Thursday, January 13, 2011

What ever happened to "Doctor"?

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."


  1. Definitely with you on this. However, for those people who I consider friends, when we're outside the walls of the office and hospital, I ask them to use my first name. For me, this is my silly way of separating work life from "outside of work" life

  2. I call myself "Doctor" when I interact with patients but I have the problem of some of them wanting to call me "Stacie." I guess this is because I am younger - I can't imagine them calling my older colleagues by their first names. I'm trying to figure out the polite way to tell them not to call me Stacie anymore...

  3. It is not limited to the MD ranks; my chiropractor goes by Dr. [first name], which is uncomfortable to me. I know her socially because our daughters are friends, and I usually end up addressing her as "[friend's] Mom" because I have trouble saying her first name with the title Dr. I have too many associations with "Dr. Nick" from the Simpsons...

    Perhaps it is related to the general casualization (for lack of a better word) of the entire medical profession? Nurses used to always wear white uniforms, but now even the receptionists at the doctors' offices wear scrubs. At the hospital, I had to look very carefully at people's badges to make sure it wasn't just some random person in scrubs trying to steal my baby.

  4. Good topic, Doctor. In the late 70's, we also had resident physicians who didn't want to be called "Doctor". It seemed that the "denial" of doctor status" was one way to "power down" and not be threatening or aloof from patient "status". I found some clarification about this position in The Healer's Power by Howard Brody, MD, PhD (1992, Yale University Press). I still refer to Dr. Brody's insightful commentary frequently to refresh my insights about power and compassion. While the White Coat Ceremony serves to help students understand the obligations and potential separateness of our profession, the virtue of compassion (as demonstrated by countless Family Physicians) "is integrally linked to the ethical use of power in the physician-patient relationship. Surely, being with the sufferer and helping him find his own story to attach meaning to his experience is a prime example of shared power. Few things that the physician can do have the capacity to empower the patient to a similar degree. ... To be compassionate in response to the suffering of the patient is therefore one of the most powerful things a physician can do: but this is possible only to the extent that the physician is willing to adopt a position of relative powerlessness, to acknowledge that the patient's suffering has incredible power over him and that he cannot remain unchanged in the face of it. This is a major irony of the physician-patient relationship, in which a sense both of one's own healing power and of one's necessary humility forms a synthesis of the apparent contradiction of power and powerlessness."
    Some may not feel ready for this type of struggle for professional development and don't want to fully accept the title of Doctor.

  5. It would be interesting to hear more from physicians about why they might desire to be called "Doctor", rather than "I'm John Smith, the resident doctor on call".

    From my perspective, the use of titles is about both real power and the perception of power in the physician/patient relationship.

    While I agree with Dr. Synonymous' assertion that being present in the patient's suffering is a key milestone in becoming a professional, I cannot follow how this leads to the suggestion that embracing a title is a somehow a marker of this professional development.

  6. I sometimes struggle with this issue as well. I don't run into this a whole lot as I introduce myself as Dr. and my staff refers to me as Dr. I have a few patients that call me by my first name, but that is rare.

    I think balancing the close and friendly relationship with the official side of the relationship is tricky sometimes. You have to maintain some authority so that patients see you as an expert not a friend.

  7. I invite patients out of the waiting room by first name only to respect privacy. I introduce myself as Dr. Throckmorton Moviedoc, and they get to decide whether to call me Dr. Moviedoc or just plain Throckmorton.

  8. I am a veterinarian. I also have a PhD.

    Sometimes clients say things like "oh, so you've had as much education as a real doctor?"... My usual reply is "as a real doctor? what am I? an imaginary doctor?"

    In the work setting, I always introduce myself as Dr. Myname. Clients sometimes say: "and what is your first name?". While I am a woman and look young for my years, I do take this question as disrespectful. I usually reply by saying "I just go by Dr. Myname".

    Most clients accept that, but I have lost one appointment (that I know of) because of the "I just go by Dr. Myname" when the client called me by my first name 3 times in a row while I kept repeating Dr. Myname 3 times in a row.

    Right or wrong, I worked hard for my doctorates and I do not like them disregarded.

  9. I found this article interesting. Even though it's a few years old, I'm also in my mid-thirties and think the use of last names is not just one of formality, but of respect. However, when I am in a hospital, PTs are addressed by last name, doctors by last name, but the nurses are addressed by first name. Why the distinction of respect? I find the informality among the professions, i.e. doctors to nurses, an issue of classicism. When one professional requires address by honorific and last name, but does not respond in an equal fashion to a co-worker or colleague, you cement the idea of a value-based hierarchy. If you think people should be addressed by last name, of which I agree, then you need to respond in an equal fashion.