LAUSR

When I was a youngster, some time ago now, growing up in suburban Sydney, I remember my father became quite ill. It would have been in the mid-1950s. Our local doctor was called and my mother was advised that my father was to be placed in a dark room and no one was to disturb him, particularly me. I was told that he was bleeding from the bowel, probably the stomach. On the first day of his confinement, our family doctor told my mother that if the bleeding did not stop he would have to see a ‘Mister (someone)’ as he might need surgery. This disturbed me even more; why couldn’t my father see a proper doctor? I simply had to ask the question. To my surprise, the question brought a degree of mirth to the sombre occasion. Dr Pearce went to great lengths to explain to me that this ‘Mister’ was a highly trained surgeon. He was so highly trained that he was called ‘Mister’ as a recognition of his status. He was a ‘Doctor’ who had become a ‘Mister’. As a 7-year old, I was relieved but still a bit confused. I still remember it. My father was visited twice a day by Dr Pearce and after about 5 days, the crisis was over. I remember my father was told to drink stout as it was a good iron source. This pleased him immensely! He then went on to see the ‘Mister’ in Macquarie Street where apparently they all worked. He avoided surgery. The gender-specific title of a surgeon is an interesting phenomena and is considered by some as a form of inverted snobbery. The origin harkens back to the 1600s when barbers would perform surgery. I am told that the pole with the helical red stripe on the white background displayed outside barber shops is a reflection of the tradition of their surgical service and blood-letting. They were the surgeons of the day; the product of an unstructured apprenticeship. Physicians were university educated and used the title of ‘Doctor’. The origin of the title of ‘Mister’ dates back to King Henry Vlll who by Royal assent recognized the merger of Barbers and Surgeons under the name of ‘Mastery and Commonality of Barbers and Surgeons of London’. It gave those who trained in the practice (an apprenticeship) the right to call themselves ‘Master’. The surgeons agreed to not cut hair or pull teeth, which was the province of the barbers. In time, the title was abbreviated to ‘Mr’ and became ‘Mister’. This collegiate relationship between the barbers and surgeons continued until 1745 when the surgeons left the barbers and formed the Royal College of Surgeons of London. Of course, they retained the title of ‘Mister’. The title of ‘Mister’ for surgeons has been a long-standing source of criticism, confusion and bemusement. As a 7-year old, I was not alone. It has been a long-standing source of social commentary. It was even the subject of debate in the New Zealand Parliament in 1951 and stimulated an editorial in the London Saturday Journal in 1839, to mention a few. The use of ‘Mister’ is common in the United Kingdom and New Zealand but less so in Australia. It is rarely used in Canada and totally confusing to Americans. In this issue, Professor Susan Neuhaus discusses another aspect of this gender-specific title. A point of view that I believe to be even more important. According to our 2016 Activity Report, 11.6% of practicing surgeons in Australia and New Zealand are females. The number is growing as females now represent 28% of our trainees. Has the gender-specific title of ‘Mr’ caused a feeling of inadvertent discrimination? Does the prenominal title of ‘Mrs’, ‘Miss’ or even the more confusing title of ‘Ms’ translate well professionally? All adult males tend to be called ‘Mr’, but the title ‘Mrs’ or ‘Miss’ denotes marital status. ‘Ms’ is not even a word. Virtually, no female surgeons use the gender-specific prenominal. The article does demonstrate geographic differences but we should ask the question, is it time to move on and drop the tradition, a permutation of ‘Master’ in any event. The late Hugh Phillips, past President of the College of Surgeons of England, even described the practice as a ‘form of old tribalism’ and advocated that the practice be stopped. There is a view that it will probably die out with time but I am forming the impression that the new generation of surgeons are becoming more traditional than their predecessors. The article demonstrates that the title of ‘Mr’ in younger surgeons is gaining popularity. As a surgeon from New South Wales, it is my observation that the prenominal of ‘Mr’ is rarely used professionally. College correspondence is usually the only time ‘Mr’ is used as it is an ‘opt out’ option on our profile. If it is causing discomfort to our female colleagues, is it time to ‘opt out’ and change ‘Mr’ to ‘Dr’ as our preferred prenominal?