In the US, Canada and now more recently in Australia our profession is gaining a new identity.
In these countries, optometrists are increasingly calling themselves doctors of optometry and while the term can be misleading no one is saying an optometrist is a physician.
Furthermore, it appears that this allows the public in these countries to better understand the optometrist’s role in ocular health while minimising the retail aspect of optometry involving spectacle sales.
Now, is this a good or a bad thing? Understandably to many of us in the profession, this at first glance appears to be quite unusual. However, in the UK both dentists and veterinarians do indeed use the title ‘Dr’ (although they often, not unlike optometrists, only hold a bachelor’s degrees). It could be said that these professions have been successful in not being identified or mistaken by the public as physicians.
To their benefit, the title seems to have garnered their professions respect from the public for their clinical skills, recognising that they have specialist knowledge and skills that are not in any way associated with retail but with the actual health and well-being of their patients. Does this mean that optometrists in the UK could also become doctors of optometry?
My colleague and I think now more than ever we must ask how do we want to identify as a profession? Are we the public’s champions who provide primary eye care services or do we just sell spectacles and only test health because it is a legal requirement?
With minor eye care services (Mecs) and other services becoming more prevalent this identity is very important. However, our role in primary eye care is undermined somewhat in high street practice.
On the high street, optometrists have always been referred to as ophthalmic opticians and often the public who come for an eye exam do not understand this title.
Our historical roots and close association with our brother profession, dispensing opticians, a well-respected, knowledgeable and historic profession with its own well-established identity make this association very emotional. However, this makes it very difficult for us to describe in detail our status as eye health providers rather than retail workers.
To better explain, an optician is defined by the Merriam-Webster online dictionary as ‘a maker or dealer in optical items and instruments’. It is useful to compare this definition with the definitions optometry and optometrist. An optometrist is defined by the Merriam-Webster as ‘a specialist licenced to practice optometry’ where optometry is explained to be ‘the health-care profession concerned especially with examining the eye for defects and faults of refraction, with prescribing correctional lenses or eye exercises with diagnosing diseases of the eye, and with treating such diseases or referring them for treatment’.
The question is then who are we really? Who do we want to be?
In closing, the title ‘Dr’ in our humble opinions might help us as a profession to communicate our status as the non-physician, non-surgical but still specialist primary eye care provider who can make a positive difference to our patient’s ocular health on the high street.
Ophthalmologists or ophthalmic surgeons use the term ‘Mister or Miss’ after gaining their MRCS post nominal title. Why do we not take ‘Dr’ after gaining our post nominal title?
If we as members of an autonomous optometry profession want to change, we must then decide what that change looks like for ourselves as members of the optometry profession. The Honey Rose case and others involving patient’s driving who do not meet the visual standards show us that the public is placing demands for high quality eye care service, and eye care services not based on sales.
The decision for this title ‘Dr’ should be decided and voted upon by a poll conducted in Optician by members of the profession who are not academics but practicing optometrists who insist we deserve the right be recognised for our specialist skills. A public poll or a petition is truly the only way to get this message heard in all corners of the profession.
It is imagined that the proposed title would be a courtesy title to be used in the consulting room and in the provision of written clinical advice. However, we propose optometrists would be limited in using the title Dr in publications or non-clinical academic settings (unless the holder was a PhD) and a ‘doctor of optometry’ would have further ethical standards to defend ocular health before considering the retail implications – to be further defined by voting by members of the optometry profession with some consultation from our ophthalmology colleagues.
Not all optometrists would be required to use the title, only members who agreed to further determined standards. We would both be very interested and work very hard in polling the results of attitudes of members of the profession regarding this and other issues, hoping to publish subsequent articles with data from practising optometrists on the high street.
How dentists and vets won courtesy titles
Although dentists are not ‘doctors’ in the traditional use of the word, they are free to use the title so long as it does not mislead patients about the services they deliver.
It follows a high profile ‘Call me Doctor’ campaign in the 1990s by Dr Douglas Pike, which was part-funded by fellow dentists and supported by the British Dental Association. Eventually, the General Dental Council altered its guidance so that dentists could use the courtesy title in the UK.
However, in 2008 the ASA ruled unfavourably on one such dentist who was using the Dr title.
It prompted the General Dental Council to consult on the subject again in 2010, following a mixed response from patients and the general public when the term was used in the absence of a PhD or medical degree.
Nevertheless, the status quo was kept and the profession continues to benefit from using the prestigious title.
Veterinary surgeons have enjoyed the same courtesy use since March 2015, when the Royal College of Veterinary Surgeons (RCVS) found 81% of its members were in favour of such a move.
Guidance by the RCVS at the time said use of the title was optional, and that veterinary surgeons using the title ‘should be careful not to mislead the public’.
It was deemed important the use of ‘Doctor’ or ‘Dr’ by a veterinary surgeon did not suggest or imply they hold a human medical qualification or a PhD, and it was to be used in conjunction with their name and either the descriptor ‘veterinary surgeon’ or postnominal letters.
A similar protocol could be adopted by optometrists given the pre-existing affixes used by eye care professionals.
In a statement to Optician, the GOC said while there was nothing in the Opticians Act to stop optometrists using the title, ‘if a registrant was holding themselves out to be something they’re not, that could be a fitness to practise issue’.
Michael and Joshua Mandel, pre-reg optometrists
Cause for a campaign?
Do you agree that optometrists should use the title ‘doctors of optometry’? Email your reaction to joe.ayling@markallengroup.com.