What's In a Name: What Should Patients and Doctors Call Each Other?

The doctor/patient relationship is highly personal and complex. The physician must maintain a professional rapport and the patient's dignity, respect the person's privacy, and convey an impression of competence.
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"What's in a name? That which we call a rose
By any other name would smell as sweet?
Romeo and Juliet (II, ii, 1-2)

I've never had a good nickname. My Gramps has always been one of my heroes, and he called me "Dicky" until the day he died. I loved my Gramps, but as I grew older, went to medical school and donned my starched white coat, the nickname didn't seem quite right. In high school I was Rich and Richie, but fortunately my wife saw fit to call me Richard and it stuck. I like being called "Doctor," but must admit that I would trade it all in a heartbeat for an interesting, ear-snapping nickname.

Growing up, our family doctor was a longtime friend of the family. When he was young he was part of a club where each member adopted the name of an animal. His brother was "turtle" while he was "fox or foxy." I grew up in Chicago without the "yes sir" and "yes ma'am," formalities of Texas, the state where I practice. As he approaches his 100th birthday, I can still picture him in his crisp white coat or flipping burgers in his backyard, but he will always be "Fox" to me.

The Encounter

I like to wear a carefully-selected necktie and put on my starched white coat with "Dr. Richard C. Senelick, M.D." embroidered neatly over the right breast pocket. Last week I walked into one of my exam rooms to greet a new patient -- a young man in his mid 20s. Here is how the situation played out.

Me: Good Morning Mr. Smith, my name is Dr. Senelick. I understand that Dr. Jones wanted you to see me today.

Mr. Smith: Good Morning, you can call be Bob.

Me: Bob, I will do that. What seems to be the problem?

Mr. Smith: Well, Richard, it all started a month ago...

Wait -- what did he say? Richard?

I immediately knew there was an article I had to write. What are the rules of engagement in the 21st century? I was trying to figure out what made me feel uncomfortable, and whether Bob had an agenda or if he was merely working from the much more informal viewpoint of his generation.

Name Games

I will avoid the entire conversation about who we call a doctor in this country. My brother with a Ph.D. from Harvard tells me that I have the vocational degree as opposed to the true doctorate. To a point, I agree that I may have few transferable skills.

Then there is the commonly used moniker, "doc." I remember a premed undergraduate classmate who everyone called "doc." He was the only one of us who did not get into medical school. Irony, misfortune -- whatever you call it, I don't know who started calling him "doc."

The doctor/patient relationship is highly personal and complex. Patients disrobe and endure being poked and prodded in embarrassing positions and locations. They must feel comfortable relaying their most intimate information to someone who may be more than 30 years their junior. Through all of this, the physician must maintain a professional rapport and the patient's dignity, respect the person's privacy, and convey an impression of competence.

We may see our peers as both friends and equals, and feel comfortable always using their first names. However, at work the boss or supervisor may be referred to by their last name while the employees are called by their first names. It takes us back to childhood days when adults always called children by their first names, but cringed when their son's friend calls them by their first name. Does a physician who wishes to be called "doctor" but calls patients by their first name reflect a similar position of authority or superiority to this adult/child dynamic?

Here is a bit of "armchair sociology" that has no scientific basis. I see no evidence that informality makes a positive contribution to the therapeutic experience. If I call a patient by their first name, it would seem only fair and equal that I offer up my first name. I have always addressed my patients by their last names and titles, particularly in San Antonio, Texas, where military titles are extremely important. Familiarity also seems inappropriate in an environment where the patient does not see the same provider at each visit and has to start from scratch. Long gone are the days of a family physician who cared for three generations of the same family. Since a sizeable portion of patients and physicians may be offended by the use of their first name, it seems best that, unless invited to do so, we stick to formal titles.

Jeans, Shirts and Tennis Shoes

I just can't resist a few words about the young doctor who walks into a patient room in jeans, collarless tight fitting shirt that shows off his hours in the gym, and the latest, electric blue, cross-fit training shoe, socks optional. You can call them Doctor Bob, Ezra, Sally or Maria -- I have seen them all. In the study "Patient and House Office Etiquette on Physician Attire and Etiquette" published in JAMA , 65 percent of patients wanted their doctor to wear a white coat and 52 percent objected to their physician wearing jeans. While this was before the days of $200 designer jeans, I imagine it still holds true.

We cannot ignore the imbalance in the relationship between the physician and the patient, but it is the obligation of the physician not to take advantage of this imbalance. The nature of a physician's or nurse's attire should not be about their personal comfort, but about adjusting to what makes the patient comfortable. There is no doubt that this will vary amongst different cultures and geographical areas, but health care professionals must meet the needs of our most conservative patients. I have never had anyone object to my tie, white coat and a respectful greeting.

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