LAST WEEK'S PATIENT'S ADVOCATE COLUMN INCORRECTLY REPORTED THE LOCATION OF MCGILL UNIVERSITY. IT IS IN MONTREAL. (Published 10/6/ 87)

George Arnstein, 63, has some complaints about doctors.

His thoughts echo scores of others constantly being mailed to us by disturbed patients.

Arnstein, who holds a PhD in education, is a former member of the District's Educational Institution Licensure Commission and a particularly articulate patient.

"My problem," he writes, "has been physicians' inability or unwillingness to treat the patient as an individual, to have him participate as a partner in the overall process."

He describes some incidents. None endangered him, yet they are telling: "My internist had retired and referred me to a younger man who also was adjunct faculty at a local university. During my initial exam, he asked if I objected if some of his students were part of the interview. I agreed and was introduced to half a dozen 'doctors.' "

Actually, "they were third-year medical students, not doctors, while I was introduced as Mr. Arnstein, despite my bona fide PhD, something I do not usually emphasize. Still, they were imposters; I was not." "This same internist made a highhanded decision. When I reported for a routine physical exam, there appeared a substitute whom I had never encountered. He mumbled his name.

"Upon inquiry, I was told that my regular internist was tied up but would join us toward the end of the exam. In fact, he did not (and I am confident that he never planned to be there) . . ."

Later, Arnstein mentioned his concern over the substitution. The regular doctor "did not seem to understand," and "he is now my ex-internist." "My new internist, with whom I feel much more comfortable, sent me for an ultrasound examination."

The lab doctor courteously introduced himself, then "a young woman, not introduced, asked me to lie down, and did I mind being the first patient subjected to a new machine? No, I did not mind . . . There entered a man, not introduced, who turned out to be the new machine's demonstrator, and another presumed physician, who introduced himself with a mumble.

"The demonstrator then demonstrated. I was greatly relieved (and they were quietly disappointed) when I turned out to be 'grossly normal.' But even now I do not know who the demonstrator was, whether he was a physician or technician or both, or who the woman was (I did catch her first name), who then repeated the demonstration with the demonstrator's assistance.

"I was not asked for comments, feedback or whether I was comfortable. I was not; the lengthening examination made me stiff and tight."

"My point," he concludes, "is that physicians ought to observe the common courtesies. Before strangers poke at my body, they should introduce themselves and their technicians, and they ought to make clear who's in charge.

"And they ought to stop inflating the ego of students by promoting them prematurely, no matter how firmly established the tradition may be." ::

On this matter of medical students being introduced to us as "Doctor." It has been going on for decades at university medical centers and teaching hospitals.

Medical students begin working in the hospital wards and outpatient clinics at least in the third of their four years in medical school. They often begin this exposure in their second or even first year.

Dr. Martin Shapiro is an assistant professor of medicine at the University of California at Los Angeles Medical School. In "Getting Doctored" (New Society Publishers, $29.95; $9.95, paper, publication, Nov. 1), he tells of his education at McGill University in Toronto.

As part of teaching him to interview and examine a patient, he explains, his mentor began calling him "Doctor" before patients on his very first day of hospital training, midway through his second year. "I was terrified; I blushed and even thought momentarily of running from the room. 'Surely the patient knows that isn't true,' I thought."

This is typical, he reports, and "students are usually called 'Doctor' around the time they begin their clinical training. Few students resist . . . Nevertheless, it is not infrequent to feel uncomfortable in the early stages when someone addresses them as 'Doctor.' Later, they will feel uncomfortable when someone does not."

That first day, however, "the title certainly seemed inappropriate . . . We knew far less about recognizing disease than did the nurses, the orderlies or even many of the patients."

However, Shapiro soon decided, there are "good reasons" for the practice. Acquiring "a professional identity" is necessary "to deal confidently and 'professionally' with patients and health workers." The designation relieves the students' anxiety and makes it "easier to function." Also, many physicians feel patients should think the person examining them is "a physician, or something more than just a student."

By the third year of medical school, "it was thought inappropriate" that patients be told "that the person in white who came to see and examine them each day (their 'primary care physician') was in reality only a student." And "most members of the class had learned well by fourth year how to play the part fearlessly and with many of its subtleties: paternalism, aloofness, omnipotence."

Going back to his first year in the hospital, Shapiro says, "what soon became evident was that the patients were willing to play along. They all knew we were neophytes (word quickly gets around a hospital ward about who's who), but they accorded us the deference due to members of the medical profession and regularly took the trouble to address each of us as 'Doctor.' "

I wonder about this. I wouldn't address them as 'Doctor' if I knew better, nor would George Arnstein or many other patients. But we might not know better. ::

What is the practice at a typical American medical school, say George Washington University here?

Probably not consistent. Dr. Carole Horn, director of student admissions, says, "Students are given an option. Some introduce themselves by name and say, 'I'm here to learn medicine.' Some say, 'I'm Dr. Soandso.' We permit them to do whichever they want.

"I often say, 'This is Dr. Soandso. He's the medical student.' So it's made clear he's a medical student and given the title for that reason. That ought to be made clear {to the patient}. But I'm not sure that always happens."

Dr. William Minogue, George Washington Hospital medical director, differs.

"I know of no policy here," he says, but "I don't favor" calling students "Doctor." " 'Doctor' is something you earn, something that establishes that you have certain training and judgment. I think a teaching hospital ought to be up front and say, 'This is a medical student,' or 'This is a resident,' etc. I think we should identify anybody who walks into a patient's room."

Minogue, like Shapiro, reports that patients actually "love the idea" of having a student help care for them. The student is typically open, friendly, eager to converse with the patient.

A student may make no medical decisions, Horn says, and may only make recommendations to the resident, a young doctor also in training but presumably well enough trained to make decisions. Still, Shapiro reports, more experienced students often act in effect as interns, indeed taking increased responsibilities.

My own reaction? If I'm in a hospital or a doctor's office, I want to know just who is examining or treating me or drawing my blood. I had not thought much about this subject before, but after reading Shapiro I intend, on any future hospital stay, to ask any young man or woman in a short white coat, "Are you an MD?"

I hope I can ask it in a friendly way. I have no objection to cooperating in a student's education, unless my desire for privacy at the moment should interfere.

I do object to deception, which can lead to arrogance in the susceptible and the attitude that patients are, after all, persons to be manipulated for their own good.

A small deception, some may say. But a deception nonetheless. Next Week: Doctors in film, books and TV.