Barber-surgeons at work!

This caricature from the 16th century shows barber-surgeons combining haircuts with various surgical tasks (from Hæger K. The illustrated history of surgery. London: Harold Starke, 1998).

The tradition of addressing surgeons as “Mister” or “Miss” rather than “Doctor” is firmly entrenched in English surgical practice. This tradition is generally thought to have had its origins in the days of the “barber-surgeons”, after the Company of Barbers united with the various guilds of surgeons in 1540.1 The blade-wielding skills of barbers had given them opportunities for surgical practice, and “surgeons” at that time seldom had formal qualifications. Whether the two professions united for financial reasons or to bolster their numbers after the Black Plague of the 14th century is unclear.2

By the beginning of the 18th century, physicians and a few surgeon members of the Great Company of Barbers and Surgeons had gained university qualifications.3 All other surgeons were, quite naturally, addressed as “Mister”.

With the separation of the surgeons from the Great Company of Barbers and Surgeons1 in 1745 and the establishment of the Royal College of Surgeons of London, the title “Mr” was retained and began to be seen as a label of status, as it marked the completion of formal examinations.

The strong influence of the Royal College of Surgeons of England in the formative years of the Royal Australasian College of Surgeons (RACS) led to the persistence of the term in Australia.

Anecdotally, the use of the term “Mr” appears to be losing favour, at least in New South Wales, and we sought to determine the prevalence of “Mr’s” among urologists in New South Wales and Victoria.

Practising urologists with workplace addresses listed as NSW or Victoria were identified from the List of Members 2003 booklet of the Urological Society of Australasia.3 Data were collected from the letterheads (or signatures on letters) of practising urologists and, if letters were not available, by contacting urologists’ secretaries by telephone. The level of membership and year of attainment were recorded from the booklet.

Of a total of 134 urologists, data about preferred title were collected from 69 with practice addresses in NSW and 56 with practices in Victoria (response rate, 93%). Year of commencing Society membership ranged from 1963 to 2002. The preferred title across NSW was “Dr”, whereas “Mr” predominated in Victoria (Box). Five Victorian urologists preferred the title “Dr” included among these were all the female urologists contacted who were practising in Victoria.

The use of the title “Mr” among NSW urologists appears to have become obsolete. As NSW is the state with the most urologists, the umbrella title of “Mr”, as dictated by English tradition, can no longer be used for male urologists.

The first female urologist in Australia completed her training in 1993, and currently about 10 women are practising as urologists in Australia. Greater numbers of women are entering urological surgery training, and, at the time of writing, there are 10 female trainees in advanced urological training posts across Australia. The use of the salutation “Dr” among female urologists, in states where “Mr” is used for male urologists, potentially may cause some confusion — patients may be uncertain of their surgeon’s qualifications. Female surgeons in the United Kingdom are traditionally addressed as “Miss”, regardless of marital status, but convention has expanded to include more recently “Ms” and “Mrs”.4,5

The attitudes and practices of surgeons across Australia, as well as the shift to more women in the profession, should be reflected in surgeons’ titles, and consideration given to phasing out the archaic title of “Mr”.