Kookaburra with meat

Kookaburra with meat
photo by Lander 777

Thursday, January 26, 2012

Can anyone can call themselves a doctor in Australia?

Holidaying  recently on Queensland's Sunshine Coast, I was not surprised to see a thicket of compliementary and alternative health practitioners. (In Australia, CAM seems to be a coastal, touristy, warm climate phenomenon. I guess it has parallels in Florida, California, Thailand, and the Costa del Sol; but not so much in Aberdeen, Winnipeg, or  Reykjavik. Tell me if I'm wrong.)

What did surprise me was the use of the title "doctor" by a number of health practitioners who gave no appearance of having either a medical degree or a doctorate of any kind. 
One example is here:

(This photo is of a glass door leading into the practitioner's room. The door has the sign on it.  The practice is at a swimming pool which is reflected in the door, although the photo looks like the sign is hanging in empty space or superimposed on a photo of the pool. It was taken by me in January 2012).

This practitioner styles herself "Dr". She appears to have a bachelor's degree in science and a masters degree in health science specialising in osteopathy. She does not list a medical degree or a PhD or other doctorate in any discipline. The national register for Australian Health Practitioners confirms these as her qualifications.  

I make no criticism of this individual - it appears to be a common approach adopted by a number of health practitioners and approved by their regulatory authorities. But I do question the policy stance of the law if it really allows this to happen.

"This would never happen in NSW", I blithely thought to myself.  "This is Queensland after all - the State whose longest serving Premier tried to allow a Quack cancer therapist to set up shop.  Queensland is the flaky state".  Queensland has had its scandals and formal inquiries about bad medical practice.  I was sure things would be improving, but perhaps they hadn't yet touched the complementary and alternative fringe.

With an air of anticipatory southern state superiority, I looked up the NSW law on the question....oh, the shame! The NSW law appears not to prevent it either. 

I was sure there used to be a law against falsely calling yourself a doctor in NSW. There is for lawyers (see here and here). How had this happened? How could the rigour and esteem of the once proud NSW medical profession have been thrown to the wind? 

Well, until middle of 2010, it was a criminal offence in NSW for a person not qualified through a medical degree to represent themselves as a medical doctor or physician:
(1)  A person who is not a registered medical practitioner must not take or use any name, initials, word, title, addition, description or symbol which having regard to the circumstances in which it is taken or used indicates or is capable of being understood to indicate or is calculated to lead persons to infer that:
(a)  the person possesses a degree, diploma, or other qualification of a nature which would entitle the person to be registered as a medical practitioner, or
(b)  the person is registered as a medical practitioner under this Act.
Maximum penalty: 50 penalty units or imprisonment for 12 months, or both.
(2)  A person who is not a registered medical practitioner must not advertise himself or herself, or hold himself or herself out, to be a registered medical practitioner, doctor of medicine, physician, surgeon, legally or duly qualified medical practitioner, qualified medical practitioner or medical practitioner.
Maximum penalty: 50 penalty units or imprisonment for 12 months, or both.
In the middle of 2010, following an agreement by the Council of Australian Governments (COAG) in 2008, all states adopted a national law regulating the health professions based on the Queensland model.  The law covered 10 'professions': 

chiropractic, dentistry—including dental hygienists, dental therapists and dental prosthetists—medicine, nursing and midwifery, optometry, osteopathy, pharmacy, physiotherapy, podiatry and psychology
Section 113 of the law provides in part that 

A person must not knowingly or recklessly—(a) take or use a title in the Table to this section, in a way that could be reasonably expected to induce a belief the person is registered under this Law in the health profession listed beside the title in the Table, unless the person is registered in the profession...
"The Table" lists the following titles within various "health professions":

Aboriginal and Torres Strait Islander Health Practice
Aboriginal and Torres Strait Islander
health practitioner, Aboriginal health
practitioner, Torres Strait Islander health

Chinese Medicine 
Chinese medicine practitioner, Chinese
herbal dispenser, Chinese herbal medicine
practitioner, Oriental medicine
practitioner, acupuncturist


dentist, dental therapist, dental hygienist,
dental prosthetist, oral health therapist

 medical practitioner

Medical Radiation Practice
medical radiation practitioner, diagnostic
radiographer, medical imaging
technologist, radiographer, nuclear
medicine scientist, nuclear medicine
technologist, radiation therapist

Nursing and Midwifery
 nurse, registered nurse, nurse practitioner,
enrolled nurse, midwife, midwife

Occupational Therapy

 occupational therapist
pharmacist, pharmaceutical chemist
 physiotherapist, physical therapist
podiatrist, chiropodist

The key point is that the terms "doctor", "physician" and "surgeon" do not appear in the Table above. While nobody who is not registered as a "nurse" can use the title "nurse" in a way that could reasonably be expected to induce the belief that the person was a nurse, the law does not protect the title "doctor" in the same way.

This law does not it in its terms prevent any of these health professionals from titling themselves "doctor", at least so long as they state the type of health practitioner they are.

Some of the health and related professions on this list are quite scientifically oriented. Others are not. The mere fact that one is scientific ought not, in my opinion, entitle the use of the title "doctor" unless you are qualified as a medical practitioner or hold a doctorate awarded by a recognised university.  No doubt there are members of all of the above professions who hold doctorates. Most do not. Those that don't should not use the title "doctor" unless they are a medical doctor.Why should this exception apply only to medical practitioners (ie only to doctors)? Because that is what the word "doctor" means by its ordinary accepted usage.

What does "doctor" mean? The Macquarie Dictionary (Sydney, 1981) has this definition:
n 1. a person licensed to practise medicine, or some  branch of medicine; a physician or medical practitioner other than a surgeon. 2. a person who has received the highest degree conferred by a faculty of a university. a conventional title of respect of such  a person....a man [sic] of great learning...
Surprisingly, the Australian medical profession appears to have been slow to protect the title of doctor. In its joint submission (along with other Australian medical bodies) on the exposure draft of the national law, the AMA did not take up the issue of when could someone use the titles "doctor", "physician" or "surgeon". Their only concern appeared to me to be distinguishing medical doctors from PhDs.  (This is redolent of what one hears about medical doctors being concerned about status in clinical case conferences and ensuring everyone knows if a person has a doctorate instead of a medical degree).

Chiropractors have been quick out of the gates and frankly quite brazen in their approach. They have not changed their level of training or qualifications one bit, but they have issued a statement that they will amend the register of Chiropractors to officially call all their practitioners with the title "Doctor".  The Chiropractic Board of Australia has issued chiropractic advertising guidelines which advise chiropractors that they can use  the title doctor so long as they
 " make it clear that they do not  hold registration as medical practitioners; for example, by
including a reference to their health profession whenever
the title is used, such as:... Dr Walter Lin (Chiropractor)."
How this makes it clear that the person using the title doctor is not a medical practitioner is beyond me. An uninformed but intelligent layperson may well assume that the person is a medical practitioner who also has qualifications in chiropractic therapy; just as there are many medical practitioners who also have qualifications in acupuncture, Chinese medicine or otherwise regard themselves as "integrative".

Frankly, in my opinion there is nothing in the advertising guidelines of the Chiropractic Board that protects the public from advertising that is misleading and deceptive. There must have been a heated subterranean debate within the 14 national boards that (are soon to) make up the Australian Health Practitioners Regulation Agency about these guidelines - because the Psychologists (to their credit) disagree with the Chiropractors. Astonishingly, this disagreement, evidenced by the reference to what psychologists are advised by their professional Board, is contained in the very next paragraph of the Chiropractors' guidelines:

The Psychology Board of Australia has developed
specific advice for its profession. It advises registered
psychologists that use of the title ‘doctor’ in their
practice has the potential to mislead members of the
public. Specifically, patients or clients may be misled
into believing that the practitioner is a psychiatrist when
they are not. Therefore, registered psychologists may not
use such a title unless they hold a doctoral qualification....
Where a registered psychologist holds
a doctoral qualification that meets the above standard,
if they advertise their services to the public, they should
make it clear when using the title ‘doctor’ that they are
not a registered medical practitioner or psychiatrist, for
• Dr Vanessa Singh (Psychologist)

In other words, chiropractors acknowledge that it may be misleading for a psychologist to call themselves doctors, even if they hold a doctoral degree (if they don't also specify it is not a medical doctorate), but it is not misleading for a chiropractor who does not hold any qualification generally understood to be that of a doctor to do so. Incredible.

And what's more, the guidelines don't even try to construct an argument about why they should now suddenly be regarded as doctors. They just say, in effect, "we're free to do it, come aboard". The Australian Chiropractor's Association regard "doctor" as a "courtesy title"  that apparently ought to be available to any health professional who has done 5 years' study, whether of medicine or otherwise. They argue that because dentists and vets have begun to use the title "doctor" this should be extended further.

But, there is nothing in the new health practitioners law that limits the use of the term doctor to those with 5 year's study.There is nothing in the law  that limits who can use of the term "doctor" (or for that matter "physician" or "surgeon") at all. If chiropractors and osteopaths are doing it, soon it may be podiatrists, Chinese medicine practitioners, acupuncturists, pharmacists, nurses and midwives.

Some of these professional groups seem more restrained in claiming to be doctors than others.

The Chiropractic Board is also right to draw its members' attention to the Trade Practices Act (now replaced by the Competition and Consumer Act 2010), although they seem to suggest that following their guidelines will comply with the Act. I wonder if this is so. I am not a trade practices lawyer, but I wonder if this kind of behaviour is not prohibited by any number of provisions under the Australian Consumer Law.

Why does any of this matter? Because people may be deceived. Because they may be denied medical care on the false assumption that they are seeing a doctor and that the doctor will have in mind anything really medically serious they need to attend to. Because there is a mounting death toll from people who have used alternative medicine instead of medicine. And because the use of the term "doctor" in relation to people who are not is untrue.

The Australian Competition and Consumer Commission did a great job in cracking down on the bogus Power Balance bracelets.  Now's the time for them to find the right case to run against the misleading use of the term "doctor".