The Honorific and the Hippocratic Oath, Deconstructing “Doctor” in a Modern Healthcare Ecosystem
The recent Kerala High Court ruling, permitting physiotherapists and occupational therapists to use the honorific ‘Dr’, is far more than a legal clarification on nomenclature. It is a cultural and professional flashpoint, illuminating a profound current affair at the heart of India’s evolving healthcare landscape: the struggle to reconcile traditional hierarchies with a modern, collaborative, and patient-centric model of care. This decision, while legally sound and conceptually progressive, unravels deep-seated tensions regarding professional identity, public perception, patient safety, and the very soul of healing in a complex medical world. It is a microcosm of a global shift, forcing a reevaluation of who gets to be called “doctor” and what that title truly signifies in the 21st century.
Deconstructing the Monopoly: History, Academia, and the “Modern Misconception”
The court’s judgment is intellectually robust, grounded in historical and academic etymology. By noting that ‘doctor’ (from the Latin docere, to teach) originally signified a “learned individual qualified to teach,” the bench exposed the claim of exclusive medical ownership as a “modern misconception.” This aligns with global practice where PhD holders in physics, literature, or law proudly use the title, signifying the pinnacle of academic achievement in their field. The court correctly observed that no single profession holds an exclusive legal monopoly on an academic honorific.
This legal reasoning strikes at the heart of a professional guild mentality that has long dominated medicine. The Indian Medical Association’s (IMA) opposition, while understandable from a perspective of protecting a hard-earned brand, risked appearing as territorial gatekeeping rather than a defense of patient welfare. The court’s dismissal, citing the absence of such exclusive provisions in the National Medical Commission Act, underscores a legislative intent—whether deliberate or inadvertent—to avoid creating a closed shop. The concurrent upholding of the National Commission for Allied and Healthcare Professions Act, 2021, is pivotal. This landmark act formally recognizes and regulates 15 allied health professions, granting them a statutory identity and a pathway for professional growth. The Kerala judgment is the logical judicial affirmation of this legislative vision, embedding these professionals within the formal architecture of healthcare.
Beyond Title: The Real Triumph of Collaborative Care
The most significant impact of this ruling may not be the prefix itself, but the symbolic validation it confers. For decades, allied health professionals (AHPs) like physiotherapists and occupational therapists have operated in a professional penumbra. Despite possessing rigorous undergraduate (BPT/BOT) and postgraduate (MPT/MOT) degrees involving years of anatomy, physiology, and clinical training, they have often been perceived—and treated—as adjuncts or technicians, not as primary clinicians. This has manifested in lower pay, less autonomy, and public unfamiliarity with the scope of their expertise.
By granting them the right to the ‘Dr’ title, the court has performed a powerful act of professional elevation. It signals to society that these are not mere assistants but autonomous, highly educated specialists with a distinct and critical domain of knowledge. This is a victory for the very “idea of a multi-disciplinary, patient-centric healthcare” the editorial endorses. A patient recovering from a stroke does not need just a neurologist (Dr. A) and then a “therapist.” They need a team where a neurologist (Dr. A), a physiotherapist (Dr. B) specializing in motor recovery, and an occupational therapist (Dr. C) focusing on daily living skills collaborate as equal professional partners in a shared rehabilitation plan. The title helps flatten an artificial hierarchy that can impede communication and fragment care.
This shift is crucial for India’s epidemiological transition. As the burden of disease shifts from acute infections to chronic, non-communicable diseases (diabetes, heart disease, musculoskeletal disorders), the model of care must shift from a singular, curative intervention to long-term management, rehabilitation, and lifestyle modification. In this paradigm, the physiotherapist managing cardiac rehab or the dietician counseling a diabetic patient are not peripheral but central. Recognizing them as ‘Dr’ formally acknowledges this changed reality.
The Inevitable Anxieties: Boundaries, Blurring, and Public Trust
However, the editorial wisely tempers celebration with caution. The court itself “earmarked clear boundaries, saying they cannot prescribe medicines.” This is the crux of the anxiety within the medical community and a legitimate concern for public safety. The title ‘Dr’ carries immense psychosocial weight for patients. It is an archetype of the healer, the ultimate authority in moments of vulnerability. The fear is that title parity could lead to role confusion.
Could a physiotherapist ‘Dr’ be mistaken by a rural patient for a general physician, leading to delays in essential pharmacological treatment? Could unscrupulous practitioners misuse the title to peddle pseudoscientific treatments? These are not frivolous concerns. The editorial’s call to ensure the title “isn’t misused to con people” is paramount. The responsibility now lies with the newly empowered professions to exercise this right with extreme ethical rigor, explicitly communicating their specific scope of practice to every patient. “I am Dr. X, your physiotherapist” must become a standard, clear introduction.
Furthermore, this ruling exposes a regulatory grey area. While the court has clarified who can use the title, the broader question of who cannot remains fuzzy. What prevents a practitioner of alternative medicine with a PhD from claiming the title in a clinical setting? The editorial’s concluding plea for legislative clarity is urgent. Parliament must enact a clear provision, perhaps within the NCAHP Act, that explicitly defines the educational qualifications (e.g., a professionally accredited master’s or doctoral degree in a clinical field) that entitle one to use ‘Dr’ in a healthcare context. This would protect the title from dilution by outright quacks while respecting the court’s academic rationale.
A Challenge to Medical Elitism and a Path to Dignity
At a societal level, this ruling is a subtle but powerful challenge to the classism and elitism entrenched in Indian healthcare. The doctor-patient relationship has historically been one of profound asymmetry. Part of this authority stemmed from the unique, almost mystical, status of the ‘Dr’ title. By democratizing it among qualified health professionals, we may, over time, foster a more collaborative relationship not just among professionals, but between the healing team and the patient. It reframes healthcare from a priestly dispensation to a coordinated service from a team of experts.
For the AHPs, this is about dignity, recognition, and just deserts. They endure long academic rigors, face clinical risks, and bear the emotional labor of patient care. Denying them a title that PhDs in non-clinical fields use freely was a lingering insult. This judgment rectifies that, potentially boosting morale, attracting higher-caliber students to these fields, and improving retention in a sector facing shortages.
The Global Context and the Road Ahead
India is not alone in this debate. Countries like the US have long had ‘Doctor of Physical Therapy’ (DPT) degrees, while in the UK, the title’s use is governed by professional norms and context. The Kerala judgment brings India in line with this progressive, team-based understanding of healthcare.
The road ahead requires nuanced navigation:
-
Professional Responsibility: Allied health professions must adopt stringent self-regulatory codes on title use, emphasizing transparency. Their councils must actively educate the public on their roles.
-
Medical Community Adaptation: The IMA and doctors must move from opposition to constructive engagement. The focus should shift from guarding a title to defining and protecting the specific acts (like prescribing scheduled drugs, performing surgery) that remain exclusive to MBBS holders, as legally mandated.
-
Patient Education: A massive public information campaign is needed to explain the new landscape: “There are different kinds of doctors for different needs.”
-
Legislative Action: Lawmakers must heed the call for clarity, crafting a law that prevents misuse while upholding the court’s inclusive principle.
Conclusion: From Exclusive Title to Inclusive Ethos
The Kerala High Court ruling is a landmark that correctly separates the academic honorific from the specific legal license to practice allopathic medicine. In doing so, it has initiated a necessary, if uncomfortable, conversation about power, recognition, and collaboration in healthcare. The true measure of this decision’s success will not be how many more nameplates bear the prefix ‘Dr’, but whether it translates into more respectful interdisciplinary teamwork, improved patient outcomes, and a stronger, more integrated healthcare system. The title ‘doctor’ may not be exclusive, but as the editorial headline reminds us, a doctor’s job—in its fullest, most collaborative sense—remains one of society’s most exclusive responsibilities: the sacred duty to heal, comfort, and empower. That duty is now, rightfully, a shared mantle.
Q&A: Navigating the New Landscape of “Doctorhood”
Q1: The court based its decision on the academic origin of “doctor.” Does this logic open the door for professionals like PhD-holding dieticians, clinical psychologists, or even PhDs in alternative medicine to claim the title in clinical practice?
A1: The court’s logic, based purely on academic attainment, does create a potential slippery slope. A PhD-holding dietician or clinical psychologist could mount a strong claim under this rationale, as their doctorates are in clinically relevant fields. This is why the editorial’s call for legislative clarity is critical. The next step must be to distinguish between an academic doctorate and a clinical/primary care designation. A new law should likely stipulate that the use of ‘Dr’ in a patient-facing healthcare setting be reserved for those holding specific, recognized professional doctorates or master’s degrees accredited by statutory bodies like the NMC or the NCAHP. This would include physiotherapists (MPT), occupational therapists (MOT), and perhaps clinical psychologists (PhD/PsyD), but would exclude a PhD in History who practices homeopathy. The principle should be: Title use in healthcare requires a license to practice a statutorily recognized clinical profession at the highest level.
Q2: How might this ruling impact the dynamics within a hospital or clinic? Could it lead to conflicts between MBBS doctors and allied health “doctors” over authority and decision-making?
A2: Initially, it could create friction. Some MBBS doctors may feel their authority is being diluted. The key to preventing conflict lies in reinforcing scope of practice, not title hierarchy. Hospitals must establish clear, protocol-driven frameworks for collaboration. For instance, a patient’s diagnosis and medical management (drugs, surgery) remain the purview of the treating physician. The rehabilitation plan following a knee surgery, however, falls under the autonomous expertise of the physiotherapist ‘Dr’. Interdisciplinary team meetings should be structured to respect each domain’s expertise. Leadership should foster a culture where the question is not “Who is the higher-ranking doctor?” but “Which doctor’s expertise is paramount for this specific aspect of the patient’s care?” The ruling, ironically, could improve dynamics by granting AHPs the confidence to communicate as equals, leading to better-informed collective decisions.
Q3: From a patient’s perspective, especially in semi-urban or rural India, could this cause confusion and pose a risk? How can this be mitigated?
A3: The risk of confusion is real. A villager might hear ‘Dr. Sharma’ and assume they can treat fever, when Dr. Sharma is a physiotherapist. Mitigation requires a multi-pronged approach:
-
Mandatory Verbal Clarification: Regulatory bodies should mandate that AHPs introducing themselves as ‘Dr’ must immediately specify their profession: “Hello, I am Dr. Sharma, your physiotherapist.”
-
Visual Cues: Clinic nameplates, hospital gowns, and ID badges should have clear, bold lettering stating the professional designation (PHYSIOTHERAPIST, OCCUPATIONAL THERAPIST) alongside the name.
-
Public Awareness Campaigns: The government and professional councils should launch simple campaigns (posters, radio jingles, social media shorts) explaining the different “types of doctors” using relatable analogies, much like different engineering specialists.
-
Role of the Referring Physician: The MBBS doctor who refers a patient to an AHP has a duty to explain: “I am referring you to Dr. Rao, who is a specialist in physiotherapy for your back. She will guide your exercises, while I manage your pain medication.”
Q4: The editorial mentions overcoming “classism” in healthcare. Could this ruling, in the long run, help address the huge disparity in pay and working conditions between MBBS doctors and allied health professionals?
A4: It has the potential to be a significant step in that direction. Pay and respect are intertwined. The denial of the ‘Dr’ title was a symbolic manifestation of a lower status, which was used, consciously or not, to justify lower remuneration. By granting the title, the court has removed one major symbolic differentiator. This empowers AHPs to negotiate for better pay from a position of recognized professional parity. Hospitals seeking accreditation for multidisciplinary care will need to demonstrate robust teams, increasing the demand and value for these professionals. However, the title alone is not a magic wand. Sustained advocacy by their professional councils, unionization, and market forces of demand and supply will be the primary drivers of pay equity. The ruling provides the crucial ammunition of dignity and formal recognition for that fight.
Q5: Does this ruling represent a move towards a “Western” model of healthcare, and is it suitable for India’s resource-constrained, doctor-starved environment?
A5: It does align with Western models of interdisciplinary care, but its suitability for India is nuanced. In a doctor-starved country, one could argue for maximizing the scope of MBBS doctors, not creating new “doctors.” However, that is a limited view. The AHPs are not replacing MBBS doctors; they are complementing them, allowing the MBBS doctor’s time to be freed up for complex diagnosis and treatment that only they can do. A physiotherapist managing routine arthritis rehab allows an orthopedist to focus on surgical cases. This is an efficient division of labor, crucial for a resource-constrained system. The challenge is ensuring this model works in primary health centers, not just urban hospitals. It requires posting AHPs at the block level and defining their role clearly. The ruling, therefore, is not about aping the West but about rationally deploying India’s entire skilled health workforce in a tiered, team-based system to maximize reach and quality—a model that is not just suitable but essential for India’s complex health challenges.
