By Michael T. Puerini, MD, CCHP-A and Dean P. Rieger, MD, MPH, CCHP
Posted on June 21, 2010 –
In correctional settings we employ a large number of mid-level providers. Although we encourage our mid-level providers to be clear in identifying themselves clearly, and thus avoiding patients confusing them with physicians, in reality patients often address mid-levels as doctor even when the mid-level is explicit about his or her status. It turns out that there are other types of credentials confusion going on, and we are going to describe a recent example. The circumstances have been changed to make identification more difficult, and to protect the guilty.
A large jail is served by an extensive mental health group. The mental health director, who is very competent, completed her master’s degree before obtaining her PhD. She is licensed by the Board of Psychology at the master’s level but not as a doctor. Yet she introduces herself as Doctor Xxxx whether talking with patients, command staff, or other civilian personnel. Is she crossing the line?
She is certainly aware of the licensure differences; doctoral level psychologists have practice privileges beyond those of the master’s level, and she carefully adheres to the constraints of her license, at least in her patient interactions. Other licensed health care personnel at the facility are unaware of this circumstance. Should the licensing board be informed? The imperative to support patient autonomy underlies issues of informed consent. Surely a patient’s consent to be treated by her is less than informed if the patient does not understand the credentials of the treating professional. But wait. In the correctional setting we don’t give inmate patients the right to choose their, may we say, doctor. So is there any practical difference between an inmate patient being treated by a real doctor or by a sort of doctor?
This particular dilemma was presented to other mental health practitioners in the form of a posting on several bulletin boards. As with this column, it was posted in a de-identified manner. The poster anticipated uniform condemnation of the marginal dishonesty. To the poster’s surprise, the overwhelming response was that, so long as the professional had earned a doctorate, whether she was licensed at the doctoral level was irrelevant. Clearly there is room here for multiple interpretations. What do you think?
