My previous post was about symmetry in addressing each other in clinical communication. Some responses indicated that clinicians ask patients what they would like to be called. And this is what I would like to comment on.
I’ll declare my hand – I don’t like this question. Still, things are rarely clear and easy, so let me start by saying that I do think that the question has a positive side. It makes me, the patient, at least seemingly, a decision-maker. In an interaction with the powerful doctor I can actually call the shots. Well, at least some of them. And even though I do believe that this is not trivial, I still don’t want to be asked such a question.
In the previous post I wrote about two axes on which terms of address work – power and solidarity. It means that in my interaction with someone terms of address can construct me (or them) as powerful/powerless, but also we can get closer or more distant from each other. Now, I am not immediately aware of any publications on that, so let me tell you what, I think, happens between the doctor and the patient when the doctor asks “What would you like to be called?”.
Let’s start with the power axis. As a patient, I cannot simply ignore the power imbalance between the doctor and me. So my decision, really, is about how to deal with (acknowledge?) it. Fortunately, however, I have ready-made cultural scripts helping me to do it. After all, at school we, pupils, call teachers using formal – and powerful – honorifics (Mr, Miss etc.), while they do not reciprocate, underscoring the power imbalance between us. And so I can acknowledge the ‘natural’ power imbalance and depending on my cultural, social, personal background and history, I might be only to happy to construct myself as less powerful. In any case, I need to choose the more familiar form of address.
But then there is solidarity. As you ask me your question, I might also read it on the solidarity axis and I might want to construct our relationship as more friendly, pleasant. I might want to stress my positive attitude towards you. After all, I am supposed to like you, respect you etc. Yes, you guessed it, I also need to choose the more familiar form of how you will address me.
Interestingly, the two options correspond well with Penelope Brown and Stephen Levinson’s theory of politeness and its two kinds (for an introduction to their theory you can click on this link; if you want more, you can read their 1987 book “Politeness”). In the case of the first scenario, I am using strategies to minimise imposition on the doctor and offer a relationship on my terms, one which is essentially symmetrical. That’s negative politeness. In the other scenario, I am seeking to stress affinity. That’s positive politeness.
Your question, doctor, offers me very little choice, but to give up being Professor, Doctor, or even Mr. I would have to become Dariusz. Can you really imagine my saying:
“I’d like to be called Professor Galasinski.”?
I mean, can you? Yes, of course, you would accept the formality I ask for, you would probably call me what I asked. But it would have soured our relationship, wouldn’t it? You would have thought how pompous, stuck up, and full of myself I am. You would still provide care, yet, our relationship would be different. And let’s not forget that ‘professor’ might actually trump ‘doctor’ and that might wreck our relationship completely. So, I promise, I will never do it to you/us.
You, on the other hand, please don’t ask me what I would like to be called. There are default ways of addressing an adult stranger, even though they are changing. So, please, play it safe. Let’s concentrate on what I have come to see you with and let’s not nuance our relationship, at least not just yet. There might be time to do it, after we’ve known each other for some time. But let’s not rush things…
There are two postscripts to be written, though. First, what I wrote above is based on a sound politeness theory, but I have no idea what happens after doctors ask such questions. It would be very interesting to learn how many patients actually resist reducing formality imposed by the situation. Second, terms of address are little, insignificant things. After all, in the grand scheme of the universe or even my health, whether I am called Dr or Dariusz, really doesn’t matter. It’s the (wretched) ‘outcome’ that matters. And yet, some time ago I wrote that little things matter. I referred to a doctor shaking my hand, looking up at me. Terms of address sit next to these. And yes, they matter. They do, because they create a relationship between us, a relationship based not only on empathy, but also on respect. For as much as empathy is important, so is respect. Negotiating those two is far from easy, but then clinical communication is not and cannot be.