“What’s in a name? That which we call a rose
By any other name would smell as sweet.”
Here at St.Emlyn’s we are interested in lots of things. Some are really clinical, but we are also very interested in the human side of medicine and in particular in reflecting on how we might improve as a clinician. One question that came up recently is the use of first names in the ED. Basically, do you use your first name in the workplace with colleagues, seniors, juniors, nurses, hospital staff and patients?
Is this an important question you might ask? Well I think it is as names are important. Names tell people who we are, but in the healthcare setting we also have a bunch of titles that are linked to what we do and I’m interested in how these are used.
I have been lucky enough to visit many different hospitals recently and it is interesting to see how clinicians refer to each other and presumably to patients too. In our own practice I see docs rotate through the department as trainees or as consults and again there is great variation and I wonder if it matters.
So, what should we do when we meet patients? Should I introduce myself as ‘Simon’ or perhaps as ‘Professor Carley’, and does it even matter what we say at the beginning of a consultation?
There is plenty of work from psychologists that tell us that first impressions are important and although non-verbal clues are arguably the most important I believe that language also counts. Over the years I’ve used lots of different approaches. Permit me to take you through my titular journey……
When I first qualified I introduced myself as DOCTOR Carley (emphasis intended) as I was probably a little insecure in my role and felt that the badge lent credibility to uncertain clinical skills. I’m not sure it did but as an emotional crutch it worked for me. I suspect that the stethoscope, white coat, badge, Oxford Handbook in the pocket and Med school tie also gave some clues but in my internal assessment I still felt a bit of fraud and leaned on the title for support.
A little later on in my career I became a Fellow of the Royal College of Surgeons and earned the right to call myself Mr MR, that’s MISTER Carley when answering the phone. This was a different reason, I had a little more self confidence than in my houseman years but the change in title and use in practice was all about belonging to a new club. The title of Mr associated me with a specialism, a feeling of joining a team of surgeons who I aspired to be at that time. This was a feeling of separation from those who had turned away from the craft of surgery, and I see similar behaviours now. Junior surgeons answer the phone with a firm and slightly stressed ‘Mr’ in the months after getting fellowship. I don’t begrudge them this really, I was just the same. Patients frequently found it a little tricky to understand, some asked when the doctor was coming (sometimes after a full surgical exam which was a little disconcerting), others considered me young to be a consultant (I was an SHO at the time), so clearly it was not an effective title to others. It just felt good for me.
As a registrar in EM I bobbed back and forth between Mr and Dr until really quite late on in my training.
I can’t really remember when I decided to change, but I think it was when I was working with the rather inspirational Pete Driscoll in Salford (a doctor who had fantastic patient engagement) that I realised that introductions are really important.
So, I decided to change from ‘Hi, I’m Mr/Dr Carley, what brings you here’ …. to …. ‘Hi, I’m Simon, one of the doctors here, how can we help?’
Now this is not a scientific study and I have no data but I found that it was easier to engage with patients if I used my first name. When patients come to the ED they are often frightened and unsure of what is happening. We appear with vast numbers of organsiational and physical cues that we are in a position of power over them. The uniforms, the appendages (stethoscopes etc.), the technical terms and the fact that we already know something about the patient from the triage notes mean that we generate an enormous ‘power distance’ between the patient and ourselves.This can compromise our ability to get a good history and exam from the patient, may then reduce our ability to diagnose and lead to poor patient outcomes.
So basically I think it’s a bad idea and we should do what we can to reduce the ‘power distance’ between patients and clinicians.
I believe that this does work for me and I encourage others to do the same. If you don’t do this already, give it a try and see if makes a difference. I think it does and I think you will find that it does too.
What about colleagues?
Do you use your titles when speaking with colleagues? I don’t think most people do but I have been surprised to see some teams use formal titles even when talking between colleagues at the same grade. I’m not sure I understand that, but each to there own. At least when clinicians are at the same grade it’s a level playing field, but what about when juniors communicate with seniors?
Arguably this is exactly the same issue as when we speak to patients, perhaps even more so as in hospital medicine hierachies are explicit and culturally embedded. Hierachies are dangerous though as they can inhibit communication. It’s vital that juniors are empowered to speak up and question everything around them, including the decisions of seniors, and I believe that titles inhibit this. As seniors and teachers we should again be doing as much as we can to reduce this inhibitory power distance between ourselves and our learners.
All of the great teachers that I know thrive on interaction and engagement with trainees. Learning is at its best when we share experiences and discuss topics in an open and safe way. For those who have tried to flip the classroom this year you will know that interactive learning only works when trainees feel that they can interact and if they perceive a great power divide they will not feel that they can do this. As a senior in the department the distance will always exist through explicit hierachies, but if there is anything that we can do to lessen this then we should. using a first name and talking to trainees as equals is one small step in this process…. and it’s completely free and takes no time.
I also think that there is a patient safety issue here. I live in fear of a junior colleague letting me do something dangerous because they do not want to correct the Prof. This is a genuine issue for all senior docs who can make mistakes just like everyone else. In the airline industry there are many examples of junior staff in the cockpit feeling unable to speak up about dangers leading to disaster. The airline industry has learned a great deal about this and has worked to encourage juniors to speak up, with part of this being about reducing barriers to communication. It is something that we can learn from in healthcare too.
Well perhaps not that much really. If you already use your first name with patients and colleagues then all of this will be old hat. If you don’t then I invite you to try.
Exercise 1. For you next shift try introducing yourself to every patient and their family as ‘Hello my name is YOUR FIRST NAME, how can we help…..
See how that feels and reflect on whether it changes the consultation. It won’t always but I think you will find that it does for some. If you can cope with the experience of using your first name with patients then you are ready for exercise 2.
Exercise 2. If you are senior clinician ask that your juniors to use your first name. That’s all of them right down to med students, and whilst we are at it that goes for all the people on your team, all the support staff that make the department work. See how it feels and reflect on whether it improves communication in your team. Some colleagues won’t be able to do this and to be honest it’s up to them if they want to keep using your title, in some cultures that’s just the way it is, but even by inviting them to use a first name is a small but useful step in lowering power distance.[/learn_more]
[learn_more caption=”Not going to do it”] Fair enough. There are reasons why you might not want to do this. Perhaps in your institution it is the norm, even the expectation, to use titles. If that’s the case and you don’t want to stand out then fine.
However, if you recognised yourself in the somewhat vain descriptions of myself at the start of this post then just ask yourself whether you use your title to prop up your internal anxieties in response to your personal imposter syndrome. I can only tell you that I’ve been there and the reality is that you already have the power and authority that comes with the job and that it is your clinical actions that will determine your worth, not the title you use.
You may ask if I use my current title much these days and the truth is not that much in the ED. I do wheel it out in formal meetings, in research settings and in relation to University work. It is also used if I feel the need to make myself feel important, (though in truth it’s sometimes used when I have my own personal imposter syndrome in full flow). However, that’s for the admin side of life. In clinical practice I don’t use it much at all as it’s not usually necessary and it can get in the way for all the reasons described above.
What else can I say but, thanks, and……..
My name is Simon, one of the docs who contribute to St.Emlyn’s.
Thanks for reading.
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