“Call me Kate,” my pediatric allergy attending corrected in a soft British accent. I introduced myself by referring to her as “Dr. Swann.” Her bright yellow nametag indeed read, “#hellomynameis Kate.”
I was pleasantly surprised: it’s rare for fellow physicians, particularly if there is an ingrained hierarchy, to allow for first names. As a resident, in a training program in Canada, I was used to being called by my first name, though the residents were advised to call our superiors by “Dr. So and So.”
But this was a new experience: I was on elective in the U.K. with the pediatric allergy team for a month (the team behind the groundbreaking LEAP study on preventing peanut allergy), and was pleasantly surprised to learn just as much about the importance of introducing oneself to a patient and how this might impact both patient care and hospital culture. I would learn that this would be one of many factors that provided ‘psychological safety,’ by implicitly allowed both patients and staff to speak up, as it helped flatten the hierarchy that is typical in hospitals.
The #hellomyname is campaign was started in August 2013, after a terminally ill cancer patient, Kate Granger was hospitalized for sepsis, a life-threatening infection that takes over the body. Granger was disturbed by the fact that very few staff introduced themselves. As a doctor herself, with the National Health Service Granger never realized what the impact might be as a patient. Since her death in 2016, the campaign has the backing of over half a million doctors in the U.K.
Granger is survived her husband Christopher Pointon, who has made it his mission to help spread the initiative around the world. He has also given hundreds of talks in the U.S. and around the world, and the campaign is now in 20 countries. Yet he shares that the campaign got off to a rocky start with some initial backlash.
“We noticed that with more senior doctors, there was some resistance,” Pointon says, “They would say, ‘well my name is on the door, or on my nametag, so why the introduction?’ to which we’d say they need to be role models for new junior doctors coming through,” Pointon says.
And times have changed. In 1985 a patient, writing to the Canadian Medical Association Journal, expressed dismay at being referred to by their first name, and that had tables been turned (referring to the doctor by his first name) it would be ‘patronizing.’ In response, a doctor wrote in to say that a patient referring to her by her first name would be ‘inappropriate.’ An article from 1990 formally studied whether doctors should call their patients by their first names (common practice now, but not then), and whether patients should call their doctor by their first names. Interestingly, while patients didn’t seem to mind being referred to for by their first names, almost 70% of patients didn’t want to refer to their doctor by their first name.
Since then, other researchers have studied how patients and doctors address themselves. A recent study found that most patients – 99% of those interviewed — wanted to be addressed informally. But, clarity matters: over half preferred another name other than their legal first name. Another study found that only 35% of patients preferred to call their doctor by their first name, and choosing a formal address was associated with male patients, those born overseas, and lack of familiarity with the doctor.
But could there be drawbacks?
Generally, due to how tricky my own surname was, I referred to myself with my first name when caring for patients.
However, studies do show that, particularly among women and non-white doctors, this can lead to biases that can be catastrophic.
For instance, a study published last year found that surnames are usually used for male scientists compared to female. The researchers believe there are consequences to this, specifically that it could affect perceptions around deservedness of awards.
As well, other research has found that men introducing doctors during hospital conference presentation rounds are less likely to use the title “Dr” for women, compared to men, which can perpetuate the well established gender biases we see in academic medicine.
Perhaps it’s not specifically the issue of using first names, but an issue with doctors not introducing themselves in the first place. Last year a study from Ireland was published about the #hellomynameis campaign found that among the patients and doctors surveyed, at least 11% did not introduce themselves, according to the patient, though several were not sure. What’s more is that 90% of patients surveyed felt that the introduction made a difference to their visit.
“The campaign is less meant to force people into being on a first-name basis, but really about how a simple introduction can make a huge difference, so the value of healthcare workers introducing themselves to each other, and to patients, in order to improve communication and the therapeutic relationship,” Pointon says, “For instance my medical record says ‘Christopher’ but I’d like to be known as ‘Chris,’ and this matters to me that my doctor clarify this.”
Rana Awdish’s recent bestseller, “In Shock,” is similar to Granger’s story in that a world opened up when Awdish found herself on the other side of the bedside. Awdish ends her book with several pages of communication tips, including a section on how doctors and patients should introduce each other, with the aim of improving the therapeutic relationship.
A few months ago, I received a kind letter from a patient’s mother about the care I provided for her daughter who had been ill for many weeks in hospital with a difficult diagnosis. In it she said she trusted me like she would a family member. I noticed that the letter addressed me as “Dr,” though I never once introduced myself that way, choosing to use my first name. Did the way I introduced myself make a difference? Possibly, but while it wasn’t sufficient in and of itself, it was likely an important piece of caring for a patient where I needed to advocate tirelessly in a clinical environment that lacked psychological safety.
So should doctors use their first name? If they prefer it. But it should be made clear when they first meet. The larger goal of ensuring the patient feels heard, understood, and respected enough to speak up and share their concerns should not be forgotten. And introductions are one place to start.
Amitha Kalaichandran, M.H.S., M.D., is a resident physician and writer based in Ottawa, Canada. Follow her on Twitter at @DrAmithaMD