Is there a doctor in the clinic?

Using the term “doctor” as a chiropractor

By Nevena Brown, Principal, Meridian Lawyers, on behalf of Guild Insurance

Background of the term “doctor”

The term “doctorate” first appeared in medieval Europe and referred to a licence to teach at a medieval university. Over the years, it evolved in the academic world to refer to degrees granted by universities in philosophy (a doctor of philosophy or PhD) and other research doctorates such as a doctor of science. Beyond academia, professional doctorates emerged such as a doctor of medicine (MD), doctor of dental surgery (DDS) and others. The appellation of “doctor” (from Latin meaning “teacher”) was usually awarded only when an individual was in middle age! It indicated a life dedicated to learning and the spread of knowledge. Hence, any individual who earned a doctorate degree in any speciality field could call themselves “doctor”.

Over the years, the term “doctor” in common parlance allowed an inference that individuals who utilised the title held a medical or physician qualification. This layperson’s understanding of the term “doctor” and potential misuse led to various statutes and guidelines being enacted in Australia in relation to use of the title, much of which was encapsulated in the now repealed State and Territory legislation which governed the professional practices of various health related industries, such as the Medical Practitioners’ Registration Act 2001 (Qld) which prohibited Queensland chiropractors from using the title unless they held doctorates, and only then if they set out the details of the doctorate after their name. 

State and Territory legislation in Australia has now been superseded by the National Law (as adopted in various forms in all states and territories), which currently governs 10 specified health industries nationally in relation to their members’ registration, accreditation and practice.

Current position on using the term “doctor”

The National Law does not prohibit a health practitioner of one of the specified industries from using titles such as “doctor” or “professor”. However, one of the fundamental purposes of the National Law is to protect the public, and it is explicit in prohibiting practitioners from performing conduct that could amount to misleading or deceptive conduct.

Accordingly, section 117 of the National Law prohibits a practitioner from knowingly or recklessly taking or using any title that could be reasonably understood to induce a belief that the practitioner is registered in a health profession or a division of a health profession in which the practitioner is not registered.

The functions of enforcement and monitoring of such health law, which were formerly performed by the various State and Territory health industry bodies, are now performed by the national industry boards, supported by Australian Health Practitioner Regulation Agency (AHPRA).

The Chiropractic Board of Australia has issued Codes and Guidelines in relation to the application of the National Law and other relevant best practice issues. These guidelines have, in essence, been adopted by all of the Australian boards of the various industries, including the Medical Board of Australia.

Taking into account the common usage and understanding of the title “doctor”, the guidelines recommend that practitioners, if they choose to adopt the title “doctor” in advertising, must make it clear that they do not hold registration as medical practitioners.  This can be accomplished by specifying exactly what their health profession relates to, for example:

 Dr John Doe (chiropractor)

It is a standard requirement that even if a health practitioner does hold a doctorate degree or PhD (which entitles them to use the title), to ensure that a patient does not assume that the practitioner holds medical qualifications, the practitioner’s specialty must be clear, for example:
 
Dr Joanne Bloggs (doctor of psychology)

What does this mean for chiropractors?

In one way, from a legal perspective, the National Law has opened up the potential use of the “doctor” title  to any of the 10 industry specialists who are governed by the law. However, certain provisions of the National Law have imposed legal obligations on the use of this title and the various industry boards’ guidelines for advertising have extended such restrictions by imposing ethical and moral obligations on practitioners.

In short, the use of the title “doctor” must not mislead the public and such misleading conduct could cause disciplinary proceedings and findings against that practitioner.

The question of whether to use the title is, of course, a matter for each practitioner. As it is likely that more health practitioners may start to use the title of “doctor”, it is arguable there will be even greater confusion in the public arena as to what this means.

Extra care must be taken to ensure that the patients do not assume that some additional medical qualifications have been earned. Whether a patient is under a misunderstanding in this regard may need to take into account any relevant culture or literacy issues of the patient. In the event that a practitioner elects to use the appellation “doctor”, as a minimum, Dr John Doe (chiropractor), should be used on all forms of literature in which the chiropractor’s name is referenced, as well as in any signage at the practitioner’s clinic and the like.

Only time will tell if any palpable confusion of the public in the use of such a title will cause the legislators to again enforce rigorous prohibitions on its use. Watch this space.

This is an article from the Guild/CAA Risk Management Committee. For more articles and information on risk management for chiropractors visit www.riskequip.com.au/chiropractors