A junior doctor by any other nameBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4797 (Published 17 October 2017) Cite this as: BMJ 2017;359:j4797
A major sovereignty dispute is burning in Catalonia, a game of nuclear war “chicken” is being conducted over Twitter, and Ben Stokes is facing possible exclusion from the upcoming Ashes contest. Despite these pressing issues, last week the Times chose to carry the front page headline: “Top medic demands end to junior doctor job title.”1
England’s chief medical officer, Sally Davies, had publicly voiced her support for the Oxford Health Alliance’s campaign to end the use of the title junior doctor, a term the Oxford University academics considered “unjust, progressively inaccurate, detrimental to self-esteem, and widely misunderstood by the general public.” The story, also covered in the Sun and the Daily Telegraph, publicised the CMO’s call for job titles that give doctors “the respect they deserve.”
What happened next could be seen as a microcosm of how highly charged media debate about the medical profession and the NHS has become, an example of emotions, politics, and frustrations running high.
The terminology debate is far from new and has been discussed in this journal on several occasions over some years.234567 But the general public’s (mis)understanding of doctors’ roles and responsibilities was brought into sharper focus during the 2016 dispute over the junior doctor contract, and campaigns such as this arose, in part, from juniors’ frustration. You might therefore expect doctors to welcome some medical leaders’ public support of the Oxford campaign.
Health Education England’s medical director, Wendy Reid, described the issue as a “very welcome debate … as current terminology could not only risk undermining [doctors] but also potentially lead to confusion for the public.”8 However, she cautioned in her statement that HEE was “not in a position to change the name ourselves” but was “willing to play our role in any future discussions around this issue.”
The president of the Royal College of Anaesthetists, Liam Brennan, boasted in a letter to the Times that the college had “for some time abandoned using [the title] ‘junior doctor’” and agreed that “a title that better reflects the experience and skills of this group of doctors would be a positive step forward.” The consultant psychiatrist Agnes Ayton tweeted in agreement of abandoning the term: “It is easier to infantilise staff if they are called junior.”
What happened next was more interesting. The media coverage prompted a backlash from doctors, including juniors, who suspected a hidden agenda. The Guardian columnist Rachel Clarke, a specialty doctor in palliative medicine, branded the issue a “distraction of a manufactured debate about job titles” that “serves a convenient purpose to have junior doctors bickering among themselves about what they would like to be known as.”9 She proposed that the chief medical officer should instead “campaign for meaningful action [on issues threatening the NHS], not a conveniently cost-neutral name change.”
The Times’s front page story on the CMO’s comments trumped coverage of a report by the Care Quality Commission, released the same day, that warned that quality and safety in the NHS could deteriorate as a result of rising pressures.10
This did not go unnoticed, and doctors expressed their suspicion over the timing and prioritisation of the news. GP trainee Marie McVeigh saw the story as “yet another example of a futile exercise missing the point entirely, possibly by design.” She tweeted: “A distraction tactic—what’s the real NHS story today?”
Hannah Barham-Brown, deputy chair of the BMA’s Junior Doctors Committee, also saw ulterior motives behind the story’s headline coverage. “It’s almost like they’re making a loud noise implying they care, to cover gargantuan issues that directly affect the wellbeing of staff,” she tweeted.
The campaign to ban the term junior doctor raises more questions than it answers. How could it be banned among the public and the media? What should replace it? Do doctors’ titles affect the care of patients?
But the prominent coverage prompted doctors to raise the more pressing point: is any of this the real priority right now?
Competing interests: I am a year 4 specialty trainee in gastroenterology and general internal medicine.