A few weeks ago, my young nephew, Sam, a final year medical student, asked, “Dr. Ben, why do medical doctors resent optometrists being called doctors?” I was alarmed.
I was just recovering from a near heart attack from a post I read a few minutes before, sent by a colleague who related how a doctor had terminated the life of his patient who was no longer responding to his treatment. I had come to instantaneous judgment.
“What kind of doctor is this? He must be wicked and definitely lacked compassion. How did he pass through medical school! He must be nothing but a quack?”
I did confirm, at the end of the post, that he was indeed a doctor – a veterinary doctor – and his patient, a goat! I could have been saved all the expletives and mental torture, if from the onset, he had been referred to as a veterinary doctor.
Armed with this experience, I wasn’t going to fall victim of another prank. I therefore started by asking him, “Who is a doctor?” Sam answered: “Anyone with a higher degree – a doctorate (PhD) conferred by the university can be called ‘doctor’. It could be in Engineering, Law, Mathematics, Economics, Theology, Philosophy or any other discipline.
There are, however, a few exceptions. Against the run of play, our universities award the title “Doctor” instead of ‘Bachelor’ to the first degree graduates of Veterinary and Optometry. Thus, the vets, receive ‘Doctor of Veterinary Medicine’ (DVM) and Optometrists, ‘Doctor of Optometry’ (DO).
“What about the medical doctor?” Please note that the sequence of the words in the preceding sentence. ‘Medical’ comes before ‘Doctor’. Our universities, in line with other disciplines, give Bachelor of Medicine & Bachelor of Surgery (MB,BS) to medical doctors as their first degree – not ‘Doctor of Medicine’!
The Doctor of Medicine (MD) is a higher degree equivalent to the PhD. The title ‘doctor’ is not on any certificate of the medical doctor. It is conferred on the medical doctor by convention and it’s now legally appropriate. There is a long history behind this! It will be addressed on another day.
Medical practice is regulated by the Medical and Dental Council of Nigeria and medical doctors are also known as medical practitioners. No one can legally practice Medicine without being registered by the Medical and Dental Council of Nigeria. Since optometrists are not medical doctors they are not licensed to practise medicine.
A veterinary doctor is a doctor by right. An optometrist is a doctor of optometry by right. They are awarded these degrees by accredited universities in Nigeria and no one can take these degrees legally conferred away from them.
The bone of contention is therefore the confusion created by the aberrant reference to the optometrists as “eye doctors,” instead of doctor of optometry conferred on them. The only eye doctors (or eye medical doctors) are therefore ophthalmologists.
An ophthalmologist is a medical doctor who specialises in all aspects of eye care including diagnosis, management of ocular disorders and diseases and intervenes surgically if necessary. You cannot become an ophthalmologist until after your first degree, which gives you the right to be called a Medical Doctor.
You then spend another six to eight years (which includes internship, national service and passing the examinations of the National Postgraduate Medical College) to become an ophthalmologist – an eye medical specialist (an eye doctor). You may also spend additional one to two years to sub-specialise in one of the seven divisions of ophthalmology.
By Nigerian Standards, considering the length of time taken to go through the programme, the minimum age anyone can qualify as an ophthalmologist is 32 years. Only the ophthalmologist qualifies to be called an eye doctor.
An optometrist, on the other hand, is a healthcare professional (not a medical practitioner) registered by the Nigerian Optometry Board to provide optical services, which includes the identification of vision-related problems requiring correction with optical appliances such as glasses.
Since they have to examine the eyes to be able to do this, they must encounter some eye disorders not correctable with optical appliances which they have to refer to ophthalmologists. They are allowed to provide simple, non-invasive primary eye care within the limits of definition of primary care.
However, they have the added advantage that their training exposes them to many eye conditions which they’re better able to recognise and refer to the ophthalmologist for treatment.
For an optometrists to go into full scale treatment of eye diseases is to cross the limit of his training into the realm of the medical profession for which he is neither well equipped nor licensed to practise. It would therefore be wrong to call him an eye medical doctor, which is reserved for the ophthalmologist.
Optometrists complete a four-year university programme in the School of Optometry to earn the Doctor of Optometry (OD) degree. This is a first degree programme. They are therefore qualified to be called doctors of optometry.
In a well organised health care system, the optometrist and the ophthalmologist should work seamlessly together with the patient as the focus. But when there is a cleavage, the informed patient must know where and when to go in search of better attention to keep his sight.
Patients must insist on referral to an ophthalmologist if and when they feel their best interest is not being served. Only the ophthalmologist can come to a decision after a thorough examination and possibly necessary investigations. Remember, the eye is a small but important part of the body and often mirrors what is happening in the rest of the body.