Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Saturday, January 12, 2008

Name Calling

Cranky Prof has a mini-rant at the end of her latest post, about being called "Mama" by people other than her own spawn, but when she moved on to her annoyance at her given name being used by health care professionals, I realized something about my own practice.

I always tried to be good. I remembered what I was taught as a med student about treating patients respectfully by not using their first names until invited to do so. All through residency I was good, never using patients first names until invited to do so. I did notice that relatively few older patients seemed overly upset when nurses and aides and other little chippies running around the hospital used their first names without permission; almost like it wasn't worth the effort to take offense, although they certainly had every right.

When I began my practice, I was good. My default address form to my patients was Mr./Ms. Lastname. I would then introduce myself by my first and last name, without the "Doctor;" I figured it was assumed, although sometimes I would add, "I'm the doctor."

As a young whippersnapper, it worked just fine. I was nice and polite, and none of my patients had reason to be cranky about me, at least not about any promiscuous use of their first names.

What about children, though? It would have been terribly stilted to call for "Miss Droolmeister" when she was there for her four month checkup. So of course I always called kids by their first names. And teens. Not their parents, of course, but with younger patients it felt perfectly appropriate.

Then from time to time, I found myself uncomfortable calling people Mr. Smith or Ms. Jones. Can you guess who? Yep; people much younger than I. College kids. Folks in their twenties (once I was well into my thirties.) I finally realized that it was ok to use first names with people younger than I, both because younger generations tend to be less formal, and because etiquette has always allowed it. Given that I always know how old patients are before I face them (name and date of birth are at the top of every page of the chart, even if I don't sneak a peek at their registration form, which I usually do) it's easy enough. Here's how the greetings break down (not that I consciously decided to do this; I do what feels right, and am only now codifying it):
  • More than 20 years younger than I (ie, young enough to be my kid): "Hi, John; I'm Dr. Dino."
  • Less than 20 years younger than me: "Hi, Jane; I'm NumberOne Dino."
  • Older than me: "Hi, Mr. Dinkleheimer; I'm NumberOne Dino."
  • Usually patients up to about 10 years older than me will say, "Please call me Shlomo."
Finally, I realized that the pool of people who fell into the category of "younger than I" was getting bigger and bigger every year. Talk about a "duh" moment; as I get older, more people are younger than I.

I also notice is that things bother me less and less as I get older, like being called by my first name by some young chippie in the dentist's office. No offense intended to CrankyProf and others who get all bent out of shape at the indignity of inappropriate familiarity, but I find it just doesn't bother me nearly as much as it used to. I must be getting old.


At Sat Jan 12, 10:41:00 PM, Blogger Rossweisse said...

I only take offense at being called by my first name when person doing so insists I refer to him/her by title and surname - e.g., "Hello, Rossweisse, I am Dr Wallach." GRRRR! I assume, at that point, we are on first name basis and proceed accordingly. If s/he is going to be informal, we are both going to be informal. It's just that simple.

At Sun Jan 13, 03:24:00 AM, Blogger Sara said...

I suspect this is always a much bigger issue for women than men. I've had plenty of female doctors introduce themselves as Firstname Lastname, as I would probably do, because it feels weird and pretentious to me to introduce myself as Dr. Lastname (at least to patients). But then, as a woman, they aren't sure you are the doctor, even if the last name is the last name of the doctor they were expecting.

I always thought there was sort of a gender issue in there. I've never had nor seen a male doctor introduce himself as anything other than Dr. Lastname.

At Sun Jan 13, 07:44:00 AM, Blogger #1 Dinosaur said...

MSILF: Here's why you're right: in essence, it's a power issue. Men seem to be more interested in/concerned with keeping the upper hand whenever possible. Women seem to recognize when that interferes with the task at hand; ie, we've learned to choose our battles. As the physician (or parent; I use that phrase a lot when I discuss parenting) I have the power; I don't have to keep making patients aware of it.

At Sun Jan 13, 12:23:00 PM, Blogger Lynn Price said...

Maybe I'm just cranky, but I find it rude to have the young chippie call me Lynn. It's like my kids' friends calling me Lynn - it's presumptuous. If I want to be called Lynn, I'll tell you. But if you don't know me, and you're in a professional setting like a doc or dentist office, have a modicum of respect.

As for docs, I've been going to mine for so long that it would flat out weird for them to call me anything other than by my first name.

And, Dino, even though you're horribly misguided about CAM, you're always good. :->

At Sun Jan 13, 07:30:00 PM, Blogger Amanda Young said...

Dear Mr. Dino, I am a very young nurse (27, but started nursing at 21) and am currently nursing in the deep south, TN. I have also nursed in Tampa, now here is the intresting Tampa Mr./ Mrs. 'last name' was the only way to go. Here in TN my older pts love, LOVE to be called Mamaw/ Papaw or Granny esp if I have grown to have a good relationship with these pts and see them offten. I always start off by the restectable Mrs. Smith but am told "oh, don't call me that, it makes me feel old!'

It's funny to me that Mr/Mrs makes them feel old but Granny does not :)

At Sun Jan 13, 08:51:00 PM, Anonymous Anonymous said...

Hrm. I never worried that the doctor was calling me by my first name, because I was always younger than the doctor, until recently.

In my church community, the children always call the adults "Sister Smith" or "Brother Garcia". This is where I usually interacted with kids until mine were in school and I started volunteering a lot. So "Mrs. Chopine" just sounded really wierd to me for a long time.

At Sun Jan 13, 11:06:00 PM, Anonymous Anonymous said...

I've never had a problem with anyone calling me by just my first name. It justs gets annoying because it's not pronounced the way it's spelled, so I'm constantly correcting people and sometimes feel like a nag since they're just pronouncing it the way you'd think it's pronounced.

Anyway, when I first went to the family practice I'm currently at, they had you fill out the forms, and one question was, How would you like the staff to address you? e.g. John, Johnny, Mr. Doe, Reverend Doe, etc. For names that may be mispronounced, please show us here, to the best of your ability, the proper pronunciation.

Now I see that on top of the file it says Doe, Jane ("Janie" JAY-nee)

I was told by one staffer that a bigger problem comes with people over 18 living with their parents, and both have the same name. When you mail something, if you don't know whether to put Jr. or III, then you're sort of screwed, since the younger one may be Jr. if the father is Sr., but the father might also be Jr. while the son III! So you might end up with the son getting a letter intended for the father. Or if the son isn't a patient at that practice, and you don't know there's a suffix associated, then you risk someone seeing information that he's not privy to. It's also a nightmare in terms of confusing insurance paperwork.

I've always just called the doctors Dr. _ and they've never introduced themselves by first name. It's usually "I'm Dr. Jane Doe" or "I'm Dr. Doe." It's harder with the nurses. Do I call them Nurse Doe or Jane or Ms. Doe? I'd like to call them "Nurse Doe" because it professionalizes the occupation (just like I think the US should adopt the practice of other countries in which "Teacher" is a professional title) but don't know if that's a commonly accepted custom. Also, if you have a doctor with a really long hard to pronounce name, is it rude to call him "Dr. D" if you'd totally butcher his name, even if he doeesn't say, I'm Dr. Dostoyevsky. You can call me Dr. D.?

One more thing to think about. Since you're a solo practice doc, you wouldn't run into this situation. But in a multi-practice doc, if everyone followed your rule, then you'd have some patients who are called Mrs. Doe by some doctors and Jane by others! That's why I think the question that my practice uses (how would you like to be addressed) is a wise idea.

At Mon Jan 14, 03:22:00 AM, Blogger MLO said...

Mabye I'm a premature old-fogie, but a doctor should not be calling a patient by their first name unless they are:

-- Invited to do so,
-- Have known the patient outside of professional stuff, and the patient calls them by the first name,
-- trying to get someone out of being unconscious.

I realize this might sound weird from a GenXer but, really, I really perceive it as a power play be a physician when he/she calls me by my first name without letting me call them by their first name. (I also dislike the idea of calling nurses by their first name. They should be Miss or Ms. or Mrs. - but I think I 'm weird on this issue.)

At Mon Jan 14, 01:27:00 PM, Blogger GeorgeH said...

I think a lot of it is how far South you grew up and where you practice.

At Mon Jan 14, 03:31:00 PM, Anonymous Anonymous said...

This post made me think back on the (relatively few) encounters I've had with my current doctor, and I don't think he's used my name at all.

Overall, I prefer first names; calling me by a title would make me feel old and would probably make me look over my shoulder for my mother. But no name at all? Does this mean he doesn't like me? :(

I would *never* call a doctor by his/her first name. I just wouldn't. It would seem too familiar. I would rather the professional line not be crossed.

I once had a specialist who looked to be the same age as me, and he asked me, "Is it all right if I call you (First Name)?" It seemed really weird to be asked that by someone of my own generation.

What I do *not* want people calling me is "young lady." When my 70-something mother was recently hospitalized, the staff kept calling her this, and it made the whole family super-annoyed. I mean, someone in their 70s obviously is not young... so why say it? It just seemed paternalistic.

At Tue Jan 15, 01:39:00 PM, Anonymous Anonymous said...

For some reason, all this reminded me of when I first met you. I came with my wife ~17 years ago. We all introduced ourselves, and you said (looking at my wife, "You must be the patient" and to me: "You're here to make sure I don't have horns." If you consider the converssation thread as being "respect in introductions ", it's not that big of a nonsequiter.

Obviously,that initial encounter ended our search for a family doctor.

At Thu Jan 17, 09:15:00 AM, Blogger This is Sixty said...

I don't call doctors by their first name, but don't attach a bunch of meaning to it. It's just a custom I grew up with - I don't feel the doctor has more power than me or I am in a weaker position. It's just like calling a sandwich a sandwhich. It is what it is. Even though the doctor has the power to see me naked, I have the power to put my clothes on and walk out of the room. Let's not turn ourselves into victims.

As a nursing student our instructors have pounded into our heads not to call patients pet names like "sweetie" or "honey". As a dialysis nurse my patients LOVE IT when we call them sweetie-honey-baby. I alwasy start out by calling them "Mr. Soandso", but as we get to know each other, and in dialysis we become quite familiar, the pet names slip out easily.

So for the nine-tenths of one percent of patients who are offended by it, I think I will defer to the 99.9% who appreciate it.

At Fri Jan 18, 11:37:00 PM, Blogger denverdoc said...

I always call my patients from the waiting room (Jane Doe?) and then introduce myself by first and last name. I generally have my stethoscope 'round my neck to 1) identify me as doctor, 2) so I know where it is when I need it. I prefer being called by my first name, although I am partial to the appellation 'Doc,' and I generally use first names unless the name is archaic--Edith, Harold, Burton, etc.--suggesting the owner hails from the 'greatest generation' and is thus old enough to be my parent.

You certainly have a knack for hitting issues. I'm still mulling over your call for internists to get out of the primary care business. Trying to unruffle my feathers and thinking of a rejoinder. Realizing my practice is more like a family one, sans pregnant women and small children--than an internists, and glad that it is. You may, in fact, be right.

At Mon Jan 21, 07:24:00 PM, Anonymous Anonymous said...

I have to admit I'm one of those patients that does not like being called "sweetie" or "honey"! Even when I had a doctor I visited four times a week, I didn't like it at all when he called me "sweetie." Especially since I addressed him as "Dr. X." I think those terms of endearment should be reserved for spouses, couples, close friends, and family.


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