Forms of (clinical) address
My Twitter timeline has been full of conversations about titles how and in what contexts to use them. One of the tweet threads was about medics introducing themselves to patients and each other. The version that seemed to win was introduction by the medic’s first name. So, here is another post on terms of address in clinical communication.
Before I continue, I need to say (again) a few words about forms of address. Brown and Gilman (you will find reference in one of my previous posts on forms of address) were the first to show that forms of address are very sensitive to the social context of communication and can be thought of in terms of the power and solidarity. And so, terms of address do not only reflect the relative positions of interactants vis-à-vis one another and in society in general. The speaker’s choice of a particular form of address locates the addressee in social space and defines, or constructs, the social actors’ mutual relationship.
And so, the more ‘professorially’ I am addressed (or want to be addressed), the more the relationship between the speaker and myself is constructed in terms of power (whether the relationship is symmetric or not, is a different issue). On the other hand, the more ‘Darekness’ is emphasised, the more solidarity is claimed for the relationship. Needless to say, things get more nuanced and complicated, as forms of address can be negotiated or rejected. For example, I once talked to a police officer and during the conversation I explicitly asked not to be called by my first name, but by my professional title.
So, after this, back to clinical communication. The first time I noticed it was when I was watching the show Embarrassing bodies. A lot of televised consultations started with doctors saying something like:
- Hello, I’m Pixie….
- Hello, I’m Christian…
Every time I heard it, I cringed. I really didn’t like this imposed matey-ness, shortening of distance, presumption that the patient wants and needs such ‘friendliness’. But I thought it was more about television than about clinical communication. The recent tweets I read suggest that it’s not.
And so, I want to consider the first-name introduction from a doctor. Before I do, I guess, I need to declare my hand. I dislike it, well, I strongly dislike it. Part of my disliking is likely to be cultural. Although the statement can be nuanced, in Polish adults who don’t know each other don’t address each other by their first names. Much like in French (vous), German (Sie) or Spanish (usted), we use the polite form (Pan or Pani). A doctor calling me Dariusz (or Darek, which is diminutive of Dariusz) during a consultation is just about unthinkable, unless the doctor wanted to offend me. So, for me, the shortening of the distance is really quite problematic.
Also, I understand that because of the absence of the polite form for addressing each other and the ambivalence of ‘you’, using the first name is likely to be different in English from what it is in Polish. In other words, in Polish it is likely to be more intimate than in English. Still, even in English using the first name suggests high level of solidarity and low level of power. And this is why I have a problem with doctors using their first name to introduce themselves.
It is uncontroversial to say that clinical communication is about power. To oversimplify it somewhat, doctors are the powerful ones, patients are the powerless ones. Both communicatively and socially, doctors are allowed to do more than their patients, for example, they can ask questions about patients’ private lives or take decisions about their patients. So much has been written about doctors’ power that there is hardly any more to be said here.
And here is the contradiction. The person who has all this power introduces her or himself in a way which suggests something entirely different. Instead of constructing the relationship between us in terms of power, the medic constructs it in terms of much solidarity. I realise that 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, at least it’s not obvious and clear that it is.
I think first-name use can be seen in terms of masking. Have John or Mary (rather than Dr Smith or Dr Brown) lost any power they have over me? Have I been endowed with any more power myself because I address them by their first names? Both questions definitely get a ‘no’! Whether it’s Dr Smith or John, Dr Brown or Mary, the power imbalance remains the same. 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.
My second problem comes back to my own preferences. You see, I don’t think I am the only patient who doesn’t want to call their doctor by their first name and vice versa. Just like I think that medical language (whatever it is) has some uses, I also think that (a certain level of) formality has some uses. “Hello, I’m John” not only imposes a particular relationship on me, it also re-casts our consultation into something which I find difficult to accept. Moreover, I tend to think that formality of consultations works more in my favour than in yours, actually, precisely because you cannot take liberties, and I am not tempted to think that somehow you’re more on my side. And I also think that some formality doesn’t mean that you cannot hold my hand, if needed. Formality is not the opposite of empathy.
Finally, and I keep repeating it, I really could not care less if I call you by your first name, if I still see you happily rocking in your comfortable armchair as I am perched twisting on a chair at the side of your desk (I really would like to give a piece of my mind to the person who moved the chair from across the desk to its side – it’s so bloody simplistic). 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 here we come to the bottom line. You see, the bottom line is that it is your choice. Your choice, not mine. You decide what I shall call you, and not me. And whoever thinks that saying: “You can call me whatever you like.” changes anything, they should think again. This is because you can cancel that permission with one word. But this bottom line has another dimension – it is founded on the assumption that calling you by your first name is as easy for me as it is for you to call me so. And, believe me, it’s not. I wonder whether medics who happily say: ‘Hello, I’m John’, spared half a thought on that. No, on reflection, I don’t wonder that. They don’t.
Let’s conclude. I want to say that I do realise that there will be people who will love your matey-ness, who will be grateful to the doctor whom they can call by their first name. Language, as ever, escapes easy rules and prescriptions. This is precisely why clinical communication is very difficult. So, I’d rather you played it safe, doctor. You might want to consider, for example, that shortening the distance between us doesn’t work for everyone.
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