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Uncle and Doctor: Terms of Endearment or Old-Fashioned Barriers?

On my first day of intern year, my attending corrected me in the hallway after I introduced myself to a patient by my first name. Following this, I sheepishly adopted a habit of saying “I’m Dr. Last Name” when sticking out my hand to greet a patient. In clinic, the nurses call me “Dr. Last Name,” even when saying a casual hello. When you refer to yourself as a doctor enough times, you start to believe it.

Initially, my last name preceded by the title “Doctor” felt like a strange costume, an early Halloween on July 1. I stumbled on the words, wondering if my patients would see through the facade. I resolved that I would try “Dr. First Name” after switching to pediatrics — to make it easier for people to pronounce, and to help me shed some of the formality.

Several nurses and allied health professionals in the hospital use white tape or a sticker to cover their last names on their badges. While this is likely an attempt to maintain privacy from patients on social media, this technique ultimately reduces them to a single word. Nurses used to have a title of “Sister First Name,” and in some countries, such as India, the term “sister” is still used. Besides arguments for “sister” being non-inclusive for male nurses, the term “sister” is also deemed old-fashioned, as most providing health care are no longer nuns or monks. The title “doctor,” however, seems etched in stone. Many patients prefer to use that formality.

When I was growing up, the only adults whose first names my parents deemed appropriate to use were my aunts and uncles. Still, that was only if I preceded their names with the appropriate familial title. In contrast, my friends’ parents remained “Mr. and Mrs. Last Name” well into college.

By fourth-year of medical school, I began switching from “Dr. Last Name” to “First Name” when writing emails to specific attendings who had become mentors. I even built up the courage to say their names out loud once or twice in conversation. In residency, I have found that many attendings are comfortable with residents using their first names, although that does not seem to extend as much to medical students.

The knighting of residents with formal titles varies depending on context. While the hallways and computer work stations are informal, formality persists in patient rooms. These linguistic acrobatics can make encounters feel artificial or staged. It does not feel authentic for my attending to call me “Dr. Last Name” in front of a patient, as she never refers to me directly that way. Yet, when patients have occasionally referred to me by my first name, I feel a little part of me cringe — a part of me that was not there before residency.

When I saw myself as my first name, I would ask nurses for advice on what to order or how to help a patient. As my confidence has grown, I have adopted the title more, and a separation has settled in. I belong in the resident work room, responding to pages as the doctor who brings answers and prescriptions. Distance is acculturated, and the familiarity of my first name seems to violate that distance.

We put on our professional cloaks when we embroider “Dr. Last Name” into our introductions, business cards, and white coats. Maybe it instills more confidence in the care our patients receive, but it likely inhibits some closeness of connection. We must weigh these pros and cons when considering how to address ourselves and others.

Austin Wesevich, MD, MPH Austin Wesevich, MD, MPH (3 Posts)

Resident Physician Columnist

Duke University Medical Center

Austin is an intern in Duke’s combined Internal Medicine/Pediatrics residency program. After spending the last ten years as a student at Washington University in St. Louis (WashU), minus a one-year stint in Malawi, which he chronicled in his in-Training column, “Lessons in Lilongwe”, Austin is excited to explore a new institution for his residency training. His column provides real-time reflection on the difficulties and small victories of life as a resident and how social support systems and interpersonal connections are critical to that journey. You can follow him @drwesevich.

The Med-Peds Bunch

In light of recent press on resident burnout and depression, The Med-Peds Bunch explores the lived social support systems of a current Duke resident. Come join Austin as he begins his med-peds journey and reflects on feelings of family in residency.