I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name...but not with "Doctor." (e.g., "Hi, this is John Smith from the Family Health Center.")
I occasionally see the residents' patients for urgent visits. When I ask them who their regular PCP is at the office, I get a first name response about half of the time. (e.g., "Jane" or "Dr. Jane") I have seen this same phenomenon in the hospital when I'm on the inpatient service; I'll reference the family medicine resident caring for a particular patient by title and last name, and the patient will say "who?" I have since learned to then provide the resident's first name, to which the patient will invariably sigh with relief and say "oh yes. He/she has been so nice."
You have probably guessed by now how I feel about this use of first names. I may be only in my mid-thirties, but perhaps I belong to an earlier era. I address my patients (over the age of 18) by their titles and last names unless they have given me permission to do otherwise. When I meet new patients, I address them by their first and last names and then ask them how they would like for me to address them. My expectation is that they will address me as I prefer to be professionally addressed: "Dr. Middleton."
I suspect the blurring of casual and corporate that has occurred in the rest of the business world is happening in medicine. I am addressed by my first name in the vast majority of transactions I undertake as a customer, almost always by people who don't know me. Perhaps the "Doctor" title is yet another casualty of that blurring. I would, however, argue against allowing the traditional cues of our professional identity to erode.
Unlike most other businesses and professions, we physicians have a sacred contract with our patients. They allow us into the most private and intimate details of their lives. In return, we pledge to maintain stringent professional boundaries related to our behavior and give them the best of our intellect and compassion. Being addressed as "Doctor" is a constant reminder to me - and to everyone I interact with - of the oath I took to fulfill that pledge.
Please hold me accountable, and keep calling me "Doctor."