls, following Chiropractor treatments? Now this would be quite the study!

      Subsequent injury or untimely death would be easy to overlook if one had no knowledge of a “Doctor” visit having taken place. Perhaps it should be a standard question (Have you recently visited a Chiropractors office and had an upper neck manipulation?) on every Hospital Emergency, Police or Highway Safety report following any serious incident.

      With repeated neck twisting I have had Doctors explain to me it can be likened to a weakened garden hose that keeps getting stretched or kinked. It’s only a matter of time before there’s a leak.

      Despite you clearly and repeatedly telling your Chiropractor that your neck wasn’t the problem, he/she didn’t get the message. You are not alone. Today thankfully there are many Chiropractors who are abandoning such folly and doing away with rapid upper neck manipulation.

      I am sorry to hear of your ongoing pain but wish you better days ahead!

      • @David Nette

        I was unaware of you story until I looked further. Evidently your wife’s case is quite well known… and verified, which takes it out of the anecdote column.
        I am sure that after all I’ve endured these many years, you and your wife all the more. I empathize with both of you.
        I have to admit, sometimes the neck adjustment did come with a little pain, other times with a sense of relief. Relief from what ?… I’m not sure. Occasionally it did feel better. Sometimes there was a sense of “something good just occurred” …. what exactly I couldn’t tell ya, so I would be assuming. Just stupid ignorance I suppose, just blindfully going along with what my DC was applying as his technique.

        I’m not for or against DC’s. I hold MD’s and SCAMers both the same to “do no harm”.

        Prayers to you.

  • The cesspool of ego-aggrandizement if not full-blown narcissism captured in this piece and comments. Healthcare is doomed.

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