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Beyond the Mainstream

Know a Doctor's Title to the Letter

July 02, 2001|BARRIE CASSILETH

When you seek advice from a "doctor" or read something by a "doctor," do you really know what kind of doctor he or she is? Do you know how that person's background might affect the information and care he or she gives?

Among the initials after names of people referring to themselves as "doctor" are MD, PhD, DC, DO, ND and OMD. It pays to find out on whom we are depending when we ask for information, help or care. Generally, "doctor" refers to a medical doctor ("MD"), a person who completed four years of undergraduate college, four years of medical school, and usually two to 12 years of postdoctoral training in a medical specialty.

Lisa, my daughter-in-law, has been studying to be a plastic and reconstructive surgeon for 12 years (since high school graduation), and she has not yet completed training. Although she earned the right to be called MD when she finished medical school and has had several years of internship and residency training, she is still not ready to begin her chosen work. She will be in her mid-30s before she starts a medical/surgical practice, with a huge debt and a long delay in starting both her career and family life.

On the other hand, there are thousands of "doctors" who establish practices with barely four years of medical education or some other post-high school education without specialty training in actual medicine.

There are significant differences in medical science training, experience and understanding of treatments among the "doctors" in our health-care system. The initials after the name indicate a level of training, certification or licensure by an appropriate state board of experts. Some people who identify themselves as doctors have no medical training at all. You would not want a "doctor of philosophy" (a "PhD" like me) to prescribe medication or remove your appendix. Look carefully at any health-related recommendation from someone who simply calls himself or herself "doctor" without accompanying credentials.

Chiropractic (a chiropractor is a "DC"), the most popular of alternative therapies, was founded in the 1890s by D.D. Palmer, a Davenport, Iowa, grocer and mystic healer. Chiropractic depends primarily on manipulation of the spine to correct a wide variety of medical problems. Through analysis by X-rays and palpation, the chiropractor looks for irregularities or misaligned vertebrae that may interfere with nerve function and that can be corrected by manipulation of the spine. Modern colleges of chiropractic now include clinical sciences, laboratory experience and clinical practice. Chiropractic has been shown scientifically to help lower back pain and related problems. In these areas of activity, it is generally no longer viewed as "alternative."

Chiropractors who use spinal manipulation to treat medical problems, however, would be considered practicing in an unproved, alternative fashion.

Homeopathy is a discipline practiced by people with a wide range of backgrounds, from medical doctors to self-trained lay practitioners. There are no national standards or licensure requirements, nor is there a specific set of initials in general use to identify a homeopathic physician, although "MD(H)" may sometimes be used. Homeopathy developed therapies in a fashion that is almost the exact opposite of mainstream medicine. It begins by looking for cures through the study of symptoms rather than by attacking probable causes of disease.

Founded in the late 18th century by a German physician, Samuel Hahnemann, homeopathy depends on Hahnemann's "Law of Similars," in which the patient is treated with an extremely dilute liquid that originally included a material that caused symptoms similar to those the patient was experiencing.

Naturopathic medicine ("ND") avoids the use of pharmaceutical drugs and other products of modern medicine. It is promoted as a low-cost, gentler alternative to mainstream care. Although it relies essentially on the same diagnostic science as does mainstream medicine, treatments differ. They include botanical medicine, nutritional therapies, homeopathy, acupuncture, hydrotherapy, Asian medicine and manipulation of muscles and bones.

Medical doctors, doctors of osteopathy ("DO") and doctors of chiropractic ("DC") are all licensed by individual state certification boards. An MD(H), or homeopathic doctor, is not specifically licensed, while an "ND," a doctor of naturopathic medicine, is licensed in 11 states (California not among them). It is not unusual for people to receive training in more than one discipline. A DO, or doctor of osteopathy, often completes basic MD training, adding training in skeletal manipulation in support of a theory that diseases are due to a loss of structural integrity.

Doctors of Oriental medicine ("OMD" or "DOM") are trained in the use of herbal remedies and acupuncture (acupuncturists are licensed in 34 states, including California). Their diagnostic and treatment methods are rooted in belief systems that go back thousands of years. They are based on a complex of ideas, including a vital life force said to flow throughout the body, yin-yang opposites in well-being, illness and all of life, and the need for a balance of forces within the body before good health can be achieved. Training requirements vary widely from state to state in the United States.

Most doctors take pride in their training and display diplomas and certificates in their offices. They are worth looking at when you visit.

If in doubt, take charge. Ask about the training and experience your chosen doctor has completed.

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