What do you want to be called? This is a question that keeps popping up in Twitter discussions of how to address the patient. Doctors will tell you proudly that they ask the question, some will tell you the question is designed to redress the asymmetry of power in the interaction. In this post I will argue that it does nothing of the sort.
Let me start with a story. My British GP called me by my first name and I hated it. I hated it because it only underscored the imbalance of power between us. I am an educated and ‘degreed’ professional and I was able neither to tell the doctor to stop, nor to respond by calling him by his first name. I simply was unable. The frame of the clinical encounter with its power differential was so strong, I could not resist it.
There are many social/cultural reasons for it. For example, in Polish one uses polite forms as a default; as a child of communism I was brought up to obey and fear authority. And so, every time I saw the doctor, I was frustrated with my inability to protest against his way of addressing me. Time and again, I left the surgery furious with myself. Despite all the social and symbolic capital I had, I was cornered into being someone who let the medic construct a relationship of more asymmetry. As a way of paying him back, I challenged him more often than I care to remember. To a considerable extent, at least for me, our relationship was very unhelpful, I was fighting, for fear of sounding too bombastic, for my dignity. Interestingly, it all also meant that, he told me years later, that the doctor feared seeing me.
I can’t remember how long it took me, but after some time, I decided enough was enough. And so, when I went to see my GP and said “Hello, [first name]”. And, boy, did he hate it. When he heard his name, he was visibly taken aback. He tried to rein it in, to no avail. I clearly crossed a boundary, and, yes, I did significantly redress the power imbalance in our relationship, at least in the way we communicated. Incidentally, I wish I could say it felt liberating. It didn’t. If anything, the situation made me realise how asymmetrical our relationship had been. It also made me realise that I had never been able to tell him to stop, that I didn’t want to be ‘Dariusz’ to him.
But what has it got to do with the question “What would you like to be called?”, you might ask. Well, everything. The question is as much an exercise of power as calling me by my first name, moreover, it leads the patient into the situation they might hate, just as I hated it.
Before I start, I want to acknowledge, the question can have one a positive aspect. It makes me, the patient, at least seemingly, a decision-maker. In an interaction with the powerful doctor, I can actually make choices and the choices are not trivial, at least it looks that way. Let me also remind you about terms of address. They work on two axes: power and solidarity. It means that in an 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. And so, “Prof. Galasinski” makes me powerful (and distant), “Darek” makes me less powerful and close. So, what happens between the doctor and the patient when the doctor asks: “What would you like to be called?”.
As a patient, I cannot simply ignore the power imbalance between the doctor and me (this is why it is so irritating to read all those medics who say that patients simply make a choice, we don’t). So, my decision, really, is about how to deal with it and I do have ready-made cultural scripts helping me do it (school, medicine, some workplaces etc. provide them). Thus, I am likely to acknowledge the ‘natural’ power imbalance, moreover, depending on my cultural, social, personal background and history, I might even be happy to construct myself as less powerful. I will call you doctor, you will call me Dariusz, yippee!
But then there is solidarity. Dariusz will also do nicely. By saying that I would like you to call me by my first name, I 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. I will call you doctor, you will call me Dariusz. Brilliant, two birds, one Dariusz and Bob’s your uncle.
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 the way I asked. But I would fear that our relationship would be different; the risk is too high. Indeed, judging by Twitter doctors’ responses, this is what their patients go for (I don’t know any research into this). It doesn’t take advanced linguistics to see that the question “What do you want to be called?”, in fact, corners me into one answer. And yes, some people might like the answer, but what about those who don’t? Is it just tough? Incidentally, I once answered the question what I would like to be called with: Professor Galasinski. I was not called that even once and the trainee doctors tried very hard to avoid addressing me directly. Interesting, isn’t it?
A couple of reservations. Address forms change. More and more often, we use first names as a default in addressing stranger adults, as they lose the familiarity. With time, we shall see whether the solidarity axis will need to be amended by something more familiar. It’s worth noting, however, such changes don’t seem to apply to doctors, as they tend to remain doctors. How useful for them.
The second reservation is that, as ever, things are never so simple. In a Twitter discussion, Jacek Debiec, suggested that non-binary patients might provide a context in which a question about what they would like to be called is warranted and acknowledging. I tend to agree. And I say ‘tend’ because I think that in a good clinical relationship, it is the patient who should feel able to start such a conversation (see below).
Anyway, you will argue, if the issue is symmetry, how about when you, the clinician, introduce yourself by your first name. “Hi, I’m Sally.” It is very easy to suggest that this is something nice. The doctor is stressing friendliness, solidarity, empathy and what have you. That must be good, mustn’t it? Well, it’s not so obvious at all.
Clinical communication is about power and I have a problem when the person who has all this power implies otherwise. For have John or Mary (rather than Dr Smith or Dr Brown) lost any power they have over me? Do they listen more? Do they empathise more? Or better: what power have I gained through calling them by their first name? Well, none, innit? The medics’ implied friendliness changes nothing in our relationship and I would really prefer if you, doctor, acknowledged it and stopped pretending that we are somehow mates.
In fact, I still see you happily rocking in your comfortable armchair as I am perched twisting on a chair at the side of your desk. You type as I speak to your side, you ignore what I say and I am supposed to be overjoyed by your allowing me to call you John? Give me a break, will you?
And I hope you noticed the verb ‘allow’ in the previous paragraph. It speaks to the bottom line: how we address each other is always the doctor’s choice. For it’s always the doctor who decides whether to ask the damned question, not the patient. And any decision ‘we’ make, can be revoked by snapping the medic’s fingers.
Conclusion? There is no escape from medical power and the asymmetry it introduces into the clinical relationship. You, doctor, will always be more powerful than me – it’s inevitable. And so, I prefer seeing a doctor who understands it and reflects on it, rather than one who deludes themselves by ‘giving me the power back’. They don’t.
Postscript 1. In all the discussions on forms of address, the assumption made both by patients and by doctors is that it is for the clinician to ask the question. Is it really beyond the realm of what’s possible to imagine a situation in which my relationship with the clinician allows me to say to them: Actually, I’d rather you called me “Mr Galasinski”? Or the other way round: Could you call me “Dariusz”? In other words, why is it only for the medic to open that channel of communication?
Postscript 2. For years, I did a seminar on forms of address at my university. I asked students what they thought of addressing their lecturers by their first names. Inevitably, the answer they didn’t like it because such forms masked our ‘true’ relationship. The students were lulled into false security, thinking we are all very nice and friendly, only to discover that those nice and friendly people could and did fail them if they thought it was appropriate. The friendliness was gone in an instant.