The other day, a nurse asked a patient, “What would you like to be called: Ed, Eddie, or Edward?” Although it may seem minor compared to other issues I dealt with this week, it is something I have reflected on frequently over the years.
This photograph, dated 1968, features Capt. Lois Brown, US Army (Retired). At least, I believe she held the rank of captain; she may have been a lieutenant. Regardless, she was a retired military officer and served as my first hands-on nursing instructor in 1971. She introduced herself to us as Miss Brown, and that is how we addressed her. I recall within the initial weeks of instruction she emphasized the appropriate way to address patients. It was not “Honey,” “Dear,” “Eddie,” or even “Edward.” Similarly, as nursing students or nurses, we were not to use our first names—Ken or June—but rather the formal title, such as Mr. McCormick or the gender-appropriate title of the era. Throughout nursing school, I was Mr. McCormick to patients.
When I started nursing practice in 1977, I carried on as Mr. McCormick. Later, when I became a nursing supervisor at a younger age, providing supervision to nurses who were sometimes much older than I, I continued to identify myself as Mr. McCormick. Perhaps I thought I needed to do that to “assert rank.” Likewise, through medical school, and when I started my medical practice, when I introduced myself to patients, I was Dr. McCormick; to nurses, I was Dr. McCormick; and to anyone else, I was Dr. McCormick. At this point, it was no longer a matter of asserting rank. It was a matter of the proper way for a healthcare professional to address a patient. First names, I was taught, are not appropriate. Maybe it was alright for persons much younger than I, not old enough to vote, but for anyone else, no first names. When patients wanted to call me by my first name, I did not correct them, but I resisted calling them by their first names, even by invitation.
When I started working in the organization I am with now, it was a little difficult. Local practice was for staff, nurses, and others to refer to physicians as Dr. First-name-goes-here. That was something I wasn’t used to, and my habit of introducing myself as Dr. McCormick was something that the people around the organization weren’t used to. But I have stuck to it. Should I have? I imagine that some people see it as a persistent practice of “asserting rank.” Is it? I did a quick Internet search and looked at some peer-reviewed and non-peer-reviewed writings on the subject.
- A column published in the New York Times in 2009 discussed the subject and invited readers to comment. I looked at just the first 10 comments on this article and found the responses mixed. Only one person was definitely against formal titles. Four of the commenters seem to have mixed feelings and were flexible. Five of the commenters seem to lean pretty solidly toward formal approaches. I found the last comment that I read the most informative and pertinent to my comments above about asserting rank. This writer’s opinion seemed to be that either way of address, formal or informal, was all right as long as the forms of address were reciprocal. That is, if the doctor was Dr. then the patient was Mr. or Mrs. That way, no power differential is asserted. (Parker-Pope T. For Doctors and Patients, Formal Titles or First Names? New York Times. December 14, 2009. https//:archive.nytimes.com/well.blogs.nytimes.com/2009/12/14/for-doctors-and-patients-formal-titles-or-first-names/ accessed April 8, 2025.)
- A study published in the British Medical Journal (BMJ) in 2016 (done in Australia) found that patients preferred a more informal approach, but that may not be pertinent to my location in the US. (Parsons SR, Hughes AJ, Friedman ND. Please don’t call me Mister: patient preferences of how they are addressed and their knowledge of their treating medical team in an Australian hospital. BMJ Open 2016;6:e008473. doi: 10.1136/bmjopen-2015-008473 accessed April 8, 2025)
- A short letter published in the BMJ in 2005 reached the following conclusion: “Overall the results show that the majority of people do have an opinion regarding how they are addressed by doctors, and of those that have an opinion, the majority would prefer to be addressed by their first name.” (BMJ 2005;331:1091 accessed April 8, 2025)
- In an article published in the Journal of the American Board of Family Practice, the authors concluded: ” These data indicate that one cannot predict reliably how a new patient will prefer to be addressed but that the great majority of established patients will want to be called by their first names. (Gilette, RD, Filak A, Thorne C. First name or last name: which do patients prefer? JABFM. 1992;5(5):517-522. DOI: https://doi.org/10.3122/jabfm.5.5.517 accessed April 8, 2025)
For now, I am going to continue with the way I was socialized, fairly hard-core formal. I will consider relaxing when specifically invited to do so, but it won’t come easily.
Photo credit: “Nursing Demonstration,” Kent State University Libraries. Special Collections and Archives, accessed April 8, 2025, http://omeka.library.kent.edu/special-collections/items/show/190.