Is there a doctor in the house?

To be honest, I use my Dr title at every opportunity, unashamedly so, and to my partner's eternal amusement.

This is, I know, sometimes frowned upon in certain circles, including by some of my colleagues, I'm sure. I can only assume this to be true because, probably out of politeness, no one has ever mentioned it directly to me. I have, however, sensed a subtle implicit expectation from others that I shouldn't use my title (for example in my email address). Lots of other clinical psychologists don't use their titles and so I wonder if this is an unspoken rule that I am inadvertently breaking. It has often made me wonder about the use of the 'Dr' title, and why its use (or not) seems important to me.

This question came up again recently when I had a medical appointment, and on calling my local GP surgery I was asked quite bluntly by the receptionist, 'So what kind of Dr are you?'. When I answered, (equally bluntly, as I was in pain) that I am a clinical psychologist, the next question was, 'Oh, so you're not a medical doctor then?'. Perhaps I was feeling a bit vulnerable, and I am sure the question was well-intended, but this felt uncomfortable and reminded me of the 'power' bestowed on this title and how its value has somehow become to 'belong' to the 'medical profession'. 

This feeling of, in some way, being 'a lesser doctor' had resonated with me on previous occasions. I remember my aunt a few years back, not really having a clue what it means to be a clinical psychologist and the arduous professional journey it involves in the UK, saying "so you're not really a doctor". While practising in the NHS, the medical model always seemed to me to be more dominant, and for clinical psychologists, this feeling of being relegated to a lesser status than that of a 'medical doctor' seemed commonplace.

I recall a specific incident during a training session on sleep disorders, which was presented by a junior 'medical doctor', feeling like I wanted the world to swallow me up when he commented at the start  'welcome everyone, as there are no doctors in the house today, I will keep my terminology basic'. This was an insult to everyone in the room not only me, yet it really resonated with me at a deeper level, as an affront to our profession. Yet I said nothing.

On a professional level I have, when my professional opinions have been suppressed or disregarded, experienced a feeling I can only compare to a 'microaggression'. Perhaps that is too strong a term and maybe unfair, given that as a profession we do seem to conspire with this approach.

I don't know why this hierarchy exists at a professional level. Perhaps this is historic, or because there may be a belief that clinical psychology training is less demanding than medical training. I would argue this is a myth in the UK, as any UK clinical psychologist may be able to attest. Most trainee clinical psychologists will have had extensive post-graduate clinical or research work experience before acceptance on a clinical doctorate programme.

With acceptance only occurring after they have competed against thousands of applicants, and are then increasingly selected based on their broader clinical, as well as 'lived', experience. This means that all clinical psychologists have often had to overcome extensive barriers and adversity just to enter one of the most demanding training regimes in the country. Thus, the years of training and completion of a combined doctorate in research and clinical expertise this is, in my view, no less challenging than training to be a junior medical doctor.

My belief is that our profession might play down using the doctor title because of the fear of seeming 'entitled' or the imbalance of 'power' this might signify. Using the title may thus be seen by some as an unnecessary imposition of power or status. I do agree, that careful awareness of this particular element of power we hold is extremely important, as is careful reflection of all aspects of power and privilege we may have present in our lives and work. As reflective practitioners isn't it better to be curious and reflect on this openly?

For me, this label is also not about the status, and it holds so much more than just a 'title'. It is a reflection of my journey as a migrant, coming from a background of trauma and deprivation. It tells the story of someone who has had many struggles to overcome to succeed, the example through which I hope to inspire the young people I work with. As much as the umlaut on the ë in my name, it reflects my identity and features heavily in many aspects of my social graces (Burnham, 2013), as well as having prominence in my salient circles (Buchanan, 2020).

Furthermore, I believe that using our title in an appropriate and respectful way, we can be empowering, making the voices heard of others in a position of less power or for those who are subject to inequity or discrimination. I have experienced this often in my work with children and young people (and their carers) who have been in the care system, who frequently do not have a voice and often have multiple struggles to contend with. My title has been used effectively to advocate for their rights and to help others understand their particular struggles.

I believe we have a special role to play in ensuring our professional status is elevated ensuring our voice carries as much weight as the voices of medical colleagues, for the benefit of the profession and our clients. I would encourage my fellow clinical psychology colleagues to start using our titles with pride, humility, and reflection, advocating loudly and effectively, for those who cannot do so!  Is there a Dr in the house? Hell yeah!

Dr Mariëtte Henning-Pugh (she/her) 
Chartered Principal Clinical Psychologist
BSc (Hons) DMS PsychD CPsychol PGCert Neuro FHEA AFBPsS

References

Buchanan, N.T. (2020) Salient Circles Diagrams: Making Intersectional Identities, Privilege, Power, and Marginalization Visible, Women & Therapy, 43:3-4, 400-404. 
Burnham, J. (2013). Developments in Social GGRRAAACCEEESSS: visible-invisible, voiced-unvoiced. In I. Krause (Ed.), Cultural Reflexivity. London: Karnac.

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