A fallacious document

The heading of this document was carefully selected so as not to call it clearly and simply “An Incorrect Title”. It refers to the deceitful, fraudulent and otherwise pompous title of “Surgeon-Doctor” which the great majority of Medical Faculties and Schools in this country award to their ex-students after a more or less sufficient preparation lasting an average of 5 or 6 years. This educates students in the details of basic sciences, pathology, clinical medicine and pharmacology, with basic knowledge for practical ends restricted to the field of surgery.

The title of “Surgeon-Doctor” implies that the holder of this certificate is prepared to practice as a “Doctor” as well as a “Surgeon”. The meaning of both terms should be explained, even though this is done very superficially. According to the twenty-first edition of the dictionary of the Royal Academy of the Spanish Language, a “Doctor” is a “person legally authorised to profess and practice medicine”. Medicine is the “science and art of preventing and curing the diseases of the human body”.

A surgeon is “a person who professes surgery”, and surgery is the “part of medicine that has the aim of curing diseases by means of operations”, so that a surgeon is therefore said to be: “he that cures with his hands”.

Medicine and Surgery are both broad, enormous fields that could not be covered by a single person. When they leave college recent graduates with the title of “Surgeon-Doctor” are a long way from dominating either of these universes. This necessarily means that they will have to continue studying and do so until they cease practicing.

If one is aware of the limitations of one's qualification at graduation, humble enough to admit them and also genuinely desirous of practicing as an honest and competent professional, then the obligatory step is to undertake postgraduate studies. The range of options is almost infinite. It is basically possible to choose to gain more in-depth knowledge in the field of either medicine or surgery.

It is a pity to admit it, but at this stage of development those who do not undertake postgraduate studies become petrified in a limbo of professional practice, with knowledge that becomes outdated amazingly quickly, leading to professional obsolescence and increasing inefficacy, making them incapable of even minimally effective work.

This process of specialisation arose surprisingly late in the history of Medicine, which had been conceived to be an art and science from the remote past of our ancestors: Galen, Hippocrates, Avicenna and the other founding fathers.

From its dark and traumatic origins, medical knowledge gradually increased until it achieved an unimaginably complex refinement. This now surpasses the capacity of the imagination and surprises us from one day to the next with increasingly promising innovations.

At most a century and a half ago, a minute time in human history, Medicine emerged from its original darkness to become a practice based on scientific principles (or evidence-based, which is the preferred modern expression).

All doctors, even the old-fashioned type, were necessarily “general practitioners” who shared a limited amount of knowledge. They slowly grew in knowledge by acquiring increasingly useful diagnostic tools and finding better treatments with fewer undesirable side-effects.

Before the avalanche of scientific knowledge that now – fortunately – means that practice is now less empirical and is increasingly supported by biotechnology, doctors did what they could when they could. They did so with the best of intentions, with the backing of a title that permitted them to work as a doctor as well as a surgeon. Their knowledge, which was enormously restricted in comparison with current information, justified their title as well as their work. Today there can be no justification whatsoever for keeping the deceptive title of “Surgeon-Doctor”.

The truth must be told, even if it is repetitive: professionals graduating from our schools of Medicine enter a highly competitive world without the knowledge and skills to practice their profession in a way that would be minimally acceptable within the medical field. They are also totally incapable of surgically operating on their patients. Surgery is a perfectly differentiated branch of medicine, although it is both complementary to and linked with clinical practice. Graduates from the school of Medicine not only lack surgical knowledge and the skills involved in surgical techniques, as the truth is that they DO NOT know how to operate and are unable to do so. This requires a long and arduous training process lasting for at least four years as an intern in General Surgery, before they are able to deal with everyday surgical cases: hernioplasties, appendectomies and cholecystectomies, etc.

Nobody could imagine conferring the title of “Neurological Doctor” or “Endocrinological Doctor” on someone who had only just graduated in Medicine. It seems perfectly clear that anybody who is a qualified “Neurologist” or “Endocrinologist” must have followed a postgraduate program for several years as an intern to acquire the knowledge and skills intrinsic to their speciality. So why then do the graduates of the majority of Faculties and Schools of Medicine in this country receive the title of “Surgeon-Doctor”, when they lack the training that is necessary to practice surgery?

Our suggestion seems incredibly simple: someone who has not been trained to operate cannot be termed a “surgeon”.

Based on all of the above arguments we believe that there can be no delay in deciding to remove the qualification of “Surgeon” from the title of “Doctor”. Given that the qualification of “Midwife” was removed in the past from their professional title, there cannot be the slightest doubt that things should now be definitively called by their correct name: recent graduates from the school of Medicine should receive their corresponding title of simply “Doctor” or perhaps “Graduate in Medicine”, or “General Practitioner”, no more. Those who unscrupulously practice as a “Surgeon” without being one must be stripped of their “Letters of Marque” granted by a fallacious document.

We hope with fingers crossed (given that there is nothing more we can do) that this proposal will be heard by receptive ears, and that it will overcome bureaucratic inertia, disarming apathetic asthenic civil servants who are also immobile and averse to change and rejecting political incompetence.

The aim is clear, correct, noble and just. It deserves to win through. This initiative must gain the recognition of its contemporaries as well of future generations.