3 May 2016

What do you call your doctors? Jane or Dr Smith?

This article from the BMJ was retweeted by a couple of our neonatal consultants: Is it Jane or Dr Smith?

While I admit to having limited interest in how junior doctors address their consultants (although I was always quite surprised when they referred to them as 'Dr X'), I am more interested in the confident statement that:
Evidence indicates that patients want to call their doctor by their professional title. This has obvious benefits in terms of keeping a professional distance and engendering both trust and confidence.
Sadly, I couldn't find the original article cited in support of this statement, but it certainly piqued my interest.

I can say quite confidently that I personally have no desire to address the medical team by their professional titles. In fact if you are my doctor and you want to be called by your professional title, you'd better address me as 'Ms Roper'. (I note that this doesn't happen.) In general, we fell very quickly into addressing the medical team as Laura, Sam and Tom, not Dr Smith, Dr Jones and Dr Bloggs. And whether we felt trust and confidence in Laura, Sam and Tom depended on whether they were a) honest, b) trustworthy and c) competent, not on what we called them. The better doctors in terms of being honest, trustworthy and competent, in general, seemed to refer to themselves by their first names. I wonder if the need to maintain 'professional distance' is heightened for those doctors who lack confidence in themselves, who are proclaiming by their use of their title: "Trust me, I'm a doctor!" Junior doctors in particular were very prone to introducing themselves by their title, which might back this theory up.

Also, by using titles for themselves but not for patients (or parents of patients), doctors seem to be maintaining not so much professional distance as hierarchy. Hierarchy is perhaps even more heightened by the persistent use of the 'titles' mum&nbsp and dad&nbsp for parents in the NICU. Not only are parents refused the dignity of being addressed by their title while their doctors wish to be addressed in this way; they are even denied the courtesy of using their first names, often being addressed only by the dehumanising 'mum' or 'dad'. They have become generic people of no importance in the system. They are no longer humans with names but people in the role the NICU place them in.

We got quite used to calling doctors by their first names, and only used their surnames when deliberately resorting to excessive formality in order to make a point. I felt this broke down barriers and often placed us in a stronger position. Negotiating with equals is a stronger position to be in than being dictated to by superiors. One very senior doctor (the medical director of PICU, if you want to know quite how senior) once told us: "We decide what to do and then we tell you." This is clearly the medical expectation of how the care of babies in hospital should be managed, but parents need to challenge this and insist on their rightful place as part of the team around the child, and one way to do that is to act in every way as equals. For parents in the position of having their child discriminated against in terms of medical care (ie. most parents of children with trisomy 18) this is even more important.

So what do you call this doctor? Might I suggest starting with 'Jane', not 'Dr Smith'.

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