So, last weekend the hospital released me to continue my treatment as an outpatient, then two days later on my first outpatient visit , they re(-)admitted me. Now I'm released again, but have been told to bring a packed bag to my outpatient visits...so you can expect my posts to continue to be erratic for a while. The good news is that I don't actually feel
poorly, so I can blog when I have access to the Internet. The bad news is that I have plenty of time and desire for blogging when
in (the) hospital, but no access to the blog. Catch-22.
So, the combination of dealing with a lot of different doctors and watching daytime reruns of
ER left me thinking about the differences in doctors' titles/roles in American and British hospitals. I must admit that, despite having watched a lot of medical dramas and having read a lot of medical thrillers and memoirs in my youth (the better to feed my hypochondria), I've never been clear on what exactly an (AmE)
attending physician is/does or how a (BrE)
senior house officer relates to a (BrE)
registrar. So, with a lot of help from
Wikipedia, I've been trying to teach myself the ins and outs of these titles.
Let's start before we get to the hospital ward. In the UK, your regular doctor, the one you see in their (AmE)
office/(BrE)
surgery, is your
GP or
general practitioner. In AmE, the insurance-driven name for such people is
primary care physician, but most people would just call that doctor
my doctor or their
family doctor (who works in or operates a
family practice--a term that is found in both countries, but in my experience is more common in the US). The term
general practice is also known in the US, but one doesn't hear people talking about their
GPs.
When your GP/primary care physician decides that you require more speciali{s/z}ed attention, they refer you to a
specialist--but in BrE they're likely to say that they're referring you to a
(specialist) consultant. The experience of such referral can be somewhat different in the two countries. Let's say your usual doctor wants you to see a gastroenterologist. In the US, they say "I'm going to refer you to Dr. Guts." Then you get an appointment with Dr. Guts and meet Dr. Guts at that appointment. In the UK, you are referred to Mr Entrails'
clinic (more on the 'Mr' shortly). Maybe you will see Mr Entrails--you're likely to on the first visit, at least--but you might see someone else in his clinic team, or
firm (the term that Wikipedia reports--not one I've come across in the patient's seat). The consultant Mr Entrails has overall responsibility for your care, but a variety of more junior doctors might see you. Mr Entrails' clinic will most likely be located on hospital grounds, whereas American Dr. Guts will probably see you in an office complex--often one built specifically for medical offices.
In a hospital context, there are different titles (and responsibilities) for specialist doctors at different levels of training. In the UK, there's apparently been a move to 'moderni{s/z}e' medical career paths in the National Health Service, though I've seen little evidence of the changes reported on
this NHS site. It says that a new title, Specialty Registrar [StR], replaces Senior House Officer [SHO] and Specialist Registrar from August 2007. But I was being seen by SHOs and Specialist Registrars at our hospital. So, I don't know if the new title applies only to people who have started since August 2007 or whether it's been abandoned, since when one hits the link for further info on the NHS site, one gets a 'page not found' message. For a comparison of new and old titles, see the table on
this Wikipedia page. I'm going to stick with the old titles, since they're the ones I've experienced. [NB: Yes, it's
specialty, not (BrE)
speciality. This is one of many examples of BrE medical jargon being closer to AmE than to non-jargon BrE.]
So, in the UK, you're a medical student, then once you qualify as a doctor, you go on to be a
house officer (
Pre-Registration House Officer in the old system,
Foundation House Officer in the new). After this, the doctor has a choice of going the GP route (which involves more training, but not all the titles I'm about to reel off) or undergoing specialist training for a minimum of two years as a
Senior House Officer, followed by 4-6 years of further training and increased responsibility as a
Specialist Registrar. One takes exams to go from one level to the next, with the highest level being
Consultant. The amount of time one needs to train for these various positions varies by the specialty, culminating in the Certificate of Completion of Training after exams from the specialist college (e.g. the
Royal College of Obstetricians and Gynaecologists). All of this is overseen by the General Medical Council, which determines the standards for entry onto the
specialist registers that allow one to work in hospitals as a consultant.
In the US, you're a medical student, then for your first year in the hospital you are an
intern, which may or may not be considered the first year of your
residency, during which you are a
resident (physician). This can also be called
house officer, as in the UK. After residency, one may or may not get a fellowship for sub-specialty training, before going on to be an
attending (physician) [or
staff physician] the equivalent of a (BrE) consultant.
In the UK, medical training begins at the undergraduate level--which is to say, people can be 'medical students' from their first year (BrE)
at university. In the US, medical school is for (AmE)
graduate/(BrE)
post-graduate students, and the undergraduate students do
pre-med degrees, which cover a lot of science, but also, like other US undergraduate degrees, a
liberal arts curriculum. (Law training differs in a similar way in the two countries.)
At least, that's how I understand all this. Anyone with better knowledge is welcome (as ever) to correct me in the comments.
Now, a few words on what you call these people. In the US, medical doctors, no matter their specialty or status, are usually called
Dr. [Surname].
In the UK, there's a kind of reverse snobbery, in that GPs and more junior specialists are called
Dr [Surname], whereas surgeons and other consultants go back to being
Mr or
Mrs or
Miss--though I've only met men in the consultant role so far, so I can't vouch for the actual use of
Mrs and
Miss. (Note that BrE tends not to put a (BrE)
full stop/(AmE)
period at the end of title abbreviations like
Dr, Mr or
Mrs, while AmE almost always does.) Here, I'll rely on
Wikipedia again:
In the United Kingdom, South Africa, Australia, New Zealand, Canada and other areas whose culture was recently linked to the United Kingdom, the title Doctor generally applies to both academic and clinical environment. "Registered medical practitioners" usually do not have a doctorate; rather, they have the degree of Bachelor of Medicine (usually conjoint with Surgery). Cultural conventions exist, clinicians who are Members or Fellows of the Royal College of Surgeons are an exception. As an homage to their predecessors, the barber surgeons, they prefer to be addressed as Mr, Mrs, Ms or Miss, even if they do hold a doctorate. This is first because they have normally achieved another degree - that of Master of Surgery (MCh from the Latin magister chirurgiae) from a university. When a medically-qualified person passes the notoriously difficult examinations which enable them to become a member of one or more of the Royal Surgical Colleges and become "MRCS", it is customary for them to drop the "doctor" prefix and take up "mister". This rule applies to any doctor of any grade who has passed the appropriate exams, and is not the exclusive province of consultant-level surgeons. In recent times, other surgically-orientated specialists, such as gynaecologists, have also adopted the "mister" prefix. A surgeon who is also a professor is usually known as "Professor", and similarly a surgeon who has been ennobled, knighted, created a baronet, or appointed a dame uses the corresonding title (Lord, Sir, Dame). Physicians, on the other hand, when they pass their "MRCP" examinations, which enable them to become members of the Royal College of Physicians, do not drop the "Doctor" prefix and remain doctor, even when they are consultants. In the United Kingdom the status and rank of consultant surgeons with the MRCS, titled "mister", and consultant physicians with the MRCP, titled "doctor", is identical. Surgeons in the USA and elsewhere may have the title "doctor".
So, there we go. Probably a topic that interests me much more than you, but what are blogs for, if not self-indulgence?
Oh, and by the way, one of the registrars has added to the
Canadian count. So, that's 12. The nurses just asked where I was from. Score one for the nurses!
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