This news article laments that doctors don’t get enough respect:
‘Kind of Awkward’: Doctors Find Themselves on a First-Name Basis . . . Female doctors were more than twice as likely as male doctors to be addressed by their first names . . . Patients were more likely to address general practitioners by their first names than specialists. . . . “Use of formal titles in medicine and many other professions is a linguistic signal of respect and professionalism” . . . Studying this issue, which they refer to as “untitling,” poses a number of challenges . . . 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 . . .
The article, by science reporter Gina Kolata, continues:
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.
OK, so that’s one take. Here’s another perspective, from Martha Smith commenting recently on our blog:
Self-policing in medicine is one that particularly irks me — I’ve had too many experiences with physicians who do ridiculous things — things like prescribing a medication for ulcers, when the problem is a pulled rectus abdominis; or trying to remove a growth in the nose by freezing it off with liquid nitrogen.
I have mixed feelings on all this. On one hand, I call my doctor Doctor So-and-so, not using his first name, and as student I called all my teachers Mister and Missus and Professor. On the other hand, I much prefer when students call me Andy or Andrew or even Mister rather than Professor, and I agree with Martha that doctors get too much deference in our society and it is.
What bugged me about the above-linked news article is that it just seemed to accept the idea of deference to doctors as a matter of course, without presenting any countervailing arguments or even a quotation from someone on the other side to make the point that calling doctors by formal titles is a distancing that can reinforce the idea that doctors are infallible. Or even the more basic issue that this sort of deference contradicts the democratic ideal of American society. Much of the article discusses discrepancies between how men and women are treated. Maybe the right way to solve this is not to be giving more deference to female doctors but rather by treating the male doctors more like everyday people.
I believe the gender difference is real – no doubt it calls for empirical verification and there are likely to be various bad studies conducted, but I strongly suspect that informality is more common with female physicians and academics than with male ones. I’d also suggest that this reveals a sort of unconscious bias or latent discrimination along the lines that we have heard about regarding various “tests” for implicit bias. But what is missing from both the implicit bias and any new findings of differential informality of physicians (by gender) is evidence that this implicit/latent differential treatment translates into actual meaningful discrimination. In other words, is the tendency to more often use a female doctor’s first name translate into less willingness to be treated by them or lower “grades” given to female physicians? That I’m not at all sure about.
As with Andrew, I’ve always preferred students to call me by my first name, although many students are uncomfortable with this and use “professor” or “doctor.” This is particularly true with my European students. I don’t make an issue of it – I let them call me whatever they want, although when I communicate via email, I always sign my messages with my first name only. Similarly, when I communicate with academics that I don’t know, I use my complete name and address them as Dr. or Prof. in my first message. They usually respond addressing me by my first name, and I then do the same. This is the sort of informal dance we engage in that signals mutual respect. I think the usual practice is for the initiating party to defer to the recipient to steer the correspondence towards more or less informality.
So, (how) does this relate to the issue of whether the formality imparts too much deference to authority for doctors or academics? I think the use of the titles does reveal a bias towards inferring authority of doctors/academics. Though this is often misplaced, I think the opposite might disturb me more. Even though I prefer my students to use my first name, their initial use of Dr. or Prof. is a sort of recognition of my training and experience. I think I need to then earn their continued respect, but it doesn’t bother me that they grant me some limited authority to begin with. And, I can say that when I’ve been an expert witness and been cross examined by lawyers who refer to me as Mr. rather than Dr., it doesn’t feel innocent and it does bother me.
I rambled a bit here – but to return to the point (as I see it) of the post: I believe differential use of titles by gender (or any other characteristic) does reveal an implicit difference in treatment – but I’d like to see evidence that this translates into real meaningful impacts. I’ve been similarly bothered by the research that reveals extensive latent discrimination (such as the Implicit Association Test, https://edib.harvard.edu/implicit-association-test-iat) which doesn’t quite convince me that these implicit associations translate into meaningful differences in behavior.
Dr Lehman-
Your points are well taken. Totally anecdotal discussion to follow. I live in an area with a lot of Trump Redness. A lot of my patients have substantial prejudice against African Americans and Arabs as well as (among males) a certain paternalism toward women. My impression is that these particular patients have enthusiastically supported those physicians at least after following their recommendations and getting a good result. Gut sense is that these patients follow the advice of those physicians and respect it. I doubt the first name thing translates into different outcomes but suspect more studies will come out to support the premise—likely with crap data and analysis—because that’s what happens.
Interesting. I would disagree with both you and Dr. Covello that I would completely expect that these implicit biases definitely translate into meaningful difference in behavior.
I’ve have numerous patients who would refer to other physicians (colleagues) and staff as “that fill-in-the-blank-ethnic woman” and yet have never heard a patient refer to my male colleagues in the same way. I’ve also had patients state that they trust me (as a male) more than some of my female (or under-represented in medicine) colleagues of the same subspecialty when they wanted a second opinion, but never heard the same about a male colleague. I know that I’m not professionally more knowledgeable than my colleagues and I’m sure that my personality and bed-side manner don’t explain it all.
However, I too don’t expect that this will show up easily in any particular study looking at medical outcomes (especially in my field of medicine where it takes years to decades for patients’ disease to progress.)
But I do expect that these implicit biases serve to discourage some people to stay in medicine (I’ve had residents and faculty in addition to nurses and staff tell me as much). That could be studied. I wish that the Mayo study had asked the 1000 providers about their preference for informality and the use of their first name.
I think you are committing a logical fallacy. You observe many unfounded differential treatments of groups A and B, and it is likely that there is also an implicit bias between the two groups, and then conclude that the biases translate into meaningful differences in behavior. So: differential treatment implies bias. But that doesn’t mean that implicit bias implies differential treatment.
I took the Implicit Association Test for the 2nd time, and it once again shows that I have a strong implicit bias in favor of whites compared with African Americans. I don’t deny that – indeed, the value of such tests is to alert me to a strong subconscious motivation, one that I actively try to balance through mental effort. Do I engage in active discrimination? It is, of course, possible, but I don’t believe I do (and I am aware of the potential and actively look for it). I think it is likely that most humans have implicit associations (biases) in several dimensions, especially those involving race, gender, physical appearance, etc. Does that mean that most people engage in meaningful discriminatory treatment? And, can we quantify what “most” means? Those are the questions I remain unconvinced about.
> But what is missing from both the implicit bias and any new findings of differential informality of physicians (by gender) is evidence that this implicit/latent differential treatment translates into actual meaningful discrimination.
I get what you mean that it would be interesting and useful to learn about the downstream effects of differential informality but would also like to note that I would guess many (but not necessarily most) physicians view the differential informality as itself meaningful discrimination.
As a personal anecdote, for some reason I’m totally fine with physicians being called “Dr.” but don’t like doing so for professors. I think it’s because I’ve always known that MDs were referred to as “Dr.” but only learned that people call PhDs that later in life.
Too much handwringing about such a thing. I’m a surgeon. I walk into a room and say, “Hi I’m Len Covello,” and patients call me whatever they want. I practice in Indiana which, I found 20 years ago on moving here from the DC area, is much more socially deferential to physicians and formal in address. In my environment, most patients use my title. The ones who reflexively call me “Len” are usually middle aged guys in sales, or something similar. That’s just them.
Either form of address is fine, in my view. Who cares?How people address their physicians actually says more about them than you. We all treat people we like and people we don’t: most of us have no “great person” filter at the door. Any physician miffed at being called by first name is worrying about insignificant bullshit. As for what the familiarity vs deference implications are in the address: certainly present.
I’m probably undervaluing the offense that might be felt by historically denigrated members of the profession—minorities and women. But I do feel that such dynamics are present regardless, and familiar to those who experience them frequently. Those physicians make their recommendations through prejudice all the time and then move on to the next person. If the patient undervalues an opinion due to prejudice: his/her loss.
My patients do not actually *know* me. They really do not know how smart or dumb my opinions are. If you do not know me, you really cannot insult who I am. (That job is left for family and friends!)
To paraphrase Marcus Aurelius: That someone has insulted you is your opinion. Remove the opinion and the insult is removed. That the insult harmed you is also an opinion. Remove the opinion and the harm is removed. /finis
Admittedly, my knowledge is perhaps a few decades out of date. I was a postdoc in the Netherlands for a couple of years in the 1960s and immediately followed up with a postdoc appointment in Norway. Back then, the Dutch system required that addressing the professor required the word, “Professor,” and a visible necktie was mandatory under the jacket. In Norway, being more egalitarian, clothing was more geared to the climate. There was a loudspeaker system for the large institute and “professor” was never used–only the last name. But, having just come from the Netherlands, I was uncomfortable at this breach of the etiquette I had just been exposed to in the Netherlands. In Norway, unlike in the Netherlands, the informal “you” was immediate with the big jump being the use of the first name.
My assumption is that things have changed completely since then–certainly no loudspeakers in this age of smartphone technology–but perhaps, from an American point of view, there is still undue deference to authority in the academic world of Europe.
As to the medical world in the United States, Andrew’s advice
“treating the male doctors more like everyday people”
is out of the question and at my age, humility is the order of the day. Here are some tips on how to be humble
https://www.wikihow.com/Be-Humble
The important person in the doctor-patient relationship is the patient. The important person in the doctor-patient relationship is the patient. When you’re a young medical student, you thank the patient after an exam. As you acquire knowledge and more importantly develop the skills to be a physician, they begin to thank you. We should be humbled by the respect and deference that people give us. In my field at the end of the day, I went home to a nice supper while my patients went home with veins full of doxorubicin.
My patients were often reluctant to say my name because it is full of phonemes that don’t come naturally to anglophones. When they mispronounced it, I would tell them that they did better than my mother-in-law.
I have seen female physicians receive less respectful responses than I did. Asian physicians do get asked about their origins which can be annoying especially to people who trace their ancestry to Canton who have been in the US for five generations due to severely restrictive immigration laws.
I call my primary care doctor “Doctor” because I want to emphasize that I am in her office as a patient. She is comfortable with the use of her first name.
It’s funny that someone who completes medical studies automatically receives a doctoral degree. Not the least bit of scientific research necessary?
Physicians aren’t scientists.
At best they use science, but they’re not trained at doing science.
What I found is
“Doctor comes from the Latin word for “teacher” and originally referred to a small group of theologians who had approval from the Church to speak on religious matters. Eventually the term saw greater use referring to qualified academic and medical professionals.”
Scientific research doesn’t appear to be essential. For the record, I’d far prefer my physician to stick a needle in my arm (or even listen to my heart) than my average (or even above average) PhD in physics (or Economics, or Statistics, or….).
There is definitely a lot of unconscious bias and social slights that are commonplace in medicine (as in all fields). I’ve seen patients (and others in medicine) more commonly refer to residents and fellows, women, and minorities more informally. Mayo, while they get referrals from all over, is located in a mostly rural, conservative area, so that probably affects what they see (the regression didn’t account for the patient’s region).
That being said, I prefer people who don’t know me well to call me Dr. Brown in a professional setting and Mr. Brown when I’m a customer. Calling me by my first name presumes some sort of familiarity with me as a person that isn’t present in most encounters.
From a stats standpoint, they did the (ill advised?) process of running a univariate analysis and then dropping some predictors before doing a multivariate regression. Seems kind of stupid when there were messages from nearly 15000 patients. Also, they treated patient age (ranging from 0 to 104) as a linear effect which seems suboptimal. With that many observations, it should have been possible to look at patient-physician age differences (were pts older than their doc more or less informal than pts younger than their doc) and gender interactions (were male patients more likely to refer to female docs by first name?)
When writing to academics I don’t know I’ll address them as “Professor”. If the reply by first name, I’ll reciprocate.
I have always called my physician, surgeon, dentist, optometrist, etc. “Doctor” even though they almost always call me by my first name. Professionally I was “Mr. O’Connor” (I was a HS teacher) but as a patient I was merely “Mark.” I don’t have an issue with informality but I think it should go both ways. Either we both use first names or we stick with “Dr.” and “Mr.” or whatever. When I was teaching I always called my colleagues “Mr.” or “Mrs./Ms.” when I was around students and only used their familiar names when we were off-duty. I thought it was a show of courtesy and collegial respect, not to mention a reminder to the students that we were their teachers and not their pals. When I worked in an “alternative” setting (continuation school) the students did not like to use titles and merely referred to us by our last names!
I’ve been told that I’m an “interesting patient,” and as such have seen many doctors. While I always call my doctors “Dr. so-and-so,” it’s notable that they almost always use my first name when writing about me in their notes. I rarely see myself referred to “Mr.,” and only one doctor has ever referred to me as “Dr.” — though most doctors ask me what I do for a living and usually find out that I have a PhD.
I personally don’t mind their using my first name and it’s possible that all these doctors wouldn’t mind if I used theirs. But if doctors insist on being called by their title, they should extend their patients the same courtesy.
I always felt as a teacher, that trying to ensure “respect” from students by requiring them to use formal address was a kind of crutch.
I find it more challenging and more rewarding to earn respect through more sophisticated and more enriched pathways. Imo, “respect” of the sort founded on formal address is pretty fragile. I don’t think that a robust respect is something you get because you’ve demanded or enforced it.
In my experience, there are plenty of teachers who required formal address who weren’t at all respected by students. That isn’t to say that for many students, using a formal address isn’t for them, a sign of respect. In such situations, it can be very confusing for students to use a less formal form of address. Sometimes challenging them in that regard can be growthfull, but sometimes counterproductive.
In the end, it’s a social custom and should be seen as part of Socio-pragmatics. It’s similar to the custom whereby in some cultures students won’t feel comfortable walking out of the classroom until after the teacher has done so first.