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Above: Pharm D candidates at the Guru Nanak Institute of Pharmaceutical Science & Technology, Kolkata; they can prefix “Dr”/Photo: gnipst-pc.ac.in

With the pharmacy council allowing its degree holders to use the “Dr” prefix, practitioners of modern medicine are irked and patients are left confused as to whom to go to in an emergency   

 

By Dr KK Aggarwal

As per Medical Council of India (MCI) ethics regulation 2.1, every doctor has an obligation towards the sick: “Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission… A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient…”

Regulation 2.4 says: “The patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency….”

In an emergency situation, the only answer is a modern medicine doctor or one registered with the Medical Council of India.

But it is regulation 1.1.3 that is especially important and defines who is a physician: “No person other than a doctor having qualification recognised by Medical Council of India and registered with Medical Council of India/State Medical Council(s) is allowed to practice Modern system of Medicine or Surgery. A person obtaining qualification in any other system of Medicine is not allowed to practice Modern system of Medicine in any form.” So, in an emergency, the public must find a doctor with an MBBS degree and the accepted way of doing it is to search for a person who has prefixed Dr before his name.

MCI ethics regulation 1.4.2 also says: “Physicians shall display as suffix to their names only recognised medical degrees or such certificates/diplomas and memberships/honours which confer professional knowledge or recognises any exemplary qualification/achievements.” In the case of MBBS doctors, it will be modern medicine.

Article 18 of the Constitution talks about abolition of titles: “No title, not being a military or academic distinction, shall be conferred by the State. No states can officially issue titles.” When I got the Padma Shri by the president in 2010, I was cited a Supreme Court ruling as part of the briefing: I cannot use Padma Shri Dr KK Aggarwal under Article 18. But I can use Padma Shri awardee Dr KK Aggarwal or recipient of Padma Shri Dr KK Aggarwal.

The prefix Dr used by modern medicine doctors is not given by the Medical Council of India, a medical college or a state university, but by society to differentiate us from others and identify us as modern medicine doctors. However, today, even a person who has completed doctoral research and is awarded a PhD, prefixes Dr to his name. Practitioners of AYUSH systems of medicine also prefix their names with Dr even though they have their own appropriate terms such as Vaidya (Ayurveda), Hakim (Unani), Naturopath (Naturopathy), Yogacharya (Yoga) and Homoeopath (Homeopathy). One must remember that in an emergency, these systems of medicine are not effective. That’s not all. Universities also felicitate eminent individuals for their contribution in many fields such as literature, science, sports, music, cinema, social service, etc, with doctorate degrees. These individuals also prefix Dr to their names.

Now there is talk of the Pharmacy Council of India (PCI) authorising candidates receiving the Doctor of Pharmacy degree (Pharm D) from recognised universities to use the “Dr” prefix. This title reflects entitlement and identity and the Indian Medical Association (IMA) is against it being used by those trained in other streams of medicine as it confuses people during medical emergencies. In a letter issued to the director of Board of Examination and Evaluation of Sant Gadge Baba Amravati University, the registrar-cum-secretary of the PCI, Archana Mudgal, has informed that the University should use the “Dr” prefix before the names of candidates while awarding them degrees. But as universities in Maharashtra were not issuing degrees with “Dr” prefix, members of the Doctor of Pharmacy Association of Maharashtra approached the PCI for clarification. The PCI then issued a circular stating that Pharm D candidates can use Dr before their names. Legally, this is only an executive order and not a legally sanctioned clause.

Physiotherapists have also been asking for Dr as a prefix. Tomorrow, even nurses will start writing Dr as a prefix. Of course, quacks are also prefixing Dr before their names. And surprisingly, even health products are using Dr liberally such as Dr Morpen, Dr Fixit, etc.

The use of Dr as a prefix is widespread, be it dentists, veterinary doctors, acupressure and acupuncture specialists or occupational experts. The easiest solution to distinguish these branches of medicine would be to have specific degrees such as XYZ, Doctor of Pharmacy.

When I was the National President of the IMA, this matter was discussed on many occasions. We were getting many complaints from the public of being misguided and exploited by untrained doctors during emergencies.

Different variations of Dr were being used—DR, DR., Doc, Doc., Doctor, Dr (Modern Medicine), Dr (Homeopathy), Dr (Ayurveda), Dr (Naturopathy), Dr (Dental), Dr (Veterinary), Dr (Yoga), etc. I personally started carrying a stethoscope around my neck as a symbol of modern medicine and being available in any emergency.

While one can stop pharmacists or physiotherapists from using Dr before their names, one will never be able to stop AYUSH doctors from doing the same. So the IMA copyrighted an emblem for modern medicine which is to be used by all its doctors to differentiate themselves from those in other fields.

The government must come out with a regulation so that ordinary people can differentiate between doctors of different systems of medicine. The confusion can cause fatal errors and delay in treatments. Will the government listen or should we again look to the judiciary to intervene and take a decision?

—The writer is President, Heart Care Foundation of India, and President-elect, Confederation of Medical Associations of Asia and Oceania

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7 COMMENTS

  1. I agree with your view sir but nowadays physiotherapists, nutritionists, occupational therapists are using Dr. Prefix openly, they have bechlor degree not doctorate degree and you can also find this on the website of many hospitals which maintains an employee directory and nobody stops them while Pharm.D is a professional doctorate degree in pharmacy and these graduates have right to use Dr. Prefix.

  2. Respected sir,
    The role of PharmD (Doctor of pharmacy) are-
    1. Preventing Adverse drug reactions.
    2. Therapeutic drug monitoring.
    3. Patient counselling.
    4. Preventing drug-drug and drug-food interactions.
    5. Providing an update of new drugs to physicians.

    And the syllabus includes pharmacotheraputics, pharmacology, toxicology and others in deep as compared to an normal MBBS syllabus.

    The above mention roles can also be performed by physicians but due to there busy schedule, diagnosing OP patients, ward rounds for IP patients etc. these roles have been not checked or taken under considerations causing unwanted and unintended effects.
    The main aim is to improve patient health care and improve efficacy of the medicine given to patient and not to replace any profession and generate conflicts.

    As far as emergency patients are concerned, the patient first should approach physician for diagnosis and medication orders and then the medication chart, dosage, frequency, and drug interactions are checked and reviewed for further alternatives available for the situation and following roles which are beneficial for the patient will be taken care by PharmD Doctors.

    Thanking you,
    Your’s sincerely
    Aaron Papade
    (PharmD)

  3. This blog is shocking for me because I never expected a former president of IMA will write such an immature blog. We all know the moto behind the ‘Dr’ prefix is to indicate a specialized knowledge in a particular field. The basic term for a person who diagnoses and treats a disease is a ‘Physician’. Just because it’s a trend to call Physicians as doctors doesn’t mean you can discourage and any other field from ‘Dr’ prefix. Eventually, I suggest IMA to respect other health care professions too apart from their own.

  4. Is word Dr a copyrite of IMA?
    Are ethics and law or act are same?
    Is using Dr prefix by a non modern Clinician punishable offense?
    Who invented term Dr – IMA, MCI or Indian Doctor who practice modern medicine?

  5. I am physician and a member of IMA. Since the ex-head of IMA is talking about medical ethics, I would like to point out that endorsement of consumer products by doctors and indirectly by doctor’s associations is also unethical as per MCI guidelines. Then, why is IMA endorsement being shown for ASIAN PAINTS & CROMPTON LED BULBS for anti-bacterial action. There is no peer reviewed published literature anywhere that proves the point. IMA obviously does not do any research on its own.
    Secondly, IMA did not bother about the corrupt practises of MCI under Ketan Desai because many IMA members were either MCI inspectors or members themselves. Isn’t that dereliction of duty and conflict of interest? Who is going to listen to you when there are so many allegations.
    Thirdly, under Ketan Desai, MCI members as high as Vice-President of MCI [Dr. Kesavankutty Nair] were on the board of private medical colleges such as Ramachandra Medical College, Porur which was widely known to hold sham entrance exams and auction of all their medical seats to politicians, businessmen and their kids. I know of several candidates who have booked from MBBS to superspecialty courses for 5 – 10 crores in advance i.e all 3 levels of medical seats are booked in advance.

  6. The word doctor derived from Latin verb docēre Latin pronunciation: [dɔˈkeːrɛ] ‘to teach’

    Doctoral degree is the most highest degree given by the universities.. Previously, medicine course was one of the highest degree which one could obtain from universities, along with science, philosophy, art etc. The word “Doctor” is later accepted as synonymous for the word” physician”

    Author of this article seem to be unaware of the etymology of the word ” doctor”
    Lack of research before publishing this article is evident

  7. Stethoscope is the symbol of modern medicine? ???
    Thanks for the new info.
    Even locksmiths use stethoscope.
    I think govt. Should ban selling stethoscope in public shops, since it can create chaos during emergency

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