Why are you operating on me, Mister?

barbersurgeon

In most parts of the world, when you go under the knife you expect to be cut open and sewn up — and everything in between — by someone known as Dr. (or Dr — but that’s for a separate discussion). All medical practitioners — whether physicians, surgeons, psychiatrists, or dentists — are generally referred to as Doctor Someone. But trust the UK to be different: there, surgeons go by the seemingly lowly title of Mr, Miss or Mrs. As do dentists.

The reason is simple and dates back to the Middle Ages: physicians and surgeons differed historically in terms of their respective education, training and credentials. Right from the beginning, physicians have had to undertake formal university training to earn an academic degree in medicine before they can enter practice. The resulting degree, or doctorate, bestows the title of Doctor of Medicine or Doctor on successful graduates.

Surgeons followed a very different path until the mid-19th century. In medieval Europe, the most common medical practitioners were the “barber surgeons” who used their tools and expertise both to cut hair and to perform surgical procedures, usually on the battlefield caring for soldiers, or treating their royal paymasters. Rather than pursue formal academic educations and medical degrees, they trained and qualified as craftsmen, usually serving surgical apprenticeships along the way. In England in 1540, the Company of Barber-Surgeons was formed. Over the next two hundred years, under increasing pressure from the separate and flourishing medical profession, the surgeons eventually broke away from the barbers, forming the Company of Surgeons in 1745 (which became the Royal College of Surgeons in 1800 after being granted a royal charter); by the 19th century, barber surgeons had virtually disappeared.  This organization oversaw the training and examination of surgeons, awarding successful practitioners with a diploma — rather than the medical degree conferred by academic institutions on graduating physicians. Hence the 19th-century surgeon retained the title of Mister, despite his relatively rigorous expertise and experience.

Nowadays, surgeons follow the same academic path through medical school as their physician contemporaries, becoming Doctors of Medicine once their degrees are conferred; they then undergo a further period of postgraduate study and training in order to acquire full consultant surgeon status, at which point they are addressed as Mister — the title bestowed, ironically, on the most senior, prestigious and highly trained medical practitioners in the UK.

Like British surgeons, dentists aren’t referred to as Doctor. This is simply because they don’t necessarily earn a medical degree, like the 18th-century surgeon, but instead receive a Bachelor’s of Dental Surgery (BDS, BChD, or BDent). In recent decades, British dentists have demanded the right to call themselves Doctor, so that they can enjoy the same privileges (and presumably salaries) as their European and other foreign counterparts. However, medical doctors have objected to the idea, arguing that such a title might mislead patients about the extent of their expertise. The Advertising Standards Authority ruled in favor of the medics in 2008, stating firmly that “Dentists must not use the title doctor unless they are medically or academically qualified to do so.”

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