Nurses expect to be called by their first names, should doctors follow?

I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician.

When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, white dresses, white shoes, and white hose. They were never called by their first name except by those who knew them personally. Male nurses were few and far between. We had none in the medium-sized community hospital where I worked.

Of course things have changed a lot from those times. Female nurses no longer have to wear those awful hats and uncomfortable starched dresses. Having everybody in scrubs does improve comfort, although it can make it hard to tell the PICU nurse from the housekeeping person cleaning the PICU.

The most significant change to me is that nurses now expect both patients and doctors to address them by their first names. In fact, they have to: my name badge has my full name on it, but the PICU nurses only have their first names and the first initial of their last name. I’m told that at hospitals which still have a nurse’s last name on the badge, the nurses themselves put tape over it to obscure it.

I’m told the reason for this change is personal safety and security. Nurses have close, intimate contact with patients and families, and they fear stalkers. Yet I’ve also been told by security people that, if somebody really wanted to find out the last name of a particular nurse, it wouldn’t be that difficult. I’d love to see some actual data about this issue.

Medicine has long been rigidly hierarchical. Nurses, whose relationship to physicians for many decades was more or less a master-servant one, have struggled for recognition and respect. The fact that physicians were once overwhelmingly men and nearly all nurses were women compounded this effect. (In pediatrics, at least, this profile is changing — now over half of pediatricians in training are women.)

I have wondered now and then about calling nurses by their first names, but continuing to call physicians “doctor.” Is that fair? Somehow it seems to me it should be all one or all the other — both sides using the first name or neither.

This question crops up from time to time on nursing discussion boards, and always seems to lead to pro and con debates. Nursing leaders also ponder the implications of this new familiarity. I’m curious what anybody else thinks about it.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

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  • Maryann

    My peeve is not the interactions between doctors & nurses. I’m a midwife and old enough to be the mother of most of the doctors I work with; I have no problem calling them by their first names. What I can’t stand is the doctor who walks into the room and greets my client by her first name while introducing her or himself as “Dr. So-and-so.” In most cases there is no reason whatsoever that Dr. S. can’t ask the client what she prefers to be called. In my dream world, Dr. S. would be comfortable using her or his own first name with clients, but there is too much power in the title and I suspect doctors would be loath to relinquish it. Fine – but treat the client with the same respect.

  • http://rlbatesmd.blogspot.com rlbates

    I would say no for the simple reason of identification. If I introduce myself to a patient in the ER as “Ramona” it is much harder for them to find me using the phone book or internet, then if they are thinking of me as “Dr. Bates”

  • stargirl65

    I think that using the title of doctor helps define the relationship. I call all my adult patients by their last names so I am not creating an unequal standard. The few patients that call me by my first name are either close friends or patients with boundary/emotional issues.

  • Dave Hubbard RN

    As a male nurse and former Navy Corpsman who has been at it for over 40 years I too have seen the changes Dr Johnson notes and frankly I have no problem with being called by my first name and fear no stalkers. Of course I am male, kinda ugly and an old gomer so not likely to be stalked by some hot young female (hey I can fanaticize can’t I). I am unable to remember an incident of this happening to a female nurse but that does not mean it could not and has not happened in the past. In general society has become much less formal and first names are commonly used even in the business world.

    As for calling a physician “Doctor Whoever” I have no problem with this since I believe having obtained an MD deserves respect, even for those incompetent fools with MD behind their name. I have a rather large number of physicians who are personal friends whom I do address by their first name. The decision to address them as Doctor or by their first name is dependant upon the setting. Anytime a patient is present it is always Doctor. If around other nurses or physicians who know I have a personal friendship with the physician then it is usually first name, if not then it is Doctor. There are physicians who even though they are personal friends that I will address as Doctor simply because of their achievements. This is simply a show of respect. It may be more based upon tradition but not all traditions are bad and should be preserved.

    • ninguem

      Well said. I believe the saying is “respect the rank, not the person”.

  • BladeDoc

    So to paraphrase: the nurses get to choose, mostly choosing their first names for the apparent security benefit (although there are a few nurses at my hospital who continue to have “Mrs. So-and-So, RN on their badges) and therefore in the interests of “fairness” Drs, should follow suit. Ummm, no.

    AFAIC nurses would get more respect if they continued to insist on the professionalism of their titles and last name instead of trying to tear everyone down the the least common denominator of “we’re all just buddies here.”

  • PCP MD

    When I was in medical school I spent a month with Dr. C, pediatric thoracic surgeon. He had a reputation of saving kids left and right and medical students walked in awe of him. One day he was paged overhead and he asked me to return it for him. I did, saying “Dr. C returning a page.” He joked with me that I sounded pretty much like him, except that he never calls himself Dr. C, he just says his first and last name, because there is no need to advertise that he’s a doctor. People know who he is and the appropriate level of deference and respect are given to him by his peers and staff alike. I liked that approach, so ever since then I just introduce myself to patients with my first and last name. Patients can call me what they like, it’s not offensive to be called by my first name. Patients I know well, and most of the elderly I take care of, call me by my first name and that’s cool. But some patients take the liberty to call me by my first name when they don’t even know me and I certainly don’t know them. They call my office and refer to me by my first name like we are old buddies. It can be confusing to the nurses. Regarding first names, my only pet peeve is when people I don’t know call me by my first name and when they shorten my name like we are buddies when we are not. Like if someone introduces themself as Gregory and you call them Greg, that may offend that person because they just specifically told you their name is Gregory and you called them something else, a name they may despise. I’m just saying, I notice when that kind of thing happens and remember the people who take that liberty. They are not among my favorite patients.

  • http://mystrongmedicine.com Sean

    Yes, I agree the conflict in nomenclature brings about many questions for the practitioners and the patients. The problem is there is no unified ‘voice’. Personal opinion and professional responsibility lines continue to be ‘vague’ and misleading at times.
    As a nurse, I would have a difficult time being referred to as ‘nurse _’. And in that same breath, I think calling a doctor by their first name has its place, but not at the patient’s bed side.
    I honestly don’t know what the answer is, but we do need a united voice for both the physicians and nurses. In the end this ‘difference’ only complicates the professional relationship between nurse and doctor, and continues to confuse our patients.
    Great post.

  • Max

    The one good thing about using first names is that patients will likely be more reluctant to sue ‘Joe’ than they are to sue ‘Dr. Smith’. How can you sue a friend, right? Good Ol’ Joe! But you can damn well sue ‘Dr. Smith’!

  • Melissa

    As a petite woman working in ED and urgent care settings, where I don’t have a pre-existing relationship with my patients, I find it helpful to introduce myself as “Dr. Lastname.” When I tried dropping the “Dr.” it seemed to create confusion among the patients as to my role, and I even received complaints from patients who swear they never saw a doctor, “but that little nurse was really helpful…”

    I do encourage nurses and staff to call me by my first name; some do and some don’t and that’s fine with me, but even the ones who do generally use “Dr.” in front of patients. And unlike many doctors, I don’t use “Dr.” at all in social settings.

  • http://www.chrisjohnsonmd.com Chris Johnson

    @PCP-MD:

    I tend to do what you do. I answer telephone pages as “Chris Johnson,” unless I’m calling somebody who might be confused by that. Some nurses call me by my first name, some don’t — I don’t correct them either way and let them call me whatever feels appropriate to them. I do, however, call nurses by their first names because these days that’s what they all expect, and would find me calling them “Nurse Jones” to sound sarcastic, I think.

    Parents (since I’m a pediatric ICU doc) invariably call me Doctor, so that issue doesn’t come up with me. I suspect it’s because I’m 58 years old. Some of my women pediatrician colleagues expect to be called by their first name by mothers of their patients, particularly if they are near to each other in age.

    One construction you will hear is a clever compromise — calling a physician something like “Doctor Bob.” That retains some professionalism, but is also more casual. I hear that usage a lot when parents talk to pediatricians.

    • http://curbside.posterous.com Nuclear Fire

      I answer ” Doctor Nuclear Fire” on the phone just because communication on the phone is less clear and I want them to be sure who they’re talking to. I frequently answer my own phone and for awhile it was confusing to people that they were actually talking to the doctor. “Can you make sure you pass that message to the doctor?” “I am the doctor.” “The real one?” “Yes.” “Then why are you answering the phone?”

      The two issues being confused in the article are the difference between doctor as used as part of the name vs. the title.

      I and patients found it really annoying being unable to tell who on the floor is a nurse now that everyone wears scrubs and goes by their first name. Recently, the RNs added a huge badge to their name tags with a large “RN” that can clearly be seen from down the hall. It’s been a huge success. When in the hospital or meeting patients for the first time, using “doctor” isn’t about arrogance, it’s about clearly stating your job.

  • http://www.StressResources.com Pamela Ressler

    Thank you for the interesting topic and discussion. I, too, have seen many changes in both dress and formality in my 30+ years in nursing (I still have my nursing cap tucked away somewhere). I am a nurse with my own private practice and I see clients generally in an outpatient setting, but I interact daily with medical colleagues, nursing colleagues, social work colleagues, as well as business leaders. I see the change in use of honorifics and formality as a societal change and cultural shift, not just a health care shift. Routinely using honorifics for one party and not the others in the dyad or triad of communciation (i.e. Dr. Smith but calling patients and nurses by first names) creates an uneven balance of power and lessens the perceived value of the other members of the team. I use the word “team” purposefully, as I believe that we need to encourage and empower patients and families to play a valuable role in the team approach of health care delievery. Personally, I introduce myself to patients and families by both my first and last name and I always ask them what they would prefer to be called. When introducing myself to professional colleagues I also use both my first and last name, and take my cue from how they respond with their introduction — if they respond with Dr. Smith — then that is what I will call them. I generally prefer to be called by my first name when working with patients or colleagues but that is a choice on my part and I let them know that preference — it is not the default. I am happy to abide with whatever the other people in the “team” choose for their own comfort zone.

  • Lisa Marie RN, CCM

    My experience is a not much different, I address all doctors as Doctor so & so no last name. I understand the reasons for first names only. A number of hospitals use Lisa Marie B. just the first word of last name.

  • Matt S

    “Hi! Mr. Patient’slastname? My name is Myfirstname Mylastname, a resident doctor working with the Mycurentservice.”

    1. Chose the most respectful way to address the patient and the ball is now in their court if they want to be called anything else.

    2. I let them know I was a doctor.

    3. I gave them my full name and, again, the ball is in their court as to what they want to call me.

    Exceptions:
    -little old ladies who look old school and who would probably benefit from an old fashioned patient-doctor relationship.
    -when you’ve got your take-control-of-the-situation voice on and it’s easier to say in an authoritative voice “My name is Dr. Firstname Lastname.”

    I mean, that title is just another step in the dance we dance as doctors. As for expecting nurses to call you doctor? Pah. We’re all part of the same health care team–titles and useless formalities get in the way of team work.

    …just my two cents.

  • ninguem

    And then at the same time we get chastised for addressing the patient by the patient’s first name.

    Respect goes both ways.

    I suspect there is a reason why people want physicians to drop the title they earned.

  • http://33charts.com DrV

    Whoa. This is s dicey one. I introduce myself by first name although it’s typically quite obvious I’m a doc. Parents often address me by my first name but usually after they know me. I wouldn’t be have any problem with those who didn’t know me addressed me by first name.

    But I’m an odd duck. And I don’t wear a white coat. For what it’s worth.

  • Hannah Bodenstein

    I’m an RN. I have a hard time with this. I usually feel that with docs in my age bracket, if I work closely with them, then first names are ok. But when the physician is older, in a leadership position, I feel more comfortable with the title. It has to do with acknowledging and respecting someone. Personally, it feels silly to have someone address me as Nurse Hannah. But, as others have said, it somehow sets up a situation where it seems as though some members of the team are represented as having more value than others. While this does not pose any discomfort among colleagues, one can sometimes experience a moment of discomfort at the patient bedside. I’ve often thought about this- nice post..