“Do you remember my name?”
Like a broken record, I repeat this question again and again as I make rounds in the hospital. My patients’ universal answer, given with furled eyebrows and an apologetic look is “uh, no, I don’t remember”.
My response: “Don’t worry. It’s Dr. Tony Breu, but call me Tony.” Theirs’ (again with furled brow, but also a smile): “Oh, okay.”
In a busy teaching hospital, it is not uncommon for a patient to encounter dozens of medical personnel. Nurses, physical therapists, case managers, social workers, and doctors. Herds of doctors. The typical inpatient model is tiered with medical students, interns, residents, and attendings working together. This means that any one patient frequently has four or more people acting as their provider. Often the team will make rounds in the morning, standing in a circle of white coats leaning over the bed. At other times, especially on weekends, each member will pop in on their own, asking similar questions and doing similar exams. Add to this the cadre of consulting doctors (e.g. cardiolgist for the heart, gastroenterologists for the bowels) making visits and it is not surprising that patients are left to wonder “who is my doctor?”
And, more and more commonly, none of these people is their primary care provider (PCP). The role of the senior doctor on the team team, the attending, is increasingly being filled by a band of internists dubbed hospitalists. Most hospitalists, myself included, do not have a primary practice. Instead, we care for people only while they are inpatients, passing them back to their PCP at the time of discharge.
This leaves people, sick enough to require a stay in the hospital, under the care of strangers. A lot of strangers. So when I meet a patient I find it essential that they know the name of at least one of their doctors. This partly explains why I use my first name. I feel strongly that I would rather a patient know my given name than we bother with the formality of an honorific. If they are more likely to remember “Tony” than “Dr. Breu”, than “Tony” it is.
But my belief that remembering first names is easier is only part of it. If my desire that they remember were enough, my constant reminders would likely suffice. There is more to it. When patients are admitted they are thrust into a strange environment, stripped of their usual attire in favor of the hospital gown, given their medications when they are ordered instead of by their usual routine, and awoken at all hours for vital signs checks and to ensure they have no pain. Throughout all of this, formality reigns. Patients and doctors refer to each other as “Dr.” and “Mr.”, “Ms.”, or “Mrs.” with the ritual observance of protocol.
It seems to me that a bit of informality can help create some semblence comfort in a place of routine discomfort. And while I prefer the use of first names, I try to ensure that informality in address does not lead to unprofessional dress. On most days, I don the expected white coat and formal attire. They may call me Tony, but that does not negate negate the fact that I am their doctor.
And first names go both ways. I have found that, when asked, “what would you like to be called?” patients almost universally say “oh, you can call me Bill.” This is true for young patients and old, women and men, those who are frequency sick and always well. When given a choice (and I always give it), they share a preference for the name they use with friends and family. As with much of medicine, even this has been studied. And while I cannot know with certainty that their is therapeutic benefit in something simple as a name, I am at least secure in knowing I am honoring a preference.
Still, for some doctors I work with, dropping the “Dr.” is a tough sell and in many situations, I agree. Women are unfortunately subject to stereotypes which say that any female who walks into my room must be a nurse. One 29 year-old female doctor I know describes being asking if she were a nurse. When she replied that no, in fact, she was not, the patient comforted her by saying “Don’t worry honey, you will be some day.” For many women physicians, it is an unfortunate fact that they must not only remind patients who they are, but what they are too.
For others, like primary care doctors, there is less of a worry about name recognition. As a resident I had my own panel of patients for whom I acted as PCP. I used “Dr. Breu” with many of them and “Tony” with few. In that setting I had the benefit of a long-term and one-to-one relationship which did not require the need for quizzes and reminders. Still, had I remained a PCP I imagine that over time I may have ceded the “Dr.” and allowed “Tony” to remain.
But I am not a PCP. I am constantly a stranger and a new face. And while I may quickly become a familiar face, I also have the need to be a familiar name. When I leave the room, patients should be able to say to answer their loved-ones query “what that your doctor?” with something more than “yes, he’s one of them, I think.” I would much prefer, “yes, that was Tony.”
Anthony Breu is a hospitalist.
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