Friday, August 04, 2006

What's in a Name?



Second day in a row that I'm stealing ideas from Dr. Crippen over at NHS blog. I hope he doesn't mind.


Today, in Making Friends with the Doctor, Dr. Crippen writes about his preference for addressing patients by their last names (surnames) and he comments about physicians who address their patients by their first names:

I think it is presumptuous and impertinent. It is done to give the feeling of a deep and meaningful personal relationship with the patient. It is bogus.

It's okay if I say that Dr. Crippen has a way with words?

He goes on to take a survey of his readers, asking their opinions. Actually, Blog polls seem to be the thing to do these days, Dr. A has his readers dressing him and telling him how to deal with his comments.

So back to the question of what should a doctor call a patient. In psychiatry, where relationships are so intimate and boundaries are so essential, this stuff has meaning.

To start with, I'm a fairly formal person. Well, sometimes, but definitely at work. It feels strange enough in blog-o-land to address physicians I've never met as "Foofoo" and especially "Fat Doctor." Even "Shiny Happy Person" is a bit of a stretch for me, but okay, it's a blog, it's what you want to be called and I'm not your psychiatrist. At work, with very few exceptions I introduce myself to patients as Dr. Shrinkrap (no, not really, but you get the picture) and I call folks by their last names. So, it's taken me this long to say that my blog post today is not about what I call my patients.

My blog post, instead, is about what my patients call me. Psychiatry, being a bit more intimate, and being in many ways similar to friendship, inspires patient to want to be my friend (even ClinkShrink wants to be my friend). As such, some people, even people much younger than I, will not infrequently address me by my first name, sometimes over the phone before they've met me, and sometimes after a few sessions. I have to tell you, it doesn't sit right. To quote Dr. Crippen, it feels presumptuous and impertinent. And I feel like I should confront this, but the truth is it remains a bit uncomfortable for me. Mostly, I've opted out. It's usually a thing that comes up on the phone where people are most apt to use names, and what I've done so far is to simply ignore it, and to return phone calls with "Hello, Mr. X, this is Dr. Shrinkrap, I'm returning your call." I'd say that mostly works, except that it ALWAYS works. People get the message, and probably I'm missing some great psychotherapeutic opportunity to discuss boundaries and presumption and all sorts of other things, but it feels just so stiff to ask someone why they think it's okay to call their doctor by their first name, and often I imagine it's about wanting a friendship and maybe that doesn't always need to be dissected. My favorite, by the way, were the series of calls I received from a patient's physician spouse where the messages were left for me as "Dinah, this is Dr. Smith and I want to speak with you about my husband." If Dr. Smith were say 85 maybe it would feel okay, but let's just say she's not that old.

I lied. I am going to talk a little about what I call patients. Because I want to be called Dr. Shrinkrap, and I don't like what Dr. Crippen refers to as an adult-child gradient ....or what I would call an imbalance of power and respect...I'm most comfortable calling patients by their last names. People often ask that I address them by their first names, and this feels very awkward to me, especially if the patient is my age or older. For a while, I dealt with this by simply not using the patient's name. This actually isn't as difficult as it might sound, there's not a whole lot of need for names in a one-on-one psychotherapy session where no one else is in the room. When it comes up though, it does remain awkward: on the one hand it feels disrespectful to address an adult patient by a first name, on the other hand it feels disrespectful to ignore a patient's request to be addressed in a specific way. I have, after many years and probably way too much thought, figured it out only recently. When a patient asks that I use their first name, I now say, "Psychotherapy is very intimate work and because of that it's important to have some boundaries. Using last names is one type of boundary. Having said that, it's your name and I'll call you anything you'd like."

And so, Dr. Crippen, what are we writing about tomorrow?

33 comments:

Dreaming Mage said...

I have to say that I won't see a Dr. who won't allow me to call him/her by their first name. Why?

I'm not sure but I can think of two reasons. One is that we have an intimate relation. Either you are groping my mind or you are groping my body. Either way, I can't allow that to happen and be formal with you.

The other dates back awhile. A doctor, upon being addressed by his first name, said, "I have been to 10 years to earn the name of Dr. Please address me as such. I told him, "I have been working for 15 years to become a builder. Please address me as such."

I don't think the seperation is important or helpful

Mage

Sharla said...

I was raised to be extremely respectful of people and also what they had attained in life- mainly, professions and degrees and stuff. My doctor is always "Dr. X"... I've never called a doctor by their first name. When I was 16 and I started my first job, I had to call people by their first names (regardless of age) and I almost couldn't do it. It breached something inside me. Just today I was at lunch with two of my children and an older friend, Ernest, who is in his 60s. He was insisting that my kids could call him Ernest, to which I explained that in today's world, I have adopted a double approach- they call him MISTER ERNEST. Just like they call the babysitter Miss Julie, instead of Mrs. S!! I think that it can make all the difference. And yes, I have called my doctor, Dr. Bruce or whatever.... but I still say doctor.

Anonymous said...

Many years ago my first psychiatrist in my first inpatient hospitalization called me Mrs. So-and-So. I was freaking 20 years old!!!!!!!!!! He, of course, seemed like he was a hundred.

The combination of him looking down at me through his reading glasses from across a table and him addressing me by last name even after I requested otherwise, begat an image of psychiatry that I mostly still have today, that of the older cold male psychiatrist with less warmth than a murder victim frozen in a lake, gazing at me with an analytical eye.

I address my psychiatrist and all personal physicians as "doctor." *I* prefer to keep MY distance as well.

Y'all, don't flatter yourselves too much. Not all of your patients want you to be their buddy.

You're my brain mechanic. Fix it and try not to eff it up more than it is!

Likewise, not all of your patients fantasize about getting you in the sack....Well, probably not all of them ; )

Hehe.

L

Sarebear said...

I call my ologist by his first name. I've never heard him call me Mrs. $%^#, but then, there is much need for him to use my name at all. Which can actually feel really impersonal over time, and highlight the ways therapy can feel artificial . . . so I brought the subject up with him.

He's called me Sara a very few times since then, I think, enough that it helped with the artificiality thing. Although for awhile King felt funny tripping off my lips, as it's not a usual name, but that's settled.

I think for the first 6-8 months of therapy, since I was thinking of it as a doctor/patient relationship, that that actually held me back from engaging in therapy and the therapeutic relationship as much as I am now. In my doctor/patient relationship with my family physician, that is just easy to fall within rigid boundaries. But those same, he's the doc, you're the patient reporting stuff to him, boundaries, interefered with what, this last January, I began to learn could and should happen in psychotherapy. At least for me, anyway. And in what and how I related to King in the therapeutic relationship.

It's such an intimate thing, baring one's soul, that to all of a sudden (most likely when I'm talking about him, since, again, the therapist doesn't really have much opportunity for needing to use the patient's name directly, without seeming like they are avoiding it) call him Dr. Mower, instantly reinforced a formality to the relationship, a distance that immediately cut off what emotional connection I was feeling with him.

It's been his acknowledging of his own humanity, that also helped me bring up the issue of what to call him, and helps me relate to him when I call him King, as a person, instead of "The Doc", because we're two people both experiencing life, he just happens to be the expert who is helping me through my experiencing of it. My calling him King, with his permission, is an acknowledgement and an acceptance of that common human experience, and is really helpful for me. I have EXTREME problems feeling emotional connection with people, so maybe I'm more just a sub-class of a type of patient that needs some different measures to help encourage that connecting I've found helpful for creating a therapeutic relationship, I don't know.

Anyway, that's my experience. Dr. Brinley, my iatrist, on the other hand, seemed rather surprised when I mentioned a few weeks ago, King by first name; he seemed startled. I mentioned then that that's what I call King.

Maybe it's partly a difference in attitude between iatrists and ologists, but then I can't generalize from just my ologist, anyway.

Sarebear said...

Oh, I generally and usually refer to King as Dr. Mower on my blog and elsewhere, as our therapeutic relationship is, well, in his office, between us, as it were. Not like it's a secret, but I have a respect for him and the examples from his life that he shares, that I wouldn't just share with other people. In this context of discussing the issue, though, I referred here to him by first name to illustrate the issue.

NeoNurseChic said...
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healthpsych said...

I always refer to my (medical) doctors as Doctor Whatever. Just feels more comfortable to me. Some use my full name, some use my first name. I don't really mind what their preference is, although I think I perceive those that use my first name as being more empathic and having a better bedside manner, although I don't confuse this with friendship. I don't need friendship from my doctors, I need good medical care.
With my patients, I always introduce myself with both names. In our initial talk about therapy, what happens and boundaries etc, I always ask people what they feel comfortable with and, if they're preference is for first name use, that's what we do. But I feel okay in that I've already spelled out to the patient that our relationship is a therapeutic and time-limited one.
I personally think using surnames can restrict the rapport necessary for good therapy.

On the Same Page said...

I raise the HIPPA issue as it absurdly does or does not impact your post.

I went to a large chain-pharmacy near my doctor's office, where I'd never been, and submitted a prescription to be filled. About 15 minutes, they say. I'm looking around the store when I hear, "FooFoo (not real first name, Dinah - ah, I meant Dr. Shrinkrap), please return to the pharmacy." I make my way back and it turns out there are three FooFoo's. Hmm. "According to HIPPA regulations, we can't announce your last names." The clerk inquires, individually, the first, and then identifies the 2nd as the one she wanted. Rather than repeat the same, #2 and I remain. I am finally given my prescription by process of elimination. Same pharmacy chain, branch near my home at which I am a regular customer, they always call out full names. I raised this issue with the pharmacist. He says, "No one from [chain] ever said anything to us."

Two days later, I return to my medical group for a chest x-ray. There are approximately 6 other patients waiting with me. An x-ray tech appears and says, "Helen?" You know it - there are two. She explains, "Because of HIPPA regulations we can't use your last name." Hmm, again. X-ray tech appears, calls out my last name. I, and everyone else, break out in laughter.

And you knew it was coming, prison. First names are absolutely never used. For custody staff (and I suspect others) it is because of the perceived threat of retaliation. CO's name tags are last name only. I remember saying to a CO, "I need to see John Doe. Can you pull him for me?" He said, I have a 'Doe,' but I don't know if he's John. What's his number." The patient had been there three years. There was outrage when a website run by family members posted CO's last names.

As you would suspect, I'll personally accept pretty much anything but "f*****g quack." You'll get 90-days for that.

ClinkShrink said...

Great topic, Dinah. Every once in a while I realize how easy my professional life is. In the correctional world, I am Dr. ClinkShrink. Period. My patients are 'sir' or 'Mr. X'. Considering their consistent subtle and not-so-subtle attempts at flirtation and/or intimidation and/or familiarity, this just isn't even a question. Psychological boundaries are mandatory, as well as occasional physical boundaries.

But I don't have to deal with insurance companies so it's worth it.

ClinkShrink said...

Wow, I want to work in a system where you could give 90 days for getting cursed out. We only give 30 days for a direct threat.

Dinah said...

Okay, A few thoughts:

There are now 78 comments on The NHS Blog (Dr. Crippen, who via his comments I've now learned this is not his real last name and that in blog-o-land he wishes to be called John, so John), and a bunch here for something freshly posted on a saturday evening in August.

I've concluded that there is no one answer as to what people want to be called, but folks have VERY strong feelings about it.

Psychotherapy is about more than being a Brain Mechanic (though I like the metaphor). See my posts on The Psychiatrist as Therapist and Outside the Office. Empathy and Warmth are necessary ingredients and no one clicks with everyone.

Titles have all sorts of meaning, but there is so so much more to the therapeutic relationship and really, there is so much more to what gives a relationship its tone than the occasional stated name. Personally, I find that with some boundaries in place and the intent of the relationship clear, I'm much more likely to be relaxed and caring. Just my thoughts.

I should have added to the post that it's a whole different ballgame if someone asks first, rather than presuming that a physician simply doesn't mind or wants to be called by their last name. In the prison, they just say no.

Foofoo (Sir), by all means call me Dinah. Dr. Shrinkrap sounds so formal. Outside the office, it's Dinah exclusively. I respond to a number of other terms of endearment by the right people, and while I can't incarcerate you, know that I will be very offended by an obscenities directed at me.

Re:HIPPA and first names outloud, when one's name is "Dinah" the concept that using first names only provides any degree of anonymity (ask your spell checker this one, Foofoo) is absurb.

Friendship may have been the wrong metaphor, I borrowed it from Dr....uh, John and his post title. Therapy, by necessity however, is an intimate endeavor.

DrivingMissMolly said...

I'm going off tangent here, but I would love to hear y'all rap about what patients wear.

Many, many years ago I had a therapist who accused me of being "seductive" on our meeting. I was very young at the time and felt very hurt. I did not feel I was being seductive in dress or manner. I quit seeing him shortly thereafter.

To this day (15 years later) I give extra thought to what I wear when I see either my psychiatrist or my therapist.

I'm mentioning this because I do think it relates to boundaries also.

I couldn't imagine any woman dressing like Sharon Stone in "Basic Instinct" to see her shrink.

L

Roy said...

Umm, an odd request, but WTH...

I'm here to talk about that Miss Mol-ly
She dresses so it makes me go Gol-ly
I told her; I could see her disappointment
And now she nevers comes to her appointment

This patient, Sharon, she's a real man-hater
She tried to rape me on the ele-vator
She dress too nice, it's really a bad habit
But she makes a mean stew made out of a rabbit

Bring it on home, Clink...

Sarebear said...

This is only a very small one of MANY aspects of my therapeutic relationship. I guess I feel personally dissed by the "really, there is so much more to what gives a relationship its tone than the occasional stated name."

But then, I'm personalizing. I may have read that too personally, but I'm responding anyway.

Murky Thoughts said...

"it feels presumptuous and impertinent."

Interesting. Could you elaborate on that?

Seems to me the "Dr." is for the comfort of the doctor. A more comfortable doctor may well be a better and more dependable one, and not so hard a "sell," to the extent a patient needs to hear a pitch, but the vague "boundaries" spiel rings patronizingly evasive to my ears. Another thing is that if it were a regular bone of contention it seems like a creative and self-aware doctor could find some other way to get the emotional insulation "Dr" provides. e.g. "If this is my office, that's not my sister." Or you could talk to patients while wearing a lab coat. I dunno. Calling a doctor "Dr" is just an old-fashioned custom, it seems to me.

Dinah said...
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Dinah said...

Roy,
What's with the weird poem?

DMM,
No one has ever worn anything too interesting to see me in my office. The patients in the clinic sometimes where rather flamboyant clothes-- say head to toe in pink, or layers of coats when it's warm out, but I'm not sure I've ever felt compelled to comment on much (unless of course they wear a red sox cap).

Murky Thoughts: words stolen from John at NHS Blog, I liked them because he is so shockingly blunt. And the truth is, while this topic has gotten such strong answers(also on NHS Blog), the reality of the situation in therapy is that it really is never much of an issue. I'm not aware that anyone has ever left treatment because of how they're addressed and if it had that much meaning to someone, I'd simply go with the flow--- with a conversation if they wanted, or without one if that seemed the way to go. It's actually never come up as a problem, though I will say that I'm more comfortable being called Dinah by patients if they simply ask "Would it be okay if" (If that's what you're comfortable with, it's coo) rather then just presuming it's fine to ignore the propriety in a formal setting. Funny, but I wouldn't dream of greeting my new surgeon as Hi Sam.

Roy said...

Seriously, as Dinah notes, there are so many different feelings about who calls who what, that there seems to be no "right" or "best" way to address a patient or a doctor (or nurse, for that matter).

(Didn't nurses used to have the prefix "Nurse" in days gone by? As in "Nurse Ratched"? Things have changed.)

I've had a couple pts call me by my first name. Depending on the nature of the relationship, I may or may not tell them "I prefer that you call me Dr Roy, Mr Bertenshaw." It depends on the patient and the therapy and the clinical situation. While the relationships were a bit different, I recall that Dr Lecter called the young FBI agent "Clarice" (although he started out calling her "Agent Starling"), with the intent of gaining an undue familarity, while she took great pains to always refer to him as "Doctor" or "Doctor Lecter."

Doctor: Mr. Bertenshaw?

Mr. B: Me, Doctor.

Doctor: No, me doctor, you Mr. Bertenshaw.

Mr. B: My wife, doctor...

Doctor: No, your wife patient.

Sister: Come with me, please.

Mr. B: Me, Sister?

Doctor: No, she Sister, me doctor, you Mr. Bertenshaw.

Nurse: Dr. Walters?

Doctor: Me, nurse...You Mr. Bertenshaw, she Sister, you doctor.

Sister: No, doctor.

Doctor: No doctor: call ambulance, keep warm.

Nurse: Drink, doctor?

Doctor: Drink doctor, eat Sister, cook Mr. Bertenshaw, nurse me!

Nurse: You, doctor?

Doctor: ME doctor!! You Mr. Bertenshaw. She Sister!

Mr. B: But my wife, nurse...

Doctor: Your wife not nurse. She nurse, your wife patient. Be patient, she nurse your wife. Me doctor, you tent, you tree, you Tarzan, me Jane, you Trent, you Trillo...me doctor!

Sergeant-Major: Stop this, stop this. What a silly way to carry on.

Roy said...

Dinah, MissMolly asked us to rap, so I indulged. I had a weak moment (or a weak sense of humor).

Dr John Crippen said...

Endlessly fascinating. I think about the doctor patient relationship a lot. I guess it is about comfort zones, and we all have to find our own. If the doctor and patient have widely differenct expectations, then their relationship will not work, and the patient will move on. Or should.

I have posted on this topic twice in 8 months. Each time, it has had the fastest and most proflic comment response.

I find that fascinating too. It is obviously much on every ones' mind, though rarely articulated.

It does not much matter how it is done, as long as their is mutual respect.

I think that to call a new patient (aka a stranger) by their first name on first meeting is presumptuous and I always have.

It was the first thing that made me uneasy about midwives.


John

NeoNurseChic said...
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Anonymous said...

I do not like being called by my first name by people I don't know, or don't know well,and don't believe Dr. Crippen's fairy-tale that a doctor believes that addressing a client by first name is an indication of a deep and meaningful relationship. The nature of presumption is aggressive, and calling a client "John" without asking or an invitation to do so seems like a power play.

I once met a medical assistant at a retreat who worked for a doctor who said that he would not deal with anyone who insisted on address formally (i.e., Mr., Mrs. Ms.). Relationship, eh?

Dinah said...

Roy,

I am pleased to report that so far I have been able to avoid the Clarice-Dr. Lechter in all my professional relationships.

Sarebear,
You're not being dissed.

I'm struck by the fact that the comments on John's blog (NHS Blog) really run strongly in favor of the physician (and other healthcare workers) addressing patients by their surnames and the thought that to assume familiarity strips folks of their dignity (this was not everyone's feeling, just my distillation of the majority of over 100 comments there). Here on Shrink Rap, there is an edge of angst to the whole discussion and I think the majority feels a bit put off--perhaps even distanced & separated, rather than respected-- by the whole LastNames idea.

DrivingMissMolly said...

Mr./Dr. Roy;

I enjoyed your "rap," but it was merely an allusion to the title of this humble blog.

I prefer to wear long black pants and modest blouses to see the psychiatrist. I briefly entertained the idea of wearing the same thing each time, a sort of "uniform" if you will.

I am sure, however, that would become an object of analysis also.

L

Sarebear said...

When I first started therapy, a few weeks in, I bought a really baby-soft jersey knit red T with Grumpy of the Seven Dwarves on it, and in Sort of 70's Logan's Run Title style letters it says MOODY on it.

I had just started cutting, and when I saw and felt this shirt in the store I thought I could just feel this whenever I felt the urge . . . I wore the thing for almost a week, but it was a really good, positive thing for countering a negative urge; it was very tactile, very cuddly, and I felt like I was defying what I've felt like I've been s'posed to just shut up and be a hermit my whole life and not be a part of the world, and so it was countering that by displaying "Moody" across my chest.

So's I wore it to therapy and thought myself pretty funny, altho it probably seems pathetic . . . then again, I guess to read it he kinda had to look at my chest, which was NOT the intent. Lol.

I've pondered wearing my Monkey Steals the Peach shirt to my iatrist appointments (at least, before we got on better with each other this last time), but wondered what he'd say about hostility and all that. Google it, as it relates to martial arts. Hee hee! In the abstract, it's funny. In the specific . . . not so funny.

Thanks Dinah. I've been learning to have more courage to check out my possibly inaccurate perceptions, like that, so I'm glad you responded. It reinforces that that's a good thing for me to do is check out stuff like that, when relating to PEOPLE. (As I'm interacting w/you as a fellow blogger/person, and not as a professional, if that makes sense).

NeoNurseChic said...
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Fat Doctor said...

I posted about this name thing months ago, not that I'm callin you or Dr. Crippen copy cats or anything, but I'm all about Dr., Mrs., Ms., Mr. Anyone over the age of 12-ish deserves a title of respect. Unless you've gone out drinking with them. That's a different story.

On the Same Page said...

Personally, I prefer a drab, olive-green, 12-layers of Kevlar, Stab-Proof vest, impervious to needles, shanks, and ice picks. But unfortunately, not impervious to axes, picks, claw hammers, crowbars, lances, or spears. It is also difficult to accessorize.

jw said...

There are a few doctors I address by first name:

Bill, Harvard trained psychiatrist: He was the BIG kid two blocks over when I was a little kid

Pat, London trained opthamologist: She was the big kid down the block and the one who taught me swimming. I had a crush on her ...

Sam, (Ear nose and throat) he was just one of the guys. We did our first scuba diving together ...

Other than those three, all doctors are Dr. XXX.

For me ... it's a tough one. I do not particularily like being called Rev. XXX. My first name??? That's seems a bit rude. I'm not sure if there is a hard and fast rule here. It is more a matter of knowing me well enough to ask me what I want to be called.

Dreaming again said...

I call all my doctor's Dr. whatever (no, not whatever, but you get the point)

However, if they call me Mrs. Eagler, it makes my skin crawl.
That makes me feel OLD!!!

Peggikaye please!!! The only thing I did to earn the title Mrs. was to get married ... you EARNED your Dr. title.
I'm Peggikaye thank you.

My mother gave me my name because she loved the name, call me Peggikaye. Peggi, Pk even ... not Mrs. Eagler.
egads don't call me Mrs. Eagler till I'm 80!!! and I'm only half way there! (well, slightly over halfway)

Lindsay Beyerstein said...

I'm in the habit of addressing my doctor by his or her title, but I don't think it's rude to do otherwise.

Adults address each other by their first names in most modern workplaces. I don't see why the doctor/patient relationship should be any different in principle.

Alison Cummins said...

Fascinating.

If a doctor sets the tone by calling me by my first name, then we’re on a first name basis and I call her by her first name. Some doctors raise their eyebrows at this but hey, they started it.

With most doctors I would prefer a more formal relationship and to use surnames, but I have yet to be addressed by my surname by a doctor.

I have a psychotherapist I like. We use first names. I don’t feel belittled by her and I don’t feel like I’m being obnoxious back. It just feels right.

jcat said...

For me, seeing either p-doc or t-doc is different to other docs. There is a hugely different degree of intimacy with psych docs, these are people who know my most horrible bits - I need to feel closer to them than would be the case with formal addresses. I see a group GP, so not always the same doc, and seldom enough that we remain on formal terms. My dentist addresses me by first name, but refers to himself as Dr Bxxx, so that is what I call him.
P-doc refers to himself as firstname surname, calls me by firstname, and I talk to him as firstname (and also in email), but about him as Dr Jxxx. T-doc introduced herself by firstname, expects me to call her that, calls me by my nickname or 'sweetie' - she is younger than me, but a very mothery kind of person.
Oh yeah, and I hug/get hugged by both after most appointments, especially the ones where I've been crying a lot. Intimate yes, disrespectful, I don't think so....

Oh, and BTW anonymous L, I fantasise hugely about getting p-doc in the sack! But that has nothing to do with what I call him, or with transference either, he just happens to conform to almost everything that attracts me (except for not being way tall...) - LOL