‘Kind of Awkward’: Doctors Find Themselves on a First-Name Basis

https://www.nytimes.com/2022/10/13/health/doctors-first-names.html

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Dr. Yul Yang, a dermatologist at the Mayo Clinic in Scottsdale, Ariz., addresses all of his patients with an honorific — Mr. or Mrs. or Ms. — even if they ask him to use their first names. It is a sign of respect and a way of distinguishing his professional role as a doctor from a more personal role as a friend or confidant. But many patients do not reciprocate, calling him Yul instead of Dr. Yang.

He finds that “kind of awkward,” he said, though he lets it pass. But Dr. Yang and his colleagues began to wonder: How often do patients call doctors by their first names?

It wasn’t easy to answer this question, but Dr. Yang and his co-authors found a way — by studying tens of thousands of emails that patients sent to doctors at his institution. The results, published last week in the journal JAMA Network Open, appeared to illustrate a few themes about which doctors find themselves on a first-name basis with the people they care for.

Female doctors were more than twice as likely as male doctors to be addressed by their first names, as were doctors of osteopathy when compared with doctors with an M.D. behind their name.

Men were more likely than women to address doctors by their first name. Patients were more likely to address general practitioners by their first names than specialists.

The study found no difference based on age, whether of patient or physician. And the researchers did not examine the race or ethnicity of the patients or doctors.

The results, wrote Dr. Lekshmi Santhosh and Dr. Leah Witt of the University of California, San Francisco, in a commentary that accompanied the study, show “a subtle but important form of unconscious bias” against female physicians, general practitioners and doctors of osteopathy.

“Use of formal titles in medicine and many other professions is a linguistic signal of respect and professionalism,” they added.

Studying this issue, which they refer to as “untitling,” poses a number of challenges. At the Mayo Clinic, at least, “doctors don’t talk about it,” Dr. Yang said. And putting an observer in an exam room would create the medical version of the uncertainty principle: “Once an observer is in there everyone’s behavior will subtly change,” he said.

And there is little research to address the issue head on. A previous study, published in 2000, surveyed doctors and found that three quarters of them said some patients addressed them by their first name. But little else was available in the medical literature, and looking at emails offered a novel approach. The medical center supplied Dr. Yang and his colleagues with a trove of email exchanges, allowing analysis of 29,498 messages from 14,958 patients sent from Oct. 1, 2018, to Sept. 30, 2021.

The changing behavior they saw in the emails differs from even the recent past when it was all but unheard-of to call doctors by their first names, notes Jonathan Moreno, a professor of history and sociology of science at the University of Pennsylvania. He saw it in his own family, he added.

“My father was a psychiatrist with his own sanitarium in Beacon, N.Y., where I grew up,” he said. “Patients, their families, staff, townspeople never addressed him as anything but Dr. or referred to him as ‘the doctor.’ I don’t remember my parents ever referring to his colleagues or their own caregivers as anything but doctor, unless they were close friends.”

Popular culture of the 1960s and ’70s reflected that tradition, Dr. Moreno noted, with medical dramas like “Dr. Kildare,” which involved a young intern — Dr. Kildare — and his mentor, Dr. Gillespie. There also was the popular drama “Marcus Welby, M.D.,” starring a kindly family doctor whose patients always called him Dr. Welby but who called patients by their first names. That television tradition seems to be “one of the few that survived into the 21st century,” Dr. Moreno said.

Doctors may not enjoy the real world’s tilt toward informality. The survey in 2000 showed that 61 percent were annoyed when patients addressed them by their first name.

Their annoyance makes sense, said Debra Roter, an emeritus professor of health, behavior and society at Johns Hopkins’ Bloomberg School of Public Health. Using a first name can violate the boundary between doctor and patient.

“Doctors might find it is undermining their authority,” Dr. Roter said. “There’s a familiarity that first names gives people.”

But, she said, the consequences can be greater when a doctor addresses patients by their first names.

“It could infantilize the patient or establish the paternalism of the doctor,” she said.

Even worse, she said, are other ways some doctors address patients.

“I had an experience with a new doctor,” Dr. Roter said. The doctor entered the exam room where she was waiting and said: “Oh hello dear. Please come up to the table.”

“I was almost like, ‘Do I know you?’” Dr. Roter said. “I never went back.”