Thursday, March 2, 2017

By any other name

I don't feel comfortable with patients calling me by my first name.

I'm fine with nursing, therapy, or other staff calling me whatever they want.  But when it comes to patients, I think they should call me Dr. McFizz out of respect.  After all, I would never consider calling them by their first name without being invited.  And sometimes I even have to be reminded several times by patients to call them by their first name, because I usually default to the last name.

I was discussing this with a physician colleague recently:

Me: "One thing that bugs me is when patients call me by my first name."

Him: "Patient call you by your first name?  Really?"

Me: "Yeah!  It happens all the time.  That never happens to you?"

Him: "No.  Never."

Me: "Wow."

Him: "Well, I always introduce myself when I walk into the room as Dr. Soandso."

Me: "So do I."

Him: "How do they know your first name then?"

Me: "They read it off my badge."

Him: "Well, maybe that's the problem.  You shouldn't have your first name on your badge."

Me: "YOUR first name is on your badge."

Him: "Maybe it's because I wear a tie."

Hmm. Or maybe it's the Y chromosome?

One of my hypotheses was that patients forget that I'm a doctor during the course of our conversation, and assume I must be a nurse or therapist.  But right after this, I was with a patient's family member where I had a long conversation about medical care, and she said she was so appreciative to get information from a doctor.  Then when I left, she said, "Bye, Fizzy!"

29 comments:

  1. This comment has been removed by the author.

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  2. I am a nurse practitioner and fought my institutions' policy to have NPs wear name badges with first name/ last initial only. I don't want to be seen as a friend of the patient but as a healthcare provider deserving of respect. I feel calling you Dr McFizz shows respect (especially when you asked to be called by that name) and you should continue to ask for that respect.

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  3. Had the same problem as an RN. Confused patients give the female nurse all kinds of hell- and settle right down when the "Dr." aka male nurse comes in the room. Less respect for the female.

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  4. i have a label maker that can fix that name badge problem

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  5. I'll start by saying that I call all of my physicians "Doctor" with two exceptions, both my kids' doctors - one is our old school, grandfatherly concierge pediatrician, who calls me saying "Hi, Bob, it's Joe Green" which I take to be an invitation to call him "Joe," the other being an MD/PhD superspecialist with whom I have a personal relationship outside of the clinical one involving my kid. So, I get the general practice, and I never refer to them as anything other than "Doctor" when (especially) my kids, or any third person (including other physicians) are around. Then again, I also call my rowing coach and my spinning instructor "Coach" and I generally don't call people by their first names unless the relationship has reached the point where it seems to me to be appropriate, so calling physicians "Doctor" is the same way I treat everyone, not unique to physicians.

    That said, I really don't understand the seemingly unique expectation of physicians that in American society in 2017, where everybody goes by their first name, it's somehow disrespectful to the point of offensiveness to call a physician by their first name.

    For context, I'm an attorney. I went to graduate school for 4 years, earned a professional doctorate and an MBA, and I spent tens of thousands of hours in training over 8 years (and most people have to do 10 years) before I became a partner in a law firm. In other words, I and my partners, too, worked very hard to earn the right to practice in my profession. Nobody calls us "Doctor." In fact, the only people who regularly call me even "Mister" are my kids' schoolteachers, my son's fellow Boy Scouts and the flight attendants on planes where I'm lucky enough to be upgraded to first class.

    Even judges, who are referred to in the third person ("the Court") generally (exception for US Supreme Court justices) don't expect to be called "Judge," or "Justice" or "Your Honor" outside of the courtroom.

    Similarly, my father, a professor of chemical engineering, never went by or expected to be called "Professor" or "Dr." (honorifics to which he was unquestionably entitled by way of his PhD and his status at his university). To the contrary, he gleefully shopped at the wholesale plumbing store and had an account because in his words, he was nothing more than a glorified plumber.

    I totally get the gender issues associated with what you describe. It's unfair and inappropriate that with the level of education, training and experience you have that you should be confused for anything other than a physician. That said, I really don't get why physicians believe that their value is somehow called into question or that it's appropriate to be offended just because they are called by their first name. It just comes across as obnoxious, particularly when it's (as I've experienced) been in the context of interns who make a big deal out of pronouncing their names as "DOCTOR Jones" when introducing themselves to me in clinic visits with my kids with obscure medical issues. I guarantee that in addition to being a juris doctor myself, I know far more about the basic science and clinical issues/treatment of my kid's condition than someone who is 4 months removed from med school.

    To quote the successors to the great Messrs (see what I did there?) Merriam and Webster:

    Definition of condescending:
    showing or characterized by a patronizing or superior attitude toward others

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    1. Just as I would never walk into a courtroom and say to the judge, "Hey, Bob," it's inappropriate in my opinion to do that to a doctor. I am fine with nurses, therapists, my kids friends, the mailman calling me by my first name, and anyone who isn't probably is an arrogant ass. In fact, I recently had an interaction via email with my daughters teacher where he kept addressing me as doctor and I kept signing my emails with my first name, but I guess he was trying to be respectful.

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    2. The courtroom is different. By law, there are rules around appropriate decorum, and if the judge is sufficiently pissed off about your behavior, they can throw you in jail. That's not because the individual jurist needs a level of respect, but because the judge is the human embodiment of the court and the law themselves, so if you disrespect the judge you are deemed to disrespect the law.

      What you're describing is different - it seems to be the view that a physician *personally* is entitled to special respect and honorifics simply because they hold a medical degree, and it's uniquely with respect to relationships with patients.

      That's why I suggested it was condescending, because it's very clearly motivated by a desire to communicate and have acknowledged that you are, in some fashion, different and superior to the patient in that particular relationship.

      You are at least consistent in that you call everyone "Mister" or "Mrs." unless and until the relationship changes.

      Let me ask you, though, is there ever a point in your physician-patient relationships at which you believe it would be appropriate for the patient to call you "Fizzy?" If not, why?

      Is that reason because you are looking to maintain that position of "superiority" over the patient? If so, again, why?

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    3. If I were to walk into a lawyers office, I would certainly call him Mr. last name. I call my daughter's teacher Mrs. last name. I believe that in any professional relationship, the default should be to address someone by their last name until you have permission to do otherwise. And even when you have permission, I'm very hesitant to do so. I mentioned that my daughter's teacher would not call me by my first name, even after I gave him tacit permission. And likewise, I call all their teachers by their last name even when they sign emails with their first names. I mentioned that my daughter's teacher would not, even after I gave him tacit permission. I just think that is appropriate and professional... it's not unique to physicians. however, as somebody who is small, and female, and young appearing, I think it's even more important for me to have the title so that patients will respect what I have to say, which is important to their care.

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    4. I agree with your point about teachers, but part of that is because I'm mostly around them at the same time as kids, so it's not appropriate to call them by their first names. I also address emails by Mrs. So-and-so, but that's mostly because I'm sucking up.

      I will tell you that nobody *ever* calls me "Mr. Smith" the first time they meet me as a lawyer.

      I do sympathize with the issues associated with being female and small. I'm a 6'3" 225lb white dude with a bellowing voice, so I honestly don't have that problem, but I am sympathetic, and understand why it may be important to clearly telegraph that you are the "Physician" with a capital "P".

      You didn't answer my question, though about whether you thought it was ever appropriate in a doctor-patient relationship for that to be on a first name basis.

      Let's walk through this. You know a little something about me and my background and accomplishments. We're of broadly similar academic backgrounds, and I'm guessing that we're within a roughly 5 year age span from each other. If we lived in the same area, we'd probably have Facebook friends in common. In other words, we'd be socioeconomic peers.

      If I had an ongoing doctor-patient relationship with you (I've torn the same ACL three times, and thus have some long-standing orthopedic surgery/rehab relationships, so it's real world possible), and let's assume for the sake of argument that I'm not an asshole (my diatribe here notwithstanding, I'm actually a reasonably nice guy (as lawyers go ;) )), and I've been very clear, both explictly and implicitly, throughout our professional relationship that I trust your judgment and defer to your expertise (I believe that clearly communicating that to doctors is incredibly important).

      Would there ever be a point where you would be comfortable calling me "Bob" and me calling you "Fizzy"? If not, why? That's the crux of what I'm getting at.

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    5. To answer Anonymous - who gave a predictably eloquent and well considered opinion worthy of a lawyer. I am a medical student ... about to get the title of "Doctor." I don't think it has to do with more "value." I - personally - am going into surgery. I think the title and the white coat, etc, maintains a level of de-personalization that is actually very valuable. It has its flaws. But I think it's a reminder to me and it's a reminder to my patient that these ARE life and death matters. Certainly not all the time. But a lot. Even more than you might think. I could give a patient fluids and volume overload them and make them sick. I could give a patient oxygen and overcome their hypoxic respiratory drive and make them stop breathing! There is nothing benign that we do. Every medication is dangerous. Every decision - even the decision that something is NOT important - is potentially important. Absolutely there are many fields that are rarefied like this - it is not about being exceptional - it has nothing to do with what other fields do. Medicine is no joke. I am not joking around. At work I will be Dr. So-and-so. I will absolutely be human and personal with my patients. But I will also be their surgeon. My job will be to tell them to trust me with their lives. I can't do that quite as seamlessly as Sally the way I can as Dr. Smith. And when I have been in emergent situations I looked up at the doctor (whose name I didn't know) and I said "Doctor - please do whatever you need to do." That title mattered to me as a patient. It is inherently uncomfortable and a leap of faith to put that trust in someone. It is easier to do so if they are not a stranger - but a monolithic doctor. It's powerful and it's a power I plan to harness both to fortify myself and to fortify my patients.

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    6. To the new doctor Anon, that was really well said!

      I allow patients to call me what they prefer, but my preference would always be Doctor. Socioeconomic status and age are irrelevant. the relationship between doctor and patient is a formal one, and I agree with the above that it's important to maintain that. I would never treat a friend and I would never turn a patient into a friend.

      Ultimately, I think it comes down to personal preference though. I personally think that in any professional relationship, titles should be used. You clearly feel differently.

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    7. I don't disagree that it's a matter of personal preference. You clearly would prefer to be called Dr. Fizzy. My comments were related to the fact that you seem to be offended by people who don't feel similarly. My perspective differs from yours, though, by my personal feeling that physicians shouldn't feel *entitled* to be addressed in a "superior" fashion simply by reason of their education and profession, and thus offended if they're not.

      Anon, I share Fizzy's appreciation for your thoughtful comments. If I may offer a couple of observations, though, as someone who has spent more than their fair share of time in very well respected teaching hospitals.

      First, the title "Doctor" and the white coat are nothing but an entrance ticket to the doctor-patient relationship. If you are in an emergent situation, that can certainly be a critical pathway to necessary trust of a patient or their family.

      Once you're out of the emergent situation, the badge and coat are, at best, theatrical props, and at worst, crutches upon which you may come to rely as a replacement for an actual relationship with the patient/family.

      In my experience, interns and junior residents are the worst at having an expectation that a patient/family will instantly respect their knowledge and judgment just because they are a "Physician" and wear a white coat. That can be incredibly off-putting when it is obvious that that knowledge and judgment have not yet been developed to the extent necessary to have command of a particular situation. This is especially true when dealing with the parents of sick kids. Chances are that they know more than the chief resident about their child's situation and condition, but they don't actually expect you to know more than they do. They just want you to work with them and try to understand. Attempting to fake your way through it will turn them against you.

      You say that your "job is to tell them to trust me with their lives." That's not actually correct. Your job is to convince them that they *should* trust you with their lives. You can't make them do that, you have to earn that.

      That's what I mean by the badge and coat being theatrical props. They let you set the scene in which you will convince them why they should trust you. You're not just a doctor, but you're a good doctor, the right doctor. That part comes from how you communicate your expertise and your experience, even if you've never done it before. And that's how the title and coat can become a crutch - if you expect your patient to respect and trust you because of your title and coat, you may not do what you need to do to actually earn their trust. Many/most of the attendings I see don't even wear white coats these days. They don't need them.

      You'd be surprised how much patients notice. They know who has the respect of the other doctors, nurses, etc. in the room when they're talking. Earn their respect and you'll gain the trust of the patient. I'm pretty sure that they're not impressed by the word "Doctor."

      I'm "just" a lawyer, but I'll tell you the things that cause me to gain respect for my junior associates, and I bet they're not totally dissimilar to things that are appealing to more senior doctors.

      * Be confident because you know your stuff ("know your stuff" goes without saying), but
      * Don't be cocky.
      * If you think something's not right, say something. Even partners make mistakes, and they rely on the team to watch out for each other.
      * Don't be afraid to ask for help, even (especially) if you made a mistake. Things can usually be fixed if you tell someone who knows how to fix them in time, or even better if you tell someone that you don't know how to do something before it gets messed up.
      * Be nice to everyone. Nothing gets around faster than the word that someone's an asshole.

      [/soapbox]

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    8. As someone commented below, everyone is *entitled* to be addressed in a professional manner if they wish. I don't care if you wish to be addressed as Bob, but it's you who seem offended by my own personal desire to be addressed professionally.

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  6. I started introducing myself as [first name], one of the anesthesia doctors who will be taking care of you. It feels more natural to me. Some patients still think I'm a nurse, but they probably would have anyway if I'd introduced myself as dr lastname. None of my doctors call me mrs lastname. Thank goodness! That would mean they thought I was old!

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  7. I come from Brazil, lived in Germany and now live in the US. Each country treats the addressing of other people differently.

    In Brazil, everybody is on a first name basis and it is very rare to see someone called Mr Lastname. Most patients do use the word doctor when referring to their doctor, but it is usually Dr Firstname. Exceptions happen to those people who go by their last name as if it were a first, but in that case everyone calls them that, including family many times. It works kind of like a nickname, I hope I'm explaining this properly.

    I never demanded my patients call me anything. Some chose Dr Firstname, others chose Firstname, it never made a difference to me. Respect is something a lot more complex than calling someone with a title or last name.

    In Germany, everyone address other people as Mr Lastname until one of the parts says it is okay to change into first name and, consequently, another first person instead of third while conjugating every single verb used in communication. The whole conjugation you use to speak the same sentence while calling someone Mr Lastname or Firstname is different. It made me uncomfortable, many times I didn't recognize I was the person being called at the doctor's office, but it made sense as a whole.

    And then, I moved here. The land of not only first names, but nicknames! I will call people by whatever they introduce themselves with, it doesn't bother me at all. But I must confess I find it, at the very least, silly that one would be offended by being called by their first names.

    The only thing I feel you might be offended about is that male colleagues are called Dr Lastname and you are not, if that comes from a place of a man being respected and a woman less so. You could figure that out by asking other female colleagues. But who knows, maybe they just feel more comfortable around you? I obviously don't know what you are like in person, but you might be kinder, warmer and more willing to listen than others, which would make them comfortable. And if that is the case, it doesn't mean they don't respect you, not at all. Respect (or lack thereof) shows in different ways.

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  8. I think professional people are entitled to be addressed as they see fit. I think EVERYONE is entitled to be addressed as they see fit. Kids may call me Ms. Lastname, adults the same until they know me personally.

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  9. I wanted to "like" this comment and could not:

    FizzyMarch 3, 2017 at 4:03 AM
    As someone commented below, everyone is *entitled* to be addressed in a professional manner if they wish. I don't care if you wish to be addressed as Bob, but it's you who seem offended by my own personal desire to be addressed professionally.

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  10. From my observation it is mostly about the Y chromosome. If I can generalize without sounding sexist, women are perceived as warmer, less formal, and more feeling or nurturing. They are, therefore, easier to confide in and more understanding. This makes familiarity come easier. Men are generally perceived as more cold and aloof. While this does not excuse lack of formality, it becomes easier to understand.
    Long ago, at about age 25, I was a nursing assistant (orderly back then), but wore white and a stethoscope as we all did. Even at the age of 25 some patients would call me doctor.
    This is just my opinion, but I will ask my NP who I see as my primary care giver what she thinks. She is about half my age, but we talk about other things, too, as this is a small town and quite informal.

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  11. I call them doctor even if they are younger than me. I establish the relationship of professionalism, and if they don't take it from there, I know what kind of people and therefore doc they are.

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  12. I'm a female family med resident who's nearly finished residency, and an interesting thing I've noticed is that there seems to be a lot less confusion about the fact that I actually am a doctor when I'm in a non-hospital setting. I don't mind what patients call me, but in the hospital most patients just call me by my first name, and I think to a certain extent it's because they see so many people that they forget that I'm actually a doctor. In my community clinic, though, pretty much most patients call me Doctor Firstname. My last name is really difficult to pronounce for people of most linguistic backgrounds, so people try to call me Dr. Lastname and just struggle and so I say, "Just call me Firstname." But most of them seem to want to call me doctor, so they call me Dr. Firstname.

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  13. Another thing:

    Is it possible to change the badge from Firstname Lastname to Dr Lastname or F Lastname? I think having the first name there may invite people to choose what they prefer. If you only have your last name available, it would make it clear that this is how you wish to be addressed.

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  14. At my facility you can have security put your name however you want on your badge. They recommend for non-physicians to go with just first name so it is harder for crazy patients to track you down outside the hospital. Can you have your badge remade?

    As a woman, it is harder to get that professional respect from patients and coworkers. I have had patients ask me if there was a man around they could talk to, as though maleness were somehow a guarantee of competency. I have also had colleagues tell me flat out that I don't know what I'm talking about because I'm a woman. It is maddening. Were I in your shoes, I would also want to be known as Dr. McFizz. It helps patients think of you as competent and someone they should take seriously, and maybe reminds the other people you work with of the same thing.

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    1. How do they justify the supposed stalker-y interest of patients on non-physicians? It sounds like an excuse to make them go by their first names.

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    2. Ah. I believe it is recommended that they make sure they can't be found easily - i.e., don't get listed in the phone book, have a private profile on Facebook, etc.

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  15. A lot of good comments.

    I remember in my Mammalian physiology course the professor became livid at one of of his students for addressing him as Mr. Smith, instead of professor Smith or Doctor Smith. His actual comment was "I did not spend 12+ years in graduate school to be called Mr. Smith"

    I thought he was being a little dramatic at the time, but after the rigors of residency I understand. And I viscerally dislike it when patient's call me by my first name. I think its a younger Millenial cultural change (changing of the North American culture, I do notice that the majority of my latino patients call me Dr. First name).

    In the office every adult is Mr/Mrs Smith, and I am doctor Jefe. To my physician colleagues who are my patients, we usually go by first names. For my academic patient's I call them Professor Smith.

    I prefer professionalism in the office. Society may be picking to disregard conventional areas of formality and respcet (again in regards to historical North American norms), but I don't have to like it.

    To the esteemed lawyers question above. If we had undergone several years together and know each other well or undergone a serious medical condition successfully the transition to first names may be a natural and mutually agreed upon change.

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  16. I am Post grad 5+ in Paediatrics, in Australia. I go by First name or Dr First name. If I go to one of the rare health providers who expects to be called Dr/Sr/Pr. I tend to not use them or refer patients to them as I feel like I am attending a lecture not an appointment.

    People go to people with problems. Mostly they want to be heard and many feel they can connect better if they don't feel beneath the healthcare provider.

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  17. I vote Y chromosome on this one and it DRIVES ME CRAZY! I do think that it's because you are likely more approachable than your colleagues, but they also likely see this as a weakness. West coast everyone is first name basis, so I have patients that call me everything - first name without a doctor at all, doctor firstname and doctor lastname. However, I have noticed that when things are hitting the fan the doctor is definitely used.

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  18. As a female resident I have noticed that it seems to depend also on the patient population. Patient's that come through our resident clinic meet me first as their provider and the attending only as needed. These people generally call me Dr. Lastname. I introduce myself the same way to the attending patients, but they seem to call me by my first name or Dr. Firstname. I think it is because they hear other people (usually the attending) call me by my first name during the encounter. I don't really mind either way.

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  19. As a female resident I have noticed that it seems to depend also on the patient population. Patient's that come through our resident clinic meet me first as their provider and the attending only as needed. These people generally call me Dr. Lastname. I introduce myself the same way to the attending patients, but they seem to call me by my first name or Dr. Firstname. I think it is because they hear other people (usually the attending) call me by my first name during the encounter. I don't really mind either way.

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