Patients have begun addressing physicians by their first names.  To some physicians, this is fine. Others have a problem with it.

The rules of engagement have certainly changed in the 21st century. In society as a whole, people and relationships have been getting steadily less formal.

Developing a good rapport with a patient is essential, and what transpires during a first meeting can set the stage for the ongoing relationship. But unfortunately, there are no definitive guidelines on how physicians and other providers should be addressed, how patients prefer to be addressed, or how staff should introduce themselves. Aside from a few small studies, published data remain scant.

According to the literature that is available, some patients have indicated that they prefer that their doctors call them by their first name—although others will bristle at the thought of it, especially if they’re old enough to be your grandmother. But what about you, as the physician? Do you mind if your patients don’t address you with a formal title and instead call you by your given name? Or use that compromise of “Dr + First Name?”

Anne Marie Valinoti, MD, a New Jersey-based internist, expressed some misgivings about a patient calling her by her first name, and that it’s “one thing I’m still getting used to.” Writing in the New York Times, Dr Valinoti pointed out that there “seems to be a void in this area of etiquette: How does one address one’s physician?”

In her case, she found that it was almost always an older male patient who took it upon himself to use her first name, and usually in a friendly, offhand manner. “It might seem natural if I have had a long-term relationship with these people, caring for them over the years, but often these patients seem to make a decision at the outset to be on a first-name basis with me,” she wrote. “I wonder about these people. Are they trying to be chummy? Is it a power thing, making them feel less vulnerable while they sit half naked on the exam table? Do they just call everyone by their first names?”

On a Medscape blog, Gary Stadtmauer, MD, who maintains a private practice in New York City in allergy and immunology, finds that it “happens every now and then and it always takes me by surprise” that a patient calls him by his first name.

“I do not know exactly why some patients do this,” he wrote. “Any title commands a certain degree of respect but also is a recognition on some level that the parties are not entirely equal. Perhaps that is an uncomfortable situation for some people. Or maybe they were on a first-name basis with another doctor and they are more at ease with physicians on a first-name basis. There are probably more reasons.”

One physician reader, however, commented that doctors should “get over it” and that “this is the 21st century, and patients count also. If my patients want to refer to me by my first name and it makes them comfortable, I am happy to put them at ease.”

“I don’t think things have changed very much since then,” noted Dr Brian McKinstry, a primary care professor in England, who conducted a study on this subject in 1990. Dr McKinstry explained that in his own practice and institution, “many of the doctors use first names with their patients. Some patients do with doctors, but it’s a very definite minority.”

In his article, Dr McKinstry pointed out that some authors have argued that “using the patient’s first name but not the doctor’s maintains this unequal relationship, which can be damaging in the long term.” Taking it a step further, it has also been suggested that this “induced dependency” inhibits patients’ ability to make decisions for themselves and to take responsibility for their health.

Then there are physicians, such as Roger Suss, MD, a lecturer in the department of family medicine at the University of Manitoba in Winnipeg, Canada, who change their views over time as to what they should be called by the patient (or vice versa). When he was fresh to the practice of family medicine, he recalls being a little hesitant as to what he should call himself. Because his name is pronounced like “Dr Seuss,” the famous children’s book author, it seemed almost humorous for him to be introducing himself that way. He then decided upon using his full name—Roger Suss.

The results were interesting. Some would choose Dr Suss, which to him suggested a preference for a “traditional” doctor/patient relationship. Others would use Roger, suggesting a desire for a less hierarchical relationship on a more equal footing. However, he realized that at least to some patients, his reluctance to openly refer to himself as the doctor may have suggested to them that he wasn’t quite ready for the job.

“I’ve come to realize that some people like a more egalitarian relationship with their doctor, and some like a more hierarchical relationship,” he says. “As a young man, I projected my value of egalitarianism onto others.

“I continue to introduce myself as Dr Suss. I view it as a danger sign if my patients want to call me by my first name, but I don’t confront it,” he explains.

As for patients, he generally greets them by their full name when he introduces himself. If they’re significantly older, he calls them by title (Mr, Ms, etc.) but otherwise shifts into using their first name unless there’s a reason not to. On the occasion when there’s tension in the relationship, he’ll switch to using the title.

*Extensively edited by MED BRIEF AFRICA in interests of length. Full article by Roxanne Nelson RN BSN – an update on her December 9 2015 Medscape article – can be accessed via the SOURCE link: