It’s like an unwritten rule of some sort. Don’t reference an attending by his or her first name and certainly not without the last name in conjunction. By the time you walk across the stage and receive your abbreviated white coat, this is practically ingrained in you. Allopathic physicians, osteopathic physicians, doctors of dental surgery and doctors of philosophy alike are forever dubbed with the preceding designation of Doctor. The last name follows the title to complete the professional identification, labeling these scholastic men and women exclusively by their employment to the public at large. Interestingly enough, many professionals are known only by their first names or nicknames prior to receiving their doctorate degree. Addressing one by their surname shows respect in the appropriate context yet it also depersonalizes. It strips away the subjective foundation of organic individuality. The product is a subspecies of experts are lumped into one category and to a certain extent, perceived merely as “doctors” rather than as caregivers or friends.
Listen here look there,
Listen and look everywhere,
Tap and press you must.
Miracle healer,
Document everything and
Save all those in need.
This haiku, or a version similar to it, could serve as the mantra of these subgroup of professionals. Accountability so grand requires active minds and active bodies. Inactivity leads to diminished skills, and diminished skills leads to medical errors, malpractice suits and eventual burnout. This is what history has taught us and despite the subsequent reduction in work hours, doctors are expected to be just as engrossed in the profession as ever. With the amount of responsibility each clinician bears, it’s a surprise that names haven’t been entirely reduced to medical suffixes as is often depicted on modern day medical dramas.
As young children growing up, we all called each other by first name. So did our parents, relatives, teachers and anyone else we ran into that wanted a way to identify who we were. As adults, attending physicians are still called by their first names around the same group of people from childhood. However, patients and most of the clinical staff may not even know the physician’s first name. When transitioning from a senior resident to a faculty physician, some event occurs where that beloved first name is molted. After the right of passage is completed, the rookie doctor becomes a veteran doctor; free of restrictions, supervision and a first name.
Despite being submersed in the health care arena, tenured physicians in all disciplines must not lose track of their internal selves. Names were established to distinguish one person from another in a large crowd, but more importantly, names symbolize something deeper. There’s a certain intimacy attached to having a conversation with someone and addressing them by their name occasionally throughout. They might feel a sense of rapport from the act. That feeling can be better integrated into today’s health care environment and highlights that in some aspects, we have been a close-knit group by force rather than choice.
The interaction with a house officer and an attending physician is noticeably distinct in initial salutations. A resident, irrespective of the postgraduate year, typically introduces himself or herself by forename while an attending naturally defers to surname. Perhaps this works into the hierarchical denomination that is embedded in medicine, or simply reflective of how longevity and seniority shape a person of authority. Regardless of the reasoning, this dichotomy seems to persist throughout the various specialties in medicine.
However, professional labels cannot be completely expunged from our contemporary vernacular. Not to mention, it is commonplace to walk onto any hospital floor and witness multiple employees, all outfitted with long white coats, working on the same patient. In such a setting, it is important to identify whom the leaders or persons of highest rank are. This identification is especially necessary when difficult questions or situations require answers or solutions. As such, in these situations, the labels become a necessity.
Most individuals come to see the doctor to be healed and not to have bubbly conversations about life. Any small talk is an added bonus. Yet, meeting with Mary instead of the doctor might aid in emotional healing. Certain populations might benefit more from this type of care, such as patients struggling with a limited support system, depressed, anxious or doubtful of their prognosis. However, the impact of adopting this softer tone should not be limited to these patients alone.
There have only been a handful of times that I’ve actually heard a physician introduce their first name to a patient. In particular, one scenario involved myself working with an emergency medicine team during the weekend of a busy motorcycle rally. Unfortunately, this evening, one gentleman was rear-ended by an SUV and ejected several yards from his motorbike traveling 60 miles per hour. He presented with a litany of upper and lower extremity fractures and extensive blood loss. The trauma surgeon on call spoke to the middle-aged man lying on the gurney: “Hello sir, my name is Mary and I’m here to get you fixed up.” The response on the man’s face was as if an angel spoke to him. It was a remarkable reaction. The highly esteemed figure morphed into Mary, the reliable next-door neighbor that cooks a green bean casserole to die for.
By my admission, it’s more affable to know that Mary, who happens to be a trauma surgeon, will be cutting into my abdomen today even if I am not on a first name basis with her throughout my hospital stay. To the patient, this can lend a sense of companionship and trust in the treatment staff and facility as a whole. Few people like to visit the doctor, so for the many who do not, it is important to make their experience a more comfortable one.
The introductory greeting paints the image of a physician’s desire to heal.
Contributing Writer
University of Texas Medical Branch in Galveston
Chiemeziem is a third-year medical student at the University of Texas Medical Branch in Galveston and a graduate of the University of Texas at Arlington. He is interested in gastroenterology and working with its high-risk patient population. He wishes to share his evolving opinion of medical culture, stemming from past perception in contrast to present experience.