Title of Doctor (Hansard, 19 January 1996)

§ Mr. Michael Stern (Bristol, North-West)

I make no apology for raising on the Adjournment a matter about which, although it is of limited and, some would say, sectional interest, I first contacted the Prime Minister in 1986. At the behest of a small number of my constituents, in particular a retired medical doctor, I have tabled questions to the Minister on a number of occasions, the latest being answered by him on 14 July. At that time, I asked the Secretary of State whether he would make it his policy to provide statutory protection for the title "doctor", as used in the field of medicine and in the professions allied to it. He replied that he was satisfied that the matter was adequately covered by section 49 of the Medical Act 1983.

Like all apparently minor matters, the subject deeply engages the attention and the feelings of those who are most concerned about it. In medical professions, it involves whether a person who has obtained a doctorate, a doctoral degree in medicine, commonly referred to as an MD, is entitled to special protection of the use of the title "doctor" compared with the majority of medical practitioners who do not have such a doctoral degree.

Some people who practise regularly as doctors have no degree at all, but have a qualification that has been awarded by one of the royal medical colleges. I have had drawn to my attention the case of one practitioner whose only qualification was LSA—that is, a licentiate of the Society of Apothecaries, but was nevertheless called, and by courtesy was entitled to be called, "doctor".

In the United States and Canada, the use of the title "doctor" in medical circles is much more frequently restricted to those who have a doctoral degree, but that is because a first degree in medicine in those countries is usually at doctoral level, although many practitioners here would argue that its breadth and depth are slighter than the apparently inferior qualifications held by many practitioners in this country.

It would be interesting to know whether the Minister, in the researches that were necessary to enable him to reply to the debate, has been able to establish the proportion of doctors of medicine as defined in the Medical Act who are holders of doctoral degrees. 1 shall now turn to that Act.

Section 49(1) of the Act makes it an offence for any person who wilfully and falsely pretends to be or takes or uses the name or title of…octor of medicine". If he does so, he is liable to the penalty of a fine.

Although the wording of the Act is fairly clear, I understand from the British Medical Association that, in practice, it has proved to be virtually impossible to enforce the section within the medical professions, because it is necessary to prove the intention to mislead a member of the public. That test has proved too stringent to enable a successful prosecution to be brought.

I should like to hear the Minister's views on whether a medical practitioner is misleading the public, solely by reason of his not holding a doctoral degree, if he 1065 accedes to the title "doctor" out of courtesy or long usage when he has no legal title to have the word used to him or to use it himself.

The courtesy title of "doctor" seems to be the nub of the problem. I understand that, apart from general practitioners, ships' doctors are particularly used to the title "doctor", although few have the degree that would entitle them to it. There may be many other examples in medical professions where courtesy has overlaid the strict application of legality.

Should we care? Should we be concerned that a practice that has grown up through centuries of usage is incorrect in law and in fact? Do not the public in general acquiesce in the fact that they are not being told the strict truth about the qualifications of the people they approach on medical matters? Should we follow the rather more strict line laid down by Dr. Johnson, a real doctor, when he argued that the antiquity of abuse is no reason for its continuance?

If—I accept that there can be two opinions on the matter—the courtesy use of the title "doctor" is an abuse, clearly the toleration of such abuse is allowing it to extend itself. It was recently announced that the General Dental Council is about to introduce regulations—it may already have done so—to enable dentists to call themselves doctors, despite the fact that many of them are surgeons and are instead entitled to the courtesy title of Mr. or Mrs., which is at least less confusing.

I understand that the reason for that departure is that dentists in other parts of the world style themselves "doctor", despite being equally unqualified in doctoral degree terms. If that is the reason for the new regulations, I regret it. I have always regarded the purpose of British culture as to export truth rather than to import falsehood. Nevertheless, the General Dental Council's decision gives added point to the debate.

I do not expect my hon. Friend the Minister to announce his conversion to one side or the other of an issue that has occupied an admittedly small number of people for a long time. Indeed, I appreciate that any decision by the Government at this stage would be greeted by howls of protest whatever that decision were to be.

I should like to ask the Minister, following this brief introduction to the subject, to tell me whether the Government believe that there is any potential for abuse in the use of courtesy titles which also have legal meanings, and whether he foresees that a possible growth in the use of that courtesy title would be an abuse that the Government would need to check.

§ The Minister for Health (Mr. Gerald Malone)

I congratulate my hon. Friend the Member for Bristol, North-West (Mr. Stern) on securing this debate on a subject that is clearly dear to his heart—although, judging by what I see as I look around the Chamber, apparently not to many of our parliamentary colleagues. However, he has raised a number of important matters, with which I am happy to deal.

I thought I might help my hon. Friend if I were to establish a common-sense definition of the word "doctor". I resorted to a book which is never far from my desk, the "Shorter Oxford English Dictionary". It is 1066 worth looking at the number of definitions and the reasons for them. In a common-sense way, the term "doctor" applies to a number of different people and categories of people. The first definition is "Teacher, a learned man". Then come "Doctors of the church"—not just the Church of England, but the four eastern and the four western churches.

It continues: Holder of the highest university degree in any faculty (often honorary; used as prefix to surname)". That is the point that my hon. Friend made. The third definition becomes more general—"a Physician". That requires no qualification, but includes those who are recognised in common sense as physicians— dentist or veterinary surgeon; one who carries out repairs". The definition even refers to tree doctors, who are probably much needed in the constituency of Newbury at the moment. My hon. Friend might be interested to note that it also specifically refers not to the doctor on a ship, but to cooks on board ships or in camps who are known as doctors.

There are various other colloquialisms, with which I shall not detain the House, but I referred to that definition because my hon. Friend's remarks sought to imply that "doctor" is a title that should be reserved to those who have a certain qualification. It never has been. I will probably disappoint my hon. Friend, but I shall state none the less that the Government have no intention of reserving the title in the way that he suggests.

The House may remember the time when Paula Dixon fell ill on a flight from Hong Kong to London. No doubt the call went out, "Is there a doctor in the house?" As it happens, that cry was answered not by someone bearing the title "doctor" but by Professor Angus Wallace, a doctor, who improvised a life-saving device with a coat hanger, some plastic tubing and a bottle of mineral water, all sterilised in brandy. I was delighted to be able to write to Professor Wallace after that successful emergency operation and congratulate the learned professor on being sensible enough to put the brandy to good medicinal use after the operation by drinking it himself.

If the air hostess had asked the question that she would have been obliged to ask had my hon. Friend's wishes been entrenched in statute, the situation would have been made more difficult. Would the air hostess have had to refuse the help of anyone without a PhD? If so, it is unlikely that Paula Dixon would be alive today. What was needed was the attention of a doctor in the sense that we all recognise it, and in the sense that it is always recognised on the Annunciator in the House should one of us require the attentions of the medical profession, as happens from time to time.

The term is, of course, in general use for physicians or medical practitioners, and that is what is understood by the public. Nevertheless, my hon. Friend asked whether we were concerned about abuse. I am not concerned about the common-sense use of the word as we know it, but the House should be concerned—as my hon. Friend is—about charlatans passing themselves off as medically qualified so that they can peddle quack slimming remedies or inject collagen for cosmetic effect.

1067 Anyone pretending to be a registered medical practitioner risks falling foul of the law. The central point of my argument and dispute with my hon. Friend is that his proposal would not solve the problem of abuse or people passing themselves off, which is at the core of any activity that could be described as wrong.

It is probably more likely—because there is clearly more profit in it—for someone to choose to pass himself off as a medically qualified doctor, but in some circumstances it could be equally damaging were someone to pass himself off as a doctor of philosophy, qualified in the sense that my hon. Friend suggested.

One can imagine such a person holding himself out to the public as being highly qualified and pontificating on television about how the public should behave—not that such people do so very often. Although such a person might state that he had a proper doctorate in the sense suggested by my hon. Friend, that person would not, and the public would be deceived. The damage would occur if someone were to pass himself off as either a practitioner or a doctor who had qualified as my hon. Friend suggested.

The General Medical Council has been given responsibility by Parliament to register those fit to practise medicine in this country. Only people holding a recognised medical degree will be put on the medical register. My hon. Friend asked me specifically how many people on the register held doctoral degrees, and kindly gave me notice of his question. I am afraid that, in the time available, I have been unable to discover the number, but I shall return to his question and perhaps be able to give him the number he seeks.

The penalty for abuse of the term "doctor"—in the sense of someone who passes himself off as qualified to take medical decisions—is severe. Section 49 of the Medical Act 1983 imposes a fine of £5,000 on anyone who is convicted of pretending to be a registered medical practitioner. The Act does not define the term "doctor", because it is in common usage, but it protects the use of the following titles: physician, doctor of medicine, licentiate in medicine and surgery, bachelor of medicine, surgeon, general practitioner and apothecary. The purpose of that measure is to ensure that no one can hold himself out as one of those professionals, damage the public and feel that he can get away with it.

I do not agree with my hon. Friend that there is a problem. Most members of the public do not go to the General Medical Council to confirm that the doctor is medically qualified before entering the doctor's consultation room. There are a number of other factors on which they can rely—not least the continuing relationship that most people have with their doctor and the environment in which the consultation takes place, the surgery.

If someone consults a lawyer called Dr. Smith, he is unlikely to be confused and talk about Auntie Flo's bunions instead of the making of her will. I do not think that anyone will crack on down to the surgery under the illusion that he will have an interesting philosophical chat with a doctor of philosophy on a learned topic. I can confirm that most lawyers do not go around in white coats wearing stethoscopes around their necks.

1068 The central question posed in my hon. Friend's speech is whether the use of the title "doctor" should be regulated—and I think not. One of the reasons why I think not answers another point that my hon. Friend asked me to comment upon, about prosecutions not taking place when people abuse the title.

I tender to my hon. Friend another explanation for that lack of prosecutions—there is not very much abuse of the title, certainly not enough to justify a considerable number of prosecutions. I hope that my hon. Friend would accept that, if there were such abuses, and an attempt to mislead the public, firm legislation exists with which we could address that matter.

I do not think that we should regulate the title, because the public simply would not understand. My hon. Friend rightly anticipated that it is not a subject upon which I think the Government should embark. I would counsel him that, although we may enjoy a relatively academic debate on the subject on the Floor of the House, he might find it a bit difficult to have that serious debate in his constituency, not least with the doctors who treat all his constituents. I trust that he is using this opportunity to explore the more theoretical aspects of the question, rather than suggesting that a practical measure should be introduced to change the existing law.

My hon. Friend also referred to the General Dental Council and the changes that it has made. If he does not mind, I should like to put him absolutely right on the matter. The council has not changed regulations, or introduced new ones: it has merely amended its own ethical guidance to dentists. It is quite within its own legal powers to do that.

The amendment is relatively simple. The character of that amendment suggests the council's motives. The council has said that the change in the ethical rules effectively…allows dentists to use the courtesy title 'Doctor' in the knowledge that they will not be liable to be charged by the General Dental Council with serious professional misconduct. The council made that change because, if a dentist called himself or herself "doctor", that was previously treated as a matter of serious professional misconduct, whether it led to serious damage to patients or not. In the case of a qualified dentist, unless the dentist describing himself or herself as a doctor went beyond the professional remit, which would be against the rules, there would be no risk to patients. I ask my hon. Friend to accept that that was the spirit in which the GDC made the change to its rules.

My hon. Friend has opened an interesting debate. I am sure that the public are not so gullible as to believe that all doctors they come across are medical ones. As long as those who are not registered with the General Medical Council do not give the impression that they are registered medical practitioners, I frankly see no problems, and no need to embark on regulation of the use of the title "doctor".

One of the Government's initiatives with which I am sure my hon. Friend agrees at heart is that we should use the House to deregulate, rather than cast around for fresh ways in which we can bring new regulations to bear. I respectfully suggest to my hon. Friend that that is the case in this instance.

1069 I should like to end, particularly at this time of the year, by pointing out that title is not everything, which was recognised by a bard from my native country whose birthday we are about to celebrate, Rabbie Burns. In one of his poems, it is absolutely clear that titles, rank and all that are not nearly as important as either the talents or the skills that underlie an individual. I suggest to my hon. Friend that that is rather a good test for deciding whether someone is up to the professional role that he or she decides to play in life.

1070 As Burns said:

"For a' that, an' a' that,
Our toils obscure, an' a' that,
The rank is but the guinea's stamp,
The man's the gowd for a' that."

I am sure that my hon. Friend will thoroughly agree with that sentiment, particularly at this time of the year.