A Twitter thread caught my attention a couple of days back, about whether doctors should ever use a patient’s first name without asking permission to do so.
It was by Dr Conor Maguire, a Consultant Physician in Medicine for the Elderly, at the Western General Hospital, Edinburgh as well as Vice President (International) and Director of Education at the Royal College of Physicians of Edinburgh. He is dead set against using first names without permission, and explains why in the thread that you can read here.
How to address someone (certainly on first acquaintance) is something I’ve had to contend with throughout my working life. In my youth (I’m now in my early 70s) I was taught that it was impolite to use someone’s first name without their express permission. Indeed it was severely frowned on. Quite the wrong etiquette. I never called my parents’ friends by their first names. It’s different today; the younger generation is so much more relaxed about this sort of thing. Yet I still feel uncomfortable when I hear that. It’s also quite common nowadays to be addressed by one’s first name when using a utility helpline, for instance. It certainly grates with me when the young person on the end of the phone immediately addresses me as ‘Michael’. I mostly let it go; no point in having a row when you’re trying to sort out a difficulty with a bill or the like. Occasionally I have been asked by the person I’m talking to could use my name. And I almost always say yes. They’re being polite in asking.
I should add that hardly anyone calls me ‘Michael’, always ‘Mike’. I think my Mum only ever used ‘Michael’ when she really wanted to attract my attention. Uh oh, I must be in trouble, especially when ‘Michael’ was pronounced as a rising inflection, Aussie-style.
My first job at age 24 (in January 1973) was overseas in Peru with the International Potato Center (CIP) in Lima, whose Director General, Richard Sawyer, was an American, as were several other senior members of staff.
Americans are much more relaxed about using first names, even on first acquaintance, but it took me some months before I felt at ease doing so. I don’t think I got round to calling the DG by his first name for at least a couple of years. However, I slowly came to realise that if I met someone, shook hands, and they introduced themselves by their first name, this was a tacit invitation for me to use it, and vice versa.
However, working in a multicultural institution like CIP (and later on at the International Rice Research Institute, IRRI, in the Philippines) it was important to be aware of different cultural norms, and that such first name familiarity is not always practiced nor welcome. At CIP there was a senior nematologist, a German named Dr Rolf Schaeffer. He must have been at least twice my age. But during the two or so years we worked alongside each other, he never ever used my first name, always addressing me as ‘Mr Jackson’!
In Asia, elders (but not necessarily one’s betters) are treated with much more respect generally than I have ever seen in the UK for example. There are many age-based honorifics in many societies. When I first joined IRRI in 1991, I found it odd that my Filipino staff always addressed me as ‘Sir’. Try as I might to get them to use my name, I eventually gave up and accepted that, for them, ‘Sir’ was a much more comfortable way to address me. However, as time passed, some of the more senior Filipino staff did ‘relax’ and call me ‘Mike’. But if they didn’t want to, that was fine as well.
When, in 2001, I was asked to develop a new Office for Program Planning and Communications, I assembled a small team of professionals to help me deliver its mandate. And, in this instance, I insisted that everyone use my first name, not ‘Sir’ or ‘Dr Jackson’. Funnily enough, there was no hesitation on their part, although one of them generally just called me ‘Boss’. After all we were a small team, working cheek by jowl, and relying on each other day in, day out.
In primary and secondary school my teachers were always ‘Miss’, ‘Mrs’ or ‘Mr’. And when I went to university in 1967, we always, always addressed staff by their title, ‘Dr This’ or ‘Professor That’.
However, when I began graduate school at Birmingham in 1970, we affectionately addressed the head of department as ‘Prof’, rarely Professor Hawkes (unless we were referring to him when speaking to someone else), but never ‘Jack’. Yet the barriers were beginning to break down with one or two of the younger members of staff who encouraged the use of their first names. Even so, given my Britishness, I found it quite difficult, awkward even, to use a first name.
This issue of first name use, and titles, is actually quite topical under the circumstances, given the hoo-ha following the publication of an outrageous opinion piece that appeared in the Wall Street Journal on 11 December last about First Lady-elect Dr Jill Biden’s use of her ‘Dr’ title (she holds an Ed.D. degree from University of Delaware).
Written by 83 year old writer Joseph Epstein, a former adjunct faculty member of the English Department at Northwestern University, and titled Is There a Doctor in the White House? Not if You Need an M.D., who questioned Dr Biden’s right to and use of her doctorate title. He even suggested that ‘Jill Biden should think about dropping the honorific, which feels fraudulent, even comic.’ Not only that, he even called her ‘kiddo’. How disrespectful was that?
A you can imagine, this op-ed has attracted a whole lot of attention, ire, and even derision. It has been condemned by former colleagues at Northwestern. And in another opinion piece a few days later in The Atlantic, staff writer Graeme Wood wrote that use of her title was a choice for Dr Biden alone. There followed an outcry on Twitter condemning Epstein’s misogynistic comments, and in support of the future First Lady.
But I guess this begs the bigger question of whether academic titles should be used outside the academic environment. Most medical doctors in the UK do not hold a medical doctorate, generally just bachelor degrees. They use ‘Dr’ as a courtesy title. Likewise some dentists. At my former dental practice in Bromsgrove, the two partners both listed themselves as ‘Dr’ on the practice website, even though they only had a Bachelor of Dental Surgery degree. The MD degree is the norm in the USA.
So, should non-medics use their title? Why not? We’ve earned it after several years of hard slog, completed the requirements for the degree, and were awarded a doctorate by an accredited institution. I use my title, but if others prefer to call me ‘Mr’ that’s fine as well. Let’s not get hung up about this. I also use, on occasion, my OBE that was conferred by HM The Queen in 2012.
But let me get one thing straight. It’s all about respect, and sensitivity to all the different cultural norms we are exposed to daily. What is fine in one culture is almost taboo in another. Never assume that someone wants you to use their first name, or not use a well-earned title. Restraint is the watchword, until the signal is given to proceed to a more informal relationship.