Sunday, 30 September 2007

Name and Shame

Introducing myself never used to be difficult. I had a name, I used it, the conversation moved on.

Pretending to be a responsible professional makes things much more difficult. I don't know whether to introduce as Dr {Worm}, or rely on a more user-friendly first name.

The end result: total tongue-tying. A mumbled conglomerate of first name and surname. This leaves the indelible impression that, far from knowing the ins-and-outs of acute medicine, I'm not even sure who I am.

Not the look I've been striving for.

The trouble is, every patient seems to need a different doctor. Some patients prefer the white coat and distant manner, whilst others - usually the ones with Facebook accounts - would rather have a chat with their medical team. Not for them the formulaic introductions and formality of a bygone age.

The UK's pioneering a "Choose-and-Book" system, allowing patients to choose their hospital specialist. GPs are supposed to be able to point their patients towards the specialist who will "suit" them.

But family doctors have a responsibility to send their patients to the most competent specialist, not one who introduces him/herself by their first name. When I'm sick, I don't care if my surgeon's manners are a little old-fashioned. He can demand that I wear a top hat and tails, as long as his surgical technique's up-to-date and he gets the job done better than anyone else.

The new style of medical training is pushing through doctors with impeccable manners, first-name introductions and delightful bedside etiquette. As a nation, we haven't decided whether that's acceptable compensation for a lack of technical expertise.

We need to make up our minds before the decision's made for us. I respectfully suggest that maybe a little professional formality isn't so out of touch after all.


Steph said...

Well observed! I would respectfully respond that impeccable manners, first-name introductions and delightful bedside etiquette can be combined with competency.

Regards, Steph

PhD scientist said...

Aren't lots of your medical patients likely to be of mature years and thus likely to appreciate formality in both directions?

Both Mrs PhD (battle-scarred general medic), and the medical consultants I encounter via the bit of a medical course I run, regularly tell me this. I recall one consultant chest physician explaining me that his (almost entirely elderly) patients were almost universally "a proud bunch" and that he would feel it thoroughly inappropriate to rob them of their dignity by calling them "Jim" or "Annie" without it having been negotiated. "Mr or Mrs X, for them, and Dr Y for me, until negotiated otherwise" was his line.

Dr Grumble said...

I agree with the chest physician. And I don't see that a young person, of say 16, would be offended if I called him Mr X. He might even like it.

I wonder what Mrs PhD says about how they do it in Germany. I can't believe you can duzen with patients.

I have noticed that Germans speaking German are a lot more formal with each other than when they speak to each other in English. Odd in a way.

What this shows is that these things vary with the language and the customs current in that particular group of people at that particular time.

Medicine is surprisingly formal. My SpRs rarely call me John. It's always Dr Grumble. The nurses on the ward call me Dr Grumble and then call elderly patients by their first names. Perhaps they have asked if this is OK (but how can you say it is not). Why do they apparently give respect to me that they do not give to elderly patients. I am not happy with the latter.

I quite like to be called Dr Grumble in the ward setting. It makes it clear that you are a doctor (that's important and it is not so obvious as it used to be). And it lends an element of authority and respect which I do not need but, perhaps, the patients do. I always try and build up colleagues in the eyes of patents. They need to have trust and confidence in those that are treating them and every little helps

I am ashamed to say that I call the nurses by their first names. But that's because I can't call the senior nurse Sister X because he is a man and they are all called ward managers now. I wish I could give them a title on the ward that would describe them (everybody knows what a ward sister is) and lend them some respect and authority. It's not because they need it. It's because the patients need it.

If you go to, say, a church the priest will be robed up in some distinctive way. It creates an aura. It's needed if the congregation is going to be carried along. White coats and titles were part of all this.

I know I am swimming against the tide and what the managers would say about my views. The managers should just remember that these things have gone on since time immemorial and all those people who came before us may just have been right.

AlunW said...

I generally introduce myself as 'Hello, my name's John Smith, and I'm one of the Surgical doctors' or if the patient knows the boss, I say 'Hello, my name's John Smith and I'm Mr X's registrar'

That way they can choose to call me Doctor, John, Dr John, Dr Smith, or whatever the heck they like. It's all the same to me.

I don't go for 'I'm Dr Smith' because I'm a believer that unless someone has a doctorate, they shouldn't refer to themself with mere honorary titles. 'I'm a doctor' is fine (it's your job), but 'I'm Dr X' is just plain wrong. And you'll get picked up for it by patients (and nurses and physios) with PhDs.


On another level, I noted your comment When I'm sick, I don't care if my surgeon's manners are a little old-fashioned. He can demand that I wear a top hat and tails, as long as his surgical technique's up-to-date and he gets the job done better than anyone else.

And I wondered how you'd feel if your surgeon was a lady in a tweed skirt and pearls? ;)

Dr Grumble said...

As it happens I have a doctorate but I don't think patients consider that makes you a proper doctor. If I had just a doctorate I would be wary of calling myself doctor.

I don't really much like saying I'm Dr Grumble. I'm the consultant. It sounds a bit too important. Sometimes to make it sound a bit less grand I say that I am one of the consultants as if we are two a penny.

You need a bit of gravitas but you mustn't over do it. But it depends a bit on the patient.

PhD scientist said...

Yes, "Dr" for PhD or MBChB is a tricky one. I figure myself that in Britain it is so widely assumed that "Dr" means "medical doctor" that one has to go with that to avoid confusion.

I try to never tell people outside academia that I am "Dr ABCD" - partly because when I did evening language classes I found that once people knew I had a PhD and worked in a medical school a significant number (all ages) would start quizzing me about their frozen shoulder, dodgy knee, palpitations, homeopathic pills etc etc. Anyway, as a result I have been careful never to book myself on a flight as "Dr" anything.

Another reason is that I have found a lot of people with non-medical degrees who insist on being called "Doctor" are iffy alternative therapists who use it as a way of generating spurious credibility. You see some of them on TV.

I did originally start haunting the bad science blogs as "Dr Something" but again I continually had/have to explain that I am a PhD and not a medic. So I switched to "PhD Scientist" for the med blogs to avoid confusion.

BTW, I've never ever told a medic off for calling themselves "Dr"..!!

Dr Grumble mentioned the Germans. As he will know, the Germans broadly follow the "only writing a Thesis makes you ein Doktor" code. To add to the confusion, German medical schools don't actually formally grant medical degrees, since students take a State-set medical qualifying exam as their "exit exam". Hence the German docs who write to Hospital Doctor or similar signing themselves formally "State Med Exam (place)".

Passing the German exam entitles you to be called an "Artzt" (medical practitioner). To be a "Doktor" you have to complete some research and a small Thesis - largely on your own time during your University years. A lot of medical students do this, though not all. It is a little bit like it would be for a UK student to do an M.Res or M.Sc. When this thesis is ratified they can call themselves "Doktor". All very Germanic.

Mrs PhD, who for sundry reasons never bothered to write the thesis, found it deeply off-putting being called "Doctor" when she came to the UK as a houseman. In Germany styling yourself thus without the Thesis would have been considered very bad form and even borderline fraud. She still hasn't got used to it after well over a decade in UK medicine! Generally she has stuck to the same kind of form AlunW mentioned, i.e. "I'm Anna Schmidt and I'm one of the medical doctors".

When she first explained to me about the German Doktor-rules I thought she was having a laugh, but a German MD PhD who worked in our Department confirmed it. He told me: "No, that is exactly correct. When I finished medical school and went to do my army service (as an Army doctor) they addressed me always as Staffartzt XYZ. Only when after several months the notice came that my thesis was accepted did they start to call me Doktor XYZ".

Anyway, the boring upshot of this is that Mrs PhD and I each tend to insist the other one is the one that ought to be called "Dr". Not much of a punchline, I'm afraid.

Dr Ray said...

Even worse if you're a radiologist. Sometimes even hospital staff don't realize we are medically qualified and patients can't understand why we need to report their scans rather than their own GPs.

PhD scientist said...

I thought the anaesthetists always liked to grumble that they were the ones most routinely downgraded in the "no-one even realises we're doctors" connection, Dr Ray?

I guess this just reflects my knowing a lot more anaesthetists than radiologists

HospitalPhoenix said...

See, it's easy being a surgeon. The original surgeons weren't qualified medics, they were barbers, and most surgeons swill use the title 'Mr' even though they have a medical degree. The only difficulty arises for surgeons with doctorates. 'Hello, I'm Dr Mr Dr Phoenix...'

HospitalPhoenix said...

Oops... most surgeons still use the title 'Mr'

PhD scientist said...

Re surgeons being "Mr", Phoenix, I thought it also had a hierarchical touch these days, in that only consultant surgeons style themselves "Mr".

Have never come across a female consultant surgeon "Ms", incidentally - it seems the female surgical equivalent of "Mr" is "Miss".