The Last Word: Titles and Qualifications

By Dr Sam Robson / 01 Jul 2015

Dr Sam Robson argues for greater clarity in the use of professional titles

What’s in a name? Does it matter what we call ourselves when it comes to our patients? I think it does. Aesthetic medicine can provide an important medical service to patients, having a positive impact on their self-esteem and quality of life. Our job title will convey a certain sense of experience, expertise and ability to both prospective and current patients. The field is already considered to be a slightly grey area ethically. As it comprises completely private medicine, it could be considered by some to be exploiting patients’ desperation for remedies to treat their aesthetic concerns, or even perhaps of selling ‘snake oil’ – a term used to describe fraudulent health products or, more likely in our case, unproven medicine. To improve this negative association, practitioners should strive to put patient care above financial gain.
To this end, it is imperative that practitioners portray their capabilities and qualifications honestly to the public and their patients. In 2015, the Care Quality Commission (CQC) published an update to its Regulation of Candour which stated that, ‘Providers [of healthcare] must promote a culture that encourages candour, openness and honesty at all levels. This should be an integral part of a culture of safety that supports organisational and personal learning.’ Surely we should be advocating this culture in our medical aesthetic clinics and complying with the CQC’s notion of openness and honesty? Across the board, however, individuals claim to be “advanced” practitioners and yet where is the evidence from their practice? To my mind, at every step of our interaction with patients we must be open and credible in how we present ourselves. Simply put, we should first declare whether we are surgeons, doctors, dentists or nurses and stand behind the recommendations that only practitioners with the appropriate qualifications be permitted to perform aesthetic treatments. We should then be clear on our individual claims within each of these four practitioner categories. I have some concerns, however, about how individual practitioners prefer to portray themselves: 

Surely it is a fundamental expectation to be honest from the outset about who we actually are and our true level of qualifications and expertise

Surgeons

Under this title practitioners should obviously be surgically trained and have completed specialist training, and therefore be on the GMC specialist register. Each individual is in no doubt as to whether or not they fulfil this criterion. Within the individual professions, we understand the significance of being on the GMC register as a doctor, and take this to be a mark of excellence, having achieved a certificate of completion. If we are not surgically trained or have not completed our training, however, should we be calling ourselves a plastic surgeon, aesthetic surgeon or an ENT surgeon? To me, the answer is a clear no – and I believe that only those who have received their FRCS (Plast) status should be referred to as plastic surgeons. The lay public may presume that we have a level of expertise and seniority that we have not actually earned. Is it really appropriate to allow a perception that we are more qualified than we are? Should we be undertaking facial cosmetic surgery procedures if our expertise is in orthopaedics – unless, of course, we have formal qualifications, experience and certification in these areas?

Doctors

Are we General Practitioners (GPs) or General Practitioners with Special Interest (GPwSI)? Should we use the term dermatologist if we do not have a certificate of completion of training in dermatology? Although cosmetic dermatology is recognised as a sub specialty within dermatology,1 as far as I am aware there is no real qualification of ‘cosmetic dermatologist’ and yet so many doctors with no formal qualification in dermatology claim this title. Would it not be more transparent to declare ourselves as GPs with an interest and some expertise in cosmetic dermatology? (Although bear in mind the scope of this is yet to be defined.)1

Dentists

Unless a dentist has a medical qualification too, should they be calling themselves a ‘doctor’? It would appear that many dentists still call themselves ‘doctor’, despite patients being confused by this and even expressing in blogs a desire to have some clarity.2,3 In 2010, the General Dental Council (GDC) published a report on patient and public attitudes to standards for dental professionals.4 It stated that, “The current GDC proposal is that the use of the term ‘doctor’ (or the abbreviation Dr) by dentists should be limited to practitioners who have a PhD or who are medically qualified and registered doctors. The document continued, “It is against the law, for a dentist or DCP to use any title or description ‘reasonably calculated’ to suggest that (s)he has a professional status or qualification other than one which is indicated against his/her name in the register; however, cases alleging misuse of titles, descriptions or qualifications by dentists or DCPs can be dealt with through GDC fitness to practise investigatory/ disciplinary processes.” The document further stated that, ‘Dentists and practices should not advertise themselves as specialists where no such specialist list exists.’5 Despite these points, it seems many dentists continue to use the term ‘doctor’, which, in my opinion, has the potential to confuse and mislead patients.

Nurses

There seems to be many varieties of nurses practising aesthetics; my understanding is that there are aesthetic nurses, independent nurse prescribers, nurse practitioners, advanced nurse practitioners (ANPs) and aesthetic nurse specialists. There are nurses who call themselves ‘medical directors’, which, to me, suggests they are portraying themselves as doctors. Apart from independent nurse prescribers and ANPs, none of these titles require different or additional qualifications to one another and are merely self- appointed titles. Nurse prescribers are an exception as they do require a prescribing qualification, however, this does not indicate that a nurse is aesthetically trained – just that he or she has completed a prescribing course.6 In 2007, the Nursing and Midwifery Council (NMC) explained that the plethora of titles used by nurses is of concern, as they do not help the public understand the level of care that they can expect. In addition, the Royal College of Nurses stated in 2012 that, “Both the RCN and NMC oppose nurses and/or employers using the title of ANP where a nurse has not completed the appropriate education and preparation.”7 Surely, we should be using one title for all aesthetic nurses or setting levels of qualification where their title will change upon completion? It is confusing enough for those of us within the profession to decipher any level of expertise, qualification or experience – without bamboozling the layman with a cacophony of terms designed to impress as well. Is it not a fundamental expectation to be honest from the outset about who we actually are and our true level of qualifications and expertise, before we subject a potentially vulnerable patient to aesthetic treatment? We should be aiming to reassure the public that not only are we transparent about our ability and level of expertise; we are also aware of our limitations and will ultimately put the care of our patients first. I believe that the job titles that we claim for ourselves are the first step in establishing ourselves as a credible and trustworthy body of professionals. 

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