Every attending physician I meet within the context of work I address by their title. For example, I would always call Dr. Charles “Dr. Charles” and never “Aidan”. I only deviate from this practice when the attending physician specifically requests that I address him only by his first name. I usually need a friendly reminder.
I attribute this rigid practice to a surgery resident. (My obsessive-compulsive traits may play a marginal factor, too.) I was a third-year medical student on my first clinical rotation—trauma surgery—when I met Dr. Montgomery Ward (not his real name).
Dr. Montgomery Ward was a third-year surgery resident who attended medical school at a prestigious academic institution on the East Coast. Dark circles drooped below his eyes, neatly trimmed chestnut hair crowned his head, and thick, unsmiling lips adorned his face. He wore a medium-sized scrub top, large-sized scrub pants, and brown clogs over his off-white socks. He carried a small, black notebook in the left pocket of his rumpled, tired white coat and a stethoscope in his right pocket.
(In fact, I never wear my stethoscope around my neck when I am not actively using it because Dr. Ward provided a mocking admonition to the medical students during our first week on the service: “If you wear it around your necks like those medicine docs, it looks like a dog collar. Don’t wear a dog collar—have some class and put it in your pocket.”)
He had nice hands with nimble fingers and cleanly trimmed nails.
“People don’t show enough respect out here,” Dr. Montgomery Ward opined one afternoon, referring to the lackadaisical practices of the West Coast. “Medical students and residents should never address their attendings by their first names. Where I came from, everyone addressed the residents as ‘doctor’. It’s too lax out here.”
Already feeling anxious from my bumbling presentations during rounds, inability to scrub correctly, let alone efficiently, for operations, and fears that someone would yell at me for breathing incorrectly while in the operating suite, I incorporated as many suggestions as I could to minimize the opportunities I would look like a complete idiot.
“On the East Coast, we always address the attendings as ’sir’,” Dr. Montgomery Ward said. He didn’t tell us how to address our female surgery attendings—maybe they didn’t have female attending surgeons on the East Coast?
He practiced what he preached—watching him interact with the attending surgeons was simultaneously awe-inspiring and nauseating.
“Where would you like to begin rounds, Dr. King?”
“Would you like to personally see the wound, Dr. King?”
“Yes, sir? No, sir. Absolutely not, sir. Thank you, sir.”
“I would be delighted to assist you during the procedure, Dr. King. Thank you for considering me, sir.”
“Dr. Ward is an excellent resident,” the attending surgeons shared with the medical students. “He may be a bit formal, but he is smart and is outstanding in the operating room.”
“Monty takes this too seriously,” the junior residents snorted. “All of the ‘doctor this’ and ‘doctor that’—stop calling me ‘Dr. Penny’ and just call me ‘JC’, okay? And, really, you don’t have to call him ‘Dr. Ward’, either.”
And yet, Dr. Montgomery Ward was stern—his dark eyes glowered at us from across the circle if our presentations hinted at informality. Or even if we neglected to greet the attending surgeon by his full title. The medical students lived in discomfort under the bright glare of Dr. Ward’s scrutiny.
Dr. Montgomery Ward, however, taught well. I still have my notes that I hastily scribbled during his impromptu talk on mechanical ventilation. I never said his name—first or last. I feared that he would chuck a central line kit at me if I ever called him “Monty” and it seemed odd to call him “Dr. Ward” when we called the other residents by their first names. So I just ensured that we made solid eye contact before I asked or answered questions.
When my time on the trauma surgery service came to an end, Dr. Montgomery Ward provided terse feedback (”You did fine, Maria—good, concise presentations.”) and, rubbing the sleep from his eyes, briskly walked towards the cafeteria. I don’t think he said “good-bye”. Then again, he never said “good morning” to anyone other than the attending surgeons.
These days, I correct all the nurses and medical students who address me as ‘doctor’ and insist that they address me by my first name. Like me, some balk and insist on using my title—and I know better than to argue.
(Part of the ongoing Relationship Series.)
23 May 2007 |
it’s a tough question. i introduce myself when meeting new patients with my first name and then state that i’m one of the doctors here. when i call patients on the phone i always says dr. otherwise it takes them a while to figure who the heck is calling them. as i get older i think i prefer to be addressed as dr. in the medical setting because that’s what i am. i’m not your friend first, i’m your doctor, and to use my first name probably on some level lowers your estimation of my professionalism. i don’t care when people use my first name, and i feel bashful calling myself dr., but i would caution you, especially as a woman, that to use your first name too much might engender too much folksy familiarity. among colleagues, i think there’s about a 10 year seniority factor, any doc older than me by 10 years deserves my use of the term dr. instead of her first name.
you said it better, i’m rambling
Comment by drcharles | 24 May 2007 @ 8:32am
I came from a small midwestern liberal arts college, where we were encouraged to be on a first name basis with all of our professors. I thought aha, I am 18, this is about being an adult among adults. With the few distinguished elders who didn’t offer this option, I and everyone else used the honorific “Professor.” It felt collegial, not disrespectful. I resent that in medical school I am expected to call everyone “Dr.” — DOs, MDs, PhDs, the lot of them. Now even more than when I was an undergraduate, I am among my future colleagues. I knew this about medicine going in — one of my standard answers to the interview question of “What do you think will be hardest adjustment for you in medical school?” was the existence of a rigid hierarchy — but it still rankles. Maybe I belong on the West Coast?
Comment by LadyGrey | 24 May 2007 @ 2:21pm
Do you know any doctors that prefer to be addressed as “Dr. [Firstname]” rather than as “Dr. [Lastname]” ?
Some pastors do this, and I think I’d rather be called by my first name than last, since my last name is somewhat long, and hearing people try to get their mouths around it is just awful.
Comment by RJS | 24 May 2007 @ 2:22pm
Where I went to medical school we addressed all the senior residents formally, even if they were only a year or two ahead. It was unthinkable to address attendings by their first name.
I remember a story one of my seniors told me recently. He was doing his fellowship at one of the big name centers and there was a professor in his department who was an authority in his field and who, consequently everyone was quite deferential to. The professor discouraged this practise and insisted he be addressed by his first name. My friend could never bring himself to do that and one day the professor finally burst out, aggravated, “What does T-O-M spell?!”
My friend replied, “Sir.”
Comment by karrvakarela | 24 May 2007 @ 2:55pm
Nice post. It’s always interesting how impressionable we were at that stage. As a fellow, I view myself as a PGY-5, so I tell the students and residents to call me by first name. I am older than some of the new medicine attendings, but I address them as Dr. just because I don’t know them that well. Most attendings will introduce themselves with first and last name (leaving out ‘doctor’) to me, and sometimes they will sign their emails with their first names. I guess that is sort of a green light to call them by first name if I want, right? I have a hard time switching. If I knew someone when they were a resident, I tend to keep addressing them by first name even if they are now king of the world. On the flip side, I feel weird calling some people by their first name now that we will be colleagues, if I’ve been calling them doctor the whole time I was a resident or fellow. For me, age also plays a role. It’s much easier for me to call a younger attending by their first name than an older one.
Comment by idcrossroads | 24 May 2007 @ 3:07pm
I introduce myself as “Dr. …” just as I refer to patients as “Mr. …” or “Ms. …”. I think it’s how any relationship on a professional level should start out.
After that introduction, I just live in the flotsam and jetsam of whatever happens. To “correct” people in how you want to be referred to is to first of all, interrupt whatever was going on, and secondly is to say to someone, “Sorry, you were referring to me incorrectly…” so even when you suggest something more informal, you still maintain the higher ground of control.
Besides, I like the entertainment value of watching a patient I’m just seeing for the first time slide their chair up to the desk, prop their elbows on it, and say, “Well, Greg, here’s how it is…”.
Comment by Greg P | 28 May 2007 @ 7:51am
I’m in academia, and we pretty much refer to everybody by first name. Do you guys in medicine actually refer to each other by “Dr. John Doe” all the time? Seems kind of tedious to me. The only time when I refer to myself as “Dr.” is when somebody else introduces him/her self as “Dr.”, like in a hospital.
Comment by P. Chang | 24 Aug 2007 @ 7:47pm