“this ancient rule of the guilds”

From the website of the Royal College of Surgeons of England:

“In most other parts of the world all medical practitioners, physicians and surgeons alike, are referred to as Dr while in the UK surgeons are usually referred to as Mr/Miss/Ms/Mrs. This is because, from the Middle Ages physicians had to embark on formal university training to gain possession of a degree in medicine before they could enter practice. The possession of this degree, a doctorate, entitled them to the title of ‘Doctor of Medicine’ or Doctor.

The training of surgeons until the mid-19th century was different. They did not have to go to university to gain a degree; instead they usually served as an apprentice to a surgeon. Afterwards they took an examination. In London, after 1745, this was conducted by the Surgeons’ Company and after 1800 by The Royal College of Surgeons. If successful they were awarded a diploma, not a degree, therefore they were unable to call themselves ‘Doctor’, and stayed instead with the title ‘Mr’.

Outside London and in the largest cities, the surgeon served as an apprentice like many other tradesmen, but did not necessarily take any examination. Today all medical practitioners, whether physicians or surgeons have to undertake training at medical school to obtain a qualifying degree. Thereafter a further period of postgraduate study and training through junior posts is required before full consultant surgeon status is achieved. Thus the tradition of a surgeon being referred to as Mr/Miss/Ms/Mrs has continued, meaning that in effect a person starts as Mr/Miss/Ms/Mrs, becomes a Dr and then goes back to being a Mr/Miss/Ms/Mrs again!”

Roger Dobson wrote in the BMJ of May 14 2005:

“After a century and a half of being called Mr, change is in the air, with the president of the Royal College of Surgeons, Hugh Phillips, hinting that the days of Mr and Miss as titles for surgeons may be numbered.

Writing about the public consultation over plans for the introduction of non-medically qualified surgical care practitioners, Mr Phillips says it is important that patients know who’s who.

“The issue of job title is part of the public consultation, and this is not easy resolvable,” he says in the Annals of the Royal College of Surgeons of England ( 2005:87(suppl): 153…)

He told the BMJ: “There has been concern recently about who people are in the health service—who is actually treating you? It is not always absolutely clear to the patient, I suspect, and it is not even clear as to whether someone is a doctor. I think that is a legitimate cause for concern.

“If you look all around the world surgeons are called doctors, but we have held on to this ancient rule of the guilds whereby we weren’t physicians because we didn’t have to go to university, we were apprentices.

“All I am interested in is that people know who is treating them. It is terribly important to identify doctors, and one way of doing it is to call them doctors.

“It is clearly an anachronistic situation. It is not one of the cardinal issues facing health care, but I don’t like anachronistic situations, I like clarity, so maybe I would go down in favour of saying why not call them doctors?”…”

Stephen Pincock wrote in an obituary in The Lancet of August 13, 2005:

“Hugh Phillips
Orthopaedic surgeon and President of the Royal College of Surgeons of England. Born in Blackheath, London, on March 19, 1940, died of adenocarcinoma on June 24, 2005, in Norwich, aged 65 years.

“…He also considered orthopaedic training and mentoring to be very important, says John Albert, an orthopaedic surgeon who met Phillips in the early 1980s while a senior registrar at Norwich. “He was very interested in the concept of mentoring”, Albert told The Lancet. “He wasn’t just interested in teaching people trade-craft, as it were. It wasn’t just a question of learning surgical techniques. Where Hugh Phillips’ qualities were particularly strong was in teaching people how to communicate with patients.”

…”He wasn’t one of those people who jockeyed for position, but he was always willing to take things on”, says Keith Tucker, a surgeon colleague of Phillips’ since the late 1970s. “People voted for him in those positions because he was a great guy, a good surgeon, and a good doctor.” His work in professional associations and at a national level was motivated by “a burning desire to improve the lot of patients”, recalls Tucker. “He was also very much into standards”…

…Hugh Phillips was a man with a phenomenal capacity for work “and an amazing tenacity for his views and how things should run”, recalls his friend and fellow orthopaedic surgeon Thomas Bucknill…“He had a fantastic sense for the ridiculous”, recalls Bucknill. “Ridiculous human scenarios were great entertainment to him, but he couldn’t stand pomposity, and if someone was a bit pompous he would take them down in a fairly gently, charming way.” “.

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